Guest post: 'The odd assembly isn't enough - teachers must talk about mental health every day'

[MumsnetGuestPosts]

Mental health support for under-18s is in the spotlight. A shocking lack of beds for young people and cuts to child and adolescent services have led the Labour Party to describe the current situation as a "scandal of neglect"; it is pledging to prioritise child mental health, including training teachers to spot the warning signs.

Had this been the case when I was a child, my bipolar disorder may have been recognised. I developed my first symptoms of bipolar at 11, my first depression at 12 and first suicidal thoughts at 13 - yet I wasn't diagnosed until adulthood. That sounds shocking, but it's not uncommon. The Office for National Statistics found that approximately one in ten young people will have some form of mental health disorder - around three pupils in every class - while a study published in the Archives of General Psychiatry found 50% of adults with a mental illness experienced initial symptoms by the age of 14.

This is why we must get mental health on the agenda in secondary schools.

Talking to my teenage son reveals the worrying lack of education around mental health. Ask him what he's been taught and he's pretty scathing. He says that it rarely gets a mention, and when it does, there's too much emphasis on problems like exam stress. Having received treatment for anxiety and depression in Year 12, he's pretty clued up on the subject and gets frustrated, knowing that adolescence is when people can start to develop much more complex conditions. "They mentioned Stephen Fry, but they didn't even say what bipolar was. There must've been kids sitting in that hall who needed to hear about the more serious stuff," he told me, and he's right.

Eating disorders are especially prevalent in the upper years of secondary school; a recent study in the British Medical Journal found that ages 15-19 is the most common time to develop anorexia or bulimia. Self-harm, often a coping strategy that points to other underlying problems, is also common. Selfharm UK suggest that around 13% of those aged 11-16 will deliberately harm themselves at some point.

Less common problems can also show up in adolescence, anxiety conditions such as obsessive compulsive disorder (OCD) or panic attacks. In every school there will be a few, probably undiagnosed, cases of bipolar disorder or psychosis. And sadly, around 600 15-24 year-olds take their own lives every year – enough to fill a small secondary school.

Teachers must get to grips with the fact that some of their pupils will already have diagnosable problems such as clinical anxiety and depression. Discussing mental health issues may mean staff have to venture out their comfort zones, and nobody can blame them for being reluctant or anxious when asked to talk about it - as a society we're only just becoming comfortable talking about depression, never mind suicide or self-harm. It's tempting to wheel out celebrities. But starting a conversation about Stephen Fry without explaining what bipolar is, or bringing up YouTuber Zoella but not discussing how to help with a panic attack, means a wasted opportunity.

Learning about mental health is learning for life. As young people move into adulthood it's exciting to start work or university, leave home or have a first serious relationship - but major life changes can also be stressful, and can lead to anxiety or depression. This phase of life is also the most likely time for bipolar or psychosis to appear. We need to equip our children with knowledge about these conditions early, so that they're able to spot potential problems and seek help before they escalate.

The best way to support kids is to support teachers, by improving their knowledge of conditions and treatments and giving them confidence to talk about mental health. As a Mental Health First Aid instructor, I work with teachers to achieve this, giving participants with no prior knowledge the skills to support others in mental distress.

Supporting young people's mental health cannot be done via the odd PHSE lesson or a one-off assembly on World Mental Health day. It's about creating an environment in which staff have the confidence to talk about mental health every day. Stigmatising words like "psycho" or "schizo" need to be challenged, as do phrases like, "she's so bipolar" or "OCD, much?" It's about a cultural change, not just offering support or spotting symptoms, and the best place to begin a society-wide shift in attitudes is in schools.

[PopularNamesInclude]

Everything hjik said.

'Have teachers deal with it' is shorthand for 'we are not going to fund the appropriate and necessary services'. Put big money into Camhs. Triple or quadruple its service capacity. This would go some way to providing real help and support. Giving pointless 'training' to some overworked geography teacher is not.

[BossWitch]

That's fine cherries, perhaps you can also tell us what you plan to take out of those curriculum areas to make time for teaching mh instead? Which bit of the history curriculum can be chopped out?

