CAMHS - Minister for Education, Sport and Culture - Transcript - 24 February 2014

Health, Social Security and Housing Scrutiny Panel

Child and Adolescent Mental Health Service Review

MONDAY, 24th FEBRUARY 2014

Panel:

Deputy J.A. Hilton of St. Helier (Chairman) Deputy J.G. Reed of St. Ouen

Witnesses:

The Minister for Education, Sport and Culture Business Manager, Schools and Colleges Principal Educational Psychologist

[11:01]

Deputy J.A. Hilton of St. Helier (Chairman):

Welcome to this meeting of the Health, Social Security and Housing Scrutiny Panel. This is a public hearing with the Minister for Education, Sport and Culture as part of our C.A.M.H.S. (Child and Adolescent Mental Health Service) review. We will start by making the introductions. I am Deputy Jackie Hilton, vice chair of this panel.

Deputy J.R. Reed of St. Ouen : Deputy James Reed, panel member.

Scrutiny Officer:

Janice Hales , Scrutiny Officer.

The Minister for Education, Sport and Culture:

Deputy Patrick Ryan, Minister for Education, Sport and Culture.

Business Manager, Schools and Colleges: Cliff Chipperfield, head of inclusion education.

Principal Educational Psychologist:

I am Julian Radcliffe, principal educational psychologist.

Deputy J.A. Hilton:

Thank you very much. I would like to start by offering the apologies of our chair, who is sadly unwell at the present time. I would like to draw the members of the public's attention to the notices which are on the chairs there. Thank you. I would like to start by asking you, Minister, what support is provided by your department to children and young people suffering from mental health or behavioural issues.

The Minister for Education, Sport and Culture:

I think I will make a very general answer to that if I can. The detail, though, as this is quite operational, will come from the 2 officers on the left here. We do provide quite a lot of support, but it tends to be slightly different in the secondary area than in the primary area. I think to detail those differences the 2 officers can obviously help you on that. I think without any further information from me, I will hand over to Cliff if that is okay.

Business Manager, Schools and Colleges:

Thank you, Minister. I think we need to separate the 2 out. I think you also have mental and behavioural. One is very much our business; one is an area of expertise where we use other services, especially around the mental difficulties. Behavioural difficulties are our core business in terms of operation within both primary and secondary schools. Within our schools, through high quality teaching in the first instance, behaviours are managed, but if you are asking about the

escalation of those behaviours and how we work with those, in a second I will ask Julian to come in but expectation is at the first instance within the school environment and dealing with those behaviours through work with the educational needs coordinator within the school with the classroom teacher, managing those relationships within their environment. But there is a point at which, of course, schools will seek help other than what is available within the school environment. In the first instance, those colleagues would turn to the educational psychology team or the educational worker team, and there would come a level of expertise around that. I will give you the stages and then Julian will fill in some ...

Deputy J.A. Hilton:

Can we concentrate on the secondary schools first?

Business Manager, Schools and Colleges: Okay, yes.

Deputy J.A. Hilton:

Then we will talk about primary schools later. Let us start with children with mental health issues in secondary schools, and if you can tell me in the first instance where it may be identified that a child or young person has a mental health issue what action the school would take or how is it identified. What is the process?

Business Manager, Schools and Colleges:

Again, I will ask Julian to come in in a second, but it is usual ... we would not determine, first of all, in education whether a child has a mental health issue. However, we may be going through a process through the structures I have explained where the work we are doing with that child is not or does not seem to be addressing the issues. At that point we would turn to colleagues whose expertise is mental health and the school would make referrals into that service, or parents can or even through their G.P. (general practitioner). Julian, do you want to add anything at that point?

Deputy J.A. Hilton:

Before we just move on to that, as far as the secondary schools go, state secondary schools, has each school got a counsellor attached to it?

Business Manager, Schools and Colleges:

Yes, the M.A.S.T., multi-agency support teams, within schools have a school counsellor but the expertise of that school counsellor is not around the mental health issues. That school counsellor is supervised by a senior colleague at C.A.M.H.S. and that school counsellor would be a conduit referral into C.A.M.H.S. for a young person where they consider the issues could well be mental health problems. The counsellors do not deal with the mental health problems.

Deputy J.A. Hilton:

No, but there is a counsellor in each of the secondary schools. Does that include the fee-paying schools as well?

Business Manager, Schools and Colleges:

The fee-paying schools employ their own counsellor. The funding ... do you want me to go back to the historic why there is a difference or ...?

Deputy J.A. Hilton:

Yes, why is there a difference between fee paying and ...?

Business Manager, Schools and Colleges:

Okay. Through the Kathie Bull report of 2002, one of the key recommendations to the States ... because if you remember, that review was conducted beyond just education; it was health and social services as well. The recommendation, among quite a few recommendations at that point, was that our 11-to-16 schools, at that time the evidence was the behavioural issues were emanating from those particular schools in the main. Funds were identified from the States that are ring fenced, and to this day are ring fenced, to be spent in all 4 11-to-16 schools to develop teams, these multi-agency support teams. That would include an attendance officer because at that time back in 2002 attendance was a key issue in 2 of the schools for sure and it has since been resolved. The school counsellor was there for those confidential meetings with young people who were not necessarily acting out - and you will have come across it - they were more acting in. They were introverted, they were quiet and needed someone to talk to. There was a behavioural support teacher within the school and key workers around that team as well. So the head teachers in 2002 had to bid into that fund, a structure was put about, and what is now the children's policy group received those bids and accepted how that group would be structured across those 4 schools. At that time, with those funds, the need beyond those 4 11-16 schools was not identified. What has since happened, those head teachers have understood that the role of a school counsellor is beneficial and within their school budgets those head teachers ... they tend to be more part-time than full-time across the fee paying, and Hautlieu have a school counsellor as well.

Deputy J.A. Hilton:

Okay, so the M.A.S.T. is still operational in the 4 secondary schools?

Business Manager, Schools and Colleges: Yes.

Deputy J.A. Hilton:

So would it be fair to say, then, that a young person can just contact the school counsellor, can they?

Business Manager, Schools and Colleges: Yes.

Deputy J.A. Hilton:

So would it be fair to say that if a young person contacted a school counsellor, who then had concerns about that young person's mental health, the school counsellor can then refer into C.A.M.H.S.?

