Dawn Bowden AM: Thank you, Chair. A few questions around providing support for learners. You've set out very clearly what you think needs to happen in your report, your nine points and so on, but what's your view on the support currently provided, both in a school setting and EOTAS settings for mental health support? Have you been able to get that sort of information? Have you got a sense of—?
Dr Ian Johnson: I don't think we're really in a position to answer fully as to what's going on. I think that part of the problem is there's not really a national picture that we can pick up in terms of data or information regarding this, and I think that's really why there's been such a push towards seeing this in the curriculum.
Dawn Bowden AM: Sure. So much of your evidence is anecdotal, is it? It's people that have been referred to you, come to you for help, and you just—or your own research. What—?
Dr Ian Johnson: The research that we're going to do is really where we're at, and that's because we feel that there is a gap there regarding how young people are experiencing this within the school environment and in general. I think, in particular, we're aware of increases—quite substantial increases in some cases—regarding self-harm, and concern that manifests itself slightly differently between girls and boys. Specifically, I think there's now an increasing focus on self-harm behaviour amongst girls in the 15 to 19 age range, but we're not entirely sure of how good the support is at schools. My experience of projects that I've been involved in—I was previously in front of this committee as part of the Time to Change Wales project—was that, overall, it depends quite strongly on the senior management team and their commitment. Where the SMT has taken a lead, then it feels that schools are really doing something. Where the SMT are, perhaps, a bit more laissez-faire regarding this, then it feels that maybe schools are not making such a step forward. And to come back to the point, that's why we feel that whole-school approach guidance needs to be statutory, because we'll otherwise reach some quite uneven outcomes, because those who are doing it well will really push ahead and those that are not so engaged will not be helping their pupils in the way that they should be.
Dawn Bowden AM: I guess the EOTAS or PRU provision is going to be much more challenging then, isn't it, then main school provision. I suppose that was what I was trying to get at as well, whether you get a sense that there may be some progress being made in mainstream schools, is that following through in PRUs and EOTAS provision?
Dr Ian Johnson: I'll just be honest: right now, I couldn't give you an answer on that. I think that is something that, perhaps, slightly concerns me about the whole field is not being able to get a national feel for these issues. I would suspect that there are pockets of very good practice. I've heard discussions about things being done regionally and nationally, but I think it would be good to be able to see what that best practice looks like and how well it's done.
Dawn Bowden AM: I appreciate you're not educationalists and you wouldn't necessarily have all of that information, but have you got any sense of—again, whether this is anecdotal or from cases that are referred to you—evidence of schools off-rolling pupils with mental health problems? If you've got any evidence of that, what might the impact of that be on the individuals?
Liz Williams: Yes, I think that certainly does happen. I suppose we know this anecdotally from Samaritans research, but also I have experience of working in pupil referral units and working with some really vulnerable children, and I think there is a sense sometimes that these children are labelled as naughty and disruptive. So, children who have additional learning needs or a communication problem that potentially is undiagnosed or not really properly understood. I think when children have mental health problems and additional learning needs, often they can find the school environment really difficult. I've worked with children who have told me that they just don't enjoy being in the classroom because they feel incredibly anxious. They don't feel they can contribute to the school environment, they don't feel like they're keeping up with their classmates and, as a result, they demonstrate challenging behaviour so that they can leave the classroom. I think that's very sad. As a result, these children aren't always understood and are off-rolled in some cases. But, like Sarah said earlier, there are certainly examples of really good practice, and I suppose this links in to what approaches schools, pupil referral units and EOTAS should take to vulnerable children with mental health problems. One example I can give you is that, at one pupil referral unit, the children would get really distressed and really disruptive towards the end of the day on a Friday. I suppose that, in some schools, the teachers would have thought, 'This is ridiculous, they're disrupting the lessons', but what the teachers knew is that these children would go home, they would face such adversity, wouldn't always get a meal, would be exposed to things they shouldn't be exposed to, and the teachers were able to respond to that with compassion and empathy. But, obviously, seeing behind behaviour is really, really difficult, and I don't think teachers should have to do this alone, they should be properly trained and properly equipped. Even going up to a child—and I suppose this goes back to mental health support. Ideally, as Samaritans, we would want suicide prevention plans to be embedded in schools and to be part of the culture of schools, but obviously this can't happen if teachers aren't properly equipped and don't have the confidence to go up to a student and ask them if they're struggling. In our compassion in education toolkit, we highlight the importance of asking a child, 'Are you self-harming?', if there are signs; 'Have you tried to take your own life?', if there are signs. But obviously that's a very difficult conversation to have. So, yes, there are certainly examples of best practice, but I do believe that, if school staff aren't properly equipped and trained, off-rolling pupils, especially at key stage 4, where obviously you will hold those grades, is definitely something that they don't necessarily have the incentive to prevent. So it's worth looking at that.
