Children’s and Adults’ Care and Education Committee - 12 November 2019 Report to the Committee by the Mental Health Champion Report by Mental Health Champion, Councillor Anita Schaper, and the Public Health Principal Officer for Mental Wellbeing & Older People's Health Improvement

Purpose - To report back on the work of the Committee’s Mental Health Champion over the ​ past year, as requested by the Committee at its meeting on 22 November 2018.

Recommendation - To note and refer the report for information to the Health and Wellbeing ​ Board

Key Points

A. As requested by the Children’s and Adults’ Care and Education Committee at its meeting on 22 November 2018 a report is attached at Annex 1 which provides an ​ ​ update on the work of the Mental Health Champion for this Committee. B. The Mental health Champion has carried out a review of the current work taking place in Kingston’s secondary schools relating to promoting good mental health and supporting young people with mental health problems and has made five recommendations about how these can be enhanced, C. The Public Health Lead for mental health has responded to the recommendations and suggested how they can be progressed. Context

1. At its meeting on 16 October 2018 the Council received a report from the Health and Wellbeing Board meeting on 13 September 2018 recommending the appointment of a Mental Health Champion for each of the five strategic committees. Full Council appointed Councillor Anita Schaper as the Mental Health Champion for this Committee. 2. The role of the champions as set out in that report is: ● to be a leader and advocate for mental health on behalf of the Council and specifically for their committee ● to work collaboratively with the Mental Health Champions from other strategic committees to provide political leadership in all aspects of the Council’s work that impact on mental health, particularly the promotion of mental health and the prevention of mental illness as described by the chief medical officer in her 2013 report Annual Report of the Chief Medical Officer 2013 Public Mental Health Priorities: Investing in the Evidence and to ensure that our key initiatives on the Prevention Concordat for Better Mental Health , Thrive Kingston , and Time to change, are progressed. ● to receive a paper on the Mental Health Joint Strategic Needs Assessment (JSNA), and be assured that relevant recommendations relevant to their committees are implemented ● to work with officers who have a role in promoting mental health and preventing mental illness. ● to attend any relevant training provided by Public Health England or other partners supporting member champions including Mental Health First Aid training provided by Kingston Public Health. 3. The MH Champions initiative arose out of “Thrive Kingston: A Mental Health and Wellbeing Strategy for the people of Kingston by the people of Kingston (2017 to 2021)” which included a recommendation to: “increase the awareness and capability of policy makers, organisations, groups and providers of services to recognise risks to mental wellbeing and to respond in a way that reduces risk.” The current Administration set out its aim to “weave a mental health friendly ethos into all policies and services and appoint a Mental Health Champion Councillor”. More than 100 local authorities having a recognised Council member whose role is to advocate for mental health and champion the cause in their community. Member champions across England are now advocating for mental health in Council policies and strategies, building partnerships with health services, schools and businesses, and working with their communities to help to combat stigma and improve understanding. 4. Public Health England offers advice, information and a nationwide network to member champions for mental health and their councils in order to support leadership in local communities for better mental health. Mental Health Champions will be able to access Public Health England support and training to help them with this role. The Mental Health Champions will oversee the implementation of any recommendations relevant to their Committee from the forthcoming Better Mental Health Joint Strategic Needs Assessment (JSNA), Thrive Kingston and the Health in All policies programme. They will also ensure all relevant staff are encouraged to undertake Health Impact Assessment (HIA) training to support effective HIA on policies. They will work together with the four other mental health champions of the Council’s strategic committees to ensure a comprehensive approach to improving the mental health of Kingston’s residents. 5. The Health and Wellbeing Board will support and receive regular updates on the work of the Mental Health Champions to keep the Board updated on progress for RBK to take the steps necessary to sign up to the Prevention Concordat for Better Mental Health Programme including an update of the mental health JSNA. 6. This Committee received a report on the specific role of the Mental Health Champions for this Committee at its meeting on 22 November 2018 and agreed to support Councillor Schaper in her role and asked to receive back a report on her work at a future meeting of the Committee . It was suggested that it might be helpful if Dr Moore, as Kingston Clinical Commissioning Group Clinical Lead on Mental Health, be invited to Councillor Schaper’s meetings with the Public Health lead for mental health, Liz Trayhorn, as part of the joining up of discussions between the Council and KCCG on mental health initiatives.