Principal Educational Psychologist:

That is right, and particularly through the professional supervision they get through the C.A.M.H.S. lead, who supervises all the ... or arranges for professional supervision for the school counsellors. They have a gateway through their supervision anyway.

Business Manager, Schools and Colleges:

Just linked to your previous question, the lead at C.A.M.H.S. supervises all counsellors, so those part-time counsellors that have been employed by Hautlieu and the fee-paying schools are also supervised - clinical supervision - by C.A.M.H.S. So, every one of our professional counsellors in our schools who is meeting with young people has professional supervision from C.A.M.H.S. We have that area of expertise.

The Deputy of St. Ouen :

Just talk us briefly through the process starting from the first point where you identify a young person within a school that may have an issue, if you can just briefly take us through the steps. You have mentioned obviously initially the teacher will react with the child.

Principal Educational Psychologist:

Perhaps I will carry on from there. Essentially, when children are presenting with any emerging mental health needs - and it is probably quite important to draw a line between established mental health needs and emerging because it is quite a grey area and one slips into the other - the child will be presenting in a way which is causing some concern to a teacher, teaching assistant or other professional in the school. That teacher or professional will have a relationship with the school's E.N.C.O. (educational needs co-ordinator) in any case and they would raise that person for a discussion with the school's E.N.C.O., so the support network in school. It would likely be brought to a termly planning meeting where the school's educational psychologist meets with the school's E.N.C.O. and a whole raft ...

Deputy J.A. Hilton:

Can I just stop you there? What is E.N.C.O.?

Principal Educational Psychologist: Oh, educational needs co-ordinator.

Business Manager, Schools and Colleges:

Sorry, stop us whenever we ... [Laughter]. We do not do it to confuse but ...

The Minister for Education, Sport and Culture: I try to stop them. I tell them off all the time.

Business Manager, Schools and Colleges: Yes, he does, he tells us off all the time.

Principal Educational Psychologist:

I am sorry, educational needs co-ordinator. If you like, they have oversight for all children with a range of educational needs in school.

Business Manager, Schools and Colleges:

Every school has an educational needs co-ordinator, including the fee paying and Hautlieu.

Deputy J.A. Hilton: Okay.

Principal Educational Psychologist:

So they would have oversight of children with not just learning needs, social needs, but behavioural needs and, if you like, emotional mental health needs. Every teacher in school can have access to that E.N.C.O. in their school. Now, the school's E.N.C.O. has a termly meeting with a group of professionals who support that school. It is a termly rolling meeting, if you like, at which stage the school's E.N.C.O. can prioritise children to be seen by either the school psychologist or a behavioural support teacher or other professional as felt appropriate, by which stage that would prompt the involvement of the right kind of professionals to do some initial assessments or some consultation around that child within a termly timescale, if you like. Then it is a question of professionals who are involved making a professional decision or judgment about what the child needs, because it may be that the child just needs more appropriate school-based intervention. You can manage down quite a lot of children's needs as they are beginning to escalate. You can manage them down quite well based on the resources in school, and that is fine, but sometimes children do not respond to intervention in the way that you anticipate, at which stage the decision is made by the school psychologist in partnership with the school's E.N.C.O. or the counsellor, who might say: "This is beginning to escalate into something which feels more traditionally mental health based" at which stage referral into C.A.M.H.S. might seem more appropriate. Obviously, the parents will be in the centre of that decision as well. It is a professional judgment at any given time because it is not completely clear cut at any given time.

Deputy J.A. Hilton:

So who would refer the young person into C.A.M.H.S., the school counsellor?

Principal Educational Psychologist:

The school, probably through the E.N.C.O. However, parents can make referrals direct into C.A.M.H.S. through their G.P. as well, as I understand it.

Deputy J.A. Hilton:

Okay. From your experience, how long would they normally have to wait to see somebody from C.A.M.H.S.?

Business Manager, Schools and Colleges:

It is interesting because that was one of the questions we asked when we knew we were coming. I think it is similar to other health provider services. It is prioritised. There is obviously a finite capacity at C.A.M.H.S. and what schools are reporting is if there is a high level of need they are seen sooner. Whatever referral they get, they manage that referral caseload and they prioritise it based on need. I cannot quantify each school and each child. We have not done that piece of research, but it does vary.

Deputy J.A. Hilton:

Do you believe as a department that your requests for intervention for young people have been met in a timely fashion? Are you satisfied that the service is doing what it set out to do?

The Minister for Education, Sport and Culture:

I think there is an acknowledgement from within the department that all departments have finite resources. With the finite resources that C.A.M.H.S. have, I think it would be true to say that we appreciate that they are doing their best within the finite resources that they have. I do not think it would be ... a personal opinion from officers probably is not relative at this stage.

Business Manager, Schools and Colleges:

If I made a comment, I would not be able to evidence it so I would prefer not to make a comment. If you wanted that sort of evidence, I would have to go and seek it. We would look at referrals and we would keep a record over time. I have not had any negative comment from any head teacher who has come to us to say that we have been waiting for ...

Deputy J.A. Hilton:

Have you ever heard any negative comments from parents or teachers or counsellors about the length of time anybody has had to wait?

The Minister for Education, Sport and Culture:

I think every parent believes that their child is absolute top priority. That is just human nature.

Deputy J.A. Hilton: And ...?

[11:15]

The Minister for Education, Sport and Culture:

I think it would be surprising if parents were not obviously in a fairly emotional state at that point in time.

Business Manager, Schools and Colleges:

I think schools are realistic. The referrals are made and I think schools have had experiences where the referral was seen to be urgent and they have been dealt with. But if the urgent ones have been dealt with, there will be times where there would be delay with others. I think that is just an understanding of how that service is provided.

Deputy J.A. Hilton:

So how soon would an urgent referral be dealt with?

Principal Educational Psychologist:

If it was life threatening straight away. There are quite a few mechanisms attached to that in terms of accessing A. and E. (accident and emergency).

Business Manager, Schools and Colleges:

There was work over Christmas which showed very clearly that if it is urgent it gets dealt with that day, but if you have all your staff working and focusing on a group of vulnerable young people, then there is another group of young people who will not be seen at that time. I think that is the same with any profession where you have a diverse caseload. I cannot talk for schools because I have not any evidence through schools one way or the other. My experience over the last few months is that where a matter has been urgent it has been dealt with in a very prompt fashion.

