Good evening, everyone, and welcome to this fourth in the series Good Lives seven else's series and one of nights the
filthy weather mean astronomers can make it down from the world and people still coming in.
So come in. Please welcome my name in Thompson and along with habitat that we are the eyes on the large excluded life project.
And this series is a look at exclusion from a series of of of disciplinary lenses and delighted to have made it feasible.
This man has been with but excluded last group for about four years.
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.
She is a researcher in a couple of very key areas in terms of the work that we're doing.
First, I'm sure she'll talk about tonight. It's about school based mental health interventions should be work with the Oxford
Health NHS Foundation Trust to develop sound bite notes a lot of you in this room.
That's a joined up mental health services for all children across, particularly in secondary schools,
etc. But she's also done a lot of work on refugee and mental health needs.
And as you'll see from from there, she's also, amongst other things.
She's also does clinical work as a child psychiatrist and Department of Children's
Psychological Medicine at the Children's Hospital across the Boston University Hospital.
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.
Thank you. Thank you very much. Thank you for inviting me. I got to talk for four hours.
So do stop me, do interrupt me as well because of it's wonderful to be here.
Like as a child psychiatrist, basically, it's quite simple.
It's all about mental illness and untreated mental illness exclusion, but I'll respect the other processes involved.
Ever try and kind of make an argument for the perspective that I'm coming from.
So I've got a background. As Ian said, in kind of vulnerable children, I'm really curious about how they access services,
and I'm very interested in the school context as maybe a key location moving forward.
So what I thought I do today is talk a little bit about adolescent development from a psychiatrist perspective,
think about mental health of schoolchildren as we know it and then talk about exclusion,
think about school based provision and then think about moving forward and a few musings along the way.
So, so what happens in child and adolescent spoke quite a lot of kind of complicated tasks you have to learn.
Obviously, education is a focus on that vehicle to regulate your behaviour.
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,
and you have to position yourself in your family and become a useful part of that family.
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.
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.
And I just there's I was just to say like, it's just sometimes can happen under quite a cloud.
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,
like it's incomparable, really. I've declined basically in that context.
What else is happening today that I think we do need to think about and be aware of the difficulties of it?
I think puberty is under some measures coming a bit earlier and puberty.
This period of kind of significant pubertal growth is really a human phenomenon in other animals that go through it.
Most animals go through linear growth. So something different happens at this time of immense physical change in humans.
And I think that, you know, when we look upon transition change,
we know that we're also exposed to more potential difficulties to disrupt normal development as well.
So you have puberty, it's coming a bit earlier as a child psychiatrist,
that means that there's a major disruption happening to brain development potentially happening early,
exposing children's brains sooner to all these complexities than before,
which can help potentially explain some of what we're seeing from a mental health perspective by increasing rates of prevalence,
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,
know the number of kids that are sleeping after 2:00 a.m. What shocked us all, really?
You know, so there is it's not just all adults in society, but a lot of the young people as well,
and that don't seem to be sleeping in the same manner that they used to.
Interestingly, melatonin, which is a sleep induction hormone, is also an anti pubertal agent.
So, you know, we can maybe understand a little bit of what's happening about early puberty,
disrupted sleep, maybe having a closer relationship than we would know.
There's indications of greater family discord alongside family isolation pressures to perform.
I won't go on about this problem, I think. And then in the context of global austerity, which started around 2007.
So a lot of indicators that we're interested in around harm, homicide, et cetera will start to increase from around 2007.
And poverty and social economic deprivation, a major kind of contributors to mental health problems.
And then that kind of aligns with this whole increase in social media as well,
which, you know, has very good parts to it and has complicated parts as well.
But for a young person with developmental difficulties, it might be an extra pressure that they have to navigate and work around.
So what do we know is happening with the mental health of children in the UK?
So we had a survey in 2017, so this was Tamsin Ford was one of the people involved in the seven.
I mentioned her because she is the exclusive next man.
I sent an email saying, I don't understand why it was told, because every single paper I'm reading, you've done so.
She sent me some slides, so I'll let you know which lives are hers is.