Report of the Mental Health Champion

7. Councillor Schaper visited 5 schools. All schools are involved in the student mh ​ ​ conference and MHA programme whereby 10 year 9 students attend the conference and become mh ambassadors for a year. Overall feedback suggests ​ students are better engaging with each other, within their peer groups and with staff members as a direct result of the Mental Health Ambassadors programme. Ambassadors are raising awareness of mental health issues and spreading this awareness across year groups. 8. Some schools have also received funding from the STP to develop a whole school ​ approach to mental health “Trailblazer” funding and have noted the benefits derived from specialist staff being on-hand to help and support students, to a reduction in anxiety and absenteeism amongst students. 9. Some schools have raised the need for more advice in terms of identifying and ​ supporting young carers. 10. Councillor Schaper’s recommendations in the report at Annex 1 are: ​ ​ 1. For local partners responsible for commissioning CAMHS services in Kingston ​ to ensure that the future development of mental health support in schools in the Borough (including sixth form schools) is informed by the evaluations of the national “Trailblazer” pilots to ensure local services follow best practice. 2. For there to be a recommendation from Public Health to extend the MHA Programme to include primary schools (years 5 and 6), including transitioning support in year 6 to secondary school by the start of the school year, September 2022. 3. For Public Health to promote and ensure school link-up of the MHA Programme in terms of consistency of delivery across the Borough. 4. For there to be greater clarity amongst CCG Commissioners and Providers on funding opportunities in 2020/2021and 2021/2022 for secondary schools, including the MHA Programme and support and to ensure it is properly resourced. 5. To continue with my Mental Health Champion work visiting secondary schools, and in particular, drawing on the JSNA on young carers, to find out from staff members, including Mental Health Leads what interventions schools are delivering in order to identify young carers and end stigma and discrimination. 11. The Public Health team will progress these recommendations as follows:

Recommendation 1: The NHS long term plan states that “Over the coming decade the ​ ​ goal is to ensure that 100% of children and young people who need specialist care can access it.” All SWL boroughs have agreed through their Health and Wellbeing Boards, ​ CCG Governing bodies, school governors and trustees in participating schools and CAMHS partnership boards to work in partnership with children, young people, parents and carers to deliver these school based mental health teams. At the end of the trailblazer funding, SWLHCP we will be conducting a formal evaluation of the Whole School Approach to inform future commissioning decisions. Tackling inequalities is one of the requirements of the new trailblazer projects and the Kingston cluster will endeavour to focus on specific groups within this programme of work who are at higher risk of mental health problems and provide specific targeted actions where needed. Recommendation 2: There are already plans underway to pilot the MHA Programme in ​ ​ primary schools. The conference will include a consideration of transition and ensuring pupils have strategies in place to support them through this period. The needs of children who do not attend school will be addressed through other programmes such as the young people's risky behaviour needs assessment implementation plan. Recommendation 3: The Council’s Public Health Policy Officer: Mental Health ​ ​ ​ Improvement will be working with the School Health Practitioners to find out from teachers ​ ​ involved in the MHA how they would like to link up and share best practice. Recommendation 4: The Council is committed to continue funding Your Healthcare to ​ deliver the student mental health conference and MHA programme in the foreseeable future. There will be ongoing monitoring of the programme to ensure that the mental health ambassadors are representative of the student population and that the action plans that schools develop consider the needs of all of the pupils in the school.

Proposal and Option

12. This report is for information as requested by the Committee and the Committee is therefore recommended to note the report. 13. The Committee could refer the report, for information, to the Health and Wellbeing Board if it chooses.

Consultations 14. The report at Annex 1 has been produced after wide-ranging discussions, including with Public Health officers, Mental Health Team, staff and students in secondary schools, Anstee Bridge & other voluntary groups and charities, Health Link Workers from Your Healthcare, and other professionals, including Educational and Clinical Psychologists, Safeguarding Teams and Mental Health Leads, therapists and counsellors. Timescale 15. Specific timescales are set in recommendations 2 and 4 in para.10 of the report. Financial Context 16. Everything the Council does needs to be seen in the context of an increasingly challenging financial environment. Kingston is not alone in its challenges, one in three of all councils fearing they will run out of funding to carry out their legal duties by 2022/23. However, this position is particularly stark in Kingston. The demand for services is increasing while the funds available to meet these needs continues to fall. In 2010 the Council received £66m in government grant - by 2018 that had been cut to zero. This means that it is a continual challenge to find adequate funds to meet needs. Despite these challenges, the Council has a drive and commitment to ensure it is doing the best for residents and communities. Resource Implications 17. The progressing of the four recommendations as set out in paragraphs 10 and 11 of the report can be undertaken within existing funding.

Risk Assessment and Equalities Assessment 18. There are no risks, legal implications or equalities implications arising from the progressing of the four recommendations set out in paragraphs 10 and 11 of the report. ​ Health Implications 19. A primary purpose of the Mental Health Champion initiative is the promotion of mental health and the prevention of mental illness.

Sustainability and Road Network Implications 20. There are no sustainability or road network implications arising from the progressing of the four recommendations as set out in paragraphs 10 and 11 of the report.

Background papers - Thrive Kingston

Author of the cover report - Liz Trayhorn, Public Health Principal: Mental Wellbeing & ​ Older People's Health Improvement, Healthy and Safe Kingston, Communities Directorate. Tel 020 8547 6832 email: [email protected] ​

Annex 1 REPORT TO CHILDREN’S & ADULTS’ CARE & EDUCATION COMMITTEE:

By Councillor Anita Schaper, Mental Health Champion to the Committee

INTRODUCTION

1. As a Mental Health Champion reporting to this Committee, my aim has been to raise overall awareness of mental health in the Borough in relation to our children, young people and adults; to support initiatives that help individuals and communities cope better with mental health, and to understand the issues that can affect them.

