The code says: “These may include becoming withdrawn or isolated, as well as displaying challenging, disruptive or disturbing behaviour. These behaviours may reflect underlying mental health difficulties such as anxiety or depression, self-harming, substance misuse, eating disorders or physical symptoms that are medically unexplained. Other children and young people may have disorders such as attention deficit disorder, attention deficit hyperactive disorder or attachment disorder.”
Prevalence and impact
The Department for Education collects data annually on the number of school pupils with SEMH needs through its SEN in England statistics. The most recent statistics shows that in 2021/22 there were more than 250,000 pupils with an identified SEMH need in England, the majority in receipt of SEN Support from schools. The numbers have risen in the past year – SEMH needs are now the second most common category of SEND pupils accounting for more than one in six of the total (see graphics).
The figures also show that the proportion of children identified with SEMH needs rises as they progress through their education, with more than one in five of all SEN pupils at the age of 14 in the SEMH category compared with 12 per cent for children aged four. Despite efforts to identify SEMH problems early, the figures indicate a sizeable number of children start school with undiagnosed needs that can harm their personal and social development and educational progress at primary stage.
“Research has shown that children who have not met the expected level on half of their early learning goals through to the end of primary were not doing as well as their peers in both education and social outcomes,” a report on the SEND system by the Office of the Children’s Commissioner for England states. “The government needs to provide appropriate training for the early years workforce so that they can better identify and manage SEND.”
The DfE data does not separate out types of SEMH need so it is unclear if certain conditions are more prevalent than others. However, a number of studies over the past two years have shown the negative impact the pandemic has had on children’s mental wellbeing with around one in six under-18s now thought to have a mental health problem, up from one in nine pre-2020.
Diagnosable mental health disorders include depression, anxiety, psychosis, schizophrenia and eating disorders. Mental health difficulties may also be related to drug and substance misuse.
Other forms of SEMH include attention deficit hyperactivity disorder (ADHD) – a lifelong neurodevelopmental condition which affects mainly boys and creates difficulties in regulating emotions, organising and planning – and attention deficit disorder (ADD), which if not diagnosed early can lead to coping problems and depression, particularly in girls.
Attachment disorders and issues may also develop if a child experiences negative or disrupted interactions or bonding with caregivers in their early life; it is common among children who are in care or who have been adopted from care, and its effects are lifelong and can be severe. Children may find it extremely difficult to make and maintain positive relationships, they lack basic trust and have little understanding of “unacceptable” behaviour.
Many SEMH conditions present as co-morbid with other conditions including autism and speech and language delays. This can make identifying a child’s primary need a complex process. For example, a young child with speech, language and communication needs will find it difficult to make themselves understood which can lead to frustration and disruptive behaviour. At the same time, they are likely to have difficulty with early literacy development which may be identified as their main need in primary school but by the time they start secondary school, their frustration and possibly aggressive behaviour may have become their primary need.
The variety of needs, changing nature of them and behaviour regulation issues mean SEMH children are at greater risk of exclusion from school and struggle in mainstream education. DfE data from before the pandemic shows that in 2019, nearly half of all exclusions were of children with SEN and it is estimated that around 60 per cent of these involved pupils with SEMH needs. In state funded alternative provision settings, four out of five students had a SEN and of this group 80 per cent were identified as having SEMH needs.
Government data indicates that SEMH needs are more prevalent among children from disadvantaged backgrounds: 40 per cent of pupils with an education, health and care plan (EHCP) are eligible for free school meals compared with 22.5 per cent for all pupils.
Interventions and reforms
Supporting students with SEMH needs is challenging. Despite increased awareness of mental wellbeing in schools, better training for teachers on the issue and the development of classroom-based support programmes delivered by charities and community mental health teams, access to the kinds of support some students need is restricted both by overwhelming demand and funding cuts. Higher tier services have had to raise the severity of cases to be accepted in order to prioritise those with the highest level of need. This leaves a large section of the school population with serious (but less severe) mental health issues that struggle to get the support that is needed (see ADCS view).
There is a range of SEMH interventions pastoral staff can put into place that require a low level of funding. In-school counsellors, nurture groups, mindfulness sessions and quiet rooms are some of the measures used in mainstream education settings.
In some schools there are specialist units for pupils with SEND – there are more than 1,100 with “resourced provision” and 377 settings with an SEN unit. To ensure resources go further, some local authorities, such as Birmingham, have supported groups of schools to pool resources to deliver a specialist SEMH support offer for pupils and their families (see practice example).
For children struggling in mainstream settings there are more than 1,500 special schools in England, some with residential placements. These cater for children with specific conditions, including SEMH needs. They can be run by the state or independent sector, from which councils buy places for children in their area.
In 2022, the government published two key papers setting out plans to reform the SEND system and schools. The SEND Review highlighted significant challenges facing the SEND system including rising demand, deteriorating standards and falling trust among parents. This prompted a green paper containing a raft of measures designed to improve the processes that shape standards of care and support.
These included:
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The creation of new national standards across education, health and care services including a national framework for councils for banding and tariffs of high needs.
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A legal duty on councils to introduce “local inclusion plans” across early years, schools and post-16 education with health and care services – supported by the creation of a “local inclusion dashboard” which will set out the role and responsibilities of partners offering provision for children and young people with SEND aged 0 to 25.
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An updated Local Area SEND Inspection Framework from Ofsted and the Care Quality Commission that will be used to hold local authorities to account over failures to create inclusion plans.
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Education, health and care plans (EHCPs) will be moved online and parents will be given access to a list of appropriate placements tailored to their child’s needs.
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Plans to “streamline” the redress process which will mean tribunals will only be used for “the most challenging cases”.
