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School nurses can support mental health and wellbeing – but only if we have enough of them

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An article published online this week by Nursing Times reports on an initiative in East London to help school nurses and nursery nurses to detect and address mental health problems in children at an early stage, and to promote pupils’ emotional wellbeing and good mental health.

With child and adolescent mental health services in crisis, this could help to reduce the number of children waiting long periods for even initial appointments. Long waits can mean problems that could have been nipped in the bud have become more severe and enduring, causing distress to children and their families and increasing costs when they finally receive treatment.

Even with a well-resourced mental health care system, many mental health problems in children and young people are not recognised until they have become serious and require intensive therapeutic intervention.

This is hardly surprising – children and young people don’t have the experience to know whether what they are feeling is a normal part of growing up or a sign they need help. They are changing quickly and parents may dismiss early signs as the normal ups and downs of childhood – particularly in adolescents, who often withdraw into moody silence or explode in frustration at the drop of a hat.

“We need a well-resourced school nursing service”

A well-resourced school nursing service can play a key role in identifying children showing signs of mental health problems. Initiatives such as the one in Tower Hamlets can give school nurses the confidence and skills they need to understand and engage on mental health issues affecting their pupils.

But there’s the rub. We need a well-resourced school nursing service.

School nursing has long been a poor relation when funding is allocated. Back in 2015, the Commons’ health select committee called for the shortage of school nurses to be addressed after Ofsted reported that nursing services were inadequate in 40% of schools. However, the incorporation of school nursing into local authority public health commissioning in England in the same year has exacerbated the problem.

A UK-wide survey of school nurses undertaken in 2016 by the Royal College of Nursing revealed a workforce held back by lack of resources, understaffing and poor management, while in 2017 the college said the accelerating loss of school nurses was putting children “at risk in the classroom”.

With pupil numbers predicted to grow from 7.14 million in England in 2014 to 8.02 million by 2023, urgent action is needed.

Today’s young people face increasing pressure to achieve academically; with many jobs specifying that only graduates need apply that would once have been given to school leavers.

The influence of social media is also a source of real concern. While there are benefits to these relatively new platforms, and formal research is needed to assess their impact, stories of cyber bullying leading to children self-harming or even taking their lives seem distressingly common.

“More important than who commissions school nursing is how much funding it receives”

School nurses are trusted by both schoolchildren and their families and could play a crucial role in preventing mental health problems from taking root – and reducing pressure on mental health services.

The government has pledged to look again at commissioning arrangements for school nurses and health visitors in England, suggesting they may revert to NHS control at least in some places or circumstances. This may be a sensible move, but more important than who commissions school nursing is how much funding it receives.

Those in charge of decisions about this important specialty need to recognise its value and commit to giving it the resources and support it needs. Children and young people deserve nothing less.

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