Dawn Bowden AM: You touched, in the beginning of that response, on children being labelled as naughty. To what extent have you come across that? Is that quite prevalent? Is that quite common?
Liz Williams: Absolutely, yes. I think it's really down to the school. I think it's down to experience and it's down to the teacher. I think it links up with the question we were asked before about diagnosis and support. Lots of children with communication difficulties especially, if they haven't been formally diagnosed, they are certainly the ones that are deemed naughty, because I suppose people think, 'Well, you should be doing well, you're bright. You should be thriving in school.' But that's not always the case. Children can be incredibly anxious, have mental health problems, obviously, are exposed to ACEs and things that go on at home that not necessarily every teacher would know about. So, I think there are definitely children who are labelled 'naughty', and I think children also play up to that as well. Like I said, if children are very anxious in the school environment and in the classroom, if they know they can get out of the classroom and get into a safe space, they will do that.
Dawn Bowden AM: And then that labelling of a 'naughty' child is actually the impediment to getting that child the support that they need.
Liz Williams: Absolutely, yes, and I think that's where formal diagnosis can be helpful. I think the doors are open then to much more school support. So, yes, I think it is down to how the school approach it, and it goes back to the whole-school approach and having emotional and mental health on a statutory basis in the curriculum. It embeds emotional well-being into the culture of the school, and it means that students might know when they need help, how to be more resilient and helping themselves, and when and how to ask for help from the teachers. So, I think it's really important.
Dr Ian Johnson: If I can just pick up on one of those points, Mind Cymru conducted a series of focus groups around Wales to inform our response to the new curriculum. One of the comments that I think struck home most strongly with me was a young boy saying that, because the same teacher was responsible for pastoral and behaviour, because he had been labelled as naughty or a troublemaker, he felt uncomfortable in terms of going to that same person within the school in order to disclose the problems he was having, because there was a fear of not being believed or accepted, or it being considered as an excuse for poor behaviour, rather than them being taken seriously. I wouldn't want to over-egg that point, but I think it is an important consideration from a learners' perspective. 'If I disclose a problem, if I want to talk to somebody, are there appropriate considerations within the school setting where I can turn to somebody who maybe I might not have the greatest relationship with in other contexts?' I'd also just like to come back to the off-rolling question if I may, just quite briefly. As I said at the outset of the evidence here, Estyn conducted a piece of work on pupil registration practices that showed a substantially higher amount of off-rolling between year 10 and 11, but also a consistent level—1.5 per cent to 2 per cent—in other secondary school years. But we don't have the qualitative material to understand how much of that is related to mental health factors, and how much—because we're in discussion about school accountability—might drive some of that at year 10/11. But we don't know why that baseline of 500/600 young people every year is there within our schools. I think that needs further investigation.
Dawn Bowden AM: Okay. Thanks for that. Can I just ask you a couple of other questions about the impact of particular circumstances, and whether you've come across any issues relating to Welsh-medium provision to support the mental health and well-being of learners as an issue—that it's not been available, Welsh-medium support, for those learners? Have you come across that at all?
Dr Ian Johnson: We haven't necessarily come across it, but we haven't been looking for it either. The Estyn report notes that there are generally fewer off-rollings from Welsh-medium education to EOTAS. There are a number of potential reasons for that. That can include the complete lack of EOTAS provision within a local area. It could be the socio-economic profile, because exclusions, et cetera, are substantially higher amongst those who are eligible for free school meals, and in many parts of Wales the socio-economic profile of a Welsh-medium education school is slightly different. We are not aware of any particular work that's been done to examine the needs and the provision of Welsh-medium EOTAS. Therefore, my suspicion, without any particular evidence, would be that it happens on a local authority basis, possibly on an incidental basis, depending on the quality and the ability of staff, and possibly more prevalent therefore in west and north-west Wales.
Dawn Bowden AM: Okay. We can come back to that again, I'm sure. Do you know whether there's any impact on learners where there are actually delays in accessing EOTAS, again in terms of mental health conditions, if there's a delay in getting them to the appropriate provision? Have you got any evidence, anecdotal or otherwise, of the impact on that?