2. It has been a pleasure to work collaboratively with both my fellow Champions, and with our various partners in the Borough, including Kingston Council’s Public Health Lead for Mental health, Achieving For Children (AfC), Kingston & Richmond Clinical Commissioning Group (CCG), HealthWatch, Anstee Bridge, other voluntary groups and charities, as well as staff members and students in our secondary schools (including Mental Health Leads and Safeguarding Teams), School Health Practitioners (previously known as Health Link Workers) from Your Healthcare, and other professionals, including Educational and Clinical Psychologists, therapists and counsellors.

3. Since the outset, I have been keen to focus my activities on visiting secondary schools in the Borough to look at areas of prevention and early intervention. I have sought to use the “Kingston Thrive Strategy” document as a basis for my research, ​ ​ and my visits have involved three strands of enquiry: - To learn more about the Mental Health Ambassadors (MHA) programme and to gain insight from those involved in its development and delivery. - To gain a greater understanding of what initiatives and interventions are being undertaken in schools to tackle mental health stigma and discrimination. - To look at how partnership working in schools (and across the Borough) is helping support students with mental health issues, and to gain an insight into what opportunities are available which will enhance existing support and delivery in schools. 4. I have also drawn inspiration from various sources, including Kingston “Time to Change” Hub (local partnership), who have been instrumental in working together to tackle mental health stigma and discrimination locally, in schools, workplaces and the community. The “Time to Change” initiative and Kooth on-line counselling service were showcased at the Student Mental Health Conference hosted by Tiffin Boys’ School earlier this year, which I attended.

5. Together with my Mental Health Champion colleagues, I have been liaising with Persephone Pickering (Time to Change Hub Coordinator) from Kingston HealthWatch. Persephone has been helpful in providing us with links to the national “Time to Change” website for school leaders, for teachers and for students, plus information and links to the Employer’s Pledge, World Mental Health Day (10th October 2019), Champions’ Funding and information and promotional material on “Time to Change” Community Champions.

6. I have also been keen to learn more about what initiatives and interventions are being adopted by schools (and using external providers) to help develop coping mechanisms and resilience amongst students. I have also wanted to gain insight into how schools are identifying young carers and how schools are tackling stigma and helping end discrimination. Drawing on the Joint Strategic Needs Assessment (JSNA) for Kingston on young carers, it appears mental health extends across both social care and health. This integrated way of working may have the potential for strategic as well as operational challenges involving various partners in and across the Borough being required to work together and agree on funding and best practice. I believe there is a need for staff members, including Mental Health Leads and Safeguarding Teams, as well as School Health Practitioners and other professionals in schools, to be instrumental in identifying at risk or vulnerable students, including young carers, and directing the right response and support (please see Findings and Conclusion for further explanation).

7. It has also been particularly interesting to learn how Mental Health Leads in schools are responding to the ‘Transforming Children and Young People’s Mental Health ​ Provision’ (A Green Paper published in December 2017), which sets out the ​ Government’s proposals for creating a strong network of support in schools. I believe that whilst responsibility may rest with Mental Health Leads to oversee and adopt a more strategic and coordinating role in schools, all partners in schools need to take collective responsibility for implementing a “Whole School Approach” towards mental health, and promoting good mental well-being and resilience amongst students and staff.

8. I have also gained further insight into the South West Health and Care Partnership (SWLHCP) “Trailblazer” pilot funding. As a SWLHCP funding priority, it was awarded to 3 secondary schools in our Borough (The Hollyfield School, Girls’ School and The Tiffin Girls’ School), as well as local primary schools, and commenced in July 2019 building on an earlier project which started in 2018. Feedback suggests that having been initiated directly from the Government’s Green Paper (Point 7), this funding will provide welcome additional clinical support and other interventions in schools (please see Findings and Conclusion for further explanation).

9. From my discussions with staff members and students, it is clear that they value the importance of continued guidance and support, and I believe there is a willingness and desire to share experiences both in schools and in the wider community. Feedback suggests, however, that schools are experiencing some day-to-day and longer-term strategic challenges. Topics such as resource management and planning, funding, staff training and recruitment have been mentioned as both potential areas of risk and of opportunity and development (given the right support).

10. It appears that both teaching staff and students are investing time and effort into making the MHA Programme work as effectively as possible. The Programme has also required a degree of transition planning between year groups, and feedback suggests there is an on-going commitment from staff to having a sufficient number of Ambassadors operating in different year groups from Year 9 to sixth form (please see Table A). Despite their efforts, the MHA programme has been running for 5 years and not every school has managed to recruit MHAs in each year group. Therefore, to ensure the Programme’s long-term success, greater, targeted support (possibly via funding or other options) may be required.

11. I have, therefore, highlighted the potential need for greater networking opportunities to enhance and build on the work already undertaken in and across schools in the Borough, and these will form part of my conclusion and recommendations.

FINDINGS

School Mental Health Ambassadors (MHA) Breakdown

12. Of the 11 secondary schools contacted in our Borough, to-date, 6 have responded, and I have had meetings with The Hollyfield School, Coombe Girls’ School, , Tolworth Girls’ School and The Tiffin Girls’ School. I am due to meet with shortly (to be confirmed).