So anyway, she was involved in this repeat. So they did it in 2004 to 2007 and now in 2017.
So what we see is that about twelve point nine percent of one in eight children in Britain have a diagnosable mental illness.
And of those, about a quarter have a life limiting long term illness as well.
So that's I work in the children's hospice. I'm very interested in that.
The children with physical health problems, chronic health problems are disproportionately represented amongst this group.
It's the first time that they looked at the very young and the very old,
so under fives and 16 and 17 year olds in the survey, and the data shows that the the rates are increasing.
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?
What, what, what, what, what do they look like? Guests, all right, you don't need to know.
Sorry. That's between two 17 year olds, which demographic allies have the worst mental health?
Teachers can tell us what they're seeing in the classroom, but what do you what do we think? White or non-white?
Sorry. No one.
Why, why, because boys, it's like any other options, like, yeah,
so what girls are by far and away the worst demographic we're seeing interesting amongst 16 17 year olds.
So. So it's kind of as you enter school, you're doing all right and as you leave, you're really not.
And why is kind of mental health important from a school context?
Well, this is a really beautiful start, I think,
to show the kind of emergence and peak and mental disorders during adolescence and basically like it's all happening around secondary school
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.
So in particular, the mood disorders.
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.
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.
And this is just a slide about adolescence and depression just really showing how just the numbers are so high between the 15,
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,
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.
And so basically, there's a lot of mental health problems in the community.
And what's the relationship with education of mental health?
So we know that if you have a mental health problem, you are more likely to suffer educationally as a result of it.
But we also know that if you have an educational difficulty, a specific learning difficulty,
you are more likely to have secondary mental health problems. So this is a very, very close interrelationship between the two.
So in a classroom of twenty five, fifty five, however,
many students in the class one and five will experience a mental health problem a mild employment one in ten or a severe.
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.
So let's move to what we know about exclusion and mental health exclusion from school.
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.
So we think the most common reason this persistent disruptive behaviour that will lead to school exclusion seems to be more prevalent than boys.
Some ethnic minorities, those that have free school meals, looked after children and those on special special educational needs and in America's
clear evidence of disproportionate exclusion of vulnerable children in the school context.
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,
family factors in life put the rest and environmental factors. So if people factors social communication difficulties, poor social skills,
low academic attainment, for example, lower key stage one right results in writing and reading.
Are risk factors, fiscal exclusion from family factors that quite a lot actually so single parenthood,
teenage mothers, low maternal education, maternal school exclusion as well,
or strong risk factors for exclusion from school and environmental factors of high school morbidity,
poor school climate measured on a whole range of factors and low socioeconomic status.
So when you think about exclusion, mental health, well, is excluded,
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.
So excludes experience by children with multiple vulnerabilities and exclusions
highly relevant for broadening health and wellbeing and for education in a state.
So if you've got special educational needs and you've got eight times the risk of being excluded from school, that's significant.
And I that we really,
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.
So it's just the study by finishing last year. So she looked at, for example, poor school attendance and depression,
and she looked at school attendance and a whole range of criteria for different got.
One of those criteria were truant and unexplained absences, which obviously isn't exclusion.
But you know, you can see those two and things are likely to be similar to those that might be excluded.
And that said, that actually had increased rates of depression than those who were categorised as truant.
And you know, with depression, you get social withdrawal, you get a loss of motivation, you get a low energy,
you get sleep disturbance and a lot of kind of disruptions to your ability to function
that can impact on the way that you then subsequently interact in the school environment.
So there have been two very big systematic reviews on exclusion, mental illness, looking at it from both directions,
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,
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.
So in one systematic review, there were only five studies in choosing the other.
There were nine studies included, but what were we able to get from those that really ADHD increases the risk of likely exclusion.
So that's no surprise, I suppose, those with impulsivity and overactivity and inattention.
So, for example, ADHD 48 percent of those were excluded versus 17 percent with that.
And that seemed to be quite a uni directional relationship. So if you've got ADHD, you're likely to get excluded.
However, with depression, you get a more bidirectional relationship.
So if you have a depression, you have double the risk of becoming excluded.
