Changing the paradigm of SEMH – a manifesto for change

SEMH (Social, Emotional &/or Mental Health) is a sub-set classification of Special Educational Needs and is one that is far too often mis-understood. Young people with a ‘diagnosis’ of SEMH needs will frequently come through the educational system following a path of challenging behaviour, not ‘fitting in’ & feelings of uncertainty and failure. By the age of 12, a young person with ADHD will on average have received 20,000 more negative comments than their non-ADHD peers. Imagine being told you are lazy, stupid, loud, clumsy, etc. 20,000 times by your 12th birthday.

The term SEMH is relatively new, replacing the term EBD (Emotional and Behavioural Difficulties) only in the 2014 SEND Code of Practice. It was the first step in recognising the complexity that lies behind the emotional and behavioural dysregulation that presents SEMH needs. Dropping the word ‘Behaviour’ from the label was deliberate, an attempt to emphasise that the behaviours were a communication around an unmet need; far to often, settings that supported young people with SEMH needs were labelled ‘naughty childrens’ schools’, or even, back when I started teaching, the ‘Sink’ school.

Unfortunately, there are still far too many in the education sector who see all behaviour as deliberate, needing to be punished, so they don’t do it again. In far too many schools, we haven’t come far from the education paradigm portrayed in the iconic album, The Wall, by Pink Floyd, released in 1979. Children spoken to in demeaning ways:

"Wrong, Do it again!" "If you don't eat yer meat, you can't have any pudding. How can you have any pudding if you don't eat yer meat?" "You! Yes, you behind the bikesheds, stand still laddy!"

From Another Brick in the Wall, Part 2.

We live, still, in a society that does not fully recognise the impact of trauma and emotional neglect / abuse on young people, but ask a family who have adopted a 9 month old child, used to neglect, which arches it’s back when given a hug because it doesn’t know what else to do and they will tell you than the emotional damage goes deep.

I don’t blame colleagues in mainstream, who lack the skills to support young people with SEMH needs. They often also came into the profession with a passion for their subject, and a desire to help the next generations, but then feel that anything else shouldn’t be the school’s issue – the phrase ‘it’s outside the school gate, so not my problem’ is one I heard too often as a mainstream headteacher. But that is what specialist settings are for.

SEMH needs are often expressed by young people as immature social skills, difficulties in understanding & making friendships, mood changes, self harm or conduct problems. Some children and young people may have recognised disorders such as attention deficit disorder (ADD), attention deficit hyperactive disorder (ADHD) attachment disorder, pervasive development disorder, an anxiety disorder, or, more rarely, schizophrenia or bipolar disorder. Some will have an Autism diagnosis, although ASC should not necessarily be considered an SEMH need automatically. The 2014 Code defines SEMH need as:

“These may include becoming withdrawn or isolated, as well as displaying challenging, disruptive or disturbing behaviour. These behaviours may reflect underlying mental health difficulties such as anxiety or depression, self-harming, substance misuse, eating disorders or physical symptoms that are medically unexplained. Other children and young people may have disorders such as attention deficit disorder, attention deficit hyperactive disorder or attachment disorder.”

SEMH needs are now the second largest category of SEND (Behind Speech & Language needs), and in 2021/22, over 250,000 young people were identified with an SEMH need. Unfortunately, it is often the challenging behaviours that end up with a young person getting the help and diagnosis they need; only 12% of all 4-year olds with an SEND need are identified as SEMH, whereas this rises to 21% of all 14-year olds with an SEND need. The link between behaviour and SEMH still persists. Nationally, approximately 80% of all young people with an SEMH diagnosis are male. The challenging behaviour from male students will get them moved through the system, whereas female students with SEMH needs tend to exhibit in less challenging ways, being held within the mainstream sector. We also need to examine the disparity of SEMH diagnosis within the BAME communities.

But these numbers also mask the bigger picture; nationally, there are approximately 116,000 young people who are electively home educated. Now, there will be many reasons why parents will make the decision to educate their child at home, but in the vast majority of cases this will be because the parents cannot see their child suffering trauma by being in an establishment that doesn’t understand them, let alone adapt to their needs. And we now have a phrase coming up in popularity amongst educational professionals; Emotionally Based School Avoidance (EBSA). This is a recognition that school avoidance (& ultimately the parents’ decision to withdraw) stems from an emotional dissonance.

All of this leads to an urgent need for specialist settings, that are designed to support young people with SEMH needs, with a nurturing and supportive environment, helping them become the best versions of themselves possible. Young people with SEMH needs are being failed by mainstream education, in the name of comprehensive, inclusive education, every day. 60% of all young people with an identified SEN need who are excluded from mainstream school have an SEMH identification. We need a comprehensive, inclusive education system, where there are settings that specialise in supporting young people with additional needs. These specialist settings need to be recognised by their comprehensive colleagues as experts in their specialism, and then collaborative, local working can be constructed to support all. Akin to the NHS; my local GP & local general hospital are fine most of the time, but if I had serious heart disease or cancer, I would want to be referred to a specialist setting where people who know their area inside out are based. . .

SEMH settings are not (& never should be seen as) behaviour schools, where naughty boys are sent to be contained until they become old enough to be passed onto society, ripe for the criminal justice sector. Even though, in too many places, that is exactly what they are seen as.

I am now executive head for a trust, overseeing the SEMH provision for over 200 young people across eastern Manchester. These young people cover all key stages, from 4 years old through to 19.

We aim to see every single one of our students as individuals, with huge potential and a need for support, encouragement and love. We know, unfortunately, that for a large number of them, we are some of the few adults in their lives who totally believe in them, believe that they have the potential to be brilliant & amazing.