13. A summary of the number of MHAs take-up by each school is as follows: Key: The Hollyfield School (THS), Coombe Girls’ School (CGS), The Kingston Academy (TKA) Tolworth Girls’ School (TGS), The Tiffin Girls’ School (TFGS). To be confirmed (TBC). Currently being recruited (CBR). Not Yet Planned (NYP). Sixth Form (S/F).

Table A.

THS CGS TKA TGS TFGS

Total Number 12 15 12 27 c.36 of MHAs (Up to 25 by (Up to 22 by end 2019) end of 2019) Male 2 None TBC None None

Female 10 All TBC All All

Year 12 (S/F) NYP NYP NYP NYP 12 - Form Associates*** Year 11 4 * 8 4 8 ** c.10 -12

Year 10 8 * 7 8 9 c.10 -12

Year 9 CBR CBR - 10 CBR - 10 10 CBR - 12 (Numbers (By 11/2019) (Scheduled TBC) training for 19/11)

* THS - Total number of MHAs (12) recruited are being spread across Year 10 and Year 11. ** TGS - Introducing a mentoring scheme in Year 11, made up of Year 11 MHAs and Year 11 Prefects. *** TFGS - Form associates (Year 12 students who are trained in mental health awareness and peer mediation). These students are attached to Year 7, 8, 9, 10, 11 form groups, and these are currently being recruited (approximately 30 students). 14. A summary of activities by school (in no particular order), including any additional help and support, is as follows:

Tolworth Girls’ School (TGS) Current activities: ● MHA established “buddy” network. ● “Trailblazer” funding opportunities: Building on existing arrangement with a Clinical Psychologist once a month, there is a new window of clinical support that will be available – to be confirmed. ● Transition planning for students between Year 6 (primary) and Year 7 (secondary). ● Collaboration with Grace Dear Trust: Year 11 “safe talk training” on suicide ​ ​ prevention and mental health. Those taking part staying on in sixth form, then becoming mentors for lower year groups. ● MHAs and Year 11 mentoring scheme – sharing experiences. Currently evidence is showing an increase in achievement levels due to Ambassador-led interventions. ● On-going MHA Conference planning between staff members and students. ● Staff and MHAs setting up a framework to promote Mental Health week, cake bake sales, staff karaoke, other events, etc. ● Staff and student tutorials with Years 7 and 8. ● Chill-out room for students. ● Staff teaching (for students) on how to revise, and improve coping mechanisms and resilience. ● PHSE and “Improving Emotional Literacy” - building resilience and basic social skills for Years 7 and 8. ● “Cool Connections” (a workbook that provides a cognitive behavioural therapy (CBT) approach to positively modifying the everyday thoughts and behaviours of slightly older students (Year 9 onwards). Building social networks. With help from the Clinical Psychologist, and the Student Support Worker, staff and students can work on topics such as “Goal Setting”. Additional support available: ● “Time to Change” and reducing stigma and discrimination in schools. MHAs promoting student workshops to help engage, raise awareness and deliver peer group support. ● Staff members working with students to develop individual action plans, together with workshops and programmes looking at mental health, eg, sessions on self-harm and eating disorders. Funded by the Grace Dear Trust. First available to TGS parents and then is opened up to parents across the Borough via EventBrite.

The Hollyfield School (THS) Current activities: ● Established MHA “buddy” networks. ● MHAs raising money for community projects. ● MHAs developing well-being section in their library. ● MHA identification - wearing badges amongst students. ● “Drop-off” box organised by MHAs for suggestions and comments monitored by the librarians. ● MHA-led assemblies. ● Staff members and MHAs organising mental well-being challenges and prize giving on different mental health themes. ● Head/Deputy Head, Mental Health Leads and other staff members developing strategy – looking at role of teachers, tackling stigma and discrimination associated with mental health and identifying need and level of support required. ● “Trailblazer” funding opportunities – students receiving 1 hour 1:1 sessions per week with a Clinical Psychologist for 6 weeks. ● Inset days and transition planning for students in Year 6 (primary) and entering Year 7 (secondary). Teaching Assistants and Student Support Officers (SSOs) working together with other teaching staff across both schools to offer help and support to students. Additional support available: ● Parent-led “Time to Talk” events – setting a day and time to talk about mental health in schools. ● Staff and student-led parent evenings – dealing with exam stress; greater awareness and understanding of anxiety and depression; family dynamics. ● Triage system - using different levels of support amongst teaching staff. 7 staff currently MH trained. ● From 2020 - “Trailblazer” funding available for students (and parents) dealing with transition. Entitled “Managing Transitions and attachments”.

Coombe Girls’ School (CGS) Current activities: ● Established MHA “buddy” networks. ● Transition planning for students between Year 6 (primary) and Year 7 (secondary). ● Tutor times with Year 7 and team building. ● Prefects and peer mentors assigned to subjects. ● MHA-led assemblies. Additional support available: ● Staff members and MHAs developing and organising body image workshops. ● MHAs instrumental in helping facilitate support for students during Summer term. Examples of activities and signposting for a range of services, eg, organising “buddy” networks, Kooth online counselling service, KU19 Drop-ins via School Health Practitioners and Pegasus Theatre (funded by Kingston Public Health).

