Teams set up provide early help for pupils’ mental health issues face a 鈥渕oral dilemma鈥 on whether to support youngsters with more severe needs, experts warned MPs. Mental health support teams (MHST) were an early intervention project launched under the previous government, aimed at helping pupils with mild to moderate mental health issues. But Jo Ellins, professor at the University of Birmingham who is evaluating MHSTs, told a joint health and social care and education committee inquiry there鈥檚 鈥渟omething of a moral dilemma鈥 about whether teams help the 鈥渕issing middle鈥. These are youngsters whose needs are too severe for MHST support but don鈥檛 meet the higher thresholds for children and adolescent mental health services (CAMHS). A last year found about 4 per cent of MHST staff said they always accepted referrals for outside of their 鈥渕ild to moderate鈥 scope, while 28 per cent said “often” and 45 per cent said “sometimes”. ‘We don’t want to be mini CAMHS’ Ellins, a health services researcher, said this was done on an 鈥渁d-hoc basis鈥 and there were questions about 鈥渉ow are they making that decision within that group鈥 of youngsters. While the teams have flexibility to help these children, one team member told them 鈥渨e don鈥檛 want to become a mini CAMHS鈥 with risks of cutbacks to preventative work. Ellins said the dilemma was 鈥渄o we hold to that original mild to moderate remit which is what our frontline workforce is trained for and where we feel we can maybe have the greatest impact鈥 or do 鈥渨e stretch to cover, because we know that group that鈥檚 often referred to as the missing middle, often doesn鈥檛 access support elsewhere, there simply aren鈥檛 services for them. “It creates a real moral dilemma as to how to respond to that.鈥 She called for detailed research to understand the “missing middle’s” needs, to decide what support they need. The British Association for Counselling and Psychotherapy鈥檚 of 730,000 pupils a year facing this gap may be 鈥渃onservative鈥, she added. Schools in 鈥榠nsidious position鈥 Morgan Flack, policy officer at the NAHT school leaders鈥 union, said a lack of support for these children leaves schools in 鈥渁n in insidious position where they are then trying to work out how do we effectively support these pupils when we are not mental health professionals and aren鈥檛 actually able to support them in that particular way”. The government revealed last week it met its of 60 per cent of pupils in schools and colleges being covered by a mental health support team by April this year. It said it was on track to hit its target of all schools having access by December 2029. But the data showed how the expected number of newly commissioned health teams this year has dropped to 73, from above 100 in previous years. Claire Evans, deputy chief executive at Anna Freud mental health charity, said there was a problem between 鈥渨hat鈥檚 happening in policy and what鈥檚 happening on the ground鈥. She said many areas are not taking on trainee education mental health practitioners (EMHPs) who staff the teams because they are worried about 鈥渉aving the funding to keep them in place鈥. ‘Huge turmoil’ 鈥淲e know there鈥檚 been huge turmoil, huge change in integrated care boards, we know within services that recruitment is frozen and cuts are being made across the board whether that鈥檚 third sector, local authority, NHS services. 鈥淪o you鈥檝e got the commissioned numbers, and then the money that鈥檚 not necessarily ring fenced on the ground. So even though trainees are salary supported for the first year, there鈥檚 not necessarily any money to keep them post-qualification. 鈥淭he rollout should be accelerating but on the ground it鈥檚 a very different story.鈥 Jess Mundy, research fellow at the London School of Hygiene and Tropical Medicine, said 63 per cent of MHST respondents found it had been difficult to fill the vacant EMHP roles. There is also retention issues, MPs heard, as there is little career progress for EMHPs and some viewed the training as 鈥渧ery different to the reality of doing the job鈥. de Souza鈥檚 worries Last week Rachel de Souza, children鈥檚 commissioner, told the committees she was 鈥渟lightly worried that the new SEND legislation puts mental health outside of it. 鈥淭hat is a worry to me, so we are saying mental health will not be part of how we do SEND. 鈥淣ot because that鈥檚 the wrong thing to do, but because we have such limited capacity in schools and other places that I鈥檓 worried that鈥檚 going to impact on children getting the help they need and it鈥檒l become a bit ‘Cinderella’.鈥 Under the current SEND code of practice, social, emotional and mental health is one of the “broad areas of need”. But under the government’s reforms, mental health will not factor into five new proposed “areas of development”. In its SEND consultation, the Department for Education said the proposed change would bring mental health 鈥渋n line鈥 with the other areas of development 鈥渨hich do not lend themselves to specific clinical intervention鈥. The DfE鈥檚 reforms state many children in mainstream schools will at some point need mental health support. As a result, the reforms set out what all schools should do to support youngsters, whether or not they also have identified SEND. Clinical medical interventions are 鈥渓ikely鈥 to play a significant role in some of the new propose specialist provision packages. But schools will continue to have an 鈥渙ngoing, important role to play鈥 in early support and prevention of poor mental health. Unique identifier on ‘too hard pile’ The government plans to introduce a single unique identifier number, to help link children鈥檚 data across services. The DfE is this. But de Souza questioned 鈥渨hy it鈥檚 going so slow鈥 and urged government to 鈥済et a move on鈥 with joined up data. 鈥淚t often goes into the too hard pile, it鈥檚 cross government, so that鈥檚 difficult. I haven鈥檛 seen enough ambition for it in children鈥檚 social care, I am worried it鈥檚 more race to the bottom.” She said there is 鈥渁 risk aversion, sometimes, in Westminster and particularly in my own department, that鈥檚 like 鈥榦h, what about the data sharing problems鈥 or going straight to the most difficult case鈥. de Souza got 鈥渇ed up waiting鈥 and is working in Greater Manchester to pilot a model that could be adopted nationwide. Senior mental health leads Under the 2018 green paper commitments, the Conservatives also ran a four-year grant window for schools and colleges to apply for senior mental health lead training cash. It closed in December 2024 with 76 per cent of eligible settings having claimed the grant. Flack told MPs that members 鈥渞eally valued鈥 the training and the CPD landscape can be 鈥渁 bit challenging鈥, with many providers offering different quality training. 鈥淪o our members have made it clear to us that they would appreciate it if the government has identified a particular training need, that then should be fully funded.鈥