But if you've got excluded, you also have an increased risk of later depression.
So looking at epidemiological surveys similar to one that I told you about in 2017,
from 2004 and 2007, we would have to look at a few interesting factors.
So this is looking at the relationship, the mental health and exclusion,
so these are kids that were excluded have the experience of exclusion of the 2004 and 2007 as the top line.
So this is kind of parental classifications that child on the strengths and difficulties questionnaire.
And this is they're tied to a school score that's a broad general measure of emotional and behavioural well-being.
It's a very, very well used. Measure, so you've come across the statue quite a lot,
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.
So this is an exclusion in 2007, not in in 2004,
when you see how the parents rate their children is experiencing more mental health problems at the second time point.
And for those who experience exclusion at twenty four and not twenty seven,
you see how their rates of mental health problems are being marked as lower.
So this is just kind of explaining that so, you know, children excluding the school themselves,
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.
So you three point eight seven times more likely than you would have before.
And children, school and school have elevated excuse to schools, according to their parents in 2007.
So if you got excluded, your longer term mental health outcomes were worse.
And this, I think, is really important. So this looks at kind of exclusion rates of exclusion with unrecognised versus those are recognised.
So a large number of those getting excluded have an unrecognised mental health problem.
And where is that unrecognised? Sort of. Interestingly, it's in the emotional sphere, so conduct problems is more the external thing.
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,
you know, if the child is more withdrawn, not engaging, they might not be disrupting the classroom too much.
It might not necessarily come to the attention of services as quickly.
But in this, you see that disproportionately being excluded,
those with unrecognised emotional disorders from school, I think that's just really important to keep in mind.
As I said, it's all about mental illness, is that Harry, have I convinced you that so is and these are the odds,
according to the psychic soldiers of exclusion and psychosis in 2004,
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.
So that comes to my big passion, which is like, what can we do about this and how can we address it?
So this just shows that kind of the type of professional service and contact policy here for five to 19 years of the disorder.
So they kind of looked at all these children who had disorders and they said, who did you turn to for support?
They asked the parents and almost 50 percent of first turning to teachers for support.
So whether we like it or not, you know,
I fully understand how overwhelmed teachers are with the academic and kind of all the other stuff that needs to be managed at school.
But unfortunately, they've become a de facto mental health provider as well, because this is where parents turn to first.
What do you think I should do? How can I get some help?
And it might be the teachers, the only exceptional person for that parent to turn to, whether they should or shouldn't.
This is about kind of who's, I suppose, most acceptable to them.
So I think we just have this massive gap between those who have mental health problems and those who actually access services.
The government says it's about 20 percent of people who have a diagnosable mental health problem.
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
of young people who have a diagnosable mental health problem to be accessing services like,
I take major offence of that goal because we wouldn't be saying that for diabetes,
we wouldn't think acceptable that thirty five percent of kids with diabetes with access services by the end of the next five years.
For some reason, that seems to be tolerated in mental health homes.
Yeah, the lifelong implications of untreated mental health problems is significant.
And I would correlate with most chronic health conditions. So there's this major major problem, I think, with access.
So I want you all to get out your phones if you have them, because I want to wake you up.
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.
I have it on. But if you now want to bring it out, I would like you to go onto your phones.
The question I've got is what is the main reason why children who might need mental health services do not access them?
OK, so I want to get your phone and I want you to go on Minar dot participle dot com.
So I mean, that's why I didn't set up the name of this.
It was just automatically allocated to the main adult participle P a r t i c i p double outcome.
And I want you to say the main reason. It might be a combination of all of these,
which is the kind of the one that's the most significant for you as to why don't children access mental health services?
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?
Is it because they're scared or fearful of mental health services? Is it because they don't like talking to strangers?
Is it because they don't want their parents know? Is it that they don't want anyone at school to know?
Obviously, it might be a whole range of other things, but I just want you of those six categories to.
Place of votes, huh? It's all of them, but which one would you if you could address one of them?
Just press, press a number. Have you had a chance?
Nine of you. 10. It's going up. I'll give you another minute.
