MENTAL HEALTH & WELLBEING POLICY & PROCEDURE

CHINGFORD ACADEMIES TRUST FOR USE IN: CHINGFORD FOUNDATION SCHOOL RUSHCROFT FOUNDATION SCHOOL MENTAL HEALTH & WELLBEING POLICY & PROCEDURE (Part of...
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CHINGFORD ACADEMIES TRUST

FOR USE IN:

CHINGFORD FOUNDATION SCHOOL RUSHCROFT FOUNDATION SCHOOL

MENTAL HEALTH & WELLBEING POLICY & PROCEDURE (Part of the Medical Suite of Policies)

Return to:

School Management

Last amended: 1st April 2016

Return on:

1st April 2018

Lead staff: Ms S Goldstone

SAFEGUARDING IN CHINGFORD ACADEMIES TRUST The policies which most directly encapsulate our Safeguarding practice are available to view on our website and are all cognisant of Keeping Children Safe in Education (September, 2016) and Working Together to Safeguard Children (March, 2015) More recently, our duties within the Prevent agenda, promotion of British Values and alertness to Forced Marriage and Female Genital Mutilation have become an integral part of our safeguarding work. The following statement of Safeguarding Principles should be read as a preface to these policies. Safeguarding Principles In line with Keeping Children Safe in Education 2016, the school works towards ensuring that every child will be protected from harm and be supported to be healthy, safe, enjoying and achieving. Every child should be making a positive contribution to the school and its community and preparing to achieve economic wellbeing. Every child should feel valued and important within school, family and community 1. All Chingford Academies Trust staff, Trustees and Governors are committed to keeping young people safe and take every appropriate action and precaution to ensure that they are safe at school and, as far as staff can know, safe at home. This includes physical and psychological safety. This commitment is evidenced by:      

Establishing and maintaining an environment where children feel secure, are encouraged to talk, and are listened to. Identifying students who are suffering or are likely to suffer significant harm. Teaching and developing skills in young people, which enable them to recognise and protect themselves from abuse. Establishing a safe environment, conducive to learning. Working to prevent radicalisation through direct teaching identifying students ‘at risk’ and helping to keep students safe online. Personalising pathways for vulnerable/disengaged students.

2. The school respects the basic needs and rights of children and expects parents/carers to do so too. The school works within the framework of the London Child Protection Procedures and the Waltham Forest Safeguarding Children Board procedures (which are underpinned by the documents referenced in paragraph 1 above) 3.   

The school operates safer recruitment procedures, including: Having a team of staff who have successfully completed Safer Recruitment Training. Ensuring that one member of every interview panel is Safer Recruitment qualified. Keeping a single Central Record of all staff. Ensuring that all appropriate checks are carried out on staff and volunteers.

4. The school recognises that there are occasions when staff must work with students on a one to one basis. Safety is maintained in many ways, including: (All as set out in One to One Working Policy)    

Clear general guidance for all staff. Guidance on working in particular contexts both in school and on school business out of school. Planning one to one work to build in safety measures. Preparing environments for safe one to one working.

As a priority, all staff and visitors who work directly with children are expected to familiarise themselves with the policies which promote safeguarding. Copies have been provided to the Teaching Supply Agencies with which the schools work currently, are available in hard copy in the staffrooms and can be emailed from [email protected] Statement dated: For Review:

July, 2016 July, 2017

Chingford Academies Trust

April 2016

Background One in ten young people between the ages of 5 and 10 will have an identifiable mental health issue at any one time. By the time they reach university this figure is as high as 1 in 6. Around 75% of mental health disorders are diagnosed in adolescence.

Policy Statement The Schools promote the mental and physical health and emotional wellbeing of all its students. This policy instructs all members of staff and volunteers, is available to parents on request and is published on the school website. There is a fine line between appropriate responsiveness and inappropriate intrusiveness into the personal lives of students and families. However, all staff must respond to their responsibility to ensure the well-being and welfare of all students. Progress and achievement in school depend on this. The importance of early intervention is stressed. Intervention should be in the form of a referral to a named person. This is outlined in the guidance procedures later in this policy. The goal is determining the existence of mental health issues including anxiety and depression, self-harm and disordered eating and raising concerns with the appropriate member of staff.

