Best Practice

Mental health: Spotting and averting issues in schools

Staff wellbeing Pupil wellbeing Mental health
With NHS figures showing that one in eight students now have a mental health disorder, what can schools do to spot and avert mental health issues? Dr Margot Sunderland advises

Schools across the UK are dealing with a mental health epidemic, with both primary and secondary school leaders reporting a rise in stress, anxiety and panic attacks in their pupils as well as depression, self-harm and eating disorders.

NHS figures last month confirmed that around one in eight young people aged five to 19 now have a mental health disorder of some kind. And in 2017, 98 per cent of teachers and school leaders came into contact with pupils they believed were experiencing mental health problems, according to NASUWT research.

With children spending 190 days at school per year, teachers are in a prime position to provide much-needed support to pupils with mild to moderate mental health problems.

This is reinforced in the government’s Green Paper Transforming Children and Young People’s Mental Health Provision (December 2017), which states: “There is evidence that appropriately trained and supported staff such as teachers, school nurses, counsellors, and teaching assistants can achieve results comparable to those achieved by trained therapists in delivering a number of interventions addressing mild to moderate mental health problems such as anxiety, conduct disorder, substance use disorders and post-traumatic stress disorder.”

Research also shows that, on average, it takes 10 years for a child to get help for a mental health condition – and even then, only half who seek help get better, meaning teachers play a crucial role in spotting, addressing and mitigating mental health issues early on (Khan, 2016).

Understanding the causes

Before schools can appropriately tackle poor mental health, it is essential that they take a step back and understand the causes behind mental ill health and the transition from emotional pain, which is experienced by us all, to mental health problems.

Emotional pain for children and teenagers, which may be caused, for example, by their parents separating, an illness or a death in the family, multiple house moves or bullying at school, and the impact this can have, needs to be understood and normalised by schools.

Before discussing mental health conditions, schools should first focus on providing children with a space to talk about painful life experiences and offer appropriate support.

The wealth of scientific research on “social buffering” (having someone at the time of the painful life experience to listen, empathise and understand) shows that this can prevent students’ emotional pain from transitioning into a mental health issue.

Much research suggests that painful childhood experiences without “social buffering” at the time have a significant impact on children’s behaviour, attendance and learning outcomes.

Research into adverse childhood experiences and toxic stress (Burke et al, 2011) found that children with three or more adverse childhood experiences (ACEs), such as those mentioned above, were three times more likely to experience academic failure, five times more likely to have attendance problems, and six times more likely to have behavioural problems.

For those with four or more ACEs, more than 50 per cent were likely to have learning problems and were 32 times more likely to have behaviour problems.

Early warning signs

For teachers, early identification of the warning signs that a student’s painful life experience or emotional pain could, if not addressed, become a mental health problem is critical. Some key signs to keep an eye out for include:

  • Marked changes in concentration.
  • Losing ability to focus on learning.
  • Staring out of the window, tiredness and low self-esteem.

More concerning signs and symptoms to watch for could include:

  • Isolation and withdrawal from peers.
  • Parents also reporting marked deterioration in several areas of functioning.
  • Indications of serious self-harm or suicidal ideation.

In these cases, the pupil should be referred directly to Child and Adolescent Mental Health Services.

A role for government

Our results-driven culture and focus on academic outcomes is also adding to widespread mental health problems in schools. Exams are frequently cited as one of the worst stressors facing pupils.

In a recent National Education Union survey of teachers (April 2018), 82 per cent said tests and exams had the biggest negative impact on mental health, with exams causing children acute stress, and many pupils breaking down in class due to the pressure, or turning to self-harm or suicidal thoughts.

The NSPCC’s counselling service, Childline, receives a surge of calls from young people during the SATs and GCSE season. It received 3,135 calls from young people about tests and exams in 2016/17, an increase of 11 per cent over the previous two years. Problems sleeping and eating, school avoidance, panic attacks and self-harm and suicide are increasingly reported among young people during exam time.

Student wellbeing is just as important as academic outcomes, and needs to be treated as such. Until the Department for Education, Ofsted, Regional Schools Commissioners and the like balance the scales between wellbeing and academic achievement, there will continue to be a mental health problem in schools.

The UK should look to other countries that are less testing-focused and follow their lead. Finland, for example, epitomises progressive education policy, with a later introduction to formal schooling (age seven) and no tests in primary schools (pupils are only tested at 18) and was ranked fourth in the world for reading in the last Programme for International Student Assessment (PISA) in 2016. The UK is way down the list at ranking 22.