All right. So we'll see what people voted and they will need another second.
OK. Now, usually there.
So most people, 36 percent think it's they don't realise they have a mental health problem.
C is scared and fearful of mental health services. 14 percent to two people, each for one the president or anyone at school tonight.
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?
Well, I it says such a big phrase.
I think it's really important to think, what do we mean when I say a school based mental health defence?
And I think the first thing we have to think about is who gives the intervention?
Is it internal to the school or external to the school, for example?
It appears, is it possible support services, teachers, counsellors, third sector organisations, these new education mental health practitioners?
I'll tell you about all mental health services. So that's from internalises that when you think about mental health provision,
schools first think who then I think when you want to give an intervention to whom do you want to do it?
Do you want to do so for the whole school, for a classroom, for those at risk, for diagnosing pupils, for parents?
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?
So like just to stop there, like the evidence base of what to do is just so poor.
I can't I kind of can't believe it, given that every single person practically has gone to school.
It's not as if we're limited with the kind of sample size here, but there are very, very few studies conducted.
And then I think there's this whole thing called important,
providing issues like hold of around consent confidentiality, the evidence base, which I brought into that.
And then like, whose responsibility is it? Should education pay?
Should health place education pays health page pay this case behalf that so it might be a bit more,
but that because we can't agree, just sort of feels that you get stalled and kind of we don't move forward.
And so what I've been involved with is big mental health services adults into our secondary schools,
and these are just kind of highlights some of the other areas that we're working on in Oxford.
So we've got kind of third sector provision going on and evaluating it.
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,
including mental health, and that interventions to give schools to teachers.
We've been looking at the evidence base for parents pensions. I'll tell you now it's pretty poor.
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.
So we do things of the whole school diagnosed pupils for parents.
So all of this kind of research is going on. I'm doing a piece right now around responsibility.
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.
So what types of interventions are there as well?
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,
interventions and anti-bullying programmes of all and the mental health promotion prevention and then treatment.
So prevention is what everybody wants us to do, but nobody really knows how to do it treatment.
I think we're pretty good at. So I'm a mental health professional. I treat major mental illness.
I don't know how to prevent it, but I do know how to treat it once you got it.
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
we were finding is the schools were kind of interacting with services around individual cases,
but there was never anyone really to consult the school about whole school. So we've been trying to bring that.
So this is a scenario a 13 year old boy approached the teacher as he knows that
there is a mental health worker at the school and asks if he can see them.
The teacher asks the boy some questions that understand why he wants to be seen that the boy is not forthcoming,
although no immediate risks are apparent. From her recent observations is not very different before those results were lower,
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.
But he is adamant that he does not want his parents or anyone else's school to know.
So back to your phones, can he see the mental health worker without his parents knowing?
What do you think? Yes or no? Imagine you are this worker.
What are you going to do? Back to my Magic 14 has ever voted.
Most of you say, yes, I'm very happy. So I think the law is complicated.
I don't think it is, and we're trying to clarify it, but quite a lot of services do insist on parental consent.
But the law is not insisting on parental consent.
If the child is competent, then actually asking for parental consent without the child then goes against their rights.
So I'm doing a piece of work now to try and clarify that.
So we've been able to run a big online people survey. Not that.
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?
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.
And also so right now, if yes, we also a whole load of questions about how helpful the service was.
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?
17 percent of those kids haven't seen CAMHS. So yes, they think they would have benefited.
For those that say yes, we asked them, Why didn't you access care?
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?
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.
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
we're thinking that it's a normal part of development to become an individual,
you know, so it might be enough that parents might be perfectly well functioning parents, which most adolescents think is poorly functioning anyway.
But you know, it might not be that the parents are beating them up at home or abusing them.
They will definitely be pushing for that success. But it's just normal to want to be bit private and not talk to people,
because that's the whole point of adolescence is to make you an independent person.
At the moment, you turn 18.
So just understanding this development, we need to also find structures and systems to facilitate young people accessing care.
If that proportion is telling us, I spoke to a group of school governors,
all of whom are parents, and none of them thought parental consent was an issue.
