Mental health needs in schools for emotional, behavioural and social difficulties Latha Hackett, Louise Theodosiou, Caroline Bond, Claire Blackburn, Freya Spicer and Rachel Lever Within the UK, around 10% of children have mental health problems, but this is likely to be higher among certain specific populations. Children and young people attending provisions for social, emo- tional and behavioural difficulties (SEBD) are a par- ticularly vulnerable group whose mental health needs are under-researched. The authors, Latha Hackett, Louise Theodosiou, Freya Spicer and Rachel Lever of the Winnicott Centre, Manchester, Claire Blackburn who is a clinical psychologist and Caroline Bond of Manchester University conducted a study which involved all pupils in two schools for children with SEBD. The views of parents and teachers were sought for a sample of 71 children. The Strength and Difficulties Questionnaire and a supplementary questionnaire were used to gain a broad picture of the mental health needs of this group and the services required. The findings from these questionnaires indicate a much higher than national level of perceived mental health difficulties within this population. This piece of research high- lights that both teachers and parents identified a need for professional support, from education, social care, health and other services. These find- ings have implications for future commissioning of services. Key words: social, emotional and behavioural diffi- culties, mental health, questionnaire, services. Introduction Currently around 10 to 20% of children in Europe are iden- tified as having mental health problems (Jane-Llopis & Braddick, 2008) and schools are being encouraged to take an increasing role in addressing these needs. Weare and Gray (2003) advocated that schools should develop a holistic approach to pupils’ emotional and social well-being by emphasising positive mental health for all and developing effective multi-professional working. Current initiatives such asTargeted Mental Health in Schools (DCSF, 2008) aim to support schools in developing this approach. However, there continues to be a lack of clarity around terms such as social, emotional and behavioural difficulties and mental health, with the two sometimes being used interchangeably in the literature. For instance, Targeted Mental Health in Schools describes ‘children with mental health problems [as] – those who, in a school context, would broadly be described as having behavioural, social or emotional problems’. Much of the recent work in relation to mental health in schools has focused on early mainstream intervention. However, children and young people attending schools for social, emotional and behavioural difficulties (SEBD) are a heterogeneous group who are often at risk of being margina- lised (Cooper, 2008). The identification of mental health needs among children and young people with complex needs is not straightfor- ward. Rose, Howley, Fergusson and Jament (2009) point out that separating mental health difficulties from social factors and diagnosed conditions such as attention-deficit/ hyperactivity disorder (AD/HD) is not easy. Their survey of teachers working in English residential special schools indi- cated that teachers felt ill-prepared and anxious about how best to identify and meet the mental health needs of this population. Many respondents also commented that support services were often stretched and unable to provide the levels of support that were needed. An additional complicat- ing factor when working with this population is that place- ment in specialist provision is influenced by many factors, such as parental choice, local policy/provision and severity of need (Lamb, 2009), which also contributes to the hetero- geneity of this population. Detailed population surveys are therefore recommended in order to be able to respond pro- actively to local patterns of need and plan a co-ordinated multi-agency response (DCSF/DoH, 2008). Research evidence also suggests there is a significant overlap between mental health difficulties, psychiatric disorders and special educational needs. Quinn, Epstein, Cumblad and Holderness (1996) surveyed young people receiving Tier 2 Child and Adolescent Mental Health Ser- vices (CAMHS). At Tier 2 a child with depression, for example, would see one mental health worker. They found that 6% of children without special educational needs but 44% of children identified as having special educational needs experienced mental health disorders. Ford, Hamilton, Goodman and Meltzer (2005), in their follow-up of the 1999 British Child and Adolescent Mental Health Survey, found that having a psychiatric disorder predicted substantially increased contact with special educational needs resources, social services, youth justice and mental health services. Given the overlap between mental health difficulties, psy- chiatric disorders and special educational needs, it is not surprising that the severity and complexity of mental health difficulties appears to be higher among pupils attending RESEARCH SECTION © 2010 The Author(s). Journal compilation © 2010 NASEN. Published by Blackwell Publishing, 9600 Garsington Road, Oxford, OX4 2DQ, UK and 350 Main St, Malden, MA, 02148, USA. DOI: 10.1111/j.1467-8578.2010.00451.x