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Good evening, everyone, and welcome to this fourth in the series Good Lives seven else's series and one of nights the

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filthy weather mean astronomers can make it down from the world and people still coming in.

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So come in. Please welcome my name in Thompson and along with habitat that we are the eyes on the large excluded life project.

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And this series is a look at exclusion from a series of of of disciplinary lenses and delighted to have made it feasible.

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This man has been with but excluded last group for about four years.

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I would think for five almost I would think, says she's an associate professor in the Department of Psychiatry in Child and Adolescent Psychiatry.

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She is a researcher in a couple of very key areas in terms of the work that we're doing.

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First, I'm sure she'll talk about tonight. It's about school based mental health interventions should be work with the Oxford

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Health NHS Foundation Trust to develop sound bite notes a lot of you in this room.

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That's a joined up mental health services for all children across, particularly in secondary schools,

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etc. But she's also done a lot of work on refugee and mental health needs.

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And as you'll see from from there, she's also, amongst other things.

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She's also does clinical work as a child psychiatrist and Department of Children's

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Psychological Medicine at the Children's Hospital across the Boston University Hospital.

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So Mary is going to talk for around 40 minutes or so, and there'll be plenty of time for questions then of time to chat and have a drink at the end.

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Thank you. Thank you very much. Thank you for inviting me. I got to talk for four hours.

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So do stop me, do interrupt me as well because of it's wonderful to be here.

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Like as a child psychiatrist, basically, it's quite simple.

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It's all about mental illness and untreated mental illness exclusion, but I'll respect the other processes involved.

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Ever try and kind of make an argument for the perspective that I'm coming from.

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So I've got a background. As Ian said, in kind of vulnerable children, I'm really curious about how they access services,

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and I'm very interested in the school context as maybe a key location moving forward.

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So what I thought I do today is talk a little bit about adolescent development from a psychiatrist perspective,

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think about mental health of schoolchildren as we know it and then talk about exclusion,

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think about school based provision and then think about moving forward and a few musings along the way.

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So, so what happens in child and adolescent spoke quite a lot of kind of complicated tasks you have to learn.

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Obviously, education is a focus on that vehicle to regulate your behaviour.

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At the same time, you've got to control your emotions. You've got to work out what kind of friend you want to be to your peer group,

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and you have to position yourself in your family and become a useful part of that family.

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And you've also got to kind of do a lot of physical growth at the same time, you've got to work out your moral code.

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And at the end of this whole process, you need to become an individual. So like, it's a lot to ask in such a brief period of time.

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And I just there's I was just to say like, it's just sometimes can happen under quite a cloud.

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If I think about what I've done in the last 10 years compared to the growth that my children have gone through in that time,

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like it's incomparable, really. I've declined basically in that context.

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What else is happening today that I think we do need to think about and be aware of the difficulties of it?

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I think puberty is under some measures coming a bit earlier and puberty.

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This period of kind of significant pubertal growth is really a human phenomenon in other animals that go through it.

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Most animals go through linear growth. So something different happens at this time of immense physical change in humans.

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And I think that, you know, when we look upon transition change,

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we know that we're also exposed to more potential difficulties to disrupt normal development as well.

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So you have puberty, it's coming a bit earlier as a child psychiatrist,

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that means that there's a major disruption happening to brain development potentially happening early,

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exposing children's brains sooner to all these complexities than before,

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which can help potentially explain some of what we're seeing from a mental health perspective by increasing rates of prevalence,

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this kind of universal phenomenon. Of sleep disturbance. We've done a big study, and I was at a school today just looking at their sleep data,

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know the number of kids that are sleeping after 2:00 a.m. What shocked us all, really?

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You know, so there is it's not just all adults in society, but a lot of the young people as well,

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and that don't seem to be sleeping in the same manner that they used to.

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Interestingly, melatonin, which is a sleep induction hormone, is also an anti pubertal agent.

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So, you know, we can maybe understand a little bit of what's happening about early puberty,

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disrupted sleep, maybe having a closer relationship than we would know.

