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.

noblegiraffe - yes my DD is on the SEN register and we have been through CAMHS. My point is that in order to get to this point (and it has taken years) her problems have had to be identified, communicated, assessed, referred on etc by school staff.

With secondary looming it's not reassuring to come on these type of threads and read teachers' comments about how they know nothing about mh issues, nor do they have any time or inclination to do so and are a bit cross that they are expected to even be aware of them on top of everything else they have to do.

I'm not expecting a teacher to abandon a class - just to be properly aware of and sympathetic to a child with mh issues, and act accordingly.

With regards to learning about actual mental health issues in school, I did psychology as an A-level, and in y13, I learned a bit about eating disorders and psychotic illnesses (among other things). I also studied biology at A-level, and during my biology A-level, we learned a little about some inherited diseases, but it was more of a tool for teaching about inheritance than learning about actual illnesses.

I have to say, I think mental health issues are a bit more complicated than many physical illnesses, as with something like, for example, diabetes, the mechanisms and cause of the illness is fairly well understood. This is not the case at all with mental illness, and indeed it's likely that most mental illnesses have multiple causes or different causes in different people. They can also display differently, and different treatments work for different people. At A-level, learning about the two mental illnesses accounted for 1/6 of the two year course, being covered in roughly 25 hours of teaching time- you couldn't really take this chunk out of the biology syllabus at GCSE level or lower in my opinion.

Also, as someone who experienced disordered eating as a teenager, I found discussing binging, purging and fasting incredibly difficult. It was partly triggering, and, as no-one in the class (including the teacher) knew anything about my issues, the way they discussed it was fairly upsetting for me.

I think aspects of MH could be incorporated into the curriculum but learning explicitly about certain disorders can be difficult for sufferers, and so could cause more harm than good.

I would say it would be good for teachers to have training in dealing with acute mental health crises, but I don't think teaching about MH by non-experts in a rushed sort of way would be helpful to anyone.

Blue, I suspect almost all of us would be sympathetic but I suppose the sticking point is "be properly aware". Where does the awareness come from?

In your case in my own experience as the issues have arisen at primary I would meet with you prior to secondary and we would compile information for staff in conjunction with CAMHS if necessary and the school nurse/Dr. This would then be shared on the system and staff would be expected to act accordingly as noble described.

blue You appear to be suggesting that 'acting accordingly' isn't the same as passing the child onto someone appropriate as quickly as possible. I'm baffled as to why you would think that a teacher who should be teaching a class would be a more appropriate adult to deal with the situation than someone off-timetable who may well know the child better and have more awareness of what is going on.

I teach a kid who suffers panic attacks. The instructions are that if they have one they are to be allowed to leave and to take a friend with them. I teach a kid who has been self-harming. The instructions are to monitor their mood and behaviour and report any concerns ASAP to their mentor.

What would you have me do instead?

But is blue suggesting different?

Is she not just wanting to know that staff will know to do these things?

I read it as she wanted tobknowbher chikd would be understood and responded to. Those responses sound entirely appropriate.

noblegiraffe - fwiw, from what you say it sounds like you do have a lot of experience with dealing with children with mh issues, and are doing it well.

I'm responding to a lot of the comments at the start of the thread, which went along the lines of 'mh is an nhs problem, not my problem as a teacher'. Or 'it's something the parents should be dealing with, not me'.

You can't possibly compartmentalise it like this which is what riled me.

noblegiraffe - again, it sounds like the children you are referring to have been well assessed and are being dealt with appropriately when problems arise. If this is the case with all children in all schools, then that is good.

What's so terrible about saying I chose to become a teacher not a mental health nurse?

I hate this attitude of 'teachers should do x, y, z on top of everything they are already doing because they should care about the children in their care, end of story'. I do care. But I have a JOB. I am paid to provide a service - education in my subject specialism. If you want to change my job by adding in responsibility for providing a totally different service - FOR FREE AND IN THE SAME AMOUNT OF TIME - then I am entitled to think that that's a bit of a shit deal for me.

Yup, we can & do manage to be 'aware that Fred has MH issues', & where appropriate know what the issues are. Any concrete guidance on how to support Fred is then appreciated & taken seriously. & we can be very sympathetic to any & all problems the children we teach may experience.

If there's an issue involving a student in a lesson, we are, at best, as capable as you the parent would be, if you had to attend to that child's needs whilst simultaneously continuing to teach 29 others. Probably we are, in fact, rather less capable than you, unless we ourselves have a dc with MH issues.

In my 16 years of teaching I've experienced: fainting, vomiting, a rather crunchy head injury involving a sharp-cornered wall, umpteen meltdowns & storm outs (many & varied causes), a stroke, anaphylactic shock, epileptic seizure including incontinence, assaults, wall staple fired into someone's eye, dismantled sharpener blade used to slash self/another student, appendicitis, unexpected reaction to hallucinogenic drugs...

At this point I am a (hopefully) calm, sensible, kind, 'in loco parentis' adult in charge of the room. That's it. I can administer an epi-pen. As it happens I've had some minimal first aid training so I can try to stop bleeding or have a go at CPR.

& for anything else I can acknowledge that there is a problem, be kind to the person who is in trouble & holler for help.

As it happens I've taught quite a lot of students with diagnosed MH issues & generally been quite successful. I am sympathetic & supportive - but I can't possibly be anything more than that, & it would be arrogant & inappropriate for me to pretend differently.