Sarah Stone: Not specifically researched on that situation. I think, again, there is so much that we don't actually know and that we should know a lot more about, but I think there are some things that we can say about delays for young people who are not either in education or in anything else, and they're connected with the issues anyway. So, if you understand that there's a strong link between inequality and exclusion, and that the most likely young people to be excluded have other disadvantages as well, that's a really important issue to understand. So, being out of school or out of education for any time is going to exacerbate those pre-existing inequalities, and I can't emphasis that enough. This is exacerbating this cycle of inequality and disadvantage. So, being outside your peer group makes you vulnerable. It makes you vulnerable, and I guess the longer that continues I would expect the worse that impact and that uncertainty would be. So, there's the impact on loneliness and young people seeking an alternative community to the school one. Since the publication of our report, we have had an extraordinary level of interest from people concerned about crime. So, we've talked to the youth justice board, we've met with the police, there's a huge level of concern about county lines and about home-growing drug gangs, and the fodder that those young people are for people who will engage them in all sorts of activities, which are hugely damaging both to themselves and also to the wider society. So, I think we need to understand there's a lot at stake here for wider society in holding young people, and not allowing gaps to grow where they are not held. I would just refer you to the child death review on suicide and suspected suicide by young people, which came out very recently from Public Health Wales and Swansea University, and that looked at 33 young people who died by suicide over the past few years. One thing that came through that and was reflected in one of their suggestions for action was that those young people had not been held in education or training or employment, had slipped through all sorts of systems, and were extremely vulnerable. So, I think that's a really big message: that we need to try to hold people and not allow those gaps—where they're not held within their society—to lengthen and become really, really difficult. So, I think that's my major message on that particular one.
Dawn Bowden AM: Can I just ask, as a follow on from that, whether you've got any views on the potential impact of individual tuition on learners' well-being? So, home tuition, for instance: are pupils going to be on their own doing that? That might be in their best interest, or do you have any concerns that it might not be?
Liz Williams: I suppose we don't have actual evidence to show the impact home schooling has on pupils, but what we do know and something that is of huge concern, I suppose, to most people is that there's no central data on how many young people are home schooled. So, it's quite likely that these children are hidden or invisible and could be at a huge risk of the adverse problems that are related to exclusion more generally. Also, it is a concern, if children aren't registered with any school, how they get back into school, how they reintroduce back into the schooling environment, if that's what people think is best for them. So, I think that is a concern: not having that transparency of data. And just to reiterate Sarah's point, I suppose, home schooling could tackle the more academic side of things, so it would mean that that child is still receiving an education, but it might not necessarily help with the adverse effects of exclusion, like loneliness and isolation. That child still isn't with its own peer group. That is something that came out of the men's research, as Sarah mentioned. These men, who are now middle aged and are at the highest risk of dying by suicide, weren't always interacting with children their own age, and that did cause problems in later life. So, I think it's definitely something we don't know enough about, but I think we need to know more about.
Dr Ian Johnson: There are two questions within there, regarding the delay in entering provision and the effect of long term individual teaching. I think there are occasions on which individual tuition will be beneficial, because there may be a reason why somebody is uncomfortable and unable to operate within an educational setting. However, it may be that, on a longer term basis, that is not entirely appropriate. But it's very much an individual matter. What concerns me, I think, is the idea of there being a gap between mainstream education and entering any form of EOTAS provision due to capacity or otherwise, because that is a period in time—. We don't know whether there's the causation of or exacerbation of mental health issues amongst those in EOTAS, but it's clear that—well, it seems intuitive that a gap between being in mainstream education and EOTAS is unhelpful, not least their rights to an education, but also the feelings that young people who are probably in quite a confused and troubled state may have during that gap and how long that gap can endure. I will refer back: there was a recommendation by Estyn in their 2016 report on EOTAS regarding CAMHS support for children within those settings, I don't know whether there's been any particular progress within that—and especially the mixture of issues that may be related to both mental health and also neurodevelopmental issues and whether those are more or less likely amongst this vulnerable part of the population.
Sarah Stone: Just to draw your attention to it, I think there's an acknowledgment that there's a lot we don't know about this. Again, in the loneliness and isolation strategy, there's a commitment to analyse existing education and health data to explore correlations between exclusions or being educated other than at school and mental well-being, including loneliness and isolation. So, I think that's a very welcome commitment to try to expand our understanding in this area, because there may be some pluses as well as minuses, but actually there is so much that we don't know about this.