Purpose In Chingford Academies Trust we encourage our students to:     

Be motivated and enjoy learning Develop a range of skills to equip them for a successful adult life, such as independence and ambition Be confident, responsible, happy and feel safe Be friendly, respectful, caring and polite Experience success every day

In schools which:  Foster individual talents and abilities in every child  Have high expectations for itself, its staff and students  Celebrate success and achievement in all its forms  Value the role parents and carers play  Continually striving to improve

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Policy aims To increase the level of awareness and understanding amongst staff and parents/carers of issues involving the mental health of students, in particular with concerns regarding anxiety and depression, self- harm and disordered eating. (See Appendices 1, 2 and 3) To alert staff to warning signs and risk factors and detect and address problems in their earliest stages To provide support and guidance to all staff dealing with students who suffer from mental health issues, their peers and parents/carers. To increase the appropriate level of support available to students with mental health issues in partnership with outside health agencies.

Child Protection Responsibilities Chingford Academies Trust is committed to safeguarding and promoting the welfare of students, including their mental health and emotional wellbeing, and expects all staff to share this commitment. It recognises that students have a fundamental right to be protected from harm and that students cannot learn effectively unless they feel secure. We therefore aim to provide a school environment which promotes self-confidence, a feeling of self-worth and the knowledge that students’ concerns will be listened to and acted upon swiftly. This policy and guidance should be followed with close reference to the Confidentiality Policy, Child Protection Policy and Safeguarding Policy.

Procedures The most important role that school staff can play is to familiarise themselves with the risk factors and warning signs outlined in this policy. Figure 1 outlines the procedures which should be followed if staff have a concern about a student, if another student raises concerns about one of their friends, or if an individual student speaks to a member of staff specifically about how they are feeling.

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Figure 1. Procedures ASK, ASSESS, ACT Where a student is distressed, the member of staff should ask them What support they need and want. Assess the risk of harm to self or others and try to reduce any risk that is present. Listen non-judgementally Give them time to talk and gain their confidence Give reassurance and information Tell them how brave they have been to come forward Gently explain that you would like to help them. Do not promise confidentiality- It could be a child protection matter. Enable the young person to get help Work through the avenues of support. Explain that you would like to share their thoughts with someone else so that they can get the best help. Encourage them to speak to someone else if appropriate (appendix 4) – offer to go with them. Encourage self-help strategies (appendix 6) Appropriate Staff to complete an Incident Report using Medical Tracker Do not speak about your conversation or concerns with other students or casually to a member of staff. Access support for yourself if you need it via line manager or HR Manager. HIGH RISK CASES If you consider the student is at risk follow Child Protection procedures and report your concerns directly to a member of the Safeguarding Team

LOW RISK CASES If you feel that the student needs a period of ‘watchful waiting, communicate this to the student’s tutor and Student Progress Leader.

(See Child Protection Policy) The appropriate course action will then be taken which may include: Contacting parents/carers Giving advice Arranging professional assistance Making a referral to MASH/CAHMS

After a period of watchful waiting, a student deemed to have continuing symptoms should be referred to the Mental Health Keyworker

 SAFETY OF ALL IS PARAMOUNT All staff have a duty of care towards the students and should respond accordingly when Mental health first aid situations arise  Individual Short/Long-term Care Plan (ICP) via Medical Tracker

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Individual Care Plan (ICPs) Following consultation between relevant members of staff an ICP will be agreed between them and recorded on Medical Tracker; this would be available to relevant staff in appropriate situations, in order to provide the appropriate level of support for the student. Long-term ICP’s also be discussed with Parent/Carers.

Incident Forms To be completed using Medical Tracker

Supporting students with mental health issues The School offers an increasing range of services and sign-posting towards other agencies to support students with mental health issues, including:   

 

   

A Checklist for Staff to supply information if they suspect depression in a student, looking for academic signs, cognitive signs, social/behavioural signs and emotional signs, to ensure early intervention if needed. Clear Referral Process Self-Referral through attendance of “No Worries” lunchtime Support Group, facilitated by Mental Health Keyworker and School Nurse. Posters placed at strategic places around the school and Group highlighted regularly during assemblies or selfreferral to the Learning Mentor or Safeguarding Officer at RFS. Mentoring and baseline assessment of student’s (1) home life and family member interaction (2) school performance and homework and (3) social interaction with friends and other peers to evaluate their level of functioning and home and school. Psychological interventions including individual 1:1 mentoring to address needs and set achievable goals; group work to raise self-esteem, motivation, aspiration, attendance and wellbeing; Parenting Group “Building a healthy family from the inside out” and Student/Parent joint Group-work incorporating Cognitive Behavioural Therapy, focusing on problems, solving procedures, assertiveness and stress management strategies, to help induce relaxation and better understand conditions and causes. Training in social skills, providing opportunities to model and rehearse interaction skills and cognitive strategies to avoid depressive thoughts and interpretations Monitoring of behaviour on Recording Cards, helping to see the effects of efforts and goals attained. Regular communication with parents/carers of students in order to obtain and provide up to date information Joint Working with CAMHS and other agencies to understand support need