The Deputy of St. Ouen :

How does that fit with the early intervention type of approach that the schools are taking?

Principal Educational Psychologist:

It is a bit of a dilemma. C.A.M.H.S., like every other service, has a dilemma around early intervention in that every service would aspire to a more preventative tier 2 service, which is where you try and catch things before they escalate too high. But when you are a limited resource like C.A.M.H.S. or any other service, the challenge is making sure that you do not spend all your time redirecting all your resources into top-end, complex, specialist statutory work because you are pulling the resources that you have, which are finite, away from where you really want them. So if you get sucked up into your specialist services all the time, you cannot do the tier 2 preventative work that you need to stop it getting there in the first place, and that is the challenge, I suspect, that every C.A.M.H.S. service in the U.K. (United Kingdom) and certainly in Jersey experience at any given time. So if there is a number of episodes which have pulled you away from your tier 2 work, you will get sucked up into work that stops you being preventative in the first place. It is a bit of a catch-22. It is not specific to Jersey, can I say?

The Deputy of St. Ouen :

Whose responsibility is it with regards to providing that extended support to the individuals with, in this case, mental health problems? Is it an issue that it is an educational responsibility and, therefore, the budget of education would need to be increased to provide for that, or is it very much a partnership type of approach and it is the social services side of things that their resources need to be extended if required?

Business Manager, Schools and Colleges:

There is a point at which it is partnership and there is a point at which you need specialism. Julian has described the process where there is partnership all the way through, but there is a point at which it is a specialist provision. That is not our expertise or area at E.S.C. (Education, Sport and Culture). That is Health and Social Services.

The Deputy of St. Ouen :

So even with the early intervention, if you have an early intervention programme you would expect some form of support to come from the C.A.M.H.S. organisation?

Business Manager, Schools and Colleges: For issues around mental health, yes.

Principal Educational Psychologist:

It should be a mixed model at tier 2 in terms of early intervention.

Business Manager, Schools and Colleges:

Yes, especially if there is absolutely no diagnosis. At tier 2 it is very, very difficult and challenging to diagnose a mental health issue.

Deputy J.A. Hilton:

Can you just explain to me tier 2?

Business Manager, Schools and Colleges: Okay. Do you want to go from one to 4?

Deputy J.A. Hilton: Oh, there are 4?

Principal Educational Psychologist:

Well, it depends which model you use particularly. Yes, it goes from tier 1, tier 2, tier 3 and tier 4. Tier 1 are universal services. They are the kind of services that every child should access no matter what their circumstance, so in school high quality teaching. Then as you go up through the tiers to tiers 2, 3 and 4, it just gets slightly more targeted and specialist. Tier 4 is really acute, complex specialist services. A lot of C.A.M.H.S. work sits there. However, tier 2 services are where it is still quite targeted and preventative.

Deputy J.A. Hilton:

Just to recap, are you saying that because of finite resources that tier 2 level work, preventative work, is being compromised?

The Deputy of St. Ouen : And 3.

Principal Educational Psychologist:

And 3. Well, possibly it could, but also it depends where any service chooses to locate its services as well. So tier 2 sits between some aspects of what might historically typically be educational responsibilities and C.A.M.H.S. responsibilities. There is a bit of an overlap there. But, of course, if your specialist C.A.M.H.S. service is being called up into specialist work all the time, there is not the capacity to do the early intervention.

Deputy J.A. Hilton:

Does that cause any particular difficulties, the overlap between what you have just said, C.A.M.H.S. and the educational services?

Business Manager, Schools and Colleges:

No, I think the referrals made in by schools, the feedback goes back to schools. So where the overlap occurs, if the school refer into the C.A.M.H.S. service, C.A.M.H.S. then work with the school or the officers within the school to share that information. Obviously, it is highly confidential so there is a challenge there. If the referral goes through to C.A.M.H.S. in another fashion, via the parent or the G.P., that is private to that family and that child. Usually around these issues they are pretty confidential. So the work is constructive at the appropriate level that that agency deems, so if the school does need to know about the wellbeing of that child, that information will be shared because if there is a danger of that child being harmed ... that is just good practice and that happens. If it is not a school-based issue and C.A.M.H.S. decide: "We are working with the family on this," then they are working with the family. We are involved at our professional level where it is seen that information fed back into the school environment, to the E.N.C.O., to the school counsellor possibly, where that information would certainly support that child in their development and addressing the issues that information is fed back in. Then we get on with the business back in the school environment.

The Deputy of St. Ouen :

Just a couple of questions. Looking at mental health issues and serious behavioural problems, you say you have a number of different tiers.

Business Manager, Schools and Colleges:

One does not necessarily mean the other, or the other way round.

The Deputy of St. Ouen :

No, we recognise that, but there are 2 specific areas. Am I right, mental health issues and serious behavioural problems, there can be a blurring of the lines?

Business Manager, Schools and Colleges: Yes, they are not discrete groups.

The Deputy of St. Ouen :

It can be that a mental health issue may display itself in a behavioural issue before it develops?

Principal Educational Psychologist: Quite hard to separate them out, but yes.

The Deputy of St. Ouen :

Right. So just to get a feel, we would like to get a feel of some numbers. So, first of all, how many young people would be considered to be suffering with some form of mental health or behavioural issues within States primary and secondary schools?

The Minister for Education, Sport and Culture:

I have a feeling that we might need to research for you and refer it to you later.

Business Manager, Schools and Colleges:

I was given a series of prompts for your hearing today and that was not one I was prompted for.

Deputy J.A. Hilton:

All right, that is fine if you can do that.

The Deputy of St. Ouen :

Right, okay, what numbers can you tell us? Have you got any numbers that you are able to tell us about how many youngsters, for argument's sake, are being provided for within the special units that are allocated?

Business Manager, Schools and Colleges:

Oh, yes. For example, one of your questions was how many children are at the alternative curriculum. I have the facts around that. How many are at d'Hautree House; I can give you the facts around that.

The Deputy of St. Ouen : Okay.