It's very, very complicated. The parent lobby, you know.
So in America, parents have sued education boards for providing mental health care to their children without their knowledge.
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,
you know, if you ask CAMHS, they'll say kids are saying it's because the waiting lists too long.
Very, very few of the kids are saying that's the reason it's about seven percent.
They didn't want their peers and those issues around stigma.
They were allowed to take more than one box, which is why the percentages that add up that way.
But really, there's didn't know who to ask and demand parents.
And though I think from my perspective, other take her as what we need to work on.
We asked about safety in schools. How safety feel. Have you ever been seriously bullied?
Five point three percent A sign that being seriously bullied most days in such a.
And so this kind of brings us to what's happening in terms right now, which is made only to look at the details.
It's just to let you guys major what we're calling transformation of services and journalism, mental health services.
And it's really quite interesting the way and excessive example. Over the last three years, services have completely changed.
So we now have something called a single point of access where before a general practitioner used to refer to CAMHS,
now anyone can find the spa as it's called the single point of access.
So if you're a teacher, if you're a parent, if you're a child, if you're another health practitioner,
if you're a social worker, if you're a neighbour, you can all call the single point of access.
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.
With these changes, there has been a significant increase in the number of people accessing care.
Obviously, there hasn't been the same increase in provision. So obviously we've got improved access.
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.
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.
Government is kind of bringing in school mental health, this mental health support teams or NHS tees as the schools are talking about them.
And these comprise of school mental health leads in every school,
and this whole new tranche of work is called Education Mental Health Practitioners, or MH PS.
And these are being brought in to 20 sites across the UK and Oxford City is one of those sites.
So people working lots of city schools as from a couple of months ago are getting a part time NHP coming into that school,
who will be in a couple of weeks time to finish their course and will be fully embedded in the Oxford city system so
that employed by health and such has been delivered by a third sector organisation and they're going into schools.
So it's a massive change.
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,
they're only working with low level mental health problems. So it's a real preventive agenda.
So a lot of schools are dealing with high complexity that the service isn't for them, but at least it's changing.
And so we're trying to track it by asking to know who provides mental health support the school.
So this was last year pre blazers. Seventy three, five percent do.
Is it easy to access? Very difficult to. Very easy.
If you had emotional difficulties, would you go to the mental health team at school? Only a third would so.
So there's a lot to do to improve access and provision. So moving forward, I think that when it comes, this excluded children,
we really need to be thinking about provision, we need to be thinking about mental illness,
and we need to think about how to be making services more acceptable and accessible to children who are the most vulnerable.
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.
So bringing kind of the understanding of school, adolescent health, and I kind of really like this model.
So it's talking about a developmental need for greater autonomy during adolescence.
You know, how I kind of how that interacts with peer group identities and the fact that, you know,
basically what's happening to your brain during adolescence is that major changes is the next slide.
No, I'll talk about it. I don't know where the slides gone. So basically in development,
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.
And so how your peer group in perceives you becomes far more important than any other group,
and it's just that biologically programmed change, you know, so it's just going to happen.
So when we're thinking about exclusion of children at school at the time,
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?
And how does that impact on a child's self-esteem, their relationship with their peers, their relationship with their family and wider community?
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
these positive reactions because the audience and the peers are such an important kind of role that the the kind of messages around exclusion,
I think, are complicated because I've spent my first kind of 12 years, it feels like studying refugees.
I thought I just read one account from a refugee, if you don't mind.
He was excluded. He could so easily have been.
So I just want to read that maybe I still want to read out loud to everyone.
It's his voice. So don't worry about the grammar. Got up.
That's nice. My how did I come out from that depression, and that's it.
It was from the kids in the school, really from the kids, really. They helped me a lot.
You know, I was struggling a lot. I didn't have a confidence with my English language.
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.
Really, some of them. They were really funny. I used to like them.
They taught me to laugh, you know, and I remember my presentation was back in year 11.
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.
And you're 11. I'm going to do a presentation in front of 400 people. I got on the stage.
I was really, really terrified. What was going through my mind?
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.
