Developing a model of consultees' understanding of mental health consultation in a school setting

Recent development of comprehensive Child and Adolescent Mental Health
Services (CAMHS) has seen the growth of Tier 2 mental health consultation in
school settings. Little of the literature considers consultees' perspectives on this, nor
presents systematic studies of interpersonal process in consultation.
Using interviews with consultees and a constructivist grounded theory methodology,
I explored parent and school staff consultees' understanding of their experience of
mental health consultation in a school setting. Consultees talked about the school,
service, consultee and consultant conditions that created the context for
consultation. They described the process they experienced through the consultative
relationship overtime, and within consultation meetings; this included their
experience of being supported, learning new strategies and changing their thinking
through sharing perspectives and becoming more reflective. Finally, they talked
about the outcomes of consultation for consultants, consultees, the school and the
referral process to Tier 3 CAMHS.
Consultees' descriptions of support and change connected to psychodynamic
understandings of containment and systemic theories of conceptual change.
Consultation service models should be designed in a way that supports these
processes. Consultees' description of a disparity in consultees' and consultants'
expectations of use of the expert stance in consultation suggests that more research
is needed to explore the value of this stance. Consultees' understanding of the
changes in the referral process suggested that consultation may bring referrers and
CAMHS workers closer together in their construction of the referral process, thereby
streamlining the referral process. This raised questions about how consultation
affects referral rates, and whether it holds potential for improving access for hard-toreach
clients. Finally, the extension from consultation about cases to consultation
about organisational level processes suggests that training about consultancy and
psychological processes at the organisational level may be useful.

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