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There's indications of greater family discord alongside family isolation pressures to perform.

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I won't go on about this problem, I think. And then in the context of global austerity, which started around 2007.

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So a lot of indicators that we're interested in around harm, homicide, et cetera will start to increase from around 2007.

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And poverty and social economic deprivation, a major kind of contributors to mental health problems.

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And then that kind of aligns with this whole increase in social media as well,

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which, you know, has very good parts to it and has complicated parts as well.

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But for a young person with developmental difficulties, it might be an extra pressure that they have to navigate and work around.

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So what do we know is happening with the mental health of children in the UK?

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So we had a survey in 2017, so this was Tamsin Ford was one of the people involved in the seven.

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I mentioned her because she is the exclusive next man.

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I sent an email saying, I don't understand why it was told, because every single paper I'm reading, you've done so.

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She sent me some slides, so I'll let you know which lives are hers is.

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So anyway, she was involved in this repeat. So they did it in 2004 to 2007 and now in 2017.

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So what we see is that about twelve point nine percent of one in eight children in Britain have a diagnosable mental illness.

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And of those, about a quarter have a life limiting long term illness as well.

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So that's I work in the children's hospice. I'm very interested in that.

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The children with physical health problems, chronic health problems are disproportionately represented amongst this group.

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It's the first time that they looked at the very young and the very old,

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so under fives and 16 and 17 year olds in the survey, and the data shows that the the rates are increasing.

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So who's the worst group? I've already given a clue, but what do you think is the worst group amongst 16 year olds?

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What, what, what, what, what do they look like? Guests, all right, you don't need to know.

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Sorry. That's between two 17 year olds, which demographic allies have the worst mental health?

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Teachers can tell us what they're seeing in the classroom, but what do you what do we think? White or non-white?

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Sorry. No one.

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Why, why, because boys, it's like any other options, like, yeah,

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so what girls are by far and away the worst demographic we're seeing interesting amongst 16 17 year olds.

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So. So it's kind of as you enter school, you're doing all right and as you leave, you're really not.

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And why is kind of mental health important from a school context?

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Well, this is a really beautiful start, I think,

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to show the kind of emergence and peak and mental disorders during adolescence and basically like it's all happening around secondary school

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is really so we can't ignore the very close relationship between lifelong major mental health problems and the time that you have in school.

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So in particular, the mood disorders.

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So we know that seventy five percent of people who have a lifelong mood disorder will have started to have symptoms before the age of 15.

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Usually untreated, the anxiety disorders or significant so like, you know, that kind of key kind of 12 to 16 year age group is absolutely key.

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And this is just a slide about adolescence and depression just really showing how just the numbers are so high between the 15,

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16, 17 year olds in the US as well. And this comes from data in Gloucestershire just showing how kind of looking at self-harm, for example,

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which is in a more extreme presentation that what you see in the hospital is only the tip of an iceberg of kind of community prevalence.

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And so basically, there's a lot of mental health problems in the community.

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And what's the relationship with education of mental health?

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So we know that if you have a mental health problem, you are more likely to suffer educationally as a result of it.

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But we also know that if you have an educational difficulty, a specific learning difficulty,

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you are more likely to have secondary mental health problems. So this is a very, very close interrelationship between the two.

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So in a classroom of twenty five, fifty five, however,

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many students in the class one and five will experience a mental health problem a mild employment one in ten or a severe.

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But less than half of those who need it will get services, but they're probably causing a lot of disruption, some of them in the classroom.

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So let's move to what we know about exclusion and mental health exclusion from school.

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So from my perspective, and I realise I come from my kind of very limited mental health background when it comes to talking to people from education.

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So we think the most common reason this persistent disruptive behaviour that will lead to school exclusion seems to be more prevalent than boys.

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Some ethnic minorities, those that have free school meals, looked after children and those on special special educational needs and in America's

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clear evidence of disproportionate exclusion of vulnerable children in the school context.

