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

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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.

Which is exactly what I do if I suspected SEN or safeguarding issues or mental health problems.

But in order to suspect you have to have at least some basic knowledge and understanding of WHY you are referring. The SEN boards are full of people's experiences of being disbelieved, ignored and fobbed off by schools when it comes to making appropriate referrals and evidence-gathering for outside agencies, so there is obviously a gap somewhere.

And yes of course schools should be properly backed up by SEN and mental health professionals - it would make everyone's life a lot easier if problems were spotted and addressed earlier rather than later.

I know it would be great if I could spot all the problems a student may face. But I can't. I cannot with any level of accuracy gather evidence on a student's mental health problems, drug use, physical illnesses, nutritional difficulties... I am trained to teach maths. Most of my professional development is unsurprisingly aimed at that. I am really good at it. I am to be the best teacher I can be. I am sorry but I cannot also do the job of the NHS and social workers and police and parents. No matter how much training you reckon I can handle on how many diverse issues.

As to referring, it's pretty basic. A child who looks tired, withdrawn, angers easily, etc, might make me refer to the school welfare officer. Teachers do that already. It's not based on training. The school welfare officer is trained.

It sounds like mental health awareness training might be more appropriate for teachers (such as the one day training linked to previously, or there are several shorter awareness trainings available too) with a MH 1st Aider in the school to refer on to, who should be fully trained. These should be funded through health, imo, certainly in part, if not fully. In some areas there is occasional free training for professionals working with anyone vulnerable to MH issues or suicidal thoughts, through the voluntary sector I think. I've got one in mind and will look and link later if I can find it.

How MH fits into the syllabus is a separate issue. I'd still be really interested to know more about whether common MH issues are covered alongside physical health in Biology in England. Are there any Biology Teachers out there willing to share any thoughts on this?

Callooh - so if a parent requests referral then schools will unquestioningly refer on in all cases? That's not my experience. The fact that they don't implies that they have the knowledge and experience to make a judgement.

I realise that there must be a difference between primary and secondary with regard to all this - although you would hope that secondaries would have a good grasp since child mh and SN problems don't tend to be improved by puberty and the demands of teenage life.

PopularNames - do trained Welfare Officers only exist at secondary? If so, what happens at primary?

If I could ever fill in a form to help a parent access camhs, I would do so without hesitation. I have never been asked to do so because I refer to the welfare officer, who refers to the GP. Ed psychs and OTs and slts and camhs do ask for school input in their investigations, but no one's ever made me a gatekeeper to these sevices. I just fill in a form to hep them assess the child's needs. Because I am deeply unqualified to judge what specialist help a child may need!

How well do welfare officers know the children that they deal with? Do they have an in depth knowledge of mh and asd? Do they exist in primary schools?

I'm genuinely ignorant about this and, as a parent of a child with mh issues, hoping that someone will come up with a reassuring answer.

I work in a primary school. Our welfare officer is not called a welfare officer, but that is part of his job. Spot a problem or issue with a student? Call him. Everything from bullying to alcohol (no joke) to safeguarding. We also have a Senco, so I would say that depending on how a mh problem presents, a child could end up with either or both of them. We have SLT and an ed psych who come to the school, and the Senco arranges that. A class teacher would have little to do with it. For mh other than asd, the referral will likely be to the gp via the welfare officer. But primary schools will differ widely in their resources.

I wouldn't say that camhs has a "good grasp" of teaching A level maths necessarily, either.

Unfortunately, mh doesn't adhere to timetables. Kids can't switch off their mh issues just because it happens to be double maths and save them for their (probably non-existent) CAMHS appointment.

sorry, missed the question about an in-depth knowledge of mh and asd. No, they are there to refer a parent to other services, not to make a diagnosis. They are not health professionals and we do not have any nhs staff on the payroll.

Kids at secondary school are usually pretty good at taking themselves off to pastoral support when they cannot cope with coming to, or being in a lesson. Most with identified issues have a "time-out" card which means they can leave a lesson with no explanation. Others, who e.g. have anger issues may storm off, in which case I can only ring across to student support to inform them a student has gone AWOL. If a student is upset I normally send them out with a friend to support them.

