Counselling in schools: the front line of the child and adolescent mental health crisis
It is nearly three years since I started providing counselling in schools. Three years in which the mental heath crisis affecting children and young people has deepened by every credible measure. The statistics - eye-watering though they are, including that over a quarter of a million are waiting to be seen by CAMHS NHS teams, and that 372,800 had their referral closed before accessing support* - do not do justice to the horrors that young people face every day and the cavernous gaps that exist in the meaningful support that is available to them.
The issues that I hear about every day in schools - and in my own counselling room working with private clients who are children and young people - are not the minor stuff of the 'worried well' but life and death issues that often require specialist, long-term support. These children and young people are being encouraged - as we all are by the NHS, charities, celebrities and others - to speak up and seek support if we are not ok. They are told to tell someone that they need help and yet when they do they find very little help is available.
The room I use at one of the schools I work with.
This is not a reflection on the provision in schools. Often, the support offered in schools in the only support that can be accessed. But the knock-on effect of the pressure on NHS services, the under-investment (cuts!) in local government services which include youth work programmes and other support, means that all roads lead to schools.
My client lists in schools usually fall into two main categories. There are a small number of what could be called 'crisis' or 'event' clients. These will often be children and young people who may have experienced a sudden bereavement or some other unexpected trauma. They may have experienced some mental health challenges before - e.g. anxiety - but their mental health was not on the radar of their family, their school, or their local NHS services.
The vast majority of my clients in schools have been dealing (often alone) with their mental heath challenges for some time. They are usually known to CAMHS teams, or more likely, in the extremely long queue waiting to be seen by the CAMHS team after a referral was made (by a GP, a family member or a teacher). If they are 'seen', it is usually for an initial assessment at which they are most likely to be placed in another queue - this time for the therapy to start. The criteria for deciding whether they will receive therapy straight away, or at all, is a brutally blunt and difficult to stomach instrument. It focuses on their risk of suicide. They may have made one or more suicide attempts already but these may not be considered 'serious' attempts and will not help them move up the waiting list.
Just think about that for a minute. A child is asking for help. For help with their mental health. They have tried to end their life because of the pain they are suffering. They are then told that their pain is not serious enough to warrant immediate help. In fact, they may never get help and may become one of the 372,800 who have their referral closed before receiving support. That is in the UK. In 2024. It is nothing short of a national disgrace. A scandal. Something that should lead the news every day. But it doesn't.
Instead, these children and young people, with often desperately frustrated family members, turn to schools for help. This help is often requested when self-harm scars are spotted at home. Or when the young person is struggling to get out of bed for school. Or out of the car at the school gates. Or when they are crying so much they have a panic attack at home as they are trying to get dressed for school. Or when they cannot stay in lessons in school as they are so overwhelmed with anxiety. Or when the bullying they face online (usually through TikTok and/or Snapchat) makes them feel not good enough - or worse, as they face constant calls by their bullies to take their own life. Or they feel worse about their body after viewing content on social media. Or they have become obsessed with exercise and their weight as they feel they need to change how they look, especially after a focus on this started during one of the COVID lockdowns. Or they cannot eat a meal without being sick or wanting to be sick. Or they have become socially anxious after spending so much time during COVID away from others and spend much of their life online - being with people in real life now is overwhelming. Or they live in a constant state of fear and anxiety after growing up with a violent parent or an alcoholic or drug addict parent. Or because their autism or ADHD (whether formally diagnosed or not) makes the world a difficult place to navigate. Or they are just really sad - all the time. So sad that they want to die. So sad that they have tried to die, more than once. And yet not sad enough to get therapy on the NHS.
These are all just a small sample of the stories I've heard in schools over the last few months. Alongside this sort of stuff, I am reminded every day how hard it is to be a school student with exams, constant pressure to succeed, to get into college and/or university and to have a plan to get a job and make something of their lives. This sits alongside the day-to-day growing pains of puberty and making, breaking, building and sustaining friendships and other relationships, in a world with their every move and every setback is discussed on social media. It’s no wonder our children and young people are crying out for help. And often, just crying.
It is impossible to overstate the size of this mental heath crisis which is showing up in schools day after day. There is huge demand driven by the normal facts of life and growing up, and then turbo-charged by the legacy of the pandemic and the corrosive power of social media. There is also a huge shortage of supply of the help that would actually help. Schools are inundated with requests for help - often presenting as cries for help disguised in poor behaviour. School counsellors referral lists are too long for the time and budget available and sometimes the fact that a student is being seen by the school counsellor can count against them when being considered for support by the NHS: "they are already getting help". The help that schools give, including interventions by form teachers, heads of year, 'hubs', school nurses and others are valuable, but for most of the children and young people I see in schools, there is nothing but long-term counselling that will hit the mark.
As you place your cross on the ballot paper at upcoming general election, I wonder if you will consider who will invest the money we need to have counselling available in every school and from qualified counsellors. Nothing else is good enough. Nothing else will help us touch the sides of this crisis. Nothing else will do.
I know who is getting my vote.