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Radio Bristol


12.01.17 Parliamentary submission



Response to Theresa May




Written Submission to the Parliamentary Inquiry into the role of Education in Child and Adolescent Mental Health, from The Bridge in Schools

 The Bridge in Schools is part of the Bridge Foundation, a Bristol-based mental health charity which has pioneered mental health services for children and families in Bristol for over 30 years. Last year our Schools programme worked with 174 families across 17 local schools.

 Children’s Mental Wellbeing – the role of Education

 We welcome the Parliamentary Inquiry into Child Mental Health and the role of schools. As mental health professionals working with children and families, we are acutely aware of the growing numbers of children and young people with emotional and mental health issues in our local communities. Their difficulties are increasingly serious and complex – high-risk cases in our self-referral clinic have more than doubled during the past five years. Despite good work in CAMHS, there are major gaps in provision, especially for children aged 5 to 11, whose parents cannot pay for professional help. Moreover, freedom of information requests have found that 57% of CCGs plan to reduce their spending on child mental health in 2017.

 We would like to share some learning points from our Bridge in Schools programme, set up nearly 8 years ago in Bristol, to address these concerns through a working partnership with local schools.

 Executive Summary

  • There is a major gap in service provision for children aged 5 – 11. Vulnerability is higher in areas of high deprivation.
  • Schools are uniquely placed to host and co-deliver mental health support for this age range
  • Mental health support in schools is best based on a partnership approach, which is multi-layered (ie combines input for children, families, and school staff), and includes co-working between health and education professionals
  • Mental health training for school staff needs to be standardised across schools
  • School staff with mental health responsibility require supervision from mental health professionals to ensure safe practice
  • School staff are not equipped, and should not be expected, to substitute for trained mental health professionals in the case of more complex, enduring difficulties
  • An effective school-based mental health service will require leadership and dedicated funding agreed at a strategic planning level, on top of current provision, between relevant government stake-holders.
  • As a core provider, better integration of the third sector in service planning and provision is needed at national and local levels.

1. Mind the gap

 Our focus has been especially on children of primary or early secondary school age, in areas of high deprivation. Deprivation doubles mental health risk. And this is the age when research shows many later mental health problems are germinating. There is also more possibility of working alongside parents and addressing broader family issues, with children in this age group. However, the 5-11 year old population is very under-represented in current service provision. For instance, in Bristol where we work, the emphasis has been on services for the under 5s, eating disorders, and on a range of services for teenagers, by which time problems have often become acute. Intervention at a younger age is urgent to avoid further growth in the numbers of teenagers in crisis.

 2. Why Schools?

Schools are places where children live a large part of their lives. At primary school age, children are often better known by their teachers than by any other adults outside the family. Teachers have ongoing contact with parents and families as well. This makes schools very important in two respects:

-          school staff are in a position to notice early on when things start going wrong, discuss it with parents, and remain consistently involved over time.

-          Where children’s home situations are chaotic, schools are the most accessible and regular points of contact for connecting children/families up with professional help. This is especially crucial in complex cases where these younger children often miss out on help because of the level of family support that is needed to get to professional appointments in the first place, and to keep attending over time.

 3. School-based mental health services

 We have nearly 8 years experience of working with local schools to fine-tune a model of specialists mental health support in schools. We find that what works best is a partnership approach, bringing education and mental health professionals into a close working alliance in the local school setting. This ensures that work is joined up and responsive to local priorities. A financial aspect to the partnership has been crucial, ensuring that work is owned and valued by each partner.

Components of the service are as follows (quotes are from Heads and senior staff in partner schools):

3.1 A School observation and assessment service

In our experience, teachers and support staff can be highly skilled at building relationships with children, and supporting their emotional development as well as their academic progress.  However, the behaviour and issues of some children require more specialist assessment. On the Bridge model, when a child’s problems persist , the teacher can flag the concern to the mental health professional, who observes the child in school and may meet also with the parent. There is then a three-way discussion between family, school and therapist to build a shared understanding and approach to the child’s problems.

“Our therapist has been invaluable in providing advice to the teaching staff and SLT…Many of the strategies she has suggested have been useful for other children.”

3.2 A School therapy service

When facing trauma, abuse or sustained emotional deprivation, children will need extra help which school staff do not have the time or training to provide. A mental health professional in school, using a mix of family and play-based therapy, offers a highly effective form of early intervention in these cases. The DNA rate is very low, and there is a good support network in situ to start the conversation with parents, and help them and the child keep going through setbacks and disappointments. There are also skilled school staff available to stay in touch at the end of therapy, who can step in if things look like slipping.

