Overseeing hospital school provision for young people accessing their Tier 4 Child and Adolescent Mental Health Services (CAMHS)
Ed Hall, Head of Education at Cygnet Health Care.
It is well documented that there is a rising mental health crisis among young people.
The extent of this issue was underlined by a survey last year by NHS Providers that found 100% of mental health trust leaders said that the demand their trust/local systems is experiencing for Children and Young People services is significantly (80%) increasing compared to six months ago.
Furthermore, two thirds of trusts leaders said they are not able to meet demand for inpatient CAMHS services (65%) and latest data shows a 72% increase over usual level of CAMHS referrals.
It’s shocking data and no doubt many teachers will have seen this issue first hand – and been involved in the referrals to CAHMS.
However, while any such referral to CAMHS is chiefly about providing the necessary medical support to a child they require, a large effort is also made to maintain as much education for these children while they are unable to attend their own school.
Indeed, even when a child is registered to a CAMHS hospital they also remain on roll with their home school or college in a dual registration arrangement, with the aim that they will return once they are discharged.
Additionally, to help maintain as consistent an education as possible when a young person arrives one of our first duties is to establish their education to that point and how make it clear how we will support them going forward.
This involves speaking to their school or college and their parents or carers to find out their current study programme, their academic levels and attainment, any special educational needs, strategies which work well for engaging them, their previous attendance record and any safeguarding issues which we need to be aware of.
We also speak to the young person as quickly as possible when they arrive.
The sooner we see them, the easier it is to build a positive relationship. Once we know about their likes and dislikes and how they like to be supported, we can start to establish trust and really make a breakthrough as early as possible.
Specialist subject teachers will then use diagnostic assessments to identify specific areas for development – this ensures we aren’t making assumptions about what they know.
It is often the case that our students have not attended school consistently for a period of time due to the impact of their mental health conditions. They will have gaps in subject knowledge that need to be addressed before moving on to the next stage of learning.
All of this comes together in a detailed ‘individual education plan’ (IEP) which is very bespoke to each learner.
This level of personalisation helps prevent them from falling behind with their education during admission, as this would create more stress for them. Ultimately, we want to prepare them to go back into their community and be successful.
To help with this, progress on their IEP is regularly fed back to the wider multi-disciplinary team (MDT) of doctors, nurses, psychologists, occupational therapists, support workers and school staff who work together to make decisions that are in the best interests of each young person.
This allow them to see what progress is being made or any issues that may have come to light and adjust the IEP accordingly. This can sometimes mean adopting an entirely different approach for those who are acutely unwell if the first IEP put in place
The actual act of teaching is of course different to mainstream settings – lessons start at 10am as one example – and part of our curriculum is aimed at improving mental health functioning in education (MHFE).
This can mean some of the educational activities we use have the aim of also developing communication (with adults/peers), concentration, motivation and hope for the future.
This might include educational board games with someone anxious around peers – introduced in a graded fashion starting with the requirement only to sit opposite a peer, extending to higher order, collaborative challenges. Re-usable checklists, problem solving cards and resilience strategies are provided to help students stick with independent tasks such as reading. Organisation & planning tools, very short-term targets, links to a bigger picture/careers, and recovery through activity strategies are used alongside accreditations linked to interests e.g. Koestler Trust entries, AQA unit pathways, Arts awards and STEM activities.
We try and focus on mental health within our PSHEE program too. For example, with nutrition we will talk about foods that boost mental health and with first aid, we tend to focus on handling minor injuries because of the prevalence of self-harm amongst these young people in our care.
The flexible nature of our curriculum helps accommodate changeable mental health presentations and means young people who are judged to be high risk can still participate.
This can also means that sometimes students are taught on a one-to-one basis on the wards because of their individual health needs, or where their level of risk prevents access to the school environment.
It is the job of our school staff to make sure we pitch the work at the right level – not too easy or not too hard, and make support available should they need it. We want to give them the support they need to be challenged and to be successful.
Throughout all this we keep in regular contact with schools/colleges, invite them to review meetings and send half-termly progress reports.
As we have a major focus on attendance as an important outcome measure for Tier 4 hospital schools as we need to prepare students for attending in the community post discharge.
We have the highest expectations for this although we must make informed judgements on wellness, and co-working with the multi-disciplinary team (MDT) is essential for this.
Furthermore, because our young people are often being cared for in a secure environment, our schools must contribute to the provision of ‘least-restrictive practice’ in their care.
This is the provision of care that does not restrict individual liberty but rather maximise a young person’s independence and recovery. We must make sure our schools are inclusive to even to the most unwell, in terms of access to teachers and equipment (in a safe manner of course), opportunities to experience visits or outside speakers, or anything else that peers in the community may have access to.
It can be challenging to achieve this balance but daily risk assessments made each morning allow professional to make decisions based on individuals rather than group.
Ultimately, education provides young people with a sense of normality and routine. When you are in a hospital, participation in community associated activities can provide comfort through familiarity.
It can be so rewarding when you see a young person slowly start to engage and have fun when initially they were reluctant. It’s an important part of their journey, going through their work and seeing what they’ve achieved, in what has been quite a difficult time for them.
Ultimately we try to give them hope. Teaching is a rewarding job and it’s a real privilege to work in this setting.