[WhistlingPot]

whistling you asked about what already happens and I feel that most of what you talk about happens within the scottish PSHE curriculum. We talk repeatedly about good mental wellbeing and how to maintain it as well as how to know if it seems less good.

Thanks Passme, that's really good to know. It's very interesting you have raised Scotland as an example, it would be helpful to know if it is the same in England (particularly whether Biology syllabus covers MH issues in the same way as it does physical health issues, as this makes me think about the recent government commitment towards Parity of Esteem).

Incidentally, I believe Scotland has thrown far more into Mental Health, specifically around Suicide Prevention and Intervention, and well as Postvention; eg with their huge, centrally driven, Choose Life strategy, which pushes forward courses such as MHFA and ASIST across a broad spectrum of professions.

While I really do understand the ire of fellow teachers being asked to do yet one more thing (it feels like we are responsible for the world at times) there are schools who currently do much of what the post talks about. Of course every lesson doesn't need to 'cover it'. It should be part of your methodology in the class and ethos as a school

IMO you have hit the nail on the head there in terms of methodology and ethos. I think perhaps the concern is around whether or not all schools are signed up to the importance of this, and whether more can be done centrally to ensure MH is covered in as many ways as possible, wherever it is relevant, without it being a notably separate "thing".

Re: how do you fit it into the syllabus? I guess what we teach our children will always be subject to change, as we discover new ways of doing things, we are creating history and making landmarks in science all the time! Surely it's a matter for whoever sets the curriculum to decide and prioritise subject contect?

[WhistlingPot]

This is another case of people wanting a magic wand, when no such wand exist.

At least one teacher trained in every school?

There is no such training, that would qualify a teacher for this

mhfaengland.org/first-aid-courses/instructor-schools/

What is MHFA for Schools and Colleges?
MHFA for Schools and Colleges has been designed especially with schools in mind. Based on the Youth MHFA course but targeted to meet the needs of educational environments, MHFA Schools will cover key topics around young people’s mental health and wellbeing, with a strong practical focus on how support young people experiencing mental distress. Whilst the course is not a replacement for the 2 day Youth MHFA course, delegates will become Champions for better mental health in schools.

As a one-day course, it fits perfectly into schools’ inset training days and busy private school timetables, making it accessible for teaching staff across sectors.

How can MHFA for Schools and Colleges make a difference?

MHFA for Schools and Colleges teaches practical skills that can be used every day
It gives a deeper understanding to the complex issues relating to young people and mental health
It helps people recognise the signs and symptoms of mental health problems
It enables a young person to access appropriate professional help
MHFA England has a proven track record and demonstrates its effectiveness through evaluation

[saintlyjimjams]

How does it 'enable a young person to access appropriate professional help' when those services are more or less non functioning?

I have spent last night & this morning corresponding with our local health chief trying to secure ds1 desperately needed access to CAMHS. Considering everyone familiar with him has been saying since the second week of January that he needs urgent help this really isn't good enough.

Until you try to access CAMHS it's hard to understand how bad it is.

[noblegiraffe]

whistling it's your pet project and understandably you're keen to see it in schools. Are you aware of just how many other people are out there with their own pet projects that they want teachers to incorporate into their teaching?

I read a blog post recently, which I unfortunately can't find, where the author looked through the media last year and listed all the things that it was suggested should be taught in schools. You've probably heard of the high profile ones like British values and character. Cookery, coding, happiness, mindfulness, social media, equality and diversity, tooth-brushing. The dangers of drink, finance, humanism, black history, gay rights, first aid.

A lot of these are already on the curriculum in some form. But people always want more from schools, yet we only have 5 hours of lessons a day, a limited budget and limited expertise.

And teachers also need training time to keep up with the insane subject curriculum changes and latest diktats from Ofsted.