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So what are the actual risk factors that the more kind of nuanced and kind of better quality studies have shown that there are kind of people factors,

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family factors in life put the rest and environmental factors. So if people factors social communication difficulties, poor social skills,

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low academic attainment, for example, lower key stage one right results in writing and reading.

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Are risk factors, fiscal exclusion from family factors that quite a lot actually so single parenthood,

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teenage mothers, low maternal education, maternal school exclusion as well,

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or strong risk factors for exclusion from school and environmental factors of high school morbidity,

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poor school climate measured on a whole range of factors and low socioeconomic status.

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So when you think about exclusion, mental health, well, is excluded,

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just a proxy for unmet mental health needs because all of those risk factors fall under those most at risk of serious mental health problems as well.

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So excludes experience by children with multiple vulnerabilities and exclusions

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highly relevant for broadening health and wellbeing and for education in a state.

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So if you've got special educational needs and you've got eight times the risk of being excluded from school, that's significant.

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And I that we really,

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really need to be thinking about what is going on in this context and if there's a way we can anticipate and understand the needs.

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So it's just the study by finishing last year. So she looked at, for example, poor school attendance and depression,

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and she looked at school attendance and a whole range of criteria for different got.

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One of those criteria were truant and unexplained absences, which obviously isn't exclusion.

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But you know, you can see those two and things are likely to be similar to those that might be excluded.

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And that said, that actually had increased rates of depression than those who were categorised as truant.

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And you know, with depression, you get social withdrawal, you get a loss of motivation, you get a low energy,

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you get sleep disturbance and a lot of kind of disruptions to your ability to function

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that can impact on the way that you then subsequently interact in the school environment.

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So there have been two very big systematic reviews on exclusion, mental illness, looking at it from both directions,

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really ones by park in 2015 and ones by where in 2013 they're both in Exeter working with terms and Ford at the time,

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and both concluded, There really is a real lack of high quality research, which is why this excluded lives project is so exciting and so important.

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So in one systematic review, there were only five studies in choosing the other.

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There were nine studies included, but what were we able to get from those that really ADHD increases the risk of likely exclusion.

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So that's no surprise, I suppose, those with impulsivity and overactivity and inattention.

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So, for example, ADHD 48 percent of those were excluded versus 17 percent with that.

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And that seemed to be quite a uni directional relationship. So if you've got ADHD, you're likely to get excluded.

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However, with depression, you get a more bidirectional relationship.

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So if you have a depression, you have double the risk of becoming excluded.

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But if you've got excluded, you also have an increased risk of later depression.

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So looking at epidemiological surveys similar to one that I told you about in 2017,

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from 2004 and 2007, we would have to look at a few interesting factors.

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So this is looking at the relationship, the mental health and exclusion,

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so these are kids that were excluded have the experience of exclusion of the 2004 and 2007 as the top line.

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So this is kind of parental classifications that child on the strengths and difficulties questionnaire.

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And this is they're tied to a school score that's a broad general measure of emotional and behavioural well-being.

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It's a very, very well used. Measure, so you've come across the statue quite a lot,

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so this kind of looks that kids have not been excluded both times and excluded both sides, but here you see, I think this is really interesting.

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So this is an exclusion in 2007, not in in 2004,

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when you see how the parents rate their children is experiencing more mental health problems at the second time point.

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And for those who experience exclusion at twenty four and not twenty seven,

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you see how their rates of mental health problems are being marked as lower.

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So this is just kind of explaining that so, you know, children excluding the school themselves,

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will have an increase odds of a new onset mental health condition 2007, and that was like an odds ratio of three point eighty seven.

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So you three point eight seven times more likely than you would have before.

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And children, school and school have elevated excuse to schools, according to their parents in 2007.

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So if you got excluded, your longer term mental health outcomes were worse.

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And this, I think, is really important. So this looks at kind of exclusion rates of exclusion with unrecognised versus those are recognised.

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So a large number of those getting excluded have an unrecognised mental health problem.

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And where is that unrecognised? Sort of. Interestingly, it's in the emotional sphere, so conduct problems is more the external thing.