Lynne Neagle AM: Thank you. We've got some questions now from Siân Gwenllian. I think some of them have been covered, but—
Sian Gwenllian AM: Just in general, once a young person or a child has been excluded, is there enough support for them, not just on the educational side, but in general? Are we supporting these young people, these most vulnerable young people, once they're in the position of having been excluded?
Dr Ian Johnson: I'd say that that's something that's possibly happening locally, but we don't have a national picture. One of the things we have already noted is the time between being excluded and entering some kind of EOTAS provision. So, that in itself—and I've heard people talking about the capacity issues—shows what's happening to these children, at a time when they are most vulnerable because they are outside of the system.
Sian Gwenllian AM: And who should be supporting them? Are we being clear enough with regard to who should be giving them the support? They've been excluded, so obviously the education system has a responsibility, but are we clear enough in terms of who else's responsibility this is, and who should be co-ordinating that support?
Dr Ian Johnson: The truth is, the responsibility lies on the local education authority in that context, I would say. The point is that, often, these children deal with several other institutions. So, it's incredibly important that any service is interweaved into that setting around the child or the children who are in this situation. More information is needed about this. When I was talking earlier about inclusive education, or some kind of investigation into this, that's the kind of thing I'd look at: how to bridge that gap and what kind of support will be available. I'm concerned, of course, in terms of education, whether there is enough funding available to ensure this. But because this is a very vulnerable group, we need to take responsibility in exactly the same way, perhaps, as corporate parenting plays a role there. We need to look at that kind of system, and how we help these individuals. I know there are figures available on local authorities, but I can't remember them off the top of my head, but maybe that's something to look at.
Liz Williams: And as Ian just said, although there's a lot of responsibility by the school and the local authority, I suppose some responsibility also sits with the parent as well. But for the parents to support their child, either if they're at risk of being excluded or if the child is already in EOTAS, and that parent wants to make sure that the child is having the best education possible, the parent has to have the right amount of information. They must know where to go for support themselves, and I think that a parent can't necessarily know the rights of their child to education and what their child is supposed to be having if they're not provided with all of the information. And I'm sure this is dependent on the school or dependent on the local authority, but that's something worth thinking about as well.
Lynne Neagle AM: Okay. Any other questions?
Sian Gwenllian AM: Well, unless you want to sum up—?
Dr Ian Johnson: Just a comment, really, on the new curriculum and ensuring that EOTAS provision includes this, and how the whole-school approach will work within EOTAS, and how we ensure that the provision is available through the medium of Welsh, as we were referring to earlier, on a national level. Is it possible that it can be worked out within the local consortia, for example? How do we ensure that the teachers—? If it's initial teacher training, or if they're newly qualified teachers, or if they're more experienced, how will this be implemented through the system? Because I think that children in EOTAS situations are usually more vulnerable than others, and therefore there is a need to prioritise their well-being and their mental health. We talk a lot about certificates and so forth, and qualifications, but ensuring everybody's well-being is important, and an important outcome of the work. So, we're thinking of this whole-school approach and how it works within the new curriculum, and this is a vital point for the years to come.
Lynne Neagle AM: Just before we finish, then, is there anything you wanted to add in terms of what the committee could recommend about professional development for staff that would enhance this provision in this area?
Liz Williams: Yes, absolutely. I think it's so important for teachers to be equipped with the training and to understand the link between inequality and all the things that come under that term, and challenging behaviour, and I think if teachers are aware of that, and trained properly to deal with that, the risk of exclusion will ultimately lessen. And I think with regard to how that can happen, I think, in some cases, mental health training and mental health awareness training is supplementary at times, with just teacher's training, but I think it should be embedded in the initial teacher's training, so that, more than anything, as well as being equipped with the skills, teachers have the confidence to deal with those really challenging situations.
Lynne Neagle AM: Okay, thank you. Ian?
Dr Ian Johnson: I think that's the importance of a whole-school approach, and that being statutory, because that will ensure that everybody within the school community has that knowledge and awareness and knows what to do and where to signpost people. It means foregrounding and having that in the heart of the school ethos, and I think that turning the school into somewhere that considers mental health and emotional well-being first, rather than waiting for a problem—I think that's the key to improving the well-being of our future generations.
Sarah Stone: I just think it would be great if the community would recognise the link between inequality, adverse childhood experiences, and the opportunity that there is in avoiding a young person falling out of school, and out of anything, and out of sight. So, I think, the other side of this is that this is a real moment of opportunity to intervene positively.