Business Manager, Schools and Colleges:

If you wanted to know how many are on the inclusion register, I would have to go back and get those figures for you. We would not know all the children being serviced by C.A.M.H.S. for the various reasons I have just shared with you. So our area of business I can give you the information around, but our inclusion register details children at different levels similar to the tiers system. So some young people are moving through and when you get to tier 4 within our behavioural system that is when they are accessing resources outside of the school. So that is when they are going to d'Hautree House School or to the alternative curriculum.

The Deputy of St. Ouen :

Can I just explore something you just said just to make sure I have it clear in my own mind? You said the school may not know whether or not C.A.M.H.S. is providing support for one of the individuals within the school.

Business Manager, Schools and Colleges: Yes.

The Deputy of St. Ouen :

How then are you supposed to provide that wraparound care to that child if you are unaware of the involvement of C.A.M.H.S.?

Business Manager, Schools and Colleges:

I thought I had mentioned this earlier. If the C.A.M.H.S. professional and the parents, and the child because the child has a voice in this, if it was determined that by sharing that information with the school it was of benefit, then that information is shared with the school. Not all of the issues that C.A.M.H.S. will be dealing with would relate to the school environment or could be supported by the school environment. It could well be private to that family, to that individual child, and the G.P. There will be a professional decision and there are times that we have known about where there would have been no benefit at all for the school environment to be aware of that issue for that child. They are all very different.

The Deputy of St. Ouen : But is it not likely ...

Business Manager, Schools and Colleges:

But if the school made the referral, the information is shared with them because it is a school- based exhibition of behaviours or need.

The Deputy of St. Ouen :

But is it not likely that if a child is suffering with serious mental health issues, and you have told us that if C.A.M.H.S. are focusing on tier 4 they are likely to have that, that they will be being displayed within the school?

Business Manager, Schools and Colleges:

It is most probably likely but it is not always the case. What I am trying to say to you is there will be times - it could be the same with an adult in a work environment - where there is no benefit to that child sharing that information with the school environment. Now, I agree with you it is most likely that if a child is tier 3 or tier 4 and receiving support from C.A.M.H.S. that by sharing that information with the school environment there is a benefit, but it is not always the case.

Principal Educational Psychologist:

In many respects it is to do with the management of risk which a young person presents with. So if a young person, for example, was engaging in self-harming behaviour and was being talked through that in a relationship with a C.A.M.H.S. professional, and if a decision was made to share that information with education, if you like, willy-nilly but as a result of that the child then stopped engaging with the C.A.M.H.S. professional, then the risk in relation to that child is escalated because they are now withdrawing from the support they are getting. So in many respects these are about professional judgments that C.A.M.H.S. professionals have to make as to whether to share that or not. Because if it alienates the young person from the support they need at any given time, then ...

The Deputy of St. Ouen :

At what age would this ... presumably we are not talking young children here, we are talking of 14 and 15 year-olds upwards, are we?

Principal Educational Psychologist: Yes. Well ...

The Deputy of St. Ouen :

That group, and if they are younger than that, the person would not necessarily be making their own decision.

Principal Educational Psychologist:

No, not in that sense. Our cut-off in terms of that decision-making is typically around 14. That is when people are more likely to make their own decisions in that sense.

The Deputy of St. Ouen :

I just want to be absolutely clear. There is no requirement at the moment for C.A.M.H.S., one of your partners, to notify confidentially or discuss with the department that there is a particular individual that they are providing support to?

The Minister for Education, Sport and Culture:

If the referrals come from a direction other than school, there is no requirement.

The Deputy of St. Ouen :

Even though - let us just pick a for instance - that child obviously has some serious problems, because we know that C.A.M.H.S. is involved, and there could be other issues that are linked to it, whether it is bullying, whether it is other behavioural ...?

Business Manager, Schools and Colleges:

I think, James, the term that Julian used there, they make a professional decision, and I would have thought a professional decision would capture your concerns. I have not come across a single case where I would question the professional decision around to share or not. In other words, they have the expertise and knowledge about that child in need. If a decision was made for a case - of course, we would not know about it - for whatever the need is, then I would respect that judgment. I would not go banging on doors saying: "Give us that information" because that is a professional judgment and I trust them to take it.

The Deputy of St. Ouen :

The schools have never reported back to you that that has been an issue for them?

Principal Educational Psychologist: No.

The Deputy of St. Ouen : No, fine.

Principal Educational Psychologist:

It is taking all the issues in the round and then managing the risk associated with sharing information or not, really.

Deputy J.A. Hilton:

With regard to d'Hautree School, did you say previously that it is tier 4 young people who would find themselves at d'Hautree School?

Business Manager, Schools and Colleges: Yes.

Deputy J.A. Hilton:

How many young people are currently at d'Hautree School and what is the age range?

Business Manager, Schools and Colleges:

The current number at d'Hautree School is 14 and the age range is 12 to 16. There are no year 7 pupils at d'Hautree House at present.

Deputy J.A. Hilton:

In the case of if they are going on to further education, would they just go on to Highlands and Hautlieu in the normal fashion?

Business Manager, Schools and Colleges: Yes.

Deputy J.A. Hilton:

Can you just give us some idea of the nature of the problems that some young people might be experiencing to find themselves at d'Hautree School?

Principal Educational Psychologist:

Children tend to move into d'Hautree House because the level of behavioural challenge that they present with sits outside the threshold of what a mainstream school might typically be expected to manage on a day to day basis and/or it is perceived as not to be an efficient use of the resources we have in a mainstream school. But most often it is an escalation in the level of behavioural challenge of kids. That is what flips them up into a higher level of threshold. There may or may not be mental health needs associated with that behaviour, but it is not by definition. You do not need to have a diagnosed mental health need to move into a specialist school like d'Hautree House.

[11:30]

Business Manager, Schools and Colleges:

We need to be slightly careful about discussing d'Hautree House and the curriculum because the numbers there are so small that it is quite possible to identify the young people at the school and their needs. I am aware that the media are present and I would be really worried about identifying any young person. I am more than happy to provide any information you wish.

Deputy J.A. Hilton: All right.

The Deputy of St. Ouen :

We have been informed that currently C.A.M.H.S. have 600 open cases. Does that surprise you?

Business Manager, Schools and Colleges:

I am not sure how that quantifies in relation to benchmarked other C.A.M.H.S. or our community, so I do not have a view on that many cases because I have no understanding how that sits within ...

