Children suffer with mental health difficulties for a range of complex reasons. The Government recommends that schools develop a mental health policy that creates an environment where young people with anxiety feel supported, understood, and able to seek help, making it more likely they will feel safe and able to attend school.
Many children have an underlying Special Educational Need or Disability that contributes to their anxiety; this can include Autistic Spectrum Conditions, ADHD, Sensory Processing Disorder or Dyslexia.
SEND also include Social, Emotional or Mental Health Difficulties, which could affect a child's ability to establish friendships, cope with a variety of strong emotions, and increase a child's vulnerability to bullying.
High levels of anxiety can be classed as a disability and are a barrier to learning requiring the use of assess-plan-do- review cycles. Children and young people will need a consistent, individual support plan which is shared with all staff. If children struggle to engage, they need patience and an experienced professional to help them access the right support.
In addition to the support put in place by the SENDCO, an Educational Psychologist can assess an anxious child and recommend appropriate interventions. This input can be useful as inability to attend school is often a symptom of a significant need or problem that requires more specialist knowledge and understanding. Many Educational Psychology Services now offer an EBSA service or pathway which you can utilise so it is worth checking what is on offer.
Where severe problems occur, which are beyond the range of in-school mental health provision, schools should facilitate the child's access to more specialist support. The school nurse, or school directly can support or provide further evidence to expedite a referral. Parents can also ask for referrals to CAMHS, and Paediatricians through their GP. Unfortunately there are often long wait times for referrals , but support from schools goes a long way to ensuring the young people gain access to necessary treatment.
Schools can collaborate with other local services and providers to explore how individual needs can be met most effectively. The Local Offer can be an invaluable source of resources, information, advice and relevant support.
It is important that all professionals ensure that children and their parents participate as fully as possible in decisions leading to a support plan. Health and SEND professionals can advise schools on developing support plans that are flexible, child-led and sympathetic to the features of anxiety disorders, Autism, ADHD and other medical conditions. Plans must be communicated to all staff, and combined with development of relevant staff training and whole-school awareness. Although this may be harder to achieve in a large secondary school than a small local primary, it is fundamental to success.
An EHCP application is crucial if a school does not have the expertise or funding to fully identify a child's needs, or to offer the provision or support a child requires to access an effective education. Parents can also apply to the LA for an ECHP assessment, but a joint approach will be the most beneficial way forward. There have been delays in processing EHCP applications nationally, so support during this process is invaluable.
All medical conditions should be identified. Some illnesses are complex, or less common and may take time to diagnose and treat. Underlying physical illness can add to a child's anxiety. School must follow medical advice, and work with parents and children to support their health and wellbeing, and reduce the risk of further deterioration .
The Department for Education has issued Statutory Guidance and Departmental Advice (best practice) on “Supporting pupils at school with medical conditions“. The governing body of a maintained school, proprietor of an academy and management committee of a pupil referral unit must have regard to the Statutory Guidance in this document. This means that they must follow it unless there is a good reason not to.
Schools should have a Policy for Support for Pupils with Medical Needs.
Schools should also consider if an Individual Healthcare Plan is a proportionate response to a child's medical condition
According to the DfE absence due to both physical and mental illness should be recorded as authorised absence. The potential legal implications of unauthorised absences rarely help improve attendance, can add to the child's anxiety and substantially increase the difficulties families face. Attendance cannot take priority over health needs and families need your support rather than fines and prosecution.
Not supplying learning opportunities during absence means the pupil gets further behind which adds to anxieties around returning to school.
While on roll a school receives funding for a child so you should consider how to use that funding to support their learning in ways that reflect their needs and abilities. Your responsibility to provide an education doesn't cease if they are unable to attend.
You should notify the local authority if absence due to illness lasts for over 15 days (consecutive or cumulative). The LA have a duty to ensure that a child receives alternative educational provision whilst absent.
Recovery can be a very slow process for many children and young people despite everyone’s best efforts; helping them feel connected, significant and welcomed may encourage that big step back into school. Long term recovery needs a focus on support and encouragement for a child to enjoy other activities and friendships (not only those related to school). This will help rebuild their self-esteem, confidence and happiness, all of which are integral aspects of school refusal recover.
Child Law Advice provide information on the duties of schools and local authorities to provide education for children out of school because of exclusion, illness or other reasons.
Whilst reduced school attendance is a criteria for safeguarding concerns it is important for all professionals involved to gather evidence of the factors which may be impacting on attendance including SEND, health difficulties, and physical and mental health problems, including the impact of high thresholds for referrals, and long waiting times. It is crucial to consider:
There can be many different reasons why a child may start to show signs of school refusal. It can happen gradually, or it can happen overnight. The reason can be obvious, or it can baffle both caregivers and school staff, but when a child is frightened adults must pay attention as their reactions can help or make things a whole lot worse.
The combination of guilt for the child, pressure from schools and heavy-handed threats of fines and prosecution does nothing to ease the strain on these families and is not evidence based practice. Relationships between caregivers and schools can start to break down as their priorities diverge at this point, when instead the focus needs to be on working together in the best interests of the child.
The number one rule of getting a child to go back to school is:
Almost half (45.5%) of parents in the NFIS Attendance Difficulties survey (May 2018) stated that they have physically forced their child to attend school because they felt under pressure to do so. In addition, 21.2% felt under this pressure but had refused to force attendance.
When asked if the use of force was helpful in resolving their child’s anxiety,
36% of parents said ‘NO’
59.1% said it has made things MUCH WORSE.
Only 0.4% of parents thought force helped,
& 4.5% thought it might have helped.