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So I suppose you're more likely to notice in the conduct problems, and that's been the long term kind of problem with emotional disorders that,

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you know, if the child is more withdrawn, not engaging, they might not be disrupting the classroom too much.

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It might not necessarily come to the attention of services as quickly.

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But in this, you see that disproportionately being excluded,

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those with unrecognised emotional disorders from school, I think that's just really important to keep in mind.

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As I said, it's all about mental illness, is that Harry, have I convinced you that so is and these are the odds,

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according to the psychic soldiers of exclusion and psychosis in 2004,

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to be excluded in 2007 year double, we've got double the rate of the likelihood of being excluded if you have an unrecognised mental health problem.

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So that comes to my big passion, which is like, what can we do about this and how can we address it?

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So this just shows that kind of the type of professional service and contact policy here for five to 19 years of the disorder.

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So they kind of looked at all these children who had disorders and they said, who did you turn to for support?

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They asked the parents and almost 50 percent of first turning to teachers for support.

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So whether we like it or not, you know,

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I fully understand how overwhelmed teachers are with the academic and kind of all the other stuff that needs to be managed at school.

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But unfortunately, they've become a de facto mental health provider as well, because this is where parents turn to first.

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What do you think I should do? How can I get some help?

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And it might be the teachers, the only exceptional person for that parent to turn to, whether they should or shouldn't.

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This is about kind of who's, I suppose, most acceptable to them.

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So I think we just have this massive gap between those who have mental health problems and those who actually access services.

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The government says it's about 20 percent of people who have a diagnosable mental health problem.

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Children are actually accessing services, and the current goal for us to achieve by the end of the next five years is for thirty five percent

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of young people who have a diagnosable mental health problem to be accessing services like,

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I take major offence of that goal because we wouldn't be saying that for diabetes,

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we wouldn't think acceptable that thirty five percent of kids with diabetes with access services by the end of the next five years.

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For some reason, that seems to be tolerated in mental health homes.

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Yeah, the lifelong implications of untreated mental health problems is significant.

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And I would correlate with most chronic health conditions. So there's this major major problem, I think, with access.

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So I want you all to get out your phones if you have them, because I want to wake you up.

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No, they're not your seat, but if you've got your phone, I'm very grateful that you haven't been looking at it.

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I have it on. But if you now want to bring it out, I would like you to go onto your phones.

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The question I've got is what is the main reason why children who might need mental health services do not access them?

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OK, so I want to get your phone and I want you to go on Minar dot participle dot com.

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So I mean, that's why I didn't set up the name of this.

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It was just automatically allocated to the main adult participle P a r t i c i p double outcome.

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And I want you to say the main reason. It might be a combination of all of these,

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which is the kind of the one that's the most significant for you as to why don't children access mental health services?

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Is it because they don't realise they have a mental health problem? Is it because they don't know how to access mental health care?

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Is it because they're scared or fearful of mental health services? Is it because they don't like talking to strangers?

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Is it because they don't want their parents know? Is it that they don't want anyone at school to know?

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Obviously, it might be a whole range of other things, but I just want you of those six categories to.

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Place of votes, huh? It's all of them, but which one would you if you could address one of them?

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Just press, press a number. Have you had a chance?

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Nine of you. 10. It's going up. I'll give you another minute.

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All right. So we'll see what people voted and they will need another second.

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OK. Now, usually there.

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So most people, 36 percent think it's they don't realise they have a mental health problem.

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C is scared and fearful of mental health services. 14 percent to two people, each for one the president or anyone at school tonight.

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OK, thank you for voting. Keep your friends out because you might have to do it again. OK, so what are school based mental health services?

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Well, I it says such a big phrase.

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I think it's really important to think, what do we mean when I say a school based mental health defence?

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And I think the first thing we have to think about is who gives the intervention?

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Is it internal to the school or external to the school, for example?

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It appears, is it possible support services, teachers, counsellors, third sector organisations, these new education mental health practitioners?

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I'll tell you about all mental health services. So that's from internalises that when you think about mental health provision,

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schools first think who then I think when you want to give an intervention to whom do you want to do it?

