When mental health prevents school attendance: Guidance summary

The DfE has recently published a new document, ‘Summary of responsibilities where a mental health issue is affecting attendance’. Sensible, as the 2017 Mental Health of Children and Young People (MHCYP)1 survey presents worrying trends. NHS Digital data from 2022 show 18% of children aged 7-16 years and 22% of young people aged 17-24 years had a probable mental disorder.

Children aged 11-16, identified as with probable mental disorders were ‘less likely to feel safe at school’ (61.2%) than those without (89.2%), saying they ‘could not enjoy learning’. They often reported they ‘did not have a friend to turn to for support’. So, lockdowns and school closures worsened existing problems.

What does the guidance include?

“This document builds on the Working together to improve school attendance guidance, and should be read alongside the statutory guidance documents on parental
responsibility measures
, children missing education, supporting children with medical conditions, suspensions and exclusions, alternative provision (for children who cannot attend school for health reasons), and safeguarding.”

Summary of responsibilities where a mental health issue is affecting attendance

The guidance reminds schools, parents, and LAs of responsibilities around attendance. Key messages include:

  • Parents’ legal duty to ensure full-time education and good attendance (section 7 of the Education Act 1996, when compulsory school age and registered at school).
  • From day one of absence, parents are encouraged to communicate issues openly, engaging with any support offered. 
  • Likewise, when implementing reasonable adjustments to support attendance, school staff involve parents/carers from an early stage, emphasising that the plan aims to “maximise face-to-face attendance as much as possible.”
  • Schools can authorise absences where physical and mental health prevent attendance.
  • Medical evidence is not ‘routinely’ required. Schools should notify the local authority (LA) if attendance is likely to exceed 15 days.
  • Beyond 15 days, schools and LAs should consider if Alternative Provision is needed (Section 19 of the Education Act 1996)
  • LAs must follow existing guidance around the prosecution of parents for not complying with their attendance responsibilities.
  • Individual circumstances, including for those with SEND and EHCPs, must be considered.
  • Safeguarding is paramount.

What should schools do?

The summary states school staff ‘are not expected to diagnose mental health conditions’. This is sensible, given they are not qualified to. Nor are they expected to ‘perform mental health intervention’. This is an interesting conundrum, given that five in 30 children have a probable mental health disorder and every interaction is an intervention. The summary does not define ‘intervention’, so let’s assume they mean the clinical sense.

The DfE reminds schools to act early to prevent attendance issues from spiralling. Schools must take individual circumstances into account, offering whole family support. External agencies must be involved, ‘where available.’ There is no acknowledgement of the excessive waiting times, restrictive referral criteria, or varying levels of service experienced. School nurses can help, again ‘where available’. There’s no mention of diminishing school nurse numbers, however. In June 2010, there were 2,984 school nurses. Eleven years later, in June 2021, this had fallen by over 900, to 2,047 (RCNI). Yet we’re told parents should feel reassured that there is a plan in place. I remain staggered by the gap between DfE guidance and front-line reality.

Whole school approaches, we are told, focusing on mental health, address most issues. Anxiety must be mitigated through regularly reviewed, planned reasonable adjustments, butin general terms’. These are not to be confused with the ‘reasonable adjustments’ as defined by the Equality Act 2010 (section 20). A different phrase would avoid unnecessary confusion.

High expectations for attendance, curriculum design, and supporting young people’s development, with a senior mental health lead who will have “strategic oversight of their setting’s whole school approach to mental health and wellbeing,” will promote mental health. I don’t disagree, because supporting young minds to navigate ‘normal but difficult emotions’ is what teachers do, we can’t avoid it! Understanding how to handle the ‘just about right’ amount of anxiety needed for life is critical (Dr Dawn Heuber).

“Normal but difficult emotions”

The document accepts that children experience ‘normal but difficult emotions’, but insists they are no excuse for not attending. Non-attendance, it says, often fuels further non-attendance and “heightens their anxiety about attending in future” with the original difficulties becoming exacerbated by absences.

But parents are not dealing with normal but difficult. Trigger warning: the DfE summary does not capture how traumatising and sickening school avoidance due to mental health issues really is. Only when it is your child, do you understand this.

