Access to counsellors in secondary schools and children and young people’s community mental health services: summary report - July to December 2021

Children and young people accessing the service

In total across all returns, 12,149 children and young people were recorded as having accessed counselling services between July and December 2021.

There were more girls (7573) than boys (3942) recorded as accessing counselling provisions. 404 young people who accessed counselling services did not identify as male/female or preferred not to specify their gender.

For those local authorities who provided a breakdown of pupils by year group, the two year groups with the highest total number of service users were S3 and S4.

<P4	P5	P6	P7	S1	S2	S3	S4	S5	S6
86	34	712	1019	1245	2015	2217	2097	1278	765

A small number of pupils accessing the service were not attending school or did not specify which year group they were in.

Outcomes

The overall picture on improving children and young people’s outcomes is positive. The returns from local authorities recognise that there are a number of pupils who are currently continuing to access counselling, and have not yet completed an evaluation.

Where evaluation has taken place, some local authorities provided this information in numbers of young people, while others used percentages. Recognising this, it is clear that 4350 children and young people have improved outcomes as a result of receiving counselling. Where outcomes have been provided in percentage terms, they range from 88% to 100% of children and young people having reported improved outcomes. 

In addition to the positive improved outcomes figures, anecdotal evidence suggests the counselling service is a beneficial service to children and young people. Feedback provided from authorities included:

• “schools report the counselling service to be extremely successful at supporting CYP and advise that this can been demonstrated in CYPs increased engagement with their education, their resilience and general happiness”
• “schools report that CYP and parent feedback is extremely good. Some schools also report a perceived reduction in stigma attached to mental health challenges amongst CYP due to having counsellors on school premises”
• “we have gathered feedback from school staff on the school counselling service using a glow form and 100% of them want to see the school counselling service continue. The main feedback given by secondary staff has been how much of an impact the service has had on pupil and staff wellbeing. They commented on the benefits of having a responsive service that was easy to access and available within the school and that can provide more specialised support than they are able to”

Referrals

The majority of recorded referrals came from school staff.

Referral	Total recorded across LA reports
Self-referral	1190
School Staff	9764
Social Services	34
GP	87
School Nurse	47
Health Professional	82
Other	309
Unknown	56

Local authorities were also asked about onward referrals. Where this data was provided, onward referrals were more evenly split between CAMHS, Child Protection and other services.

Onward referrals	Total recorded across LA report
CAMHS	328
Child Protection	91
Other Service	318

The onward referrals to ‘other services’ reflected the different services which are available in local authorities, for example third sector organisations. Children and young people could also be referred on to other health services, for example GPs.

Concerns presented by children and young people

There was wide variation across local authorities on the reasons given by children and young people for accessing counselling services. Officials provided authorities with 10 suggested categories under which children and young people may present.

• exam stress
• trauma
• bereavement
• gender identity
• substance use
• self-harm
• depression
• anxiety
• emotional/behavioural difficulties
• body image

Local authorities were invited to offer further categories based on their own locality needs. A total of 75 other reasons were reported, including family issues, relationships, self-esteem, anger, bullying and identity. A full list is included below. This again confirms that young people are dealing with a wide range of concerns within their lives and continues to demonstrate the need for young people to be able to access support quickly and effectively for their mental health and wellbeing.

Online and in-person provisions

Local authorities were asked to provide information on the number of children and young people accessing in-person provision and virtual provision.

Of those who provided information, the majority of CYP were accessing counselling in-person (9966) rather than virtually (1396).

Mental Health in Schools Working Group update

In 2019, the Mental Health in Schools Working Group was established to support the Scottish Government’s ongoing commitment to supporting positive mental health in children and young people in school. The Working Group has overseen the development of new resources for school staff. This includes the Children and Young People’s Mental Health and Wellbeing: A Professional Learning Resource For All School Staff. This online resource is primarily aimed at school staff to support the wellbeing of children and young people within their schools, but anyone who wishes to upskill can access the learning. The Working Group has also developed a Whole School Approach Framework, to assist schools in responding to and supporting children and young people’s mental health.

In July 2022, the total number of users registered for the Professional Learning Resource was 2316. The Scottish Government will continue to work with the Mental Health in Schools Working Group to further promote and embed these resources.

Reasons given by children and young people for accessing counselling services

The following is a combined list of further reasons reported by local authorities, for which children and young people sought the support of counselling services.