We know they have the ability – baseline cognitive testing informs us of this. Using nationally recognised baseline assessments, the vast majority of our students fall within the ‘normal’ range for their age, so they are capable (more than capable) of achieving academic qualifications and progressing to university and beyond. It is their experiences in the past, including gaps in their education, that hold them back. We aim to unblock their potential, give them the confidence to succeed, and then support them beyond.

We have partnered with a local organisation, Upturn Enterprise, that specialises in supporting young adults into employment; a number of the adults they work with have mental health issues, frequently brought on by deprivation and poverty of opportunities. They now work with us so that all of our young people get careers advice and guidance, and workplace experiences, including work placements (something that students in mainstream no longer have in the area, post-covid). But they also have a careers mentor who will support them after they have left us too. It’s not enough for us to get a young person into employment (or training / further education), we want to ensure they succeed over the long term.

We have a curriculum that is aspirational, aimed at supporting the young person to gain the skills & knowledge they need to succeed. This is far more than the narrow definition of curriculum within the mainstream sector, with boxed subjects; we look to support them with life skills, and employability. Vocational destinations are front and central, with practical skills as important as the stuff that goes on in the classroom.

We meet their needs where they are; many of our students cannot cope (usually because of negative experiences in the past) in anything that resembles a ‘typical’ school classroom. We are looking to adapt even our core classrooms to be more ‘friendly’, with soft furnishings and small tables to work around. For some of our students, however, this is not a space they can engage with, so we have ‘satellite’ centres, locally, where we have set up teaching bases – the local cricket club & sports centre, for example, are ideal venues. We are converting a local office building into a nurture base, where we can meet students in a space that looks nothing like a school.

And for those students who are so damaged, so full of trauma, that they cannot come to our satellite centres, we offer fully online learning. Not the sort of thing offered during the pandemic, but by partnering with a truly innovative organisation, Gaia Learning, we are offering our students the option of joining live lessons, delivered entirely through the internet. A curriculum delivery model designed to be sensitive and supportive of neurodivergent needs and delivered by specialist teachers skilled in their field.

But we also need to see SEMH needs as a fully social issue; the trauma young people come with, which is often at the root of their SEMH needs, comes itself from their locality. Deprivation, poverty, lack of hope. No employment or adult role models in employment and the further pressures on the communities these students come from as a result of the ‘cost of living crisis’ we are now in.

We have young people who are effectively homeless. Young people with no stability in their lives. Young people who genuinely don’t know where the next meal is coming from if not from us. That is why we actually offer a 48 week offer, with staff providing activities, food and a safe place to be throughout most of the holidays too.

So we have staff in the setting with wider experiences; a social worker as safeguarding lead, other adults who have worked in supporting adult mental health initiatives locally and nationally. We have ‘Project Pantry’; our attempt to meet the needs of the families where our students live. This is’ itself, a huge issue – I recently posted a plea on LinkedIn for a wardrobe and a sofa bed for a couple of our families in desperate need. I received loads of reposts and ‘likes’ but no offers of practical support.

But there’s more.

Stretched local authorities, with diminishing budgets and ever-increasing demands from central government, are doing their best, but frequently things go wrong. Young people & families left for too long to get the diagnosis &/or the documentation needed to get the help they need because of lack of funds and staff. The settings I oversee are now full and bursting at the seams. All of them are well beyond the capacity they were designed for, but the exceptional staff go above and beyond every day to make sure the students we have are well served.

And there’s frequently miss-diagnosis, especially in SEMH; a young person, struggling in mainstream and so exhibiting challenging behaviours will frequently get a blanket diagnosis of SEMH without any time taken to understand the reasons behind the behaviour. Just because it’s a behaviour need, the thinking goes, it’s SEMH – back to the ‘old days’ & pink Floyd. This means young people are again placed in the wrong setting, given the wrong support, and so traumatised even further. Even when a setting recognises this (as we do) & says no, the LA can be put in a position where they place anyhow, often because there’s no-where else for the young person to go.

We need much better early intervention and assessment; again, why don’t the LA work with the specialist settings to set this up? We have the knowledge and working collaboratively, we can build the resource to deliver much better support. CAMHS (Children and adolescent Mental Health) services are stretched themselves beyond breaking point, but due to their systems (if a young person misses too many appointments, they are automatically taken off the list), young people are not identified and supported. A well planned and thought out assessment and intervention centre, with the LA, education specialists and 3rd sector health professionals working collaboratively, could help transform this.

And then at the other end, young people leaving ‘formal’ education at 18 or 19 are cast adrift. Health services have reset, social services have pulled away & education is finished. Young people in the Care system have been (if they are lucky) given a 1-bed flat and a couple thousand pounds to kit it out, but then given very little support. ?There needs to be sensitive support in place here too; again, a collaborative approach, with education, employability and health professionals, working together, to support these very vulnerable young people to succeed at adulting. This needs to recognise the ability & potential of these young people, so open access to universities and apprenticeships, whilst also recognising their continuing social and emotional needs. Again, local hubs, where they can get help and support, with even universities providing small tutorial support, etc., will provide what is so desperately needed.

There is an urgent need for this to be recognised, for people to work together to change the system. As a leader in the sector, I am doing what I can. We are doing what we can; all the SEMH settings I oversee are having this conversation right now, looking at how we support the young people and their families. How we prepare them for the next stage. We are working collaboratively where we can and are lucky to work with some exceptional partners to extend what we can offer. We are talking with our local authorities, who do get it, but are too often constrained by factors outside their control.

But we can’t do it on our own.