The Tiffin Girls’ School Current Activities: ● MHAs developing and organising “buddy” networks. ● Hosting the Mental Health Conference on 19th November 2019. ● Form associates, (students from Year 12/Sixth Form who are trained in mental health awareness and peer mediation), attached to a Year 7, 8, 9, 10 and 11 form groups - approximately 30 students currently being recruited. ● MHA-led assemblies. ● Year 7 assemblies looking at body image. ● Year 8 - work on “Friendships”. ● Year 9 - Emotional wellbeing, co-written by Sarah Finch (SENCO) and an educational psychologist, looking at motivation and understanding emotions and emotional literacy. ● Year 10 - Managing self/stress of exams and looking at motivation. “Psycho-Ed” resilience work - understanding stress and “knowing yourself”. ● Year 11 - Further “Psycho-Ed” work, looking at more defined symptoms/illnesses and tools to help students plan more effectively. Additional support available: ● Developing more ideas for 2020 - building on Mental Health Conference. ● Working and collaborating with other “Trailblazer” cluster of schools in the Borough - information sharing, eg, on MH policy, Personal, Social, Health and Economic (PSHE) Education (as a vehicle for MH and safeguarding), and developing ideas on how they can work together to help and support students and their families (please see Further Findings for more details). ● Counsellor recruited 3 days per week (self-funded). ● PSHE/”Citizen” unit of work once a week. ● “Friends” Programme (World Health Organisation endorsed), involving resilience-based course using a Cognitive Behavioural Therapy (CBT) approach.

The Kingston Academy Current activities: ● MHA-led assemblies, with more planned for 2019/2020. ● MHAs developing and organising “buddy” networks. ● Year 9 MHAs supporting Year 7s with first residential trip. ● MHAs promoting “Being in your mate’s corner” badges. Additional support available: ● On-site support from a Health Link Worker 2 days per week, combined with co-activities with MHAs. ● Safeguarding Lead support with emotional needs, including focussed work with Year 10s (GCSEs) to help students with exams, including programmes to help with anxiety, depression, low mood, suicidal thoughts, self-harm and burn-out. ● Staff members, MHAs, School Health Practitioners and Safeguarding Team developing a network of information exchange. For example: MHAs and Form Tutors systematically raising awareness of well-being in class. If MHAs have any concerns about a fellow student, they are encouraged to flag these to a Form Tutor, who in turn, may alert a Designated Safeguarding Lead for their attention. ● Staff and student dialogue – fostering greater awareness. Staff tackling normalisation of language, and students learning about appropriate use of language in school to describe mental health issues and/or conditions, eg, using the word “depression” rather than “crazy” as a descriptor of behaviour.

FURTHER FINDINGS

15. Feedback from students and staff about the MHA programme has been extremely helpful and forthcoming. I believe all staff, including Mental Health Leads, Safeguarding Teams and School Health Practitioners need to work closely together to identify individual needs, direct the right response, and at the same time develop ways to help students (for a variety of reasons) cope better with their mental health – raising self-esteem and self-confidence and helping reduce feelings of social isolation. 16. The MHAs are helping the schools to raise the profile of mental health, and are finding proactive and innovative ways of reaching out to their fellow students. Workshops and programmes, for example, are being added to the school timetable to encourage all students to come together to talk about mental health issues. 17. In terms of prevention and early intervention, the “Body Image” workshops for Year 7 in The Tiffin Girls’ School is a good example of this supportive and proactive approach. In The Hollyfield School, the staff and student-led parent evenings have also been successful in offering advice and guidance for students dealing with exams and stress related behaviour. The evenings have offered opportunities for families to gain a greater awareness and understanding of anxiety and depression and their effects on family dynamics. 18. It has also been interesting to look at the take-up of MHAs. With the exception of the all girls’ schools, The Hollyfield School currently has 10 female and 2 male MHAs, and I hope to receive additional data shortly from The Kingston Academy (from my initial discussion, my understanding is that there are more female than male MHAs - exact numbers to be confirmed). 19. Feedback suggests that mental health problems affect both females and males, but not in the same way and not in equal measure. In England, women are more likely than men to have a common mental health problem and are almost twice as likely to be diagnosed with anxiety disorders. In the co-educational schools visited, I believe that there may be a correlation between the number of female MHAs and the likely level of interest and take-up (linked to available statistics on mental health), but at this stage, this is only an observation. I would like to revisit these two schools to see how the female/male take-up is working, and whether more males are likely to take part in the future (or not), as well as what reasons they might have for taking part which are the same or different from the females. 20. In all schools, MHAs have been developing and organising “buddy” networks – the bringing together of student peer groups. This has created more opportunities for students to chat and talk about their experiences, in a way they might not have done before. 21. Although some schools are more advanced in their resource management and planning than others, the majority of MHAs have organised and taken part in school assemblies and these have been very well received. Students who have taken part as MHAs in year 9 in the last academic year, I am pleased to report are now able to advise others and mentor, help and support students starting in the lower year groups – especially those pupils in Year 7 entering secondary school for the first time. 4 out of the 5 schools visited have confirmed that they have already adopted transition planning and support in place for students entering Year 7. 22. The MHA mentoring scheme in Tolworth Girls’ School is an example of how Ambassadors are moving up to Sixth Form and offering support to students in Year 11 (although some students drop-off the Programme in Sixth Form because of other work commitments). 23. Each school has its own recruitment drive for the MHA Programme, and in order to ensure the “buddy” network can grow effectively, all schools have mentioned the importance of recruiting new Ambassadors in Year 9 who can sign-up. In most cases recruitment takes place at the end of Summer term and the beginning of the new school year. Students are encouraged to come forward to apply as Ambassadors and they are usually signing-up in the Autumn Term (Enclosure 1: ​ ​ Tolworth Girls’ School Ambassador Application Form, Year 9). 24. I have also more recently been liaising with the Council’s Public Health Policy ​ Officer: Mental Health Improvement, Emily Jenkins-Pandya, who is looking at ​ ​ mental health/resilience work being done in schools. An aspect of Emily’s work is looking at ways in which additional support can be provided to schools who are currently outside the current “Trailblazer” funding cluster. We have agreed to co-ordinate effort. Since we have both had discussions with school School Health Practitioners within Your Healthcare, our aim, moving forward, is to visit schools together, share feedback and the in-sight we have gained.

