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5 Concluding points

In this final chapter we pick out for comment some of the starker points that arise from the findings from both literature review and empirical work. Generally we have refrained from making recommendations based on these observations

Strategic implementation

• Scoping studies showed huge variation across the country in terms of implementation of new policy imperatives at both strategic and practice levels
• Responsibility for issues related to mental health in schools is spread across different sectors and shared between many disparate posts within sectors. This makes postholders less likely to come together to share information between authorities and also complicates arrangements for joint working with health and social care agencies
• Unfamiliarity or reluctance to engage with the language of mental well being results in a failure to explicitly address the issue in some cases
• How this is interpreted really depends on a political viewpoint as much as anything else. Does it represent a form of chaos which allows some authorities and schools to pay lip service to current rhetoric whilst making only imperceptible progress towards changing fundamental ways of working? Or does it represent an enviable ability of the Scottish government to allow 'local strokes for different folks'?

• We simply observe that what currently exists at both regional and local levels is a form of random experimentation which is not being evaluated in any way that would allow us to decide what is best practice or what is effective. However, we recognise the importance of local mental health and behaviour support groups and networks as a beginning to this process
• A national shortage of educational psychologists and CAMHS workers (most acute in areas of greatest deprivation) is putting pressure on schools to develop improved internal mechanisms for supporting pupils, and is altering the relationship with these agencies to one of consultation and partnership, rather than export. In some cases the shortage of specialist staff has given rise to increased capacity of staff as more creative approaches are adopted within schools. However, there remains a tension between the view that "experts" can and should provide magic solutions for troubled children, and the more holistic approach based on whole school responsibility for the welfare of each child
• Experiments in joint working or service delivery are often initiated using short-term funding streams. This exacerbates the fragmented and chaotic feel of the field and raises major issues about sustainability.

What works?

• It is a natural desire on the part of policy makers to want to know which measures are 'effective', and the pressure for education to develop more evidence based or evidence informed practice exacerbates this trend. However, it is a question which is next to impossible to answer in respect of the issues with which this project deals
• Few interventions in this field are designed to be evaluated. The random collection of 'data' which we observed in many settings is misleading and unhelpful. The complexity of school communities makes it very difficult to establish causal relationships (for example between implementation of intervention and improvement in attendance figures)

• The self evaluations undertaken by commercial organisations funded to deliver service look workmanlike but need to be regarded with a degree of scepticism
• Engagement with practitioner research or action research was limited, yet this could provide a fruitful means of evaluating small scale local interventions, with minimal disruption to vulnerable participants
• Complex social interventions are difficult to evaluate without complex (and costly) external evaluation, and their findings are very often overtaken by policy priorities and undermined by political timetables
• However, we cannot demand that the research tail wag the practice and policy dog. There is no point in advocating simpler interventions because they give clearer research outcomes when it is complex interventions that are clearly required
• Evidence points to the synergy that develops when problems are tackled in multiple ways and through a variety of strategies.

' Ownership'

• 'Ownership' of mental health/discipline problems came up as an important underlying theme, but after consideration of a three layered model of export, import and ownership, it is clear that this invokes false dichotomies and an unhelpful sense of schools needing to move towards some gold standard model of good practice
• If we remove 'ownership' from its protective punctuation, we can say that for us, it implies:
• a sense of the school and the individuals that work within it accepting professional responsibility for children's mental wellbeing as part of a general welfare responsibility
• accepting that some discipline problems may be associated with children experiencing poor levels of mental wellbeing, and not just being bad or naughty
• acknowledging that there may be ways in which schools themselves contribute to poor levels of mental wellbeing in young people
• undertaking to review all aspects of the school's ethos and functioning in an attempt to minimise negative impact and improve the positive and supportive things that schools can do.
• This model of ownership forms the basis of the staged intervention approach introduced by a number of education authorities, whereby schools are encouraged to support low level mental health difficulties themselves, consulting other professionals for support. Import of skilled personnel to work with children and young people is reserved for higher level difficulties, with export of pupils to other facilities is limited the most severe and intractable difficulites, requiring highly specialised, intensive interventions
• It seems clear that no one model of organising a school has a monopoly of virtue in this regard

• Shipping the problems off-site and washing one's hands metaphorically of them is clearly a sign that a school has not accepted ownership of the issue, but - that said - there are occasions when off-site solutions may be attractive and appropriate
• Managing the problem within the school and trying to deal with it only within the standard professional group did not always seem a healthy way of demonstrating ownership. Ownership does not imply sole responsibility for children's troubles, and it seems irresponsible and unhelpful not to attempt close levels of co-operation with parents and with other supportive professionals
• Issues of vocabulary and language impede ownership of this issue in the case of individual teachers. The language of mental health is not one to which teachers readily subscribe, both because it implies a different professional expertise, but also because mental health is often couched in a medicalised way which locates problems in the child rather than examining the socially constructed aspects of mental wellbeing and indiscipline problems
• Successful implementation of the ownership model has considerable implications for the training and support of school staff to develop new approaches to pedagogy, ethos and behaviour management which address the mental health needs of all the children in their charge.