The Deputy of St. Ouen :

Perhaps I need to ask the Minister. If there are 600 open cases, the conclusion that it is easy to draw is that at least those 600 youngsters are being educated within our schools. Do you believe that that is an acceptable number?

The Minister for Education, Sport and Culture:

I cannot give you any sensible comment on that because I do not have the experience to be able to make a sensible comment. It is outside of my range of expertise.

Deputy J.A. Hilton:

Are you aware of an increasing number of children and young people presenting with behavioural and mental health issues in our schools at the current time?

Business Manager, Schools and Colleges:

We look at the data over the last number of years and how we record that data through our inclusion register. We have seen no notable increase in the numbers of young people we are working with. The number you have quoted, is that all young people?

The Deputy of St. Ouen : Yes. This is C.A.M.H.S.

Business Manager, Schools and Colleges: All those young people are in our schools.

The Deputy of St. Ouen :

Absolutely. That is why I am asking you. What we are trying to find out is whether or not the 600 is a total number or there are additional individuals that sit outside of that number that currently are not and have not been identified and captured by C.A.M.H.S. That is why the information from yourselves that we will be looking for with regards to the youngsters that you are supporting within the primary and secondary schools will help us to paint that bigger picture, especially if, as you say, C.A.M.H.S. are focusing on the priority cases, the tier 4 level, and not necessarily focusing on and aiming at what I call the early intervention, the lesser ...

The Minister for Education, Sport and Culture:

I think, Deputy , if you have a specific set of statistical numbers that you would like from us about what we can tell you about the number of children who are on special educational need or our inclusion register and all of those kinds of things, then we can give you that kind of statistical information.

The Deputy of St. Ouen : That would be helpful, great.

Business Manager, Schools and Colleges:

We will give you the definition around our levels. Again, it is what is on our inclusion register by definition around those young people we identify as having needs. C.A.M.H.S. is a whole different business and, as Julian said, there are overlaps. I am not sure you are going to be comparing apples with apples when you look at our data and try and compare it with C.A.M.H.S. data.

The Minister for Education, Sport and Culture:

C.A.M.H.S. should be able to give you that same kind of statistical analysis over a period of time.

The Deputy of St. Ouen :

I know mental health issues are more difficult perhaps to accept or understand than a physical difficulty, but it is very easy to identify - and your department I am sure would agree - all of those individuals with physical disabilities and special needs that are provided with education throughout the States schools. Our question simply will be: as much as you have identified those individuals, we would like you to identify and provide to us the information around the individuals that you think or the schools have identified with mental health problems and behavioural issues.

Business Manager, Schools and Colleges:

No, James, with all due respect, you are mixing the definitions and the needs of the child within one question. We would be able to give you full details of all those young children in our schools from age 4.5 through to 19, for those with needs going past 16, assessed at our identified levels of need, which is school action, school action plus, exceptional need, record of need.

The Deputy of St. Ouen : Fine.

Business Manager, Schools and Colleges:

You have a piece of data on this side which says C.A.M.H.S. have 600 names on file. They are 2 very different sets of data. We have no access to their 600 names. Yes, we know that schools are aware but we do not ask schools to record. If you think of the reasons, they would have confidentially on their files children they are aware of who are being supported by C.A.M.H.S. We do not harvest that information at the centre. We harvest the needs that we address. So I can give you full information around all the children in our schools, whether it is behavioural, whether it is physical, whether it is hearing impaired, vision impaired, and I can give you exact numbers for that entire age range. That is our business.

The Deputy of St. Ouen :

I am struggling to understand that, how the partnership works. You say that you have M.A.S.T., is it?

Business Manager, Schools and Colleges: Multi-agency support team, yes.

The Deputy of St. Ouen :

Multi-agency approach. There is supposed to be a close working relationship with C.A.M.H.S.

Business Manager, Schools and Colleges: There is.

The Deputy of St. Ouen :

Yet it does not seem that there is much discussion or sharing of information, even at a very high level, between the 2 departments.

Business Manager, Schools and Colleges: Around data?

The Deputy of St. Ouen :

Around the youngsters, whether you can ...

Principal Educational Psychologist:

It is an interesting question you raise. One of the limitations or strengths, I am not really sure what it is, around the data we collect is that we do not collect any data in terms of children's mental health needs at all. All the data we collect in terms of how we categorise children is around the discrete areas of need within the code of practice, which are cognition, learning, social interaction. But the one that is relevant to mental health, if you like, is social and emotional difficulties. You can have social and emotional difficulties but not have a mental health need, if you like. There is a tension between our data and the data that C.A.M.H.S. will collect. However, there will be a number of children who have mental health needs who have social and emotional needs and behavioural needs. You cannot really compare the 2 completely. It will not be a fair comparison. But I appreciate what you are saying ...

The Deputy of St. Ouen :

I will pose the question directly. If the Island wants to identify and support all those youngsters with mental health issues and serious behavioural issues, if you are not capturing the data and if C.A.M.H.S. are not capturing the data, who is?

Business Manager, Schools and Colleges:

No, we did not say that. We have that data. We have the information on every single child. In schools as well for some of those children, if those children are accessing C.A.M.H.S. and C.A.M.H.S. believe it is right and proper for that school to know that information, that information also is shared with the school. You have 2 different departments with 2 different areas of business, which overlap at times. C.A.M.H.S. you are telling me have all the detail around the young people they support, perfectly right and proper. We have all the information and data we need around about all those young people that we need to support, right and proper. The schools, the operational base that support those young people on a day to day basis, are aware through proper professional communication of those young people being supported by C.A.M.H.S. that are in their schools that they can work with.

The Deputy of St. Ouen :

Right, and C.A.M.H.S. will be aware ...

Business Manager, Schools and Colleges: There is nothing missing there.

The Deputy of St. Ouen :

C.A.M.H.S. would be aware of all the individuals that the schools have identified, albeit that they could fit into any of these 3 tier levels?

Business Manager, Schools and Colleges:

With those young people that they are working with, that they communicate with the schools around, C.A.M.H.S. would be aware of the needs of those children in schools because that information is shared at a school level between C.A.M.H.S. and the school.

The Deputy of St. Ouen :

Sorry, just to press you on it, I am just trying to understand if there is an early warning system or process that is in place that helps to identify and draw C.A.M.H.S.' attention to ...