25. I have also been interested to learn that the SWLHCP “Trailblazer” pilot funding was awarded to schools in July 2019 building on a project that commenced in 2018. I have had the opportunity of visiting all three schools in the Kingston cluster, and their feedback suggests that students are benefiting directly as a result of this funding. Outcomes are being measured in terms of reduced absenteeism, less anxious students and more positive behaviour. One school has also seen an improvement in results, and although not linked to the “Trailblazer” funding, the students are still benefiting from having had enhanced support over a longer period (please see Conclusion for further explanation). 26. Feedback suggests that collaborative working amongst the three schools in the “Trailblazer” cluster is encouraging information sharing on topics such as mental health policy and PSHE Education. They are also looking at how PSHE can be used as a vehicle for mental health and safeguarding. As a network, I understand the cluster is also looking at the potential logistical and financial challenges they and other schools may be facing. There is an acknowledgement that schools may often not have the resources available and the knowledge and expertise on-hand to be able to focus on the right provision at the right time. Feedback also suggests that further evaluation may be required on the number of hours schools have to commit to tasks and activities and of directing funds in the right place.

27. From my discussions, I also understand there is the issue of the direction for statutory RSHE (Relationships, Sex and Health Education) provision from September 20201. Where schools are required to effectively prepare, resource and allocate provision, I believe some additional guidance and further clarity from Commissioners and Providers would be welcome2. Students have also been presenting stress and anxiety all year, not just around exam periods (GCSEs).

1www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-healt h-education 2 www.pshe-association.org.uk/curriculum-and-resources/resources/roadmap-statutory-rse ​

Particularly prevalent when transitioning to a new curriculum, hence why greater provision for 1:1 support and intervention may be necessary at that time.

28. I have also gained a greater understanding of the role of Mental Health Leads and how they are aiming to oversee and coordinate the “Whole School Approach” towards mental health and well-being, including helping to identify at risk students and those showing signs of mental ill health (including identifying young carers). I cannot confirm whether Mental Health Leads in all schools visited are doing this to the same extent. However, I believe that some may have opportunities to look at how their roles are reflected in the design of policies, curriculum and pastoral support; how staff are supported with their own well-being and how students and parents are engaged.

29. A Mental Health Lead in one of the schools visited has been instrumental in working with other staff members and School Health Practitioners to coordinate a clear pathway into students’ mental health services - referring students to NHS services where appropriate. My understanding is that members of staff in the school find it helpful to use an ‘Anxiety Template and Referral Chart for Physical and Health Concerns’ when deciding on how best to direct support and intervention (see Enclosure 2). Staff members in the school are also currently looking to develop an ​ on-line version of their newsletter (with student help), so the school can widen its message to parents as well as students and encourage families to become more engaged. 30. Safeguarding Leads at the Kingston Academy, for example, are supporting students with emotional needs, including focussed work with Year 10s (taking GCSEs) and helping students cope better with exam related stress and behaviour. 31. Coombe Girls’ School are also raising awareness of mental health by reaching out to external advisers and experts in the fields of education and clinical psychology. I believe that bringing expertise into schools, via events and seminars, has the potential to both inform staff, students and parents about the challenges, as well as the opportunities that exist within our education system. Knowledge sharing within schools, and amongst guest speakers who may be representing partner organisations, may also help inform debate and shape future direction.