The school environment; external and internal ethos

• A sense of the school and its relation to its catchment seems a critical element where the welfare of children is at the heart of the enterprise. This is an 'upstream' level of intervention if wanting to improve discipline and promote mental well-being, but its importance is fundamental
• Despite the advent of the integrated community school, the community element of the project is often one of the most underdeveloped aspects, particularly in secondary schools. Some important exceptions to this (as in our East Renfrewshire case study) need to be examined to develop good practice guidelines
• Some of the best examples looked at in the case studies were indeed offering integrated service packages, but the tendency is for these to operate to professional-led agendas, rather than to be community responsive
• Schools continue to face real difficulties in building bridges to communities and particularly to the parents of the most vulnerable children. We are still at the very early stages of understanding how to involve children and parents more meaningfully, or how professionals can interact with each other to deliver support to families and communities

• The use of workers who are employed outside the traditional professional roles, such as pupil and parent support workers, or family learning co-ordinators, seems to be one of the more successful ventures in being able to provide very disempowered parents with more legitimate voices and routes of access into the school system
• Despite the constraints referred to in this report it is clear that some teachers were skilled at creating good relationships with young people, although externally based professionals and pupil support workers based in schools were generally described as more likely to embody the qualities and to have the remit to foster these and to support young people to develop their own supportive social networks. Fewer opportunities exist within schools for teachers to develop supportive relationships with individual pupils

• In important respects educationalists continue to operate in a very different way from other professional groups, discussing children's cases and deciding their 'treatment' without feeling under any obligation to allow the presence or the voice of child or parent. It is quite difficult to see the justification for professional practices like these which are so out of kilter with best practice in health and social care. These practices often take place at the joint support team meetings which are a multi-agency forum, so within the educational setting the other professionals collude with this
• Ethos issues also operate in respect of the nature and the level of interactions between individuals studying and working in schools. The importance of the teacher-pupil relationship is paramount in promoting well-being. Recent policy changes which place the responsibility for children's happiness and safety in school on tutor group teachers, offering continuity throughout their secondary school career and linking pastoral care with PSD, should begin to address this issue ( SEED 2005a)
• Children and young people want to be recognised and responded to as individuals but there is a tension between this and the structure of schools, particularly secondary schools, in which pupils are organised in terms of classes and subjects and everyone is subordinate to the needs of the timetable
• In addition, teachers frequently see their role in terms of the need to 'control' and this creates a tension between the desire to understand a pupil's problems and the need to punish unacceptable behaviour - a tension which may also be present in the pastoral system of guidance and behaviour support

• The emphasis on control means that the problems that come to the attention of the school tend to be those which disrupt learning. Withdrawn behaviours may be overlooked when they do not interfere with teaching.

Ambitious, excellent schools?

• Are attainment agendas and the pursuit of academic curricula incompatible with schools having a strong welfare role? Opinion was divided on this question in the field
• In theory, as some of our respondents pointed out, these are two sides of the same coin. We know that happy well-adjusted pupils learn better, so the pursuit of good mental health need not necessarily be at the expense of good academic outcomes. Similarly, firm but supportive discipline and guidance regimes create the right environment in which children can prosper
• In practice, however, the constraints of the curriculum as it is now largely established in schools, and the regimes of inspection, audit and accounting of school effectiveness make the troubled or non-compliant child a very awkward fit in a system of mass education

• Many commentators spoke of a desire for more flexibility to meet the needs of individuals or groups of children. A 'one size fits all' model is at odds with the need to shift education into a new paradigm where service follows need, rather than the other way around. It was widely held that, such a radical challenge to traditional notions of education would take considerable time to be truly embedded in practice.
• There was little evidence of authorities or schools able or prepared to undertake the radical review of curriculum or pedagogic method that might be required to deliver the truly health promoting school

• There is also little evidence of reluctant teachers or head teachers being challenged and called to account for the mental well being of pupils in their charge
• In the interim we have a lot of peripheral changes - usually with respect to the PSD curriculum. Here the involvement of other professional groups seems to offer real benefit, particularly in young people's eyes, but the whole process needs to be carefully managed to deliver most benefit.

Professional partnership

• Inclusion is about schools adapting to meet the needs of a wide range of diverse learners. The change in terminology from 'special educational needs' to 'additional support needs' is intended to accompany a shift in the meaning of participation from a notion of 'readiness to be integrated' to one of 'right to be included'. For this to succeed requires a concomitant shift in attitudes
• Many more pupils are now included in mainstream schools who would formerly not have been there. But this increases expectations of classroom teachers to be able to respond appropriately to diversity and need - including the needs of challenging pupils - and this requires adequate staff development in order to build the capacity of schools
• Building teachers' morale and confidence has clear knock-on benefits for children's welfare
• The drawing into schools of other professional groups offers the chance both for building capacity on this issue within the teaching group and, of course, providing for young people additional and different services from those which teachers can offer

• An overview would indicate that we have the latter but not the former in most instances. Additionality has been achieved, but it may take time to build capacity in this way
• Some resistance was noted on the part of some teachers to believe that other workers could contribute to their own professional development. Issues of status, professional respect and understanding were widely in evidence, and were exacerbated by geographical and temporal segregation of the different groups.
• However it may be important to ensure that interventions are given time to become embedded and evaluated using appropriate methodologies with the target populations as young people move towards adulthood
• At present parallel working is the norm rather than true integration, and there is an argument for saying that more intervention is actually required now in and around schools to lever proper integration before parallel working becomes the new norm and equally difficult to shake

• The development of trust and confidence in one another's competence, the establishment of shared protocols, the drawing in of a wider circle of involved teachers will all take time and must be given time to develop. The political commitment to produce services that follow service users' need rather than professional convenience is a paradigm shift that will take some time to bed down in education

• Attention needs to be paid to the ways in which teachers learn. Mere exposure to the skills of other who interact with children in a very different way will not of itself develop capacity
• Systems of teacher-to-teacher mentoring and support look promising as ways forward, but not all teachers feel able to engage with such scheme
• A management lead in terms of championing the issue and establishing expectations about the role of the competent teacher are necessary prerequisites for engaging staff across the school. Successful joint working is also enhanced by an integrated approach to service management as observed in established ICSs, where a single high profile enthusiast can facilitate firm relationships between professional groups.

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