The green paper also set out plans to train thousands of additional early years practitioners as Level 3 SEN co-ordinators (Senco) to ensure children with SEMH needs are identified before they reach school age so that support can be put in place earlier.
The children’s commissioner for England in her report on SEND services backed the move to train more early years practitioners. “Improved provision at an early age can ensure that young people with SEND do not see their needs deteriorate,” her recent report states.
“The system must ensure that as the number of young people requiring SEND support or an EHCP continues to grow, that money and expertise does not get pulled away from early intervention support, especially in mainstream settings.”
Meanwhile, the schools white paper sets out an ambition for all children “to be taught in a calm, orderly, safe and supportive school” and for more pupils to remain in mainstream settings. Specific measures in the white paper include requiring every school to join an academy trust group, including special schools and alternative provision. It also sets out how academy trusts can deliver high quality and inclusive education.
The SEND and school reforms offer the hope of creating an education system that identifies pupils’ complex learning needs earlier and is more proactive in putting support in place so that more children don’t have to wait until they leave mainstream education to get the help they need.
ADCS view: The Right support can reduce SEMH needs
Steve Crocker, president 2022/23, Association of Directors of Children’s Services
The 2014 SEND (special educational needs and disabilities) reforms were ambitious, rightly raising expectations and extended entitlements to support for children from birth up to 25 years, but for myriad reasons, they have not delivered the intended outcomes.
The Department for Education has been consulting on the proposals outlined in the SEND and Alternative Provision Green Paper. It’s clear the current system is not working for children or their families, schools and local government, and that we need to work together, in partnership with parents, to ensure that the new SEND system does.
Since 2014, there’s been a near doubling of children with identified special educational needs and recent estimates suggest high needs budget deficits could reach £3.6bn by March 2025. Despite a recent injection of funding, the green paper did not acknowledge that costs are baked into the system for years to come, quite possibly until all children currently in the system reach 25 years old.
The number who have social, emotional and mental health (SEMH) as their primary need for an education, health and care plans (EHCP) has increased significantly and we have seen a drastic increase in the number of children who require mental health support too. NHS Digital figures show that one in six children had a probable mental health disorder in 2021, before we even consider the impacts of the pandemic. We need to reflect on why these numbers are rising and ask what this says about society.
The SEND system is based on a medical model of disability, one that assesses and identifies the needs of children but then remain relatively fixed. It’s not clear to me that this is the right model; within any reforms that are to come, we need to support a shift in the system so the underpinning principles are around a proportionate and dynamic response. SEMH and speech, language and communication categories of special needs are, by definition, mutable and improvable for many children especially where we can bring the right support and interventions around the child and family at the earliest possible stage.
We should be paying serious attention to the context and environment in which our children are growing up. How society’s norms and cultures heap expectations on children to succeed, the impact of inequalities and the creeping sense of doom from pandemics, climate crises, war, the cost of living and more. We need to think about how we help our children to thrive in difficult and anxious times while not being too quick to give them a label that will stick with them and may not always be the best way to support them in the long term. As we work alongside the government and others towards a better SEND system for children this is food for thought.
Spotlight on SEND reforms: A special school leader's view
Kay Jones, managing director and co-founder, Bettws Lifehouse
I read with interest the government’s promise to develop an inclusive system to ensure children and young people have timely access to specialist services and support – including specialist placements where appropriate.
One part of the promise really jumped out at me and is something that is crucial to ensuring children’s development as we move forward.
The government has promised that a child’s needs will be identified and met at every stage of their journey through education. At every stage.
This will indeed be such a welcome outcome for so many of the families we meet at Bettws Lifehouse. Our independent special school is designed to meet the needs of children with a range of social and emotional needs, moderate learning difficulties or on the autism spectrum, from the age of five right up until 18 years old.
Specialised support
Far too often children are signposted to our specialised setting having had to experience a succession of failed placements in schools where they have been “shoehorned in” despite reports clearly outlining the degree of specialised support they will need.
In the long term, this means the repair is extended beyond what might have been the case if an earlier understanding of the complexity of the issue had been taken into account. It is one reason why I truly hope the government comes good on this promise.
The Covid-19 pandemic has had a more far-reaching effect on vulnerable children’s mental health and anxiety levels than we first predicted.
Honest and timely acceptance of this will be crucial to establishing some positive pathways for those currently trapped by their fears.
It is only now that we begin to understand the long-term damage lockdowns did to children and families’ mental health. Many children experienced trauma in their home settings as domestic violence incidents increased significantly and the nature of that abuse was sustained over the periods of lockdown rather than, perhaps, a more isolated incident. Post-traumatic stress disorder is a reality not only for the direct victim but for children as witnesses. Provision for Key Stage 1 emotional specialist support in education is an emerging need and one that we are aware of within our school referrals.
Adequate funding
Without adequate funding into all supporting professions such as child mental health and early help services, mainstream schools alone are not in a position to manage the tidal wave of need to support socially and emotionally disabled children.
It is imperative that caseworkers within a local authority are empowered by management to make the right decisions to identify the correct support and that finance panels then meet frequently enough to pass these decisions with minimum delay.
Early and sufficient support can change a trajectory and have a lifelong positive impact. Delay in spending to save money is so often a false economy.
The reform seems to have the right fundamental aims, I now hope that translates into real help rather than lip service.
Bettws Lifehouse has run independent special schools in England and Wales since 2007
Further reading:
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Beyond the Labels, Children’s commissioner for England, November 2022
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SEND Review: Right support, Right place, right time, DfE, March 2022
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Schools white paper: Opportunity for All, DfE, March 2022
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SEND Code of Practice, DfE, June 2014