[noblegiraffe]

Tom Bennett makes the point about trying to shoe-horn the cures to society's ills nicely here, as part of a longer blogpost which is well worth a read. community.tes.co.uk/tom_bennett/b/weblog/archive/2015/02/07/don-39-t-stay-in-school-inspirational-teacher-bashing.aspx

"In any closed system, this is vital – if we’re teaching x, we teach less y. It’s easy to imagine, in the manner of a student procrastinating before their finals, or a teacher at the start of the summer break, that time is in infinite supply, and that the hour will never be late. But teachers have approximately 200 days of five hours apiece per year. As it stands, we barely get them through the syllabuses. Every week I hear a different call from a segment of the chattering classes, insisting that some social ill or other be fixed by (of course) shoehorning something into the curriculum. That’s what they aways say: teach it in schools, and the evil evaporates: sexism; body image; bullying; vandalism….


But if we focus on what will expedite practical matters alone, we rob them of their birthright. Worse (and here I’ll make a practical point), you’ve hobbled their further studies. If they’re learning about mortgages and how to sign on the dole, the cruel mathematics of time insists they don’t learn about Under Milk Wood, or Stalin, or Copernicus. If we dispute that a child should learn quadratic equations, then we leave the next generation of mathematicians helpless until university. And it’s no good, no good at all to bleat, "Well, we should teach them both then." We can’t, we just can’t. There aren’t enough hours in the day.

This is one reason why it is so maddening that teachers are so regularly and comprehensively sidelined from discussions about education. We know what can be done; frequently, we know how to pull off miracles. But we can’t change the laws of physics. Other people, external to the system, are free to say what they like; to imagine that the teaching week is infinitely elastic, and worse, to believe that any dogma or ideology can be transmitted as easily as a jingle. We can teach them healthy eating, but we can’t make them eat healthily. We could teach them about compassionate relationships, but that wouldn't cure cruelty.

A curious assumption appears to underpin this attitude: that everything that ails society could be mended, if only the education system were tinkered with and tuned in just the right way. A drop more Tolpuddle Martyrs, a pinch less Planck. The curious continuation of this philosophy leads us inevitably to the conclusion that we, the schools, the teachers, are the enemies of utopia; we are the barrier to a new Golden Age. Well, to hell with that."

saintly is correct. If there is money to be spent on this, then it should go to CAMHS who are desperately underfunded.

[LonnyVonnyWilsonFrickett]

There are supposed to be teachers appropriately trained in health interventions in schools. They're called school nurses. My DS' primary doesn't have one, I think the high school does.

There are supposed to be people trained in supporting children with additional needs in schools. They are so woefully undertrained in my son's current primary that I am training them. And he 'only' has ASD, which is pretty common - he can't be the first child with ASD they've ever taught, despite their wide-eyed innocence at his difficulties.

There's supposed to be a service to support children with mental health and well-being issues in school. It's called CAMHS. It's easier to get an appointment with the Queen than one with CAMHS, but, you know, that's what they are there for.

This is fiddling round the edges. Support the systems and posts that are already there. Cut bureaucracy, instead of increasing it. Make it easier for all the professionals involved in our children's education - including teachers - to do their jobs.

[Perfectstorm72]

This is another case of people wanting a magic wand, when no such wand exist.

Erm, no. This is another case of people being pro-active and trying to enable those who care to have a little bit more understanding of the subject.

[Perfectstorm72]

LonnyVonny very well put. I am "only" a mother - what could I possibly know? I know that my DS primary school had NOBODY trained to recognise signs or symptoms of a very common mental illness "anxiety" and we spent 2 of his childhood years (& lots of money) trying to sort something which could have been more sympathetically handled early on. That's my primary concern and hence the petition to try and save others the heartache and lost time...

[WhistlingPot]

noble I'm not sure what you mean by this is my "pet project". I am not connected to this OP (if that's what you mean?) but improving all aspects relating to mental ill health seems important, given a quarter of each and every classroom of children can expect to experience mental distress at some point during their lives. Then there is the impact on those around them; everyone knows someone who has experienced mental illness. Therefore it's likely there will be at least a few more than a quarter, if not half at least in any given classroom, who will go on to be affected by mental illness in some way.