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Do you want to do so for the whole school, for a classroom, for those at risk, for diagnosing pupils, for parents?

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And then what? What do you want to do? You know, do you want to give mindfulness or CBT or parenting skills or counselling or whatever?

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So like just to stop there, like the evidence base of what to do is just so poor.

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I can't I kind of can't believe it, given that every single person practically has gone to school.

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It's not as if we're limited with the kind of sample size here, but there are very, very few studies conducted.

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And then I think there's this whole thing called important,

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providing issues like hold of around consent confidentiality, the evidence base, which I brought into that.

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And then like, whose responsibility is it? Should education pay?

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Should health place education pays health page pay this case behalf that so it might be a bit more,

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but that because we can't agree, just sort of feels that you get stalled and kind of we don't move forward.

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And so what I've been involved with is big mental health services adults into our secondary schools,

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and these are just kind of highlights some of the other areas that we're working on in Oxford.

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So we've got kind of third sector provision going on and evaluating it.

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We've got school health nurses are not such as the only county in Britain that has kind of school have this with the public health agenda,

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including mental health, and that interventions to give schools to teachers.

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We've been looking at the evidence base for parents pensions. I'll tell you now it's pretty poor.

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And then we are looking at the evidence base kind of been looking at a whole range of different things, all of this going on in Oxford.

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So we do things of the whole school diagnosed pupils for parents.

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So all of this kind of research is going on. I'm doing a piece right now around responsibility.

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We're calling it the Wild West, the new Wild West mental health provision in schools, and I've also quite interested in the area of consent.

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So what types of interventions are there as well?

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So you've got to think of all of that and then you've got to think kind of promotion, which is kind of general wellbeing kind of types,

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interventions and anti-bullying programmes of all and the mental health promotion prevention and then treatment.

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So prevention is what everybody wants us to do, but nobody really knows how to do it treatment.

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I think we're pretty good at. So I'm a mental health professional. I treat major mental illness.

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I don't know how to prevent it, but I do know how to treat it once you got it.

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And this is what I've been involved in Oxford, kind of bringing mental health workers half a day a week into kind of specific schools because what

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we were finding is the schools were kind of interacting with services around individual cases,

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but there was never anyone really to consult the school about whole school. So we've been trying to bring that.

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So this is a scenario a 13 year old boy approached the teacher as he knows that

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there is a mental health worker at the school and asks if he can see them.

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The teacher asks the boy some questions that understand why he wants to be seen that the boy is not forthcoming,

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although no immediate risks are apparent. From her recent observations is not very different before those results were lower,

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expect to see scenes less engaged with peers and a bit irritable and to be seen as parents need to be informed as he's under 16.

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But he is adamant that he does not want his parents or anyone else's school to know.

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So back to your phones, can he see the mental health worker without his parents knowing?

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What do you think? Yes or no? Imagine you are this worker.

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What are you going to do? Back to my Magic 14 has ever voted.

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Most of you say, yes, I'm very happy. So I think the law is complicated.

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I don't think it is, and we're trying to clarify it, but quite a lot of services do insist on parental consent.

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But the law is not insisting on parental consent.

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If the child is competent, then actually asking for parental consent without the child then goes against their rights.

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So I'm doing a piece of work now to try and clarify that.

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So we've been able to run a big online people survey. Not that.

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So we had 4000 kids answer it last year and we asked them, Have you ever used child and Adolescent Mental Health Services or CAMHS, as we call it?

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And 14 percent said yes. So that is aligned with what we believe in lots of services and it's actually a high success rates of the country.

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And also so right now, if yes, we also a whole load of questions about how helpful the service was.

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It's not great, I think. So if no, we then ask them, do you think you could have benefited from using a mental health service?

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17 percent of those kids haven't seen CAMHS. So yes, they think they would have benefited.

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For those that say yes, we asked them, Why didn't you access care?

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And for those? That did I say on the next legs, I've broken that bit more and then that we've brought data from another region as well?

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And 44 percent of the kids? So it's five hundred and thirty six kids out of those four thousand five hundred forty one who answered that question.