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Supporting staff who are working with students with mental health issues The School acknowledges that staff who are working closely with distressed students exhibiting mental health problems can themselves be placed under emotional strain. Support will be provided to all staff who request it via Workplace Options - an employee assistance programme Freephone 0800 243 458 www.workplaceoptions.com All staff are reminded regularly about the specific medical and emotional needs of students within the school community and they are asked to familiarise themselves with Individual Care Plans via Medical Tracker as appropriate, when dealing with needs which require specific action to support their mental/emotional wellbeing.

Staffing In order to ensure an adequate mental health first aid provision and awareness it is our policy that there are sufficient numbers of trained personnel to support those students who are experiencing mental and/or emotional difficulties *Mental Health First Aid Key Worker is a recognised qualification.

Mental Health First Aid Key Worker 

A qualified youth mental health first aider is available during normal school hours during term time.

Is responsible for:      

Responding promptly to calls for assistance in low and high risk cases and safeguarding and child protection issues. Providing support within their level of competence Making a MASH referral Summoning immediate medical help if required Recording details of support given on Medical Tracker Signposting on as appropriate

Safeguarding Officer: Is responsible for:    

Responding promptly to calls for assistance in high risk cases and safeguarding and child protection issues Making a MASH referral Summoning immediate medical help if required Informing parents

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School Nurse 

The School Nurse is available regularly once a week at each school.

Is responsible for:  



Working closely with students, parents, carers and staff, offering support and advice on a range of issues offering medical support Playing a vital role in children’s development, carrying out immunization and screening programmes, managing medical conditions and acting as a point of contact on child protection issues Maintaining accurate records of all support given using Medical Tracker.

Designated CAMHS Worker/Psychiatric Clinician 

The CAHMS Worker is available one day per week

Is responsible for: 

  

Working with students who have Tier 1 and 2 mental health and emotional wellbeing issues who do not meet the threshold for assessment and intervention by specialist CAHMS. Offering bespoke packages of groupwork to students Offering some staff training around mental health Maintaining accurate records of all support given using Medical Tracker.

**Referrals can be made to the CAHMS worker by any member of staff in discussion with the Mental Health Keyworker/Safeguarding Officer See Appendix 4 for a full list of current trained Mental Wellbeing staff The Education Welfare Officer 

The EWO is in 2 days per week at CFS and 3 days per week at RFS and works with students and families to support regular school attendance.

Is responsible for:   

Addressing problems in school or at home Working in co-operation with the Mental Health Keyworker, Safeguarding Officer, Welfare Assistant and School Nurse on matters of mental and physical health and emotional wellbeing Maintaining accurate records of all support given using Medical Tracker, where appropriately trained.

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Monitoring Policy This Policy will be monitored by the Mental Health Keyworker, discussed with the Safeguarding Officer and Safeguarding Lead and activity will be reported to Trustees as requested. The students’ Mental Health and Wellbeing Policy and Guidance will be reviewed every 2 years as part of the policy review schedule.

Linked Policies      

Safeguarding Policy Child Protection Policy Anti-bullying Policy and Procedures SEN Policy and Procedures Confidentiality Policy Other Policies in the Medical Suite

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Appendix I

Anxiety and Depression Anxiety disorders Anxiety is a natural, normal feeling we all experience from time to time. It can vary in severity from mild uneasiness through to a terrifying panic attack. It can vary in how long it lasts, from a few moments to many years. All children and young people get anxious at times; this is a normal part of their development as they grow up and develop their ‘survival skills’ so they can face challenges in the wider world. In addition, we all have different levels of stress we can cope with - some people are just naturally more anxious than others, and are quicker to get stressed or worried. Concerns are raised when anxiety is getting in the way of a child’s day to day life, slowing down their development, or having a significant effect on their schooling or relationships. It is estimated that 1 in 6 people will suffer from General Anxiety Disorder at some point in their lives. Anxiety disorders include:    

Generalised Anxiety Disorder (GAD) Panic disorder and agoraphobia Separation anxiety Phobic disorders (including social phobia)

