‘We’re dealing with so much’: Schools turn to private therapists to meet pupils’ mental health needs

Increases in waiting lists for childhood mental health services and other therapies have resulted in Irish schools extending beyond the teaching of subjects and sports to facilitate the provision of in-school therapy.

Dorothy Ingram, a counsellor and psychotherapist, works with young people and believes the key to success lies in primary schools.

“You’re hoping to reach the children before they reach adolescence,” says Ingram. “Give them a good flavour of what therapy might be like and some coping mechanisms.”

Ingram uses play and sensory activities as the starting point for therapy with primary schoolchildren. While there is never any ambiguity about why the child is with Ingram, it may take up to three sessions for trust to develop and the talking to start.

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“They’re under no illusion about why they are with me, it’s not just to play,” says Ingram.

In many cases the parents will have prepared the student, but Ingram sets out the boundaries from the outset. “I let them know that they are in charge of the games we play and I’m in charge of keeping them safe and keeping time, so they know when they have to go back to class.”

Having the school as the base for counselling is key to its success. “It’s hugely important because that’s where children spend most of their time, and it’s a great place for the therapist to see the child in action,” says Ingram.

There are other benefits to providing an in-school counselling service. Children are less likely to miss a full day of school and, because school is a familiar setting, they are more relaxed. “I also think it helps take the stigma away from having therapy,” says Ingram. “It just becomes a natural part of school.”

There is one drawback to school-based therapy. “You can’t dig deeper, because you don’t want the child upset going back to class,” says Ingram.

The length of the sessions varies depending on the needs of the child. “Some children will pass through in six weeks, and other children come to me for the whole year or maybe into the second year, depending on the amount of trauma or loss that has been in their lives,” says Ingram.

Some students will continue the sessions into secondary school and having the familiar face to talk to can ease what can often be a daunting transition.

The Department of Education launched the first phase of a counselling pilot service for schools last September in selected primary schools across seven counties (Cavan, Laois, Leitrim, Longford, Mayo, Monaghan and Tipperary). Dublin was not included in this phase. While the introduction of this programme acknowledges the benefits of in-school therapy,.it leaves schools who are not involved in the pilot programme with the job of fundraising if they feel their students cannot wait for the extension of the pilot programme.

[ State ‘cannot meet demand’ for youth mental health services, says Department of Education ]

Ingram is working in schools who have sought her out in a private capacity and are funding in-school therapy services themselves.

Rachel Harper, principal of St Patrick’s National School in Greystones has identified the need for such services in her school community and is working with other schools in the area to create awareness and support students through an initiative called It Takes a Village.

Harper and teachers at the school noted an increase in anxiety among the children since the return to school after Covid-19 lockdowns.

“I would stand at the school gate every morning and welcome them in; it’s just my way to get to know them,” said Harper. “You’d see that some kids were finding it a bit harder coming through the school gate in the morning, you can see that anxiety there.”

[ Ireland’s growing mental health crisis for children and young people adds to a system under pressure ]

Parents were reporting that they were observing anxious behaviour in the home too. The provision of in-school therapy would, Harper believes, help address the increased anxiety levels.

“I would love to see a therapist on site, just weekly, and in every primary school,” says Harper. “Teachers are dealing with so much at the moment.”

Teachers and principals can offer support when parents raise concerns about their child, but Harper believes professional support could be more appropriate in some cases.

“It’s nice to support them but we have to remember, for the more extreme side of things, we’re not qualified, we’re not psychologists,” says Harper.

Ingram says there should be a full-time counselling service available in schools as the demand among the school population is rising.

“One session a week is enough for a child and the school staff are there to support too, but there are now too many children for me to reach,” says Ingram.

Providing access to therapy in schools has many other benefits according to Harper.

“Having a therapist is a one-stop shop, it’s the only place where the therapist will be able to link in with the pupil, the teacher, the principal and the parents,” she says.

Harper also says the fact that the therapist is meeting a child in their own learning environment, which can be more comfortable for the child.

Counselling is not the only therapy schools are funding privately. Oonagh Mac Mahon is a speech and language therapist who has been working in various primary schools for over seven years. Mac Mahon says demand has significantly increased since the Covid-19 pandemic.

“The needs are just increasing year by year, across the board in the schools that I’m in,” says Mac Mahon. “When I first started, I had my timetable and was doing one-to-one therapy, whereas now there’s a lot more need so I’m trying to do a lot more teacher training, a lot more empowerment of teachers in the classroom to lead it, and giving more group therapy approaches.”

During the pandemic, speech and language services stopped and the waiting lists for initial assessments got longer.

“So now kids are coming into the school system without having any intervention, any assessments,” says Mac Mahon. “Whereas before kids were even coming into school having been linked in with the health service and had some input, they still had a lot of needs, but the ball was rolling.”

Speech and language referrals are now being submitted at much later stages. “That’s having a huge effect,” says Mac Mahon.

[ Most young people with mental health issues are referred for treatment by themselves or their parents ]

Research shows persistent speech and language difficulties can have significant long-term negative impacts on an individual, ranging from impaired literacy and academic outcomes to employment. Mac Mahon says providing speech and language therapy in schools offers many benefits.

“The great thing is that kids aren’t withdrawn from school,” says Mac Mahon. “If they have a therapy session in the primary care centre they have to be taken out of school, they’re missing half the school day, or they don’t come back.”

Another benefit, she says, is the increased appointment attendance when the therapy is delivered in school. An evaluation of speech and language therapy services in Tallaght West Childhood Initiative Services in 2012 showed many appointments were being missed due to work, childcare, language or transport barriers.

“I can also access more children and link in with teachers when I work in schools so that they can implement strategies and goals in the classroom with the curriculum,” says Mac Mahon. “You’re able to be more impactful.”

While working with schools, Mac Mahon has also delivered information sessions for all staff at the beginning of the academic year to remind teachers how to identify an undiagnosed speech and language need.

“We can help develop an understanding from training and from discussions that, if a child has behaviour problems, they most likely have a communication issue or their comprehension is poor,” says Mac Mahon. “There’s a bigger picture there that we need to look at.”

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