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Forty four percent are saying they didn't want their parents to know. So this is a really important thing when we're thinking about young people and

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we're thinking that it's a normal part of development to become an individual,

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you know, so it might be enough that parents might be perfectly well functioning parents, which most adolescents think is poorly functioning anyway.

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But you know, it might not be that the parents are beating them up at home or abusing them.

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They will definitely be pushing for that success. But it's just normal to want to be bit private and not talk to people,

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because that's the whole point of adolescence is to make you an independent person.

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At the moment, you turn 18.

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So just understanding this development, we need to also find structures and systems to facilitate young people accessing care.

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If that proportion is telling us, I spoke to a group of school governors,

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all of whom are parents, and none of them thought parental consent was an issue.

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It's very, very complicated. The parent lobby, you know.

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So in America, parents have sued education boards for providing mental health care to their children without their knowledge.

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So this is a very, very complicated area. But I think if we have a kind of child perspective, if children are telling us this that clearly,

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you know, if you ask CAMHS, they'll say kids are saying it's because the waiting lists too long.

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Very, very few of the kids are saying that's the reason it's about seven percent.

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They didn't want their peers and those issues around stigma.

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They were allowed to take more than one box, which is why the percentages that add up that way.

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But really, there's didn't know who to ask and demand parents.

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And though I think from my perspective, other take her as what we need to work on.

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We asked about safety in schools. How safety feel. Have you ever been seriously bullied?

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Five point three percent A sign that being seriously bullied most days in such a.

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And so this kind of brings us to what's happening in terms right now, which is made only to look at the details.

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It's just to let you guys major what we're calling transformation of services and journalism, mental health services.

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And it's really quite interesting the way and excessive example. Over the last three years, services have completely changed.

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So we now have something called a single point of access where before a general practitioner used to refer to CAMHS,

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now anyone can find the spa as it's called the single point of access.

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So if you're a teacher, if you're a parent, if you're a child, if you're another health practitioner,

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if you're a social worker, if you're a neighbour, you can all call the single point of access.

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And that, I think, has been really, really interesting. So we're involved in a very big study evaluating cancer of what we've seen this.

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With these changes, there has been a significant increase in the number of people accessing care.

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Obviously, there hasn't been the same increase in provision. So obviously we've got improved access.

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But now a lot of people who are accessing care feeling like they're not receiving anything because the services are overwhelmed as a result.

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And then there's this whole green paper that people know about the green paper. So apologies if you do a massive change as well.

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Government is kind of bringing in school mental health, this mental health support teams or NHS tees as the schools are talking about them.

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And these comprise of school mental health leads in every school,

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and this whole new tranche of work is called Education Mental Health Practitioners, or MH PS.

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And these are being brought in to 20 sites across the UK and Oxford City is one of those sites.

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So people working lots of city schools as from a couple of months ago are getting a part time NHP coming into that school,

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who will be in a couple of weeks time to finish their course and will be fully embedded in the Oxford city system so

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that employed by health and such has been delivered by a third sector organisation and they're going into schools.

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So it's a massive change.

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And I went to a review meeting about this last week, and it is really interesting some of the innovations and the things that they're doing,

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they're only working with low level mental health problems. So it's a real preventive agenda.

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So a lot of schools are dealing with high complexity that the service isn't for them, but at least it's changing.

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And so we're trying to track it by asking to know who provides mental health support the school.

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So this was last year pre blazers. Seventy three, five percent do.

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Is it easy to access? Very difficult to. Very easy.

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If you had emotional difficulties, would you go to the mental health team at school? Only a third would so.

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So there's a lot to do to improve access and provision. So moving forward, I think that when it comes, this excluded children,

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we really need to be thinking about provision, we need to be thinking about mental illness,

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and we need to think about how to be making services more acceptable and accessible to children who are the most vulnerable.

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And this was published last year by Chris Bonnell and a few others, and they spoke about kind of a theory of school and adolescent health.

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So bringing kind of the understanding of school, adolescent health, and I kind of really like this model.

