In this new blog, Claire Dorer OBE, CEO of NASS, reflects on a proposal in the SEND Reforms consultation that could signal the end of a 12-year categorising of ‘Mental Health Needs’ as a distinct category of SEND, and a return to ‘Social and Emotional Needs’ within the SEND Code of Practice and proposed Specialist Provision Packages.
Claire explores why this shift raises both conceptual and practical questions about how we define and respond to need, asking where the boundary sits between educational and clinical responses, and what this means for children and young people with SEND.
Drawing on 12 years of change within SEMH provision, she reflects on how special schools have evolved services, often building support where it didn’t exist elsewhere, and what may now be at risk if mental health is no longer explicitly recognised within the system.
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The recent SEND Reforms consultation signals the end of a 12-year categorising of ‘Mental Health Needs’ as a specific category of Special Educational Needs. Instead, the proposal is that we return to a category of ‘Social and Emotional Needs’ within both the SEND Code of Practice and the proposed Specialist Provision Packages.
There’s plenty to catch the eye in the proposed policies, so this move has stiff competition but, even so, I have been surprised by the relative lack of interest in this topic. A recent LinkedIn post helped me unearth that I am not alone in having an interest in this – and how complex it is as both a conceptual issue and a practical issue to resolve in how we respond to the mental health needs of children with SEND.
When mental health first became a distinct category of SEND in 2014, I was concerned. All of a sudden, it was there, with no unpacking of how we were defining ‘mental health needs’, nor the service response needed. How did something that had traditionally been a health need translate into an educational need? What were the boundaries between expected educational responses to mental health needs and health responses to diagnosable mental health conditions. What did this mean for schools who, almost overnight, moved from being designated as Social, Emotional and Behavioural Difficulties schools to Social, Emotional and Mental Health Needs schools? There was no external support for schools in making this move so special schools did what they always do – they worked out what services their learners needed and set out to provide them.
From my position of being able to view large numbers of special schools, I have seen a pattern of service evolution and reconfiguration since 2014. Most schools started by assuming that their new role would mean them working more closely in partnership with local Child and Adolescent Mental Health Services (CAMHS) to deliver services to their learners. Most were quickly disavowed of this hope when CAMHS services could not respond to these demands. CAMHS was, and is, chronically under-funded and little thought was given in the run up to the 2014 reforms of the relative impact of having SEMH school provision within an ICB, where every student might have a need for their support. Beyond this, many CAMHS services lack experience and expertise in working with children and young people who have both a special educational need and a mental health need. This resulted in many young people being denied CAMHs support because of their SEND being seen as incompatible with therapeutic work. Signs of an acute mental health condition were too frequently viewed as just an expected consequence of an enduring special educational need.
The special school way is that if a child in school needs something and it doesn’t exist in the outside world, you build it yourself. And that’s what SEMH schools did with mental health support for learners with SEND. Over the past 12 years, we have seen schools directly employing clinical psychologists, counsellors and creative therapists, bringing the support needed to learners in school. We have seen schools that have become the transition point for people leaving Tier 4 inpatient care, developing highly specialist skills and responses. Pedagogically, we have seen schools reframe their curricula as ‘trauma-informed’, using therapeutic theories to inform educational practice. I have seen some exceptional, creative and responsive services delivered by SEMH-designated special schools and I have no doubt that children in those schools have received a level of service that could not have been recreated by health agencies at that point. There is a wealth of expertise within special schools in how to meet mental health needs alongside overlapping conditions such as autism. Sadly, much of this is invisible to the wider health world.
Philosophically, we have reached a point where it is not easy to see a clear boundary between educational and health responses – they have been integrated. The proposed reforms problematise this, suggesting that schools should focus on education, leaving mental health needs requiring a clinical response (i.e. support from a qualified mental health professional) to health agencies. On a personal level, I am not certain I believe this is wrong – or rather, I think it requires a major reconceptualisation of the role of schools and education to maintain an integrated view. It’s a clunky phrase, but it speaks to the ‘schoolness’ of schools – what is it that makes a given institution a school, rather than a treatment or care facility?
At this point, I find myself falling down a rabbit hole of arguments for and against! Schools are places of education, so should their focus be on interventions that support social emotional needs only as far as they directly apply to teaching and learning? We all have mental health needs that can impact on our ability to learn at different points in our lives – do these always require a very specific educational response or would good, child-focused pedagogy create a containing environment for most children? Should we insist on health services responding to the clinical needs of children who have diagnosable mental health conditions? On the flip side, the psychologist in me is interested in how on-site, integrated mental health support enables children to be in the relationship with their educators that is the basis for them being able to learn. I have been excited by models of support that make use of blended expertise from education and health and think they offer some valuable insights for how education might need to evolve in general to meet the needs of young people in education today. It’s a model that seems a long way away from zero tolerance behavioural policies.
I would love there to be space for this debate; for Government to have recognised that they are proposing a major shift in approach and to have invited key stakeholders to think alongside them in how these changes need to be approached in practice. Without this, we are risking a sudden falling away of mental health services currently delivered by schools, with no evidence that health has the capacity, or even will, to pick up the shortfall. Bear in mind, we have a Health Secretary who believes that mental health conditions are over-diagnosed and CAMHS services which are in a worse place now than they were when the 2014 reforms were introduced.
Whatever our philosophical views on whether mental health needs should be an educational need, the past 12 years have made it a change that will have significant practical consequences. The removal of SEMH from the SEND Code of Practice means that mental health services won’t be explicitly factored into the proposed Specialist Provision Packages (SPPs) that will determine what services schools deliver to children and the funding they will receive for this. The expectation will be that health, rather than schools, takes responsibility for delivering clinical mental health services. If health continues to fail to respond to need, special schools are less likely to be able to find the funding attached to SPPs to be able to maintain their current mental health services. There is a huge risk to existing provision and Government is currently silent on this risk.
Thankfully, we have a long time before these changes become law. We still have time to share our views before the consultation closes on 18th May, and it’s vital that we do so. This is a major change that will require a lengthy, thoughtful and well-resourced transition. Whilst the categories of send may change, the mental health needs of learners will not and we have to fight to ensure that they have access to appropriate services.
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NASS is running a series of consultation events to gather views from its members over the next two weeks, including a roundtable with DfE. >> Find out more and book
Not a NASS member?
We are running a NASS open forum for all special schools on Tuesday 28th April, 3.30pm to 5pm. In this session, we will:
- Provide an overview of the SEND Reforms and what we know so far
- Share insights from our ongoing conversations with the Department for Education
- Highlight key areas that special schools need to be aware of, including potential risks and opportunities
There will also be time for questions and discussion, giving you the opportunity to share your views and contribute to shaping NASS’s response. >> Book your free place