Business Manager, Schools and Colleges:

We have described that to you already. We described that to you right at the very beginning in terms of the process within the school, through the counsellor, through the E.N.C.O., referral into C.A.M.H.S. So we do all the early intervention work in school. We are very aware of the needs of all those children.

The Deputy of St. Ouen :

So you have full sharing right from the department to C.A.M.H.S.?

Business Manager, Schools and Colleges:

There is no gap in communication between C.A.M.H.S. and Education.

The Deputy of St. Ouen :

But with regard to C.A.M.H.S., the flow of information does not necessarily - and it depends on the cases - come from C.A.M.H.S. to Education?

Business Manager, Schools and Colleges: For professional reasons, yes.

The Deputy of St. Ouen :

Right, okay. Thank you for making that clear. St. James School, a number of years ago there was a special primary unit, very small, based at St. James. A decision was taken that it was better to provide for those young people within the ordinary or general school environment. Has that worked?

Business Manager, Schools and Colleges:

I am trying to think of the best way to answer in terms of the way ... no, because those resources are still directly addressing the needs of primary school children with behavioural issues across our schools. The reason I can say it worked is because every single child in primary age with behavioural issues are in their mainstream schools being supported by the professionals that were uniquely based at St. James School. At the end, when someone else in this room was our Minister, there were only 2 individuals at that school with all those resources. So those resources have been taken, trained in a slightly different way because they are now part of a behaviour and wellbeing team that works across all our primary schools, based on a very structured identification structure that those individuals, key workers and behaviour support teachers, work directly in supporting the children in their schools with their own teachers. So, in my view, it has worked because every single primary school child is in their mainstream school being appropriately supported by members of that team.

Deputy J.A. Hilton:

Do they have to be statemented to access that support?

Principal Educational Psychologist: No.

Deputy J.A. Hilton: They do not?

Business Manager, Schools and Colleges:

No, and we do not have statements. We have records of needs.

Deputy J.A. Hilton:

It is just record of need now?

Business Manager, Schools and Colleges: Yes.

Deputy J.A. Hilton:

Am I right in thinking that as a school psychologist you are responsible for assessing children and young people with issues on the autistic spectrum?

Principal Educational Psychologist:

Yes, but that is just part of our multi-professional team task, which sits within C.A.M.H.S., too.

Deputy J.A. Hilton:

Normally, at what age would you identify a record of need for a young person who is presenting with behaviours that may indicate that they are on the autistic spectrum?

Principal Educational Psychologist:

It does not differ in terms of a young person being on the autistic spectrum. The criteria against which a record of need might be written for any child is when there is a professional decision agreed through a panel that a child's needs and what is needed to provide for those needs sits above the threshold of money that is delegated to the schools. So if a child's needs are sufficiently complex requiring a certain level of support or range of intervention which is above the threshold we would expect a school to provide based on the money that is delegated to them to do that job, then that is the stage at which a record of need would be agreed.

Business Manager, Schools and Colleges:

Which identifies that additional need. So it is not age related. It is needs related.

Deputy J.A. Hilton:

Okay, so what you are saying basically is that each school is allocated a sum of money to deal with children with special needs?

Principal Educational Psychologist: Yes.

Deputy J.A. Hilton:

If the child presents with issues that the school recognises that additional money needs to be given ...

Principal Educational Psychologist: Made available.

Deputy J.A. Hilton:

... made available, it is given?

Principal Educational Psychologist:

It would be attached to the record of need as a resource, yes.

Deputy J.A. Hilton:

How often does that arise?

Principal Educational Psychologist:

Well, indicatively we would expect that between one and 2 per cent of the pupil population would sit above the delegated threshold. So one in 50 children, I suppose, might be expected to have a record of need. It is slightly higher in Jersey.

Deputy J.A. Hilton:

But is that shown in the figures going to the Education Department asking for extra resources?

Business Manager, Schools and Colleges:

Yes, we can give you the number of children with records of need.

Deputy J.A. Hilton:

Okay. So with regard to the autistic spectrum, I understand you have communication disorder provision units in primary and secondary school, at secondary level. If a young person had a diagnosis of Asperger's or on the autistic spectrum, would you expect that young person to have a place made available to them in one of the specialised units at secondary level?

Business Manager, Schools and Colleges:

Interesting because it is choice, is it not? It is very interesting because I have just had a very forthright conversation with one of our Asperger's boys, who was very clear where he wanted to go to school, as they can be. We have made arrangements for that to happen and it was not within one of the provisions because that young man had a very clear choice. However, in the law the first statement is children are educated within the mainstream schools. The second aspect of the law, which you are aware of, is if we cannot meet the need within the mainstream environment then a place within a special school provision is allocated. If the child with autism or Asperger's needs were seen to be that they should be within a provision within that mainstream school, that place is allocated.

Deputy J.A. Hilton:

So you might have a case where a parent believes that their child or would want their child to be placed within a unit, and indeed the child might want to be there as well, but what you are saying is if the school felt that their need could be met elsewhere then that is what would happen?

[11:45]

Business Manager, Schools and Colleges:

No, no, no. I may not have been clear what I said there.

Principal Educational Psychologist:

Rather than thinking about the diagnostic terms autism or Asperger's we try to think about the nature of the child's needs because some children have a diagnosis of autism or Asperger's and they do not present with many needs. They are comparatively straightforward to educate in a mainstream school. Those kinds of children and young people would not, if you like, need a place in a C.S.C., a communication support centre.

Deputy J.A. Hilton:

But what do you do where you have a parent who believes their child should be in one of the communication disorder provisions and they have a diagnosis?

Principal Educational Psychologist: They do have a diagnosis?

Deputy J.A. Hilton: Yes.

Principal Educational Psychologist:

The school psychologist and other professionals involved with the ... for the school, the school psychologist and other professionals involved and the parent would be asked to do appropriate assessments ... well, the parent would not do an assessment, but the professionals would do assessments and the nature of the assessment, the purpose of the assessment, is to work out what is the nature of the child's educational needs and what arrangements are needed to support them in school. As a part of their conclusions they will be concluding about whether it is mainstream on its own, mainstream with a bit of support, mainstream with a lot of support, or mainstream with provision in one of the units you are talking about. But it is about pulling together the collective views of the range of professionals involved while also taking into account the parental views on how they feel their child's needs might best be provided for.