Symptoms of an anxiety disorder These can include: Physical effects     

Cardiovascular – palpitations, chest pain, rapid, heartbeat, flushing Respiratory – hyperventilation, shortness of breath Neurological – dizziness, headache, sweating, tingling and numbness Gastrointestinal – choking, dry mouth, nausea, vomiting, diarrhoea Musculoskeletal – muscle aches and pains, restlessness, tremor and shaking

Psychological effects        

Unrealistic and/or excessive fear and worry (about past or future events) Mind racing or going blank Decreased concentration and memory Difficulty making decisions Irritability, impatience, anger Confusion Restlessness or feeling on edge, nervousness Unwanted, unpleasant, repetitive thoughts

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Behavioural effects    

Avoidance of situations Repetitive compulsive behaviour e.g. excessive checking Distress in social situations Urges to escape situations that cause discomfort (phobic behaviour)

First Aid for anxiety disorders Follow the AAA principles (see Figure 1 in main policy) How to help a student having a panic attack      

If you are sure that the student is having a panic attack, move them to a quiet safe place if possible. Help to calm the student by encouraging slow, relaxed breathing in unison with your own. Encourage them to breathe in and hold for 3 seconds and then breathe out for 3 seconds. Be a good listener, without judging. Explain to the student that they are experiencing a panic attack and not something life threatening such as a heart attack. Explain that the attack will soon stop and that they will recover fully. Assure the student that someone will stay with them and keep them safe until the attack stops.

Many young people with anxiety problems do not fit neatly into a particular type of anxiety disorder. It is common for people to have some features of several anxiety disorders. A high level of anxiety over a long period will often lead to depression and long periods of depression can provide symptoms of anxiety. Many young people have a mixture of symptoms of anxiety and depression as a result. Depression A clinical depression is one that lasts for at least 2 weeks, affects behaviour and has physical, emotional and cognitive effects. It interferes with the ability to study, work and have satisfying relationships. Depression is a common but serious illness and can be recurrent. In England if affects at least 5% of teenagers, although some estimates are higher. Rates of depression are higher in girls than in boys. Depression in young people often occurs with other mental disorders, and recognition and diagnosis of the disorder may be more difficult in children because the way symptoms are expressed varies with the developmental age of the individual. In addition to this, stigma associated with mental illness may obscure diagnosis.

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Risk Factors Experiencing other mental or emotional problems Divorce of parents Perceived poor achievement at school Bullying Developing a long term physical illness Death of someone close Break up of a relationship Some people will develop depression in a distressing situation, whereas others in the same situation will not. Symptoms Effects on emotion: sadness, anxiety, guilt, anger, mood swings, lack of emotional responsiveness, helplessness, hopelessness Effects on thinking: Frequent self-criticism, self-blame, worry, pessimism, impaired memory and concentration, indecisiveness and confusion, tendency to believe others see you in a negative light, thoughts of death or suicide Effects on behaviour: Crying spells, withdrawal from others, neglect of responsibilities, loss of interest in personal appearance, loss of motivation. Engaging in risk taking behaviours such as self-harm, misuse of alcohol and other substances, risk-taking sexual behaviour. Physical effects: Chronic fatigue, lack of energy, sleeping too much or too little, overeating or loss of appetite, constipation, weight loss or gain, irregular menstrual cycle, unexplained aches and pains. First Aid for anxiety and depression Follow the AAA principles shown in Figure 1 of the main policy The most important role school staff can play is to familiarise themselves with the risk factors and warning signs outlined above and to make the mental health keyworker & safeguarding officer aware of any child causing concern. Following the report, the mental health keyworker will follow the appropriate course of action. This may include:    

Contacting parents/carers Arranging professional assistance e.g. doctor, nurse Arranging an appointment with the CAHMS Worker Giving advice to parents, teachers and other students

Students may choose to confide in a member of school staff if they are concerned about their own welfare, or that of a peer. Students need to be made aware that it may not be possible for staff to offer complete confidentiality. If you consider a student is at serious risk of causing themselves harm then confidentiality cannot be kept. It is important not to Mental Health & Well-Being

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make promises of confidentiality that cannot be kept even if a student puts pressure on you to do so. Appendix 2

