Two years have passed and little has changed. Actions to address the mental health ‘crisis’ in children and young people has stalled, perhaps because the government has been preoccupied with Britain’s exit from the European Union. Many of the proposals outlined in the Green Paper are yet to be actioned. Not all schools have a designated senior leader for mental health. This is a key role which ensures that school mental health provision is properly led. Many schools will not be assigned an Education and Mental Health Practitioner to support young people’s mental health needs and waiting lists for Child and Adolescent Mental Health Services remain long and stringent referral criteria mean that too many children do not get the help they need. Perhaps the proposals were too ambitious but the document has seemingly done little to ‘transform’ mental health support to young people in schools.
It is equally worrying that there is currently a ‘crisis’ discourse in relation to mental ill health. The media report regularly about escalating numbers of young people demonstrating signs of mental ill health, irrespective of the fact that we are now better able to identify it when we see it and we can now talk about it in a non-stigmatising way. Although numbers may well be increasing, the depiction of mental health as a ‘crisis’ or as a ‘contagion’ is unhealthy because it perpetuates the view that mental health is synonymous with ‘disease’ and therefore is something bad. The fact is, we all have mental health. Sometimes it is good. Sometimes it is not so good. Mental health exists along a continuum and can fluctuate rapidly. Scaremongering tactics simply increase stigma rather than eradicating it.
The language in the Green Paper is worthy of analysis. The word disorder is cited 75 times. Again, this suggests that there is something ‘wrong’ with people who have poor mental health. Treatment appears 26 times and illness appears 9 times. Mental health is therefore viewed as something which is ‘within’ the individual. It is located within the body and is diagnosed and treated so that the body is cleansed. The language suggests that a medical model is being adopted: the ‘problem’ is located within the individual and all intervention is targeted at the level of the individual. A clinical model is being uncritically adopted in schools and this is reflected in the new Education and Mental Health Practitioners who will provide low-level clinical intervention, including low level counselling and cognitive behaviour therapy. In fact, the vast majority of children and young people do not require clinical intervention at all. They need to develop social connections, friendships, experience positive relationships and a sense of belonging, develop self-worth and engage in physical activity. These types of ‘interventions’ will dramatically improve children’s mental health. Some children, including those who have experienced trauma, may also need clinical interventions but clinical intervention should not be the standard response.
The problem with the medical model is that is deflects the focus away from the real causes of poor mental health. By shifting the focus to the child, attention is diverted away from the systemic factors that result in mental ill health. These factors include social inequality, social deprivation, adverse childhood experiences and an educational experience which is dominated by an academic curriculum and high-stakes testing. These factors require a political response (or intervention). Mental ill health is rooted in social circumstances rather than in the individual. By emphasising the role of schools in addressing mental health, the government is placing a sticking plaster over the problem. Schools can do a lot, but they cannot address some of the big social problems that cause poor mental health in the first place. A clinical discourse absolves those in positions of power from addressing these bigger issues. Schools cannot solve all the problems of society and should not be required to do so.