CONCLUSIONS

32. There appears a sense of collective responsibility in schools, in which staff members, students and parents, including Mental Health Leads, Safeguarding Teams, School Health Practitioners and other professionals, are aiming to work in partnership to develop a range of solutions and enact positive change. 33. Overall feedback suggests students are better engaging with each other, within their peer groups and with staff members as a direct result of the MHA programme. I believe running this Programme alongside other mental health initiatives in schools, may offer students a more comprehensive and systematic “Whole School Approach” to mental health and supported intervention. 34. It is not evident from my visits that all schools are adopting this approach or have the same strategic vision. However, I believe there is a high level of commitment from teaching staff and students, and early intervention and prevention techniques and approaches appear to be effectively woven into the various information sharing currently taking place between staff members, MHAs and schools’ “buddy” networks. 35. Ambassadors are raising awareness of mental health issues and spreading this awareness across year groups. Despite challenges to staff time and resources, there is evidence in schools of a continued commitment and a willingness to find new ways to help and support the student cohort - workshops and events are good examples of this. New Ambassadors are currently being recruited (particularly in Year 9), and they will learn new skills and become positive role models in the process. I also believe investing in MHA recruitment year-on-year will ensure the cycle of learning and greater awareness continues. 36. It has also been interesting to look at the take-up of female and male MHAs. Further analysis may provide insight into why there is a greater number of female MHAs in the co-educational schools. As mentioned in the Further Findings, I would like to revisit The Hollyfield School and The Kingston Academy to see whether there is any increase in the number of male students taking part in the Ambassdors programme (or not), and if possible, find out what their reasoning is for taking part and whether it differs in any way from the female students. 37. My understanding is that some schools are also investing in mental health staff training and are seeking additional resources. As parents are also being encouraged to take part in workshops, seminars, and programmes, the hope is that this will create opportunities for positive change in family dynamics (as relationships may suffer from a lack of knowledge, empathy and understanding). 38. Feedback from talking with both teaching staff and students also suggests there are tangible benefits for schools in raising awareness of mental health. In over half the schools visited, there is an established MHA “buddy” network in addition to other support mechanisms. For students, this has resulted in better coping strategies during exam periods and reductions in stress and anxiety.

39. Tolworth Girls’ School, in particular, is benefiting from the newly introduced “Trailblazer” funding. As a measurable outcome, they have noted the benefits derived from specialist staff being on-hand to help and support students, to a reduction in anxiety and absenteeism amongst students. As mentioned in the Findings section, although not attributable directly to the “Trailblazer” funding, Tolworth Girls’ School have noticed an overall improvement in results for Year 11 students. The school have attributed this improvement to students developing better coping strategies and resilience. 40. Workshops funded and operated in the school by the Grace Dear Trust (a local charity) have also been very well received by staff and students at Tolworth Girls’ School. One workshop, in particular has been advising Year 11s on “safe talk training” on suicide prevention and mental health. Feedback suggests that having attended these workshops, students can better articulate their concerns, and are opening up more about their anxieties with their peer groups and with staff members. Students in the sixth form who have taken part in these workshops are also able to impart their knowledge and experience to other students in the lower year groups who may be in need of support and who would benefit from this type of interaction. I am due to meet with the Grace Dear Trust shortly, and I look forward to learning more about the work they are doing in schools, in areas such as suicide prevention and well-being. 41. Students with Special Educational Needs and Disabilities (SEND) and those on the autistic spectrum are also benefiting from newly equipped facilities in Tolworth Girls’ School’s Athena unit, and there is a space nicknamed the “blue box” to allow students to come and relax and unwind, as well as a sensory room in which students can de-stress and re-focus. 42. The Hollyfield School is now receiving “Trailblazer” funding, and they have given positive feedback on the Clinical Psychologist 1:1 on-site visits. Also as a measurable outcome, I can report that this type of clinical intervention right where it is needed is making a notable and positive difference in student behaviour. 43. It is also encouraging to learn that the “Trailblazer” cluster of schools are networking with each other and sharing knowledge and experience. As one SENCO has highlighted, however, it would be beneficial to have greater provision of 1:1 support. At the moment, this type of provision is limited and there may be a need amongst students for more specialist focused intervention, including CBT approaches, especially when transitioning to a new curriculum and during stressful periods (now occurring more often throughout the year). Looking to build on the work of the “Trailblazer” pilot, and the benefits best practice may bring, has formed part of my recommendations. 44. The Joint Strategic Needs Assessment (JSNA) for Kingston on young carers, I believe has also highlighted the need for greater engagement in schools between staff and students, and an emphasis on good and effective partner link-up. From my discussions, I also believe when all staff and other professionals work together in schools, they are better able to utilise their knowledge and expertise to identify vulnerable students and those with caring responsibilities. 45. Feedback also suggests that further clarification may be required to ascertain the level of strategic delivery and coordinating support across schools in terms of identifying young carers and ending stigma and discrimination. Working alongside teaching staff and other partners, it would be helpful to find out how Mental Health Leads are overseeing the delivery of interventions where these are being delivered in schools (please see Recommendations). 46. It has also been helpful to learn, from a School Health Practitioner’s perspective, about the challenges in identifying or “directing” the right response and support into Tier 1 emotional well-being in school, particularly as they suggest, it is not always obvious what is wrong and it can take time for students to share information. I believe there is an opportunity for School Health Practitioners to build longer-term relationships with students who may be reluctant to engage with their peer groups or with teaching staff and other care professionals. 47. It has also been helpful to gain a greater insight into how important it is for schools to assess and review overall needs of children and young people. From my discussions, Mental Health Leads, Safeguarding Teams and School Health Practitioners may be best placed to form an essential link in directing the right response and support for students. Working together with other staff members and partners, their work has the potential to be of huge benefit to both students, parents and teaching staff. As this working often leads to safeguarding concerns for at risk or vulnerable students, I do believe it is incumbent on schools to continue to do this activity as a matter of priority. 48. It also appears that the MHA Programme and other mental health interventions being delivered in schools are good examples of joined-up working amongst partners. However, feedback suggests that delivery of programmes and workshops could be more consistent across all schools visited. At the moment, delivery management appears a little ad-hoc. Adopting a standardised approach towards delivery of the MHA Programme and other interventions may help when collating information and looking at (evidenced-based) outcomes. 49. Feedback also suggests there are challenges that schools are having to deal with in terms of resource management and planning and in the training-up of staff. There are also mental health challenges associated with students with SEND and those, for example, who are self-harming on-site. Whilst some schools have dedicated areas within school to help and support students and those with SEND, I believe delivering the most effective interventions may vary by school, according to their individual circumstances and levels of available resources and funding. 50. As I have alluded to in this report, the way Commissioners and Providers of services are working is also evolving. Effective interventions and consistency of delivery may require a degree of strategic planning, coordination and joined-up partnership working within schools and across the Borough. I believe all schools may benefit from the idea of co-location of teams, directing students to the appropriate services, and having professional knowledge and expertise on-site and on-hand to help and support students when they need it the most. 51. In our Borough, I have identified that there are currently multiple funding streams to help schools with mental health interventions and delivery, including those from Public Health, AfC, Kingston and Richmond CCG, the SWLHCP and SWLSTG. In terms of integration (involving social care and health), feedback suggests that there is a degree of uncertainty amongst staff members as to what additional support schools can be eligible to obtain. This has the potential to create challenges with planning and resource allocation within schools, and may mean that the benefits of intervention and accurate evidenced-based outcomes become more complex to measure (please see Recommendations).