I was like, I'm sweating. Bloody [INAUDIBLE], you know that it's just, you know, I'm going to, I'm going downhill.
And how the words came out from my mouth. You know how I said it and how I made everyone, everyone laughing.
You know, it was just remarkable. And afterwards, everyone else in my presentation, everyone came.
It was fantastic, really. We had awesome.
We had two minutes to prepare. I didn't know it just came out. Really was a miracle.
I don't know. They came through and people are tapping on my shoulder. They say I thought it was good.
No one spoke about my sweating. No one said, You sweating.
You were fouled or anything ready. Well, they said your presentation was good.
You made it. You made us laugh. You broke the ice. And I was like, Seriously, did I do that, Rudy?
Which was like, unbelievable. It was that time. That was the time I started to speak about it.
You know, that's the time after this. That was absolutely the motivation.
The kids, you know, the kids really, really just helped me a lot.
They just said, Ali, you did well, you really did well.
So the reason I thought I wanted to share this with you is because this is quite interesting young boy who was really struggling.
He was really angry. He remembers himself as being anxious. He was not engaged with any who's getting into fights,
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.
So there was. And he would say no, and he would say no, and he would refuse and he'd get more angry.
And then he describes this interesting experience of school where he was given
two minutes warning to give a presentation in the assembly that thank God,
went well. And he felt accepted and included by his peers.
And he says that was what enabled him to make the step to get therapeutic support.
So, you know, I just think we need to think about the, you know, it's like not really rocket science.
Every kid wants to be accepted by their peers. No one really doesn't want to be.
And so the guys decide to phrase this as adolescence as a quest of belonging.
You know, these are the brain changes that take place during adolescence is putting the primacy of peers there,
and school belonging is such a strong, positive mental health factor for well-being.
So feeling of belonging in school, feeling kind of belonging with adolescence.
And so what is kind of exclusion saying at that time?
And so this advice published a study about the kind of a massive package for mental health support at schools.
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,
and it doesn't say you have to do this one thing.
It's about integrating a whole number of process at many levels of schools, identifying the needs of teachers, parents,
students and the whole school community in a way that kind of thinks about what is needed to engage families,
engage students, engage teachers in a system that will be to the benefit of young people at the school.
So kind of bringing modular Evidence-Based practise in a whole kind of implementation programme and I think is a good example
of how we need to be thinking and moving forward when we think about what is needed by the most vulnerable kids in schools.
So in conclusion, like I also just said and I had to really think about the fact that,
you know, because I've got a daughter who is a criminal barrister,
she's like, Well, if a kid stabs someone three times in a week, they're going to have to get excluded.
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,
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.
But is it wisely applied? Does it serve a useful purpose?
And I do actually think before we can answer that question,
we first need to have a range of services on offer to support the most vulnerable families.
And that means through parenting, it means through, you know,
any children at risk of exclusion to have that holistic assessment, see if there's any undiagnosed.
Difficulties or mental health difficulties, they then need to access interventions that could help them and has to be within the community support,
and I spend quite a lot of time talking to some secondary schools now saying, Look, you know,
society's just changed so much that there's no real institution for anyone to turn to.
They used to be churches or in other bodies. Right now, there's nothing similar to community structures of a different.
People aren't necessarily as engaged in their social community.
That was all that's left, I think, as schools.
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.
I think we do need to provide targeted I'm not really a universal intervention that person.
I'm really I believe we've got a target what we do to those with known vulnerabilities and risk factors,
those of experience, family discord for a whole range of with separation, substance misuse, incarceration.
Those have been the victims of abuse and bullying those with health problems of those with parents,
mental health problems, those they've had early puberty.
Those are self-harming, migrant displaced populations, of course, those with learning difficulties.
So schools are really important from a child and adolescent psychiatrist perspective.
They can democratise access to care, and it's a potential way to identify and refer to clinical services.
And I think we have to think of whatever we do as part of a system of care,
look after teachers as well, think about promotion of vulnerable groups and early referral to services.
So special thank you to tens of thousands of other people who have really done most of this and helped me a lot.
So thank you for your time.