These kids have been assessed (or rather, are being assessed, it's ongoing). But the point is, they have not been assessed by me. I am not having to deal with the panic attacks. I am not having to talk down a child who is self-harming. I know about the panic attacks, I know about the self-harming, but I am not expected to do anything about them myself. I am happy to be alert to issues, and to send children out or send urgent emails. I'm happy to discuss behaviour and provide info for consultants and for meetings.

I don't want to be expected to stand over my classes and instead of checking if they understand the maths be wondering if they are bipolar or depressed. My classes take up enough of my headspace as it is. If I spot something, (like the student who left my lesson twice in a fortnight to wash blood off their hands) I'll flag it up. I don't want to be expected to go looking for things.

Bloody hell raven your teaching career has been rather more eventful than mine. No wonder the kids complain that maths is boring.

Ha noble I was just about to say the same thing!

(Though I'm siding with the kids on the maths thing...)

To be fair the fainting was probably my fault.

I was enthusiastically discussing Macduff being from his mother's womb untimely ripp'd, with reference to how my mate who'd had a Caesarian experienced it as someone doing the washing up in one's tummy.

The year 8 who subsequently toppled out of her desk was such a noted fainter that the rest of the class were quite keen to reassure me that 'oh yeah it's just Rebecca, she did it after the TB jab & when we blew up sheeps' lungs in Biology'.

But that's the thing - I was really sorry to have made the poor lass pass out, & I'd have toned my lesson down if I'd known that this was how this particular 12yo reacted to anything slightly gruesome.

& I'm not suggesting that her squeamishness was a MH issue - just that it was a thing I'd have known about if she'd been my daughter, OR if I'd been professionally involved with her wellbeing, outside of seeing her as one of a class of 30, 4 x a week.

You honestly can't know everything about every child you see of 150 in the course of a day. Best will in the world & all that - you just can't. So you can't, realistically, do what the OP here is asking. Recognise a problem & refer it to someone who is equipped to deal with it - yes, we'd all hope to do that.

He he he he! I'd have been tempted to set up a competition in the staff room, who can get Lucy to faint the most by the end of term...

Lucy? Rebecca! Brain giving up. Time for sleep it would seem.

Totally agree. Basic understanding doesn't have to cause extra pressure on teachers. May even result in less pressure in the long run.

SansaUnderCover

I have to say, I think mental health issues are a bit more complicated than many physical illnesses, as with something like, for example, diabetes, the mechanisms and cause of the illness is fairly well understood. This is not the case at all with mental illness, and indeed it's likely that most mental illnesses have multiple causes or different causes in different people. They can also display differently, and different treatments work for different people.

You know what? I think if the biology syllabus even just covered a paragraph like that, perhaps with some names of MH conditions and some general info around recovery and types of treatment (using combinations of medication, talking therapies, and lifestyle changes etc) it would be better than nothing. It would at least bring mental and physical health together on the same level (it is so damaging to segregate it) and would not necessarily linger on anything that may be uncomfortable for anyone. Maybe something could be set as homework to research, rather than covering in depth in class.

Callooh
As we have all said, I believe, we recognise the importance of it, and put into place recommendations given, and would welcome and support mental health professionals dealing with this in schools. We can look out for vague signs while we hand out 30 worksheets, challenge 3 kids for being late, count in homework, lend pens, teach challenging and differentiated lessons and do all the preparation and marking but no we can't do more.

I don't think anyone is asking for all that much more tbh. But would you not prefer a better understanding of the "vague" signs of MH issues than you have just been able to pick up randomly along the way? What currently qualifies you to understand what these signs are and what they might mean?

It is fantastic there are teachers on this thread who refer on, and are more than willing to work with recommendations after referral, but I do have some questions around this.

Can you give me, as a parent, any reassurance that ALL the secondary teachers, who will be the first point of contact for my DS and responsible for him for a significant amount of hours a day, will be willing and knowledgable enough to look out for signs that they may (or may not) understand to mean a MH issue? That any signs will not be dismissed as lazy, destructive or "bad" behaviour? Or that these signs will be picked up/acting upon in a timely enough manner to ensure early intervention by a professional, as soon as possible?

Because currently, even though I really appreciate the efforts on this thread, these are what remain my concern.

whistlingpot
I agree totally. Just a lack of basic understanding of how some mental illness can present itself ie. Anxiety symptoms can often be misinterpreted as bad behaviour (when actually a child feels extremely threatened and is displaying fight or flight instinct). This was misinterpreted from my DS in yr6 & treated as such by a teacher who sadly refused to even believe it could be MH related leading to a total downward spiral in what should have been a fun end to primary years. I appreciate this isn't the attitude of all teachers, but I can't understand or tolerate a complete rejection of even a small amount of training to give them an insight into how some children may be feeling inside but unable to talk about.

Teachers, really?
Do you have any idea how many of us have mental illnesses, are on medication and suffer from stress, depression and other related syndromes?
How hypocritical to expect us to be spouting on about good practice when we have so little say in our own mental health issues, work/life balance and are barely coping in the classroom.
Do you really want us to be honest and truthful in our teaching?

Absolutely Perfectstorm.

I do understand the anguish of subject teachers, and the pressures on them, so I am also wondering about the role of form tutor (do they even still have these? lol at my ignorance - I've a lot to get up to speed with before DS starts secondary!) who might have more important daily contact with pupils, and be able to identify any problems more readily?

' I believe there should be AT LEAST one teacher trained in every school including Primary School. In my case my son was in year 6 when anxiety began....please if anyone else agrees then sign and share my petition to the government to fund schools for approx 300 pounds to train one member of staff in mental health first aid.'

Why a teacher? Why not a trained MH counsellor in every school? They could deal with all of us, staff and pupils alike.