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So it's talking about a developmental need for greater autonomy during adolescence.

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You know, how I kind of how that interacts with peer group identities and the fact that, you know,

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basically what's happening to your brain during adolescence is that major changes is the next slide.

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No, I'll talk about it. I don't know where the slides gone. So basically in development,

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what happens to your brain is that major changes take place and and that becomes a primacy of the peer group over any other group.

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And so how your peer group in perceives you becomes far more important than any other group,

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and it's just that biologically programmed change, you know, so it's just going to happen.

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So when we're thinking about exclusion of children at school at the time,

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when their perception of how they feel they're perceived by others around them is the most acute, what kind of message are we giving when we exclude?

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And how does that impact on a child's self-esteem, their relationship with their peers, their relationship with their family and wider community?

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So we just have to be thinking about the importance of some of the messages we give kids where you get this kind of negative reactions over

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these positive reactions because the audience and the peers are such an important kind of role that the the kind of messages around exclusion,

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I think, are complicated because I've spent my first kind of 12 years, it feels like studying refugees.

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I thought I just read one account from a refugee, if you don't mind.

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He was excluded. He could so easily have been.

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So I just want to read that maybe I still want to read out loud to everyone.

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It's his voice. So don't worry about the grammar. Got up.

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That's nice. My how did I come out from that depression, and that's it.

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It was from the kids in the school, really from the kids, really. They helped me a lot.

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You know, I was struggling a lot. I didn't have a confidence with my English language.

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I would say to myself. It's still another years ago, and I'm going to speak, you know, pure English with the little kids.

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Really, some of them. They were really funny. I used to like them.

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They taught me to laugh, you know, and I remember my presentation was back in year 11.

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We were doing an activity ready. I told John how difficult it was, you know, because year nine and 10, I didn't see him.

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And you're 11. I'm going to do a presentation in front of 400 people. I got on the stage.

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I was really, really terrified. What was going through my mind?

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I was saying everyone, every single person sitting in front of me knows that I'm scared and that's why I'm sweating, because I am sweating.

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I was like, I'm sweating. Bloody [INAUDIBLE], you know that it's just, you know, I'm going to, I'm going downhill.

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And how the words came out from my mouth. You know how I said it and how I made everyone, everyone laughing.

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You know, it was just remarkable. And afterwards, everyone else in my presentation, everyone came.

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It was fantastic, really. We had awesome.

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We had two minutes to prepare. I didn't know it just came out. Really was a miracle.

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I don't know. They came through and people are tapping on my shoulder. They say I thought it was good.

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No one spoke about my sweating. No one said, You sweating.

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You were fouled or anything ready. Well, they said your presentation was good.

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You made it. You made us laugh. You broke the ice. And I was like, Seriously, did I do that, Rudy?

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Which was like, unbelievable. It was that time. That was the time I started to speak about it.

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You know, that's the time after this. That was absolutely the motivation.

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The kids, you know, the kids really, really just helped me a lot.

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They just said, Ali, you did well, you really did well.

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So the reason I thought I wanted to share this with you is because this is quite interesting young boy who was really struggling.

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He was really angry. He remembers himself as being anxious. He was not engaged with any who's getting into fights,

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and his school was asking him regularly to go and see a specific therapist who had been employed as part of the refugee mental health project.

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So there was. And he would say no, and he would say no, and he would refuse and he'd get more angry.

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And then he describes this interesting experience of school where he was given

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two minutes warning to give a presentation in the assembly that thank God,

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went well. And he felt accepted and included by his peers.

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And he says that was what enabled him to make the step to get therapeutic support.

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So, you know, I just think we need to think about the, you know, it's like not really rocket science.

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Every kid wants to be accepted by their peers. No one really doesn't want to be.

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And so the guys decide to phrase this as adolescence as a quest of belonging.

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You know, these are the brain changes that take place during adolescence is putting the primacy of peers there,

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and school belonging is such a strong, positive mental health factor for well-being.

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So feeling of belonging in school, feeling kind of belonging with adolescence.