Eating Disorders

Definition of Eating Disorders Anyone can get an eating disorder regardless of their age, gender or cultural background. People with eating disorders are preoccupied with food and/or their weight and body shape, and are usually highly dissatisfied with their appearance. The majority of eating disorders involve low self-esteem, shame, secrecy and denial. Anorexia nervosa and bulimia nervosa are the major eating disorders. People with anorexia live at a low body weight, beyond the point of slimness and in an endless pursuit of thinness by restricting what they eat and sometimes compulsively over-exercising. In contrast, people with bulimia have intense cravings for food, secretively overeat and then purge to prevent weight gain (by vomiting or use of laxatives, for example). Risk Factors The following risk factors, particularly in combination, may make a young person more vulnerable to developing an eating disorder: Individual Factors   

Difficulty expressing feelings and emotions A tendency to comply with other’s demands Very high expectations of achievement

Family Factors     

A home environment where food, eating, weight or appearance have a disproportionate significance An over-protective or over-controlling home environment Poor parental relationships and arguments Neglect or physical, sexual or emotional abuse Overly high family expectations of achievement

Social Factors  

Being bullied, teased or ridiculed due to weight or appearance Pressure to maintain a high level of fitness/low body weight for e.g. sport or dancing

Warning Signs School staff may become aware of warning signs which indicate a student is experiencing difficulties that may lead to an eating disorder. These warning signs should always be taken Mental Health & Well-Being

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seriously and staff observing any of these warning signs should seek further advice from one of the designated teachers for safeguarding children or from the medical centre.

Physical Signs       

Weight loss Dizziness, tiredness, fainting Feeling Cold Hair becomes dull or lifeless Tension headaches Sore throats / mouth ulcers Tooth decay

Behavioural Signs             

Restricted eating Skipping meals Scheduling activities during lunch Strange behaviour around food Wearing baggy clothes Wearing several layers of clothing Excessive chewing of gum/drinking of water Increased conscientiousness Increasing isolation / loss of friends Believes they are fat when they are not Secretive behaviour Visits the toilet immediately after meals Excessive exercise

Psychological Signs       

Preoccupation with food Sensitivity about eating Denial of hunger despite lack of food Feeling distressed or guilty after eating Fear of gaining weight Moodiness Excessive perfectionism

Staff Roles The most important role school staff can play is to familiarise themselves with the risk factors and warning signs outlined above and to make the mental health keyworker or safeguarding officer aware of any child causing concern.

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Following the report, the mental health keyworker/safeguarding officer will follow the appropriate course of action. This may include:     

Contacting parents/carers Arranging professional assistance e.g. doctor, nurse Arranging an appointment with a counsellor Arranging a referral to CAMHS – with parental consent Giving advice to parents, teachers and other students

Management of eating disorders in school Exercise and activity – PE and games Taking part in sports, games and activities is an essential part of school life for all students. Excessive exercise, however, can be a behavioural sign of an eating disorder. If the mental health keyworker/wellbeing team deem it appropriate they may liaise with PE staff to monitor the amount of exercise a student is doing in school. They may also request that the PE staff advise parents of a sensible exercise programme for out of school hours. All PE teachers at the school will be made aware of which students have a known eating disorder. The school will not discriminate against students with an eating disorder and will enable them whenever appropriate, to be involved in sports. Advice will be taken from medical professionals, however, and the amount and type of exercise will be closely monitored. When a student is falling behind in lessons If a student is missing a lot of time at school or is always tired because their eating disorder is disturbing their sleep at night, the mental health keyworker and school nurse will initially talk to the parents/carers to work out how to prevent their child from falling behind. If applicable, the school nurse will consult with the professional treating the student. This information will be shared with the relevant pastoral/ teaching staff on a need to know basis and to inform the ICP. Students Undergoing Treatment for/Recovering from Eating Disorders The decision about how, or if, to proceed with a student’s schooling while they are suffering from an eating disorder should be made on a case by case basis. Input for this decision should come from discussion with the student, their parents, school staff and members of the multi-disciplinary team treating the student. The reintegration of a student into school following a period of absence should be handled sensitively and carefully and again, the student, their parents, school staff and members of the multi-disciplinary team treating the student should be consulted during both the planning and reintegration phase.

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Further Considerations Any meetings with a student, their parents or their peers regarding eating disorders should be recorded in writing including:    

Dates and times An action plan Concerns raised Details of anyone else who has been informed

This information should be stored in the student’s safeguarding file held by the Safeguarding Officer.