Additional reasons for presenting	Total
Family issues	1894
Relationships	1377
Self-esteem	915
Anger	520
Suicidal or suicide ideation	428
Low mood	327
Stress at home	311
Bullying	285
Work/Academic	218
Eating	207
Identity	172
Parental separation	111
Sexuality	104
Negative coping strategies	102
Health	100
Stress	89
School issues	71
Isolation or loneliness	47
Confidence	39
Social issues	35
Transitions	34
Attachment	33
Coping with change	28
Panic attacks	28
Interpersonal skills	28
Social media bullying	28
ADHD/ASD	26
Young carer	24
Lockdown	23
Pandemic	21
Distracted	19
Other people's mental health	17
Sleep hygiene	17
Dyslexia	16
Attending school	14
Domestic abuse	13
Poor impulse control	11
Succeeding in school	11
Sexual trauma	10
Relationships with school staff/conflict	8
Homophobic abuse	8
Online abuse	8
Welfare	7
Abuse	6
Gender dysphoria	6
Communication	5
Auditory and visual hallucinations	5
Racist abuse	<5
In person inappropriate sexual behaviour	<5
Attendance	<5
Internet safety	<5
OCD	<5
Intrusive thoughts	<5
Sexual	<5
Motivation	<5
Witnessed violence or aggression	<5
Phobia	<5
Withdrawn	<5
Police incidents	<5
Assault	<5
Online inappropriate sexual behaviour	<5
Paranoid	<5
Sexual assault	<5
Medical	<5
Accused of sexual abuse	<5
Concerns for the future	<5
Upcoming court case	<5
DNA	<5
Physical abuse	<5
Recovery	<5
Sensory	<5
Peer pressure	<5
Porn addiction	<5
Risk taking behaviour	<5
Sexual abuse	<5

Children and young people’s community mental health services

Accessing the supports and services 

During the reporting period, the community-based supports and services were accessed by a total of 17,786 children and young people, as well as 792 family members and carers. Where known, the gender of service users was recorded as 53% female, 43% male and 4% other. 

59% of the children and young people using the services were of secondary school age, 33% of primary school age or under and 8% of post-school age. These figures have been assimilated as some local authorities reported age in years and others by school stage. 

Just over two thirds (10,646) of service users accessed positive mental health and wellbeing services, while just under a third (4103) used emotional distress services.

Positive mental health and wellbeing services are usually prevention services which are self-completed or form part of general wellbeing education, e.g. digital cognitive behavioural therapy or presentations and training. Emotional distress services are generally support services which are led by staff in either a one-to-one or group setting, e.g. counselling, art therapy or practitioner-facilitated support groups. Some supports cover both emotional distress and positive mental health and wellbeing.

2014 people in ‘at-risk’ groups were recorded as having used a positive mental health and wellbeing service, and 1717 were recorded as having used an emotional distress service.

‘At-risk’ groups are those who are known to be at greater risk of poor mental health, e.g. children with learning disabilities, LGBT+ young people and those who are care-experienced.

Referral routes

The most common route in to the community services was referral by self, parent or carer. More than a thousand referrals to the services were made by CAMHS and other health professionals. 

Referral made by	Number
Self / parent / carer	5426
School staff	3692
Health professional	817
Social work	452
CAMHS	220
Other	1196

Most onward referrals from the community services were made to school counselling and CAMHS.

Referral made to	Number
School counselling	196
CAMHS	128
Social work / child protection	89
Youth workers	67
Autism support	58
Non-school counselling	53
Young carers	43
Educational psychology	37
Occupational therapy	13
Other	220

Reasons for using the supports and services

Children and young people most frequently presented to the services with anxiety, emotional or behavioural difficulties, and depression or low mood. These do not reflect formal diagnoses of mental health conditions, but are the reasons given to the services as to why people have sought support. Individuals may have presented more than once and/or with a number of different concerns. 

Reason for presenting	Number
Anxiety	1920
Emotional / behavioural difficulties	1603
Depression / low mood	1138
Trauma	954
Family relationships / home issues	682
Self-esteem / confidence	590
Self-harm	523
Social interaction / peer relationships	471
Substance use (self or family)	448
School issues / exam stress	344
Bereavement	325
Emotional literacy	307
Gender identity / sexuality	265
Body image / eating concerns	264
Sleep	217
Other	2084

Outcomes

Of the service users who were recorded as having used a positive mental health and wellbeing service, 2459 said that they had an improved outcome. Of those who used an emotional distress service, 1692 said that they had an improved outcome.

Of the service users in ‘at-risk’ groups who were recorded as having used a positive mental health and wellbeing service, 1315 said that they had an improved outcome. Of those who used an emotional distress service, 1027 said that they had an improved outcome. 

The outcome figures collated are unlikely to reflect the full impact of the supports and services. In some cases, this will have been due to the fact that support was still being delivered to the person and they were not ready to be asked about outcomes. As indicated above, we are working with stakeholders to continue to develop and enhance options for reporting that will reflect more accurately the full impact of the supports and services.