These are big numbers, of people in our society, and it's impacting on our overall productivity, and the health and wellbeing of our nation. It's way more significant than some pet project of a few, seemingly well meaning but misguided individuals.

Yes, CAMHS has been allowed to become woefully under-resourced, and adult services too. They are at breaking point in fact. But nobody anywhere on this thread is saying that initiatives to improve awareness and education in schools should replace vital services to treat mental illness. Far from it.

Prevention, intervention and treatment/postvention are of equal importance. Even if resources were put in the right places in treating mental health, we would still need initiatives to improve mental health awareness and education in schools, for preventative outcomes and to support early intervention. That's why I am supporting this OP.

I completely appreciate that there seems to be a forever-expanding demands placed on what we teach children in school. But this isn't going to go away any time soon. We do have to listen to teachers who are saying it cannot be done with the education system the way it is. I hear that, and no I don't have the answer. But it is not enough to simply say no to (or ridicule) any further inclusions to the curriculum, particularly if they are evidenced to suggest improved outcomes. ( [[http://post.queensu.ca/~hh11/assets/applets/Pinfold_et_al..pdf Working with young people: the impact of mental health awareness programmes
in schools in the UK and Canada]] )

We have to find inventive ways to enrich and expand our children's learning and prioritize aspects that give the most meaningful impact to enable children to grow into adults who continue on a path of lifelong learning and application. I strongly believe better mental health knowledge and awareness in schools is a significant part of this.

[WhistlingPot]

From the link:

Incorporating mental health awareness and emotional health promotion into the school curriculum is important, because it establishes the importance of mental health issues alongside other life-skills programmes such as sex and relationships, diet and nutrition, and physical exercise. It also provides a basic framework for understanding emotional well-being and mental illness.

Programmes in both the UK and Canada received a positive response from students and school representatives, reflecting a growing commitment to promoting mental health and well-being in the classroom.

Differences between the UK and Canada in terms of the impact of the sessions on literacy and attitudes were noted. At baseline, Canadian students were more aware than their UK counterparts. This may be a reflection of general levels of mental health literacy in the UK, known to be poor (16), which have resulted in the recent commitment of government to improve the mental health of the population and reduce discrimination and social exclusion experienced by people with mental health problems.

[noblegiraffe]

Whistling, by pet project I meant your area of interest.

I have more kids in my classes with SEN than mental health difficulties. I've had no training in SEN either.

You've got a pot of money to give me some training. Would you give me training in SEN or mental health?

[BlueAndSwirly]

Schools and teachers should absolutely have at least a basic understanding of mental health issues in children and how to handle them appropriately - I'm staggered that anyone should think otherwise.

Even the most well-informed, responsible, effective parent in the world still has to hand their mentally ill child over to the care of their schoolteachers for six hours a day.

I'm fairly appalled by the attitudes of some of the teachers here tbh.

[BlueAndSwirly]

Re SEN and mental health difficulties, they are often one and the same thing, for example ASDs can cause massive anxiety, which is a mental health issue.

[BlueAndSwirly]

Also, mental health issues can profoundly affect the ability to meet educational targets, so surely it has to be something that's related to teaching? My DD's IEP is built solely around targets related to anxiety issues, and she is lucky to have a teacher that is understanding and trying to help.

[BossWitch]

I would always be and have always been understanding and tried to help my students with mental health issues. But that isn't what is being suggested by the op. The two key ideas (and the ones I object to) seem to me to be thus:

A. Teachers should be educating all of their students about a whole range of mental health problems, including very complex illnesses such as bi-polar disorders. All teachers should be doing this, and it should be happening on a daily basis.

B. Teachers should form a front line mental health service, identifying mental health problems in students.

And possibly C. Teachers should be providing a level of treatment for these mh problems in the form of mental health first aid.

Teachers aren't trained for this. There is no budget to train teachers for this. There is no available time on a day to day basis and no space in an already squeezed curriculum for this. There may well be - quite justifiably - teachers who don't want to spend significant amounts of time and energy dealing with mh issues - not because they can't be arsed, but because they feel uncomfortable, overwhelmed, saddened, helpless. (Ask yourself if you could be a mh nurse? I couldn't - I don't have the emotional resilience.)

