Mental Health: the problem with a clinical approach
Two years have passed since the publication of the government’s Green Paper, Transforming Children and Young People’s Mental Health Provision. A key element of the vision that was set out in this document was to introduce mental health support teams into schools to provide low-level clinical interventions to young people with mental ill health.
The Green Paper also emphasised that schools and teachers can play a critical role in the identification of mental ill health.
One of the reasons why schools are being positioned as playing an important role in children and young people’s mental health is because it is extremely difficult to access specialist clinical support from Child and Adolescent Mental Health Services. Waiting lists are long, services are over-stretched, and many young people do not meet the threshold criteria to gain a referral to enable them to access specialist support. Financial constraints have impacted on provision. However, it is important to remember that teachers are not health professionals. There are limits to what they can do. Teachers cannot diagnose mental ill health. They cannot provide clinical interventions. First and foremost, they are educators. They are responsible for teaching a curriculum, not for addressing mental health. It is important to remember this.
Fundamentally, although schools can play a role in preventing mental ill health by providing positive school environments, fostering a sense of belonging, providing young people with a mental health curriculum and identifying (not diagnosing) possible indicators of mental ill health, it is important to examine their role in mental health a little more critically. We know that the causes of mental ill health are largely rooted in social circumstances. Poor mental health is caused by poverty, adverse childhood experiences, trauma, social inequalities as well as individual and school-related factors. The causes are complex and multi-faceted but are linked to the social circumstances in which people live. Unless these circumstances are addressed, mental health problems will continue. The solutions to mental ill health therefore lie outside the individual rather than being rooted within the individual. Addressing the causes is critical because schools cannot completely compensate for the social circumstances which impact on children and young people’s lives. Schools can do a great deal, but young people still go back to their homes and communities outside schools and these places can be where the causes of poor mental health are rooted. Therefore, a systemic response is needed by the government to address the social circumstances which result in poor mental health. Addressing poverty, abuse and other forms of social inequalities will certainly reduce the likelihood of mental ill health developing. Providing ‘treatment’ at the level of the individual simply masks the broader external factors which cause poor mental health.
The clinical discourse which is being adopted uncritically in schools fails to address the broader social circumstances that result in poor mental health. Most young people with mental ill health do not require clinical intervention, unless their needs are severe. They require physical activity, social connectivity, a sense of belonging and a positive sense of self-worth. This is what schools can provide. The clinical model is evident through the development of a new brand of professional – the Education and Mental Health Practitioner. These professionals complete a training course, then subsequently work in schools to provide clinical interventions to children and young people. The problem with ‘treatment’ at the level of the individual is that it absolves those in positions of power from addressing the systemic factors which result in poor mental health. It is based on a medical model but given that the causes of poor mental health are often rooted outside the individual, a systemic response is required rather than model which is based on diagnosis and treatment. Putting the problem onto the shoulders of teachers who are already overworked simply masks the deep-rooted social circumstances that result in poor mental health.
Providing young people with a curriculum which they enjoy and can experience success will also go some way towards improving their mental health, but this requires a political response rather than a response from schools. Schools are constrained by the curriculum that they are required to teach and the assessment regimes which are imposed upon them. Providing young people with a more inclusive education system (i.e. an inclusive curriculum and inclusive assessment model) requires a political response to change the existing structures that underpin the education system. However, even then, this might not be enough to mitigate against the social factors which cause young people to experience mental illness. We need to stop asking schools to compensate for social circumstances and start demanding more of a systemic response from the government if we hope to see a reduction in cases of mental ill health over the next decade.
Jonathan is Professor of Inclusive Education. His research focuses on LGBTQ+ inclusion and mental health. He is a researcher, teacher educator and qualified teacher.