Those who provide public services for children and young people may have a role in the identification, prevention, and within reasonable parameters, the treatment of mental health problems. Social services and education in particular have a key responsibility to safeguard the physical and psychological health of children and identify potential areas of avoidable harm, including those which may develop within their institutions.

There is a well-recognized mismatch between the rates of child mental health problems identified in epidemiological studies and the number of children referred to child and adolescent mental health services (CAMHS). School staff will often be in the best position to identify unrecognized difficulties and also to help children and their families address prejudices associated with referral to CAMHS, though they may need training and help to do so.

The responsibilities of teachers have been confirmed by schools’ inclusion within the broad concept of CAMHS in a number of countries. In the United Kingdom, the Health Advisory Service (now the Health and Social Care Advisory Service—HASCAS), proposed a model, subsequently adopted by the Department of Health of a tiered approach to service provision, in which schools, alongside primary medical care and social services formed the first Tier.⁽¹⁾ Within this model schools have been seen as offering unique opportunities to identify problems, provide simple assessments and refer up to more specialized tiers as judged appropriate and in negotiation with caregivers. Teachers though, often feel inadequately trained to fulfil this role and look to other professionals, including psychiatrists to advise and support them. Fortunately there are a number of professional roles, some employed within
education and some outside, forming a bridge between education and mental health services. Some of these roles vary in their detail between countries, but most developed countries will have professionals (possibly with different titles) filling roles comparable to those in the United Kingdom.

It is important to note that CAMHS generally work as multidisciplinary teams, hence any support and liaison may be offered by a range of professionals and not exclusively by psychiatry. One of the HAS recommendations was the creation of a new professional group—the primary child mental health worker—with the particular aim of liaising between Tier 1 and Tier 2 services. The following are some of the professionals involved in the interface between child mental health and education:

Establishing a liaison service between CAMHS and a school can have a number of benefits including:

The majority of CAMHS services do work with schools, the nature of the intervention ranging from consultation and support for school staff to direct work with children, including observation and assessment. However, joint working between CAMHS and schools has a record of patchiness across the United Kingdom, with a lack of key personnel often leading to a fragmented service.

Good examples of joint practice are characterized by secondments between organizations, shared working environments, a clear understanding of the different roles and expertise of team members, and a shared vision of joint working.

Where good practice is operating, schools are often faced with anxieties around short-term funding for specific projects, for example, the recent initiatives ‘City Education Action Zones’, ‘Health Action Zones’, and the ‘Healthy Schools Standards’.

Schools in the United States tend to operate within multidisciplinary settings and research suggests that these are effective in breaking down professional barriers and also addressing the stigma associated with a young person being referred to external agencies such as CAMHS.

The provision of a key mental health worker within the school facilitates better communication between services and helps develop a greater understanding of how the culture of a school operates. Integrated links between CAMHS and the local authority, educational psychologists, behaviour and emotional support teams, and education welfare promotes a cohesive and collaborative service for children.