Add to that ththe fact that as soon as this becomes an officresponsibility for teachers it will be monitored by ofsted, and therefore there will need to be a paper trail to show to inspectors. So it will increase the already impractical level of paperwork required by teachers.

It could also be used as an excuse in future to avoid funding for mh services themselves - the government could deflect criticism of cuts to / dire failure of services such ad camhs by harping on about investment in mh care in schools.

All of which makes me very worried indeed.

[BossWitch]

*official responsibility

[BlueAndSwirly]

BossWitch - I realise my points have strayed a bit from the OP's, they are more in response to some of the comments by teachers which followed on.

Re some of your points

B. Teachers should form a front line mental health service, identifying mental health problems in students.

I suppose the contentious word is 'identifying' as this implies diagnosis - teachers should absolutely not be expected to diagnose and treat. However they surely need to have enough knowledge to be able to spot problems and refer appropriately (though the lack of support with referrals is another huge issue). I get that there is a huge training gap here - but the first step seems to be for the system to 'get' what some of the problems are and try to address them.

I would have thought that, for example, it is important to understand that some mental health conditions, eg anxiety (often from undiagnosed ASDs), will manifest as aggression/shut-down/avoidance/disobedience in certain situations of stress. This might occur at school but hardly ever at home, thus putting the burden on schools to identify and deal with what looks like a discipline issue but is in fact a complicated mental health issue.

Conversely, some anxious children will 'save up' their schoolday stress and release it at home - it is also important that teachers understand this and don't dismiss it as parents' inability to impose discipline.

Also there will of course be cases where parents will not seek help for their children themselves due to their own circumstances - disability, unwillingness, absence etc, so it is unfortunately left to schools to try and support the child. I can completely understand your reservations about this - especially in the light of shocking lack of funding to CAMHS and other sources of support. But children need to be supported 24/7 by what is often a woefully un-joined-up system - it's no good schools washing their hands of mental health issues when the mentally ill children are there, inconveniently, in the classrooms, with nowhere else to go.

And possibly C. Teachers should be providing a level of treatment for these mh problems in the form of mental health first aid.

As a pp said, like it or not, teachers ARE in the front-line for providing mh first aid, so it makes sense to be trained in the same way you would be trained to look after a head injury or nosebleed.

[noblegiraffe]

I'm not trained to look after a head injury either. If a child suffers a head injury, I have to call for a first aider. If a child suffers a panic attack, I call student support.

I can't look after a child with a head injury or a panic attack, I've got 29 other students to teach.

[PopularNamesInclude]

We are not trained to deal with physical health issues, either, not even nosebleeds. We do have first aiders at the school. No, teachers should not be trained or expected to pick up complex mental health issues. I wouldn't know if your child had a thyroid condition, or bronchitis, or diabetes either. Should I be trained in picking up physical health problems too? The PGCE is only a year long, but maybe if we cut training on foundation subjects we could squeeze in pre-med.

[BlueAndSwirly]

No, teachers should not be trained or expected to pick up complex mental health issues.

Why is it that some CAMHS and ASD assessment centres insist on having reports from teachers before taking referrals then? In many areas teachers are the GATEKEEPERS to these services.

[BlueAndSwirly]

By 'deal with' I don't mean personally treat the injury - but you have to be able to accurately assess the situation, call appropriate backup, and deal with the student in the meantime, surely?

[PopularNamesInclude]

If there has been an injury, I may not accurately assess the situation at all, beyond calling for the first aider to come immediately and possibly 999 if urgent and very serious. Beyond that, I would not make a call on how serious it is, or what injuries were sustained. I would refer. Which is exactly what I do if I suspected SEN or safeguarding issues or mental health problems.

I am more than happy to help any parent with access to Camhs (good luck) and SEN assessment. And if a parent wants to meet and discuss their child's mental health, I will be happy to help out however I can. Obviously. But that's not what the OP is calling for.

Fund Camhs. Fund real support by medical professionals who can offer real help.