I do very little myself. If it's lesson time, I have a lesson to teach. I can't just abandon my class.

Thanks for the info PopularNames. It is confusing because as a parent, you don't tend to have direct contact with anyone except the class teacher (well I haven't, anyway).

No need for the snarky comment about mh not adhering to timetables. Most schools do not have trained health professionals on staff. That would be wonderful, and I would support any petiton to get the government to put money into school counsellers and nurses, as Callooh said. But piling on an inset day for teachers about mh is only going to result in the govt saying, hey no need for mental health funding. We trained the teachers so everything is fine. I am not saying all of this to be dismissive but because you cannot expect education professionals to perform the job of health professionals. We really are focussed on education, and that is not unreasonable.

noblegiraffe - proactively seeking help is exactly what my DD is incapable of doing - she can't speak or even physically move properly when she is under stress. This is relatively common in children with asd-ish/anxiety issues. Which is why she is unfortunately dependent on class teachers being knowledgeable enough to realise this.

INSET = trained teachers is a claim to be very wary of.

My school put on an INSET recently. We hired an external speaker, which is unusual these days. The speaker started by saying 'this is normally a one or two day course, but I've been asked to condense it into two hours...'
We were talked through a PowerPoint at breakneck speed.

The school then put a note in the newsletter saying 'all staff are now trained in X'

I can barely remember what X is and it was only a couple of months ago.

If a parent came to the school and said my dc has this mh issue and we have seen camhs and these are the suggestions for the classroom, then of course the school would implement that to the extent possible and fundable and legally required. not really the class teacher's call Iyswim.

I didn't say it to be snarky, I said it because it is true.

From the sounds of it I perform a welfare officer role but in scotland. I have no specific training In MH other than what I have followed with my own interest and my many years experience.

I see my role as supporting pupils, parents and subject teachers in all sorts of issues which impact on learning - asn, lac or MH issues.

Maths teachers need to teach maths. I absolutely do expect them to report to me concerns and to act with sensitivity but I do the referring and the crisis management.

My role means I have access to CAMHS, ed psych, HCP and SS which allows me to direct supprt to child as vice versa.

The problem is, however that I also have timetabled classes with exams to pass so the child who arrives in crisis has to be prioritied against the class in exam prep.

99% of the time it works well if with a slight tinge of the frantic. Kids in my classes get that "one day it could be me".

At least you got it from an outside speaker noble! As opposed to a member of slt going on the two day course misunderstanding it and then 'feeding it down' to the staff later in an attempt to save money.

Blue in your situation you would not rely on teachers' knowledge of mental health to deal with your dd. Your DD would be on the SEN register and teachers would be made aware of your DD's needs and how to deal with her as an individual.

I've got loads of info in my head about various students that I teach and their individual needs. The one who's a selective mute so should not be called on to answer questions. The one with panic attacks who should be sat near a door. The one with autism who should not be sat near a window or computer. They are all individuals and what affects one child with a certain condition affects another child differently. I don't use my knowledge of autism (training = zero, btw) to decide what's best for an autistic child because they are all different. So I act on the advice and info given to me.

It sounds like most teachers see mh issues as something they are a) not remotely qualified to deal with and b) something out of the ordinary which needs to be passed on to another member of staff as quickly as possible.

I'm a bit by this since most teachers deal with kids with both mh issues and asd all day every day (whether they realise it or not). Surely more understanding is better than less?

blue I said at the start of this thread that I would love some training in dealing with kids with mental health issues. I don't, however, want to teach about mental health issues to kids, and I don't want to have to counsel, intervene, diagnose.

I'm not qualified to deal with them (I'm a socially awkward maths teacher with no knowledge or experience of mental health issues bar what I've picked up as I've gone along and from reading MN). And if a child is in crisis, then it does need to be passed on as quickly as possible because I'm certainly not going to be able to deal with them effectively while teaching a lesson. You seem to think that classes can just be abandoned?