Governing bodies, trusts and directors need to make pupil wellbeing, as well as staff wellbeing, a key performance indicator.

What can we do now?

One approach schools can take to avert mental health issues is to provide pupils with “emotionally available” adults.

In effect this means that school staff should focus on building rapport with their students and strengthening their listening and empathy skills to help children regulate their emotions and reduce their levels of emotional stress.
Research in the YoungMinds and Cello report Talking Self Harm (2012) indicates that two out of three teachers are worried that if they have a conversation with a teenager about self-harm they might make things worse. However, if they listen empathetically, this is absolutely not the case.

It is important for schools to focus on building teachers’ confidence in this area, providing them with opportunities to gain skills around the type of language to use and how to approach a mental health conversation. For example, if a teacher notices a child is expressing symptoms of poor mental health, they should take the student aside and ask open-ended questions using empathetic language.

Such as: “I’m so sorry that you are going through a tough time at the moment, would you help me to understand what is happening for you in your life at the moment?”

Or you might try: “Would I be right in thinking that things at home are hard for you right now?”

And: “Is there anything we can do to help you with what’s going on for you in your life?”

Validating the child’s feelings is important, too. Perhaps with statements such as: “Of course you’re feeling upset because your mother is sick.” And: “It’s understandable that you’re feeling worried.”

It is about building on the natural empathy that many teachers are likely to already possess. A guide for teachers – I Wish My Teacher Knew – which started with US third-grade teacher Kyle Schwartz asking her students to fill in the blank in the sentence: “I wish my teacher knew....” has become increasingly popular and is a great way to encourage children to discuss challenging feelings or experiences.

Kyle was anticipating responses such as “I wish my teacher knew I wanted a pony”, but instead the vast majority of students (90 per cent) responded to the question with answers relating to what was happening in their home life, such as, “I wish my teacher knew that my mother is ill and I’m frightened she might die”, “I wish my teacher knew that my parents have separated” or “I wish my teacher knew that I’m very lonely”.

There is an assumption that asking the question and starting a dialogue with a student about painful experiences will add to their distress, but it is actually the opposite.

Schools should also consider including activities that help children to calm high levels of stress that we know can trigger mental health problems if unresponded to.

This means including activities that provide physiological regulation (calming the body down and improving thoughts and feelings) in their school curriculum. Activities such as mindfulness, yoga or Tai Chi at the beginning of the school day have been shown to increase concentration levels, aid calmness and reduce stress levels in vulnerable students, thereby enabling them to learn.

A school in Bradford recently introduced a system that involved students choosing a feeling face when they signed the morning registrar. Children that choose a sad, angry or frightened face were consequently provided with one-on-one support by an empathetic member of staff. It didn’t take long, just a soothing voice or a hug was enough to calm the children. The school noted that the support significantly improved the pupils’ concentration levels for the rest of the day.

From a behaviour policy perspective, school leaders should look at revising sanction-based policies and implementing “relationship-based policies”, which underpin the importance of understanding the causes of pupils’ challenging behaviour and responding in a healing (empathetic and understanding), rather than a harming (angry and frustrated) manner.

Relationship-based policies will ensure schools become nurturing environments for children and that teachers interact with children in a way that brings down stress, not exacerbates it.

Teaching staff the science behind “toxic” stress (chronic unrelieved stress) and its role in mental and physical health issues, including how to bring a child’s stress levels down from “toxic” to “tolerable”, is also an important component in reducing or preventing mental health issues.

Neurochemical reactions should be taught and understood throughout schools. For example, unmourned grief can trigger violent behaviour or withdrawal and because many senior leaders do not know this many children with blocked grief are excluded for aggressive behaviour.

A child who is acting up as a response to grief should be helped to process their grief, not excluded. Neuroscience needs to be brought into professional development (and teacher training for that matter) otherwise schools may unwittingly do harm.

Schools should be catching students as they are falling, not after they have fallen. A dialogue needs to be started that normalises emotional pain and discusses the causes of mental ill health. In dealing with painful life experiences, students need an empathetic and emotionally available adult – and with children spending more than 1,000 hours at school per year, teachers are in an ideal position to provide this support.

  • Dr Margot Sunderland, a child psychologist neuroscience expert, is director of education and training at the Centre for Child Mental Health, a not-for-profit provider of CPD and training programmes for school staff. She is also co-director of Trauma Informed Schools UK. Visit www.childmentalhealthcentre.org

Further information