Deputy J.A. Hilton:

Do many parents appeal the decisions made by a school?

Business Manager, Schools and Colleges:

I have been in post 2 years and I have not come across a case where a parent wished their child to be ... a child that had the right diagnosis, wished them to be in a provision and we have not given them a place, and also I have not come across a situation where a child has been placed in a provision and the parents through due process and what Julian has just described as the process where they have said: "We do not want our child to be in that provision." In most cases, communication in the last couple of years with these families to support them has been at a high level and we try to understand the needs of the child but the wishes of the parent. So I do not think there has been an appeal around any placement decisions in the last 2 years that I know of.

Deputy J.A. Hilton:

Do you believe that currently, today, our children and young people are being looked after adequately in our schools where they have a special need, whether that be behavioural or a mental health issue? Are you satisfied that they are all receiving the help and resources that they need?

Business Manager, Schools and Colleges:

It is a very good question. Professionally, I believe we are making that provision. Honest answer as well, though: I am always having conversations with parents around the needs of their children, especially where there is a high level of need. There are always anxieties. There are always issues. It is a small number but for sure we openly communicate with those parents and wherever possible we try to resolve the issues they are facing.

Deputy J.A. Hilton:

Do you think we could do better?

Business Manager, Schools and Colleges: Oh, crikey, that is ... Minister?

The Minister for Education, Sport and Culture: Well, you can always do better.

Business Manager, Schools and Colleges: Minister, over to you on that one. [Laughter]

The Minister for Education, Sport and Culture: We can always do better.

Deputy J.A. Hilton:

How do you think we can do better?

The Minister for Education, Sport and Culture:

I do not believe that we are under-resourced. I think I would have heard by now if we were under- resourced from my officers. I have not heard that. There are areas that we would like to expand the special educational need generally, and that falls into the area of the zero to 3.5 age group, earlier intervention still, though we are getting into a slightly different area here.

Business Manager, Schools and Colleges: It is pre-statutory, yes.

The Minister for Education, Sport and Culture:

We are talking about The Bridge, we are talking about the Samares provision that we are piloting, and it is very early days yet but we will be keeping that under close observation to see whether we would like to make an application into the next medium-term financial plan. I would say it is more than a 50 per cent chance that we will want to expand what we do in the zero to 3 age range.

Deputy J.A. Hilton:

So that is to basically improve provision?

The Minister for Education, Sport and Culture:

Earlier and earlier interventions, because if you longer term want to make a difference, then things like services for deprivation and what have you is a very important area.

The Deputy of St. Ouen :

I just want to pick up, Minister, on that. You say you want to expand into early intervention, nought to 3, and I commend you for it. But earlier on we were being told that because of C.A.M.H.S.' limited resources they are focused on the most critical needs within your tier 4 area and it could be that they are missing the opportunity to deal with matters at an earlier point. So if you are saying you are going to go and ask for resources to deal with nought to 3s, who is going to ask for resources to help C.A.M.H.S. address the early intervention?

Business Manager, Schools and Colleges:

The Minister is talking around about a range of needs that come to our attention preschool, including nursery. So we are talking about reception. They are 2 very different issues. The work with C.A.M.H.S. is under Health and Social Services. The Minister for Education, Sport and Culture is identifying that pre-statutory age, which is rising 5, in other words our reception, is where statutory responsibility starts. The Minister has identified there through statement that there is benefit to be had of work with those young people prior to going to school. But that could be around physical disabilities, it could be around communication, so there is a whole range and most of those would not go anywhere near C.A.M.H.S. Operationally, we currently meet with all other agencies across the States who work with young families, and through those meetings there is a professional conversation. So when we have young children coming into reception and nursery in our schools, we are aware of their needs through proper professional conversation. I think that is what the Minister is referring to.

The Deputy of St. Ouen :

Right, so when it comes to intervening at an earlier point with regard to some of the mental health issues that some of our young people face, basically what you are saying, as I understand it ...

Business Manager, Schools and Colleges: We were not commenting on that at all.

The Deputy of St. Ouen :

... is that is not the department's responsibility, that is C.A.M.H.S.' area and expertise?

Business Manager, Schools and Colleges: We were not commenting on that.

The Minister for Education, Sport and Culture: We could not comment on that. It is outside of our ...

The Deputy of St. Ouen :

Yes, so it is not something that the department would extend or expand into. Right, okay.

Deputy J.A. Hilton:

Can you explain to us what action, if any, Education is going to take to deal with the stigma surrounding mental health issues for young people? Do you feel that there is anything that you could proactively do to help those young people currently in our schools who are receiving care for mental health problems to make them feel more included?

Business Manager, Schools and Colleges:

It is a good question. I have never consciously ...

Deputy J.A. Hilton:

I think young people by its very nature feel excluded and we have no organisation in Jersey like they have in the U.K., Young Minds, and a lack of any sort of peer group that young people could turn to. I did not know whether you had any thoughts on that or what you felt Education could do.

We have recently ... because obviously we have become keenly aware of a specific area of mental health and we have worked in partnership over the last 3 months with the Samaritans because the Samaritans have 2 programmes that they have offered us, which are both very short. One is around the postvention, in other words where there has been a serious incident, but the other piece of work they offer is around about the issue you raised around developing those relationships, raising self-esteem, having that identity. That is a very specific package which does deal with those very careful issues. Through the work of the M.A.S.T. teams within the schools, they identify and are aware of the needs of the young people. Usually, the young person themselves are very aware of their own issues and conscious of those and have anxieties, but usually the rest of the peer group is unaware but, of course, very aware for that young person who has that mental health issue. I am not sure ...

Principal Educational Psychologist:

A slightly complementary perspective, I suppose, that could be offered is that at the moment mental health sits at the top of thresholds. We talked about tier 3 and tier 4, so there is a degree of stigma attached to it. A helpful way forward, which has been explored elsewhere, is to mainstream mental health generally and pull it down into tier 2 and tier 1. That is about exposing young people: it is not something that happens just at the top in tier 3 and tier 4 but exposing it to young people and teachers who are delivering the universal services generally. But that is a huge cultural shift, whether it is in a local authority or in a department or an Island like Jersey, but it can be done. Of course, as I was alluding to before, there is a bit of an overlap between what is Education and what is C.A.M.H.S. because C.A.M.H.S., I suspect, are not funded to deliver a tier 1 or tier 2 service specifically.