52. I believe there is huge potential for the MHA Programme to be rolled out to a wider audience, and if that happens, funding opportunities and collaborative working across schools may benefit from being more clearly defined. Feedback suggests that schools want to be talking to other schools, sharing their methods and ideas for better awareness and intervention, and, when appropriate, bringing in external expertise and advice. In some schools this type of networking is already taking place (via seminars and events).

53. It is my hope that Public Health and other bodies and organisations may be able to enhance their reach across the Borough through greater collaborative working with schools and with other experts, as well as helping and promoting these initiatives (please see Recommendations).

54. It is also my hope that the work of the MHA programme will continue, and be able to benefit from partner working and a consistent collaborative “Whole School Approach” across all secondary schools.

55. I also look forward to the opportunity of gathering further evidence on the “Trailblazer” Kingston cluster of schools adopting a “Whole School Approach” to mental health. Feedback suggests that having a mental health team in place in schools will be essential in delivering effective and positive interventions, including as I understand, Education Mental Health Practitioners (four in Kingston), plus other qualified staff in mental health currently being planned.

56. Working with our partners in the Borough, and in particular SWLHCP, it is also my hope (in terms of further “Trailblazer” roll-out), that we can keep momentum and for the cluster of schools to increase in number (please see Recommendations).

57. In conclusion, it has been a real pleasure to visit our secondary schools and meet with teaching staff and students. I would like to pay tribute to the many students who have taken part in the Ambassadors programme since its inception 5 years ago and to the teachers and other professionals who have worked hard to develop and plan this programme and other initiatives and interventions. They are to be commended for their enthusiasm and commitment. 58. I have also been immensely grateful for the opportunity to gain insight into how schools are tackling a range of mental health issues affecting their students, and what sort of interventions they are managing to deliver. Being a Mental Health Champion in the Borough has also been an honour and a privilege, and I would like to pay particular thanks to Officers at the Council for their help, advice and support over the last few months.

59. I look forward to continued dialogue with schools. Having visited 5 out of 11 secondary schools in the Borough so far this year (and due to visit Richard Challoner school shortly), it is my hope to continue as Mental Health Champion, with a view to completing my visits to all 11 schools by June 2020.

RECOMMENDATIONS

Based on my findings, my recommendations are as follows:

1. For local partners responsible for commissioning CAMHS services in Kingston to ​ ​ ensure that the future development of mental health support in schools in the Borough (including sixth form schools). is informed by the evaluations of the national “Trailblazer” pilots to ensure local services follow best practice. 2. For there to be a recommendation from Public Health to extend the MHA Programme to include primary schools (years 5 and 6), including transitioning support in year 6 to secondary school by the start of the school year, September 2022. 3. For Public Health to promote and ensure school link-up of the MHA Programme in terms of consistency of delivery across the Borough. 4. For there to be greater clarity amongst CCG Commissioners and Providers on funding opportunities in 2020/2021and 2021/2022 for secondary schools, including the MHA Programme and support and to ensure it is properly resourced. 5. To continue with my Mental Health Champion work visiting secondary schools, and in particular, drawing on the JSNA on young carers, to find out from staff members, including Mental Health Leads what interventions schools are delivering in order to identify young carers and end stigma and discrimination.