Unfortunately, many parents currently report being blamed and pressured to improve attendance, without due regard to the severity of their child's difficulties. Many children are being described as ‘fine in school', when in reality they are not fine, as they often mask or internalise their distress while in school.
We recognise that there are limited resources in schools, but many helpful actions including understanding, are cost free! The longer anxious children are unsupported the harder it will be for them to return to school. Continuing to describe anxious children as being ‘fine in school' means they are less likely to be able to access the help they need to recover, and ultimately to attend regularly and achieve their potential.
Families often struggle because they find that school staff, CAMHS staff and Social Services staff do not know how each other work and do not communicate effectively. This means families get trapped in a cycle of being given advice or information by one service that is then disputed by another and this is very difficult to navigate or resolve.
Working together will be much more beneficial for all involved
The Department for Education published new School Attendance Guidance, 'Working together to improve attendance' to be applied from 1st September 2022 onwards, with further guidance published in February 2023
The recommended approach is a focus on building relationships to facilitate access to support.
Adam Luke, Department for Education School Attendance Policy lead, delivered a webinar on 19 May 2022 summarising what the new attendance guidance means for schools and academy trusts.
On 6 May 2022, the Department for Education released new non-statutory guidance “Working together to improve school attendance” to help schools, trusts, governing bodies, and local authorities maintain high levels of school attendance and improve consistency of attendance support. This webinar took place on 24 May 2022 and focussed on what the new guidance means for local authorities.
Written by Fran Morgan with Ellie Costello and edited by Ian Gilbert, Square Pegs: Inclusivity, compassion and fitting in – a guide for schools is a book for educators who find themselves torn between a government/Ofsted narrative around behaviour, attendance and attainment, and their own passion for supporting square pegs and their families.
Over the last few years, changes in education have made it increasingly hard for those children who don’t ‘fit’ the system – the square pegs in a rigid system of round holes.
Budget cuts, the loss of support staff, an overly academic curriculum, problems in the special educational needs and disabilities (SEND) system and difficulties accessing mental health support have all compounded pre-existing problems with behaviour and attendance. The ‘attendance = attainment’ and zero-tolerance narrative is often at odds with the way schools want to work with their communities, and many school leaders don’t know which approach to take.
This book will be invaluable in guiding leaders and teaching staff through the most effective ways to address this challenge. It covers a broad spectrum of opportunity, from proven psychological approaches to technological innovations. It tests the boundaries of the current system in terms of curriculum, pedagogy and statutory Department for Education guidance. And it also presents a clear, legalese-free view of education, SEND and human rights law, where leaders have been given responsibility for its implementation but may not always fully understand the legal ramifications of their decisions or may be pressured into unlawful behaviour.
Bringing different perspectives and expertise together in one place, Square Pegs aims to help school leaders and staff support children (and their families) more effectively. The authors cover a wide variety of topics – including school attendance, building relationships, trauma-informed practice, and behaviour management. Featuring contributions from more than 50 individual authors, this is an accessible, dip-in, dip-out book – perfect for busy school leaders.
Suitable for all professionals working in education and the related issues surrounding children and young people’s mental health, as well as policymakers, academics and government ministers.
Natalie Merrett, Head of Knowledge Dissemination in Schools is joined by Vicky Saward, Head of Schools Training at the Anna Freud Centre and Brenda McHugh MBE, Consultant Psychotherapist and Co-Founder of the Pears Family School to explore the topic of emotionally-based school avoidance and how schools, parents and professionals can best support young people who are affected.
At Nudge Education, our team shares our vision of a world where no child is left behind, and works to make it a reality through our mission of eradicating chronic disengagement.
We know the UK education sector is delivering fantastic outcomes, but too many young people are slipping through the cracks.
Nudge Education helps schools and Local Authorities support those students who are at-risk or have already become chronically disengaged, to help them rediscover a life worth living.
We have worked with over 200 schools within more than 40 Local Authority areas UK-wide to support them with the most challenging students to prevent crises and leave no child behind. For a life worth living.
The Dare2Dream Foundation deliver a wide variety of highly bespoke social and emotional wellbeing, positive behaviour support and alternative education provisions.
The core aim of our work is to enhance both the mental health and life opportunities of vulnerable children and young people.
Our work is located in some of the most deprived areas of the UK, with an increasingly high number of children suffering from a variety of mental health conditions.
Red Balloon was established with the primary aim of providing a full-time education for children who have self-excluded from mainstream school because of severe bullying or other trauma.
The aim is to raise their self-esteem, enable them to come to terms with what has happened and help them learn how to deal with difficult situations. Ultimately, we want to help students get back on an academic track so they can return to education or move on to college or work.
Flexibility and quality of provision are fundamental to schools and local authorities when they consider alternative providers.
Pupils enrolled with Academy21 can learn from any suitable location where there is a broadband connection and computer. This is usually from a home, school, PRU, AP setting or other learning centre. Learners remain on roll locally with all attendance and progress data provided 24/7 to the designated school or local authority officer via our online reporting systems.
Our experienced, subject specialist teachers deliver lessons via our online classroom to groups of up to 15 learners who will be logging in from all over the country. The classroom is easy to navigate and use and provides the opportunity for each pupil to manage their level of interaction with their teacher, peers, lesson activities and content.
EBSA Guide 2018 West Sussex Ed Psych Dept (pdf)Download
Primary School Survival and Regulation (jpg)Download
Secondary School Survival and Regulation (jpg)Download
Mental Health Toolkit for Schools (pdf)Download
Example Mental Health Policy and Guidance for Schools (docx)Download
NUT the Law and You (pdf)Download
Reasonable Adjustments for Disabled Pupils (pdf)Download
Environments where children can flourish (pdf)Download
NASEN Everyone Included SEN (pdf)Download