Deputy J.A. Hilton: No.

Principal Educational Psychologist:

Because they are stuck at the top doing that complex stuff. But when you start pulling it down into preventative mental health work, you do need preventative mental health workers working at tier 2 and tier 1 but also working in partnership with Education because Education is quite a complex set-up. It is hard for C.A.M.H.S. professionals to work in tier 1 and tier 2.

Deputy J.A. Hilton:

So do you think as the educational psychologist it is something that the Education Department could look at to just promote ... just make things easier for those young people?

Principal Educational Psychologist:

I do not want to be contradictory to what we said earlier and I am worried that I might be. Aspirationally, I think it is a fantastic idea but it is ... it happens elsewhere but it is not currently how things are configured in Jersey.

Deputy J.A. Hilton:

It happens elsewhere, did you say?

Principal Educational Psychologist: It does, yes.

Deputy J.A. Hilton: Where, for instance?

Principal Educational Psychologist:

Well, in most U.K. local authorities they roll out targeted mental health in schools and it is a wholesale local authority-wide initiative which tries to pull down mental health services into tier 1 and tier 2. That is what its function is.

Deputy J.A. Hilton:

So being far more open about it in schools?

Principal Educational Psychologist: Yes.

Deputy J.A. Hilton:

So young people feel that they can talk about it more openly?

Principal Educational Psychologist:

Yes, it is part of day to day experience because it is when negative mental health slips into positive mental health discussion.

Deputy J.A. Hilton: Okay, thank you.

The Deputy of St. Ouen :

Is there anything in the current P.S.H.E. (personal, social, health and economic) curriculum?

Business Manager, Schools and Colleges:

Yes, I was going to mention that. The relationships, dealing with anxieties around normal teenage development and growth and understanding what your challenges are, the P.S.H.E. programme is very strong. So when I mentioned the Samaritans, for example, it is in addition to the work that our P.S.H.E. programme puts in place, and there are a number of programmes within the P.S.H.E. programme which will deal with the challenges that our teenagers find, especially ... and with the high end of key stage 2. Relationships are a key part of that programme around the social and emotional world.

The Deputy of St. Ouen :

Just a final question, how would you encourage young people that are suffering with some form of mental health issue to feel more able to speak to others about their problems? What needs to happen?

Principal Educational Psychologist:

It depends if you go short term or medium, I suppose. In the medium-term perspective, it is about setting up cultures within schools as organisations where it is kind of okay to have those conversations because "that is what we do around here", if you like. But that really cannot happen until mental health, whether it is positive or negative mental health, is something that people are comfortable to talk about because they are exposed to those kinds of discussions in school as a matter of routine. I am not quite sure where Jersey is with that.

Business Manager, Schools and Colleges:

There would be a great danger without the expertise and without the training to introduce any aspect of that into a school environment if it is not done properly. I would be really wary of a practice where our colleagues in schools were exposed or the young people themselves were exposed through an approach where the proper training or expertise was not happening.

The Deputy of St. Ouen :

So you think we are better to wait until we have the tragic incidents that we will all be aware of towards the end of last year where we see 16 year-olds tragically taking their own lives?

Business Manager, Schools and Colleges:

I find that comment really unfair because both young people who took their lives last school year were ... it was audited extensively and I think what we will find from the serious case review when it is published is that evidence will be there. So to go from what I have said to a statement round the deaths of 2 young people who had just recently left our schools is just extraordinary, James.

The Deputy of St. Ouen :

But if you are talking about mental health and the stigma attached and if these young people are unable to express themselves or talk to people within their own environment, it leads to ... and as I say, it was not meant to be critical, it is just that I am seriously concerned that the inability to be able to express themselves and talk about their circumstances could lead to circumstances such as we have seen.

[12:00]

Business Manager, Schools and Colleges:

I cannot possibly comment on that. Both serious case reviews ..

The Deputy of St. Ouen :

But you would encourage ... Education, does the department aim to encourage young people to express themselves and share their problems regardless?

Business Manager, Schools and Colleges:

Of course it does, and evidence will show that both those young people were given that opportunity.

The Deputy of St. Ouen :

Okay, and the place that the youngsters would go to would be the school counsellor initially and their peer groups if ...

Business Manager, Schools and Colleges:

And other agencies outside of Education: within the Youth Service, with the Yes Project, through their own G.P.s, with their parents.

The Deputy of St. Ouen : Okay.

Deputy J.A. Hilton:

I just wanted to ask you about that, how the Youth Service is involved through the Yes Project. If you could just explain that, that would be helpful.

Business Manager, Schools and Colleges:

Ah ... [Laughter]. Well, the Yes Project is part of the Youth Service. It is based at La Motte, as you are aware. They are also supervised because they have a very confidential role with those young people and those young people that work through that service are then ... they are directed to ...

Deputy J.A. Hilton:

So the counsellors and the Yes Project, do they come under educational psychology?

Business Manager, Schools and Colleges:

No, they are stand alone but they are also supervised by professionals.

Deputy J.A. Hilton:

Oh, right, okay. Basically, any young person can go along to that project in La Motte Street and access counselling help?

Business Manager, Schools and Colleges:

Yes, and within every school you will find the pamphlet for the Yes Project on the notice boards and the M.A.S.T. teams have the contact details. Because sometimes the young people want to talk outside that school environment, even with all the encouragement they are given within the school environment.

Deputy J.A. Hilton:

I have heard some very, very positive things about the Yes Project.

Business Manager, Schools and Colleges:

They do very good work and over the last 3 or 4 months they have done some exceptional work, as has the Youth Service, with these young people.

The Deputy of St. Ouen :

So just to sum up, the reality is that the department is doing a significant amount in all sorts of different areas to support these young people with a mental health issue and it is not a case that they are being ignored or left to fend for themselves?

Business Manager, Schools and Colleges:

No. I am pretty confident with the structures we have in place that the needs of our young people are being met.

The Deputy of St. Ouen : Good. Thank you.

Deputy J.A. Hilton:

Thank you very much for coming along this morning and making the time to speak with us. We will close the meeting.

The Deputy of St. Ouen : Yes, thank you very much.

[12:02]