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Appendix 3

Self-Harm Introduction Recent research indicates that up to one in ten young people in the UK engage in selfharming behaviours. Girls are thought to be more likely to self-harm than boys. School staff can play an important role in preventing self-harm and also in supporting students, peers and parents of students currently engaging in self-harm. Definition of Self-Harm Self-harm is any behaviour where the intent is to deliberately cause harm to one’s own body for example:        

Cutting, scratching, scraping or picking skin Swallowing inedible objects Taking an overdose of prescription or non-prescription drugs Swallowing hazardous materials or substances Burning or scalding Hair-pulling Banging or hitting the head or other parts of the body Scouring or scrubbing the body excessively

Risk Factors The following risk factors, particularly in combination, may make a young person particularly vulnerable to self-harm: Individual Factors:            

Depression/anxiety Poor communication skills Low self-esteem Poor problem-solving skills Hopelessness Impulsivity Drug or alcohol abuse Family Factors Unreasonable expectations Neglect or physical, sexual or emotional abuse Poor parental relationships and arguments Depression, self-harm or suicide in the family

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Social Factors  

Difficulty in making relationships/loneliness Being bullied or rejected by peers

Warning Signs School staff may become aware of warning signs which indicate a student is experiencing difficulties that may lead to thoughts of self-harm or suicide. These warning signs should always be taken seriously and staff observing any of these warning signs should seek further advice from the mental health keyworker or safeguarding officer Possible warning signs include:         

Changes in eating/sleeping habits (e.g. student may appear overly tired if not sleeping well) Increased isolation from friends or family, becoming socially withdrawn Changes in activity and mood e.g. more aggressive or introverted than usual Lowering of academic achievement Talking or joking about self-harm or suicide Abusing drugs or alcohol Expressing feelings of failure, uselessness or loss of hope Changes in clothing e.g. always wearing long sleeves, even in very warm weather Unwillingness to participate in certain sports activities e.g. swimming

Staff Roles in working with students who self-harm Students may choose to confide in a member of school staff if they are concerned about their own welfare or that of a peer. School staff may experience a range of feelings in response to self-harm in a student such as anger, sadness, shock, disbelief, guilt, helplessness, disgust and rejection. However, in order to offer the best possible help to students it is important to try and maintain a supportive and open attitude – a student who has chosen to discuss their concerns with a member of school staff is showing a considerable amount of courage and trust. Students need to be made aware that it may not be possible for staff to offer complete confidentiality. If you consider a student is at serious risk of harming themselves then confidentiality cannot be kept. It is important not to make promises of confidentiality that cannot be kept even if a student puts pressure on you to do so. Any member of staff who is aware of a student engaging in or suspected to be at risk of engaging in self-harm should consult the mental health keyworker/safeguarding officer Following the report, the mental health keyworker will follow the appropriate course of action. This may include:   

Contacting parents / carers Arranging professional assistance e.g. doctor, nurse, social services Arranging an appointment with a counsellor

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  

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Immediately removing the student from lessons if their remaining in class is likely to cause further distress to themselves or their peers In the case of an acutely distressed student, the immediate safety of the student is paramount and an adult should remain with the student at all times If a student has self-harmed in school a first aider should be called for immediate help

Further Considerations Any meetings with a student, their parents or their peers regarding self-harm should be recorded in writing including:    

Dates and times An action plan Concerns raised Details of anyone else who has been informed

This information should be stored in the student’s safeguarding file held by the Safeguarding Officer. It is important to encourage students to let staff know if one of their group is in trouble, upset or showing signs of self-harming. Friends can worry about betraying confidences so they need to know that self-harm can be very dangerous and that by seeking help and advice for a friend they are taking responsible action and being a good friend. They should also be aware that their friend will be treated in a caring and supportive manner. The peer group of a young person who self-harms may value the opportunity to talk to a member of staff either individually or in a small group. Any member of staff wishing for further advice on this should consult either the Head of School or Student Progress Leader. When a young person is self-harming it is important to be vigilant in case close contacts with the individual are also self-harming. Occasionally schools discover that a number of students in the same peer group are harming themselves.

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Appendix 4

Further Reading and Useful Links Reading HM Government (2011), No Health Without Mental Health, Department of Health Websites Young Minds: http://www.youngminds.org.uk/for_parents b-eat: http://www.b-eat.co.uk/ Childline: http://www.childline.org.uk Mind: http://www.mind.org.uk/ NHS: http://www.nhs.uk/livewell/mentalhealth/Pages/Mentalhealthhome.aspx Mental Health Foundation: http://www.mentalhealth.org.uk/ Stem4: http://www.stem4.org.uk/ Royal College of Psychiatrists: http://www.rcpsych.ac.uk/expertadvice/youthinfo/parentscarers.aspx National Bureau for students with disabilities www.skill.org.uk Rethink For people with severe mental illness www.sane.org.uk Depression Alliance Self-help organisation run by people who have experience of depression www.depressionalliance.co.uk The Hearing voices network User network and local support groups for people who hear voices www.hearing-voic.org.uk Manic Depression fellowship (MDF) Helps people affected by manic depression to take control of their lives www.mdg.org.uk