Examples of good practice—but parents are crucial

A separate document of ’Effective Good Practice Examples’ illustrates how regular collaboration between parents and school, specialist agencies advising school staff, periods of reviewed timetable adjustments, and additional provision often resolve issues. But the DfE remains heavily reliant on parents offering long-term, daily support. In this cost-of-living crisis, most parents must work, so many don’t have the capacity to do this unless they are forced to prolonged take time off.

The examples refer to trusted adults. Yet there is no mention of the recruitment crisis, with 45% of leaders unable to recruit teaching assistants. No mention of ‘a problem with overcrowded classrooms, (Statista)2. We have the highest pupil-to-teacher ratio in primary schools in Europe and fourth highest pupil-to-teacher ratio in European high schools. Nursery schools’ provision is even worse. Add to that the lengthy waiting lists for diagnostics. No mention of this either.

Part-time timetables

Regarding part-time timetables, parents are reminded, ‘it is the legal responsibility of all parents/carers to ensure their child receives that by full-time attendance at school or otherwise’. Parent contracts and prosecution are referred to “when all other options have been exhausted or deemed inappropriate” (there is further guidance available).

Schools must not use part-time timetables to manage pupil behaviour (there is other guidance for that too). Full-time, face-to-face attendance in school is the goal, although full-time can occur differently, at the school’s/LA’s discretion. LAs determine the use of alternative provision under section 19 of the Education Act 1996. Regardless, in a recent podcast with SNJ, public law barrister, Steve Broach was clear; for all this guidance, LAs must provide a suitable education with medical/SEND needs provided for.

When school anxiety causes absence

So, what if it’s the school that is the original difficulty causing repeated absences of up to 15 days? The summary says there’s no need for schools routinely to ask for medical evidence and GPs are ‘unlikely’ to provide it for one-off mental health absences. Besides, GP letters must explicitly state the need for absence but schools can authorise absence without medical evidence.

“In instances of long-term or repeated absences for the same reason, however, seeking medical evidence may be appropriate to assist in assessing whether the child requires additional support to help them to attend more regularly, and whether the illness is likely to prevent the child from attending for extended periods. If a parent proactively seeks out a note from a GP, it does not imply a need for absence unless this is explicit in their letter.”

Summary of responsibilities where a mental health issue is affecting attendance

Additionally, LAs should not necessarily expect medical evidence as a requirement for the provision of alternative education (if the child is well enough), they can use their own judgement. But this element of the guidance only serves LAs and schools; it will not serve children whose mental health needs require a change of placement (if they have an EHCP, or if parents want to apply for an assessment). And, if you head to the SEND Tribunal, Steve Broach reminds us that lawyers need evidence to legally challenge. Repeated authorised absences without medical evidence may make school/LA attendance figures look positive, but they hide struggle and despair, and prove nothing in law.

Young people do not leave ‘probable mental health disorders’ at the school gates for the convenience of schools. When schools adopt the wrong strategies to manage mental health, further damage to the child can be caused. Mental health specialists must help guide school practice so that in the moment of distress difficulties are alleviated, not exacerbated. Think about how autistic masking can destroy mental health. Pushing through society’s perception of “normal but difficult emotions” teaches masking. This is harmful to autistic individuals and must not be encouraged.

So, schools must make reasonable adjustments and, says the Government, parents must (somehow) get their child to school. If not, absence can be authorised—up to a point with parents trusted unless the authenticity of an illness is in doubt. A feeling of discomfort lingers around that point, because how are schools to know? If only ‘where available’ was, instead “is always available” so well-meaning guidance could actually be followed.


  1. Mental Health of Children and Young People (MHCYP) survey: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england Mental Health of Children and Young People in England, 2022. NHS Digital, Leeds. Newlove-Delgado T, Marcheselli F, Williams T, Mandalia D, Davis J, McManus S, Savic M, Treloar W, Ford T. (2022)
  2. https://www.statista.com/topics/5790/education-in-the-uk/#editorsPicks
  3. The Hays Education Salary & Recruiting Trends 2022 guide.
  4. Outsmarting Worry’ by Dr Dawn Heuber (affiliate)

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Susan Lenihan

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