“The children have all made great progress in terms of their emotional well-being. Often this has also impacted on their academic success as they are less anxious in class and therefore can concentrate more”

3.3 Whole School Training

 In our experience, school staff have often been keen for training on basic child development, mental health, and mental health First Aid. In Bristol,  Primary Mental Health Specialists run good courses for school staff. The CASCADE training, developed by the Anna Freud Centre, is also to be piloted across Bristol.  

Currently, trainings are optional and usually limited to one or two members of a staff team. If  schools are to have a more formal role in child mental health, a challenge is how to mainstream and consolidate these trainings across school staff groups.

 3.3.1 Mainstreaming mental health and emotional wellbeing training

 Basic child mental health awareness and training is currently ad hoc, often dependent on the interest of individual staff, rather than seen as a requirement for good school practice. By contrast, government guidance has ensured that regular Child Protection training is now standard for all schools. Similar government guidance could have an important part to play in setting Emotional Wellbeing training standards for schools and monitoring compliance.

 3.3.2 Consolidating training

Stand-alone training is an important asset to build on. However, it can be presented as a quick fix substitute for staff with professional mental health qualifications. In practice, much of its value depends on how training is reinforced and developed after the original input. In our experience, there is particular benefit from a training model which combines:

-          Formal training sessions

-          Ongoing reflective practice groups led by a mental health professional

 For instance, a staff training on attachment in one Bristol primary school sparked a programme of termly reflective practice groups, grouped by Phase, so that staff had the opportunity to put their learning into practice with the help of a mental health professional. They have used the model to develop their learning, and build a shared approach to understanding and managing behaviour across the school.

 “Our reflective practice groups are considered to be very important spaces to reflect on anxieties and support each other. Staff look forward to them. The level of discussion about individual children and what their behaviour may be communicating has developed, showing an increased awareness of children’s needs. It feels like real learning has been able to take place in the last two years.”

 3.3.3 Support for specialist school staff

 All our school partners have staff trained at a more advanced level (SEN, Thrive, etc) to support children with emotional difficulties and children at risk. These staff work with high levels of distress and risk, which appear to be increasing as other services are cut. Burn-out, sickness and stress are occupational hazards. In our model, regular supervision from qualified mental health professionals is a crucial safety net for staff in these roles. Experience shows that to retain strong, effective staff, such supervision should be built into standard guidelines for professional practice ( as is currently the case for colleagues in CAMHS and Social Care, across statutory, private and voluntary sectors).

 “Our knowledge about supporting children’s emotional and mental health has much improved due to being able to have in-depth discussion with our therapist. Knowing that we have the capacity to support children in this way is especially comforting.”

 3.3.4 The limitations of training

 Training is a tremendous asset to support staff identify emotional and mental health difficulties, provide mental health First Aid, and build supportive relationships for children

in school. For most children in school, this level of support will be enough to help them weather problems and develop healthy resilience. However, staff trained to this level cannot substitute for the expertise provided by trained mental health professionals. 

 A rigorous professional mental health training is the level of expertise needed by the 10% of children in schools with a diagnosable mental health disorder. On current figures, only one quarter of these will access professional mental health help through a statutory service, and there is a risk that their needs will be continue to be overlooked by a “quick fix” approach.  The Bridge model demonstrates how basing mental health professionals in school is highly effective in addressing the gap.

 4. Funding and Human Resources

 A common pitfall is the absence of a clearly defined funding basis for such comprehensive, school-based, mental health provision. Currently, apart from voluntary sector fund-raising, therapeutic input is largely financed by hard-pressed schools on an ad hoc basis and is highly vulnerable, in light of the mounting pressure on school budgets, and focus on education targets. This past year, five separate Primary School Heads told us that they were having to decide between keeping teaching support posts, or funding key pastoral support work.

 This is the harsh reality which new policy must address, if it is have real impact. Consequently, a sustainable school-based mental health service will require leadership and dedicated funding, on top of current provision, agreed at a strategic planning level between relevant government stakeholders.

 Moreover, there is currently a shortage of mental health expertise available through statutory services. Over recent years, third sector organisations have become core providers of mental health support in the education sector. They have extensive experience and established partnerships with schools, which is a valuable resource for future planning (as well as bringing in additional financial resource through charitable grants). An ongoing challenge is how to integrate this resource at a strategic planning level, to avoid unhelpful splitting and the inefficient lack of coordination which currently prevails. 

 Dr. Emily Ryan

Manager of the Bridge in Schools

Child and Adolescent Psychotherapist.

Office: 0117 942 4510  Mobile: 07948 530 644




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