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Appendix 5

Self Help Strategies adapted from Youngminds.org – Helpline Phone: 0300 123 3393 http://www.youngminds.org.uk/for_children_young_people/whats_worrying_you/depre ssion/depression_help Depression - Self Help Strategies Talk to someone The most important thing you can do if you think you are feeling depressed is talk to someone. This could be your parents, a sibling, friend, teacher, GP but often talking about how you are feeling can really help you to feel better. People who care about you will want to help you to feel better so don’t feel worried about talking to people. If it is something specific that is causing the depression, for example if you are worried about exams, then talking to a teacher may help to reassure you or they may be able to offer practical help such as extra reading to help you feel better about things. Visit your GP If you don’t feel comfortable talking to a friend, teacher or your parents, go and see your GP – they are there to help you to feel better whether it is a physical health problem or a mental health problem and there are a number of things that they may suggest for you. Don’t suffer in silence, keeping it all to yourself will only worsen your feelings of anxiety or depression and remember, you’re not the only one to feel like this, other young people – and adults too – experience depression. Treatment There are things you can do to help yourself if you are experiencing depression:      

Talk to someone. Get some fresh air most days. Get some regular exercise – there is a proven link between exercise and better mental health. Do things you enjoy whether it is skateboarding, hanging out with friends or reading. Try to eat regularly even if it is small meals. Write a diary about how you are feeling. Remember – you are not the only one to experience depression and you haven’t done anything wrong. People can help so don’t suffer on your own, choose someone you like and trust to talk to.

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The treatment you get will depend on the severity of the depression. The National Institute for Health and Clinical Excellence (NICE) is a body that provides guidance on health issues and it describes depression as mild, moderate or severe. If the depression is mild, you will probably not be offered medication according to the NICE guidance. The doctor will probably keep an eye on your situation and offer advice on support and diet/exercise to see if that can help the issue without medication. CBT If the depression is continuing for some time, or considered moderate to severe, your doctor may refer you to your local child and adolescent mental health service (CAMHS). They will assess you and discuss with you what they think is the best kind of treatment for you. This might be cognitive behavioural therapy (CBT) which is a type of talking therapy and aims to help you understand your thoughts, feelings and behaviour. Alternatively you may be prescribed with a course of antidepressants to help you to feel better but the options will be discussed with you. The NICE guidance recommends that young people do NOT use St John’s wort. This is a herbal medicine but the guidance states that insufficient research has been carried out to check whether it is safe for young people to use it. Antidepressants NICE says that antidepressants should be given to children and young people only rarely and usually in addition to other help such as therapy. If you have mild depression you shouldn’t be offered antidepressants it is only if you have moderate to severe depression. If you do not feel better as a result of taking the antidepressants or through the therapy, tell your GP as he/she may offer you a different type of medication or therapy that may help.

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Self Help Strategies adapted from Youngminds.org – Helpline Phone 0300 123 3393 http://www.youngminds.org.uk/for_children_young_people/whats_worrying_you/selfharm/self_harm_help Self-harm – self-help strategies If you are self-harming, there is help available and it is important to get the support you need. Many young people who self-harm do so privately away from other people and do not want to talk to other people about it, sometimes for fear of how people will react, thinking that they might not understand. If you can talk to someone, this may help how you are feeling. People to talk to          

Parents Grandparents Auntie/uncle or other relative Friend Parents' friend Brother or sister Mentor School nurse Teacher Youth Worker

If you don’t feel like you can confide in anyone, then go and talk to your GP and seek medical help. Talk to your GP Talk to your GP about how you feel and any other issues you may have as well as the selfharm for example if you are being bullied or if you are feeling anxious or depressed as it may be that tackling the underlying issues will help you to cope with problems without selfharming. If your GP is dismissive or unhelpful you have a right to change GPs. But your GP can help and may offer you a range of support. The GP may offer counselling or therapy including Cognitive Behavioural Therapy which looks at understanding your thoughts and behaviour. You may also be referred to child and adolescent mental health services (CAMHS) for an assessment, or sent to hospital for treatment.

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Getting professional help NICE provides guidance on medical issues. NICE guidance has been produced on the care you should expect to receive from healthcare professionals if you are seeking help around self-harm.   