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And so what is kind of exclusion saying at that time?

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And so this advice published a study about the kind of a massive package for mental health support at schools.

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And I won't go through the details of it, but what I like about it is really models what a mental health intervention in schools looks like,

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and it doesn't say you have to do this one thing.

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It's about integrating a whole number of process at many levels of schools, identifying the needs of teachers, parents,

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students and the whole school community in a way that kind of thinks about what is needed to engage families,

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engage students, engage teachers in a system that will be to the benefit of young people at the school.

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So kind of bringing modular Evidence-Based practise in a whole kind of implementation programme and I think is a good example

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of how we need to be thinking and moving forward when we think about what is needed by the most vulnerable kids in schools.

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So in conclusion, like I also just said and I had to really think about the fact that,

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you know, because I've got a daughter who is a criminal barrister,

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she's like, Well, if a kid stabs someone three times in a week, they're going to have to get excluded.

381
00:39:51,630 --> 00:39:58,640
So I was like, I get it. That needs to be a balance of reward and punishment in schools like you can't you can't just sit there and say,

382
00:39:58,640 --> 00:40:07,790
you know, you're never allowed to do this terrible thing. There must be a reason why around the world exclusion has been used as a disciplinary tool.

383
00:40:07,790 --> 00:40:12,510
But is it wisely applied? Does it serve a useful purpose?

384
00:40:12,510 --> 00:40:15,470
And I do actually think before we can answer that question,

385
00:40:15,470 --> 00:40:20,390
we first need to have a range of services on offer to support the most vulnerable families.

386
00:40:20,390 --> 00:40:23,240
And that means through parenting, it means through, you know,

387
00:40:23,240 --> 00:40:29,540
any children at risk of exclusion to have that holistic assessment, see if there's any undiagnosed.

388
00:40:29,540 --> 00:40:38,380
Difficulties or mental health difficulties, they then need to access interventions that could help them and has to be within the community support,

389
00:40:38,380 --> 00:40:42,430
and I spend quite a lot of time talking to some secondary schools now saying, Look, you know,

390
00:40:42,430 --> 00:40:47,860
society's just changed so much that there's no real institution for anyone to turn to.

391
00:40:47,860 --> 00:40:55,780
They used to be churches or in other bodies. Right now, there's nothing similar to community structures of a different.

392
00:40:55,780 --> 00:40:59,710
People aren't necessarily as engaged in their social community.

393
00:40:59,710 --> 00:41:02,390
That was all that's left, I think, as schools.

394
00:41:02,390 --> 00:41:10,810
So whether you like it or not, as a school, you have a really essential role to play in the broader community for families as well.

395
00:41:10,810 --> 00:41:16,090
I think we do need to provide targeted I'm not really a universal intervention that person.

396
00:41:16,090 --> 00:41:22,390
I'm really I believe we've got a target what we do to those with known vulnerabilities and risk factors,

397
00:41:22,390 --> 00:41:27,910
those of experience, family discord for a whole range of with separation, substance misuse, incarceration.

398
00:41:27,910 --> 00:41:35,440
Those have been the victims of abuse and bullying those with health problems of those with parents,

399
00:41:35,440 --> 00:41:37,930
mental health problems, those they've had early puberty.

400
00:41:37,930 --> 00:41:42,970
Those are self-harming, migrant displaced populations, of course, those with learning difficulties.

401
00:41:42,970 --> 00:41:47,770
So schools are really important from a child and adolescent psychiatrist perspective.

402
00:41:47,770 --> 00:41:54,520
They can democratise access to care, and it's a potential way to identify and refer to clinical services.

403
00:41:54,520 --> 00:41:58,510
And I think we have to think of whatever we do as part of a system of care,

404
00:41:58,510 --> 00:42:04,840
look after teachers as well, think about promotion of vulnerable groups and early referral to services.

405
00:42:04,840 --> 00:42:11,110
So special thank you to tens of thousands of other people who have really done most of this and helped me a lot.

406
00:42:11,110 --> 00:42:20,480
So thank you for your time.