You should be treated with dignity and respect. Any injuries you have should be treated straight away and not left because you harmed yourself. If you go to hospital, you should be seen by a doctor or nurse who is trained to work with children and young people who self-harm, in a special area set aside for children and young people. If you have to stay at the hospital then you stay in a paediatric (children’s) ward or an adolescent paediatric unit for over 14s and be checked by someone who is properly trained the following day. When you are in hospital, someone from the Child and Adolescent Mental Health Service (CAMHS) team should carry out an assessment and ask you about how you are and look at any problems you think you have or might have when you go home. Young people who have self-harmed several times may be offered group psychotherapy - a chance to talk through your problems with other young people.

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Self Help Strategies adapted from Youngminds.org – Helpline Phone 0300 123 3393 http://www.youngminds.org.uk/for_children_young_people/whats_worrying_you/anore xia/anorexia_help Eating Disorder – self-help strategies Anorexia Help It can be really hard to cope with an eating problem or disorder on your own. Talking to someone might help you feel more able to cope. Try and talk to someone you like and trust, such as:           

Friend Brother or sister Grandparents Parent or carer Aunt or uncle Friend’s parent Teacher or College Tutor School/Mental Health Keyworker/Counsellor School nurse Youth worker

Seeing your doctor You should also go and see your doctor. GPs usually ask you the following questions in a questionnaire: 1. 2. 3. 4. 5.

Do you make yourself sick? Do you worry that you’ve lost control over how much you eat? Have you lost more than a stone in three months? Do you think you’re fat even if other people tell you that you are thin? Does food dominate your life?

If you answer “yes” to two or more of these questions, you may have a problem with your eating. Confidentiality What you talk to your doctor about is confidential and they are not allowed to tell anyone else unless they think your health or safety is a serious risk and only then they would tell your parent or carer. NICE makes recommendations for health professionals. The NICE guidelines on treating eating disorders say the right to confidentiality of children and adolescents with eating disorders should be respected. Mental Health & Well-Being

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If you go and see your GP and want help, they may prescribe you some medicine or refer you to a specialist such as a psychiatrist or counsellor. NICE says that most people with anorexia nervosa should be managed on an out-patient basis, with psychological treatment provided by a healthcare professional and psychological treatment for anorexia should be for at least six months. Being an out-patient means you go in to hospital for the treatment or therapy session and then go home again afterwards so you don’t have to stay in hospital overnight or for a length of time. Seeing a psychiatrist or expert A specialist will talk to you about how you are feeling to see if they can help. It is likely that you would see the specialist on a regular basis and in most cases you will do this as an outpatient. If your weight was dangerously low and it posed a real problem to your health then it is likely you would be admitted to stay in hospital for you to be treated. As an out-patient, the psychiatrist will ask you how long you have had a problem with food, when it started and how it developed. You will be weighed and may have a physical health examination to see if the eating disorder has affected your health at all and they may take blood tests. With your permission, the psychiatrist may want to talk to your family to see if they can help with the problem at all. If you don’t want your family involved then tell the psychiatrist this and maybe they could talk to a friend instead. NICE suggest that family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia. If you are happy for the psychiatrist to talk to your family and if you live at home, he or she may then want your family to keep an eye on what you are eating and to make sure that you are getting enough calories. You will see your therapist (psychiatrist/counsellor) regularly for on-going support and to keep checking your weight. You will be able to discuss anything that is concerning you at the sessions with the therapist or counsellor. It will be hard for you to think about getting back to a healthy weight as you have spent so long trying to be thin but you will want to get better and in order to do that you will need to know what your healthy weight is and how many calories you need to eat to get to that weight. You will also need to know how to control your eating. The therapist may suggest you see a dietician who will explain the impact of not eating on your body and how it can affect your health. The dietician can help you regain a healthy eating pattern.

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Hospital treatment Most people would be treated as an out-patient in a hospital but if you were treated in hospital it would be similar to seeing a therapist as above but in a more structured way with regular blood tests and you will be regularly weighed. NICE says that healthcare professionals need to balance whether a child or adolescent with anorexia nervosa needs to be treated in hospital alongside their educational and social needs. Compulsory treatment If you are seriously ill and you cannot make decisions for yourself or you need to be protected from harm, then doctors would carry out compulsory treatment. This is unusual and would be if your weight was so low that it was putting your life in danger. NICE says that feeding against the will of the patient should be a last resort and should only be done in the context of the Mental Health Act 1983 or Children Act 1989.

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