This week, rather than the usual spontaneous musings and rantings, I promised to convert a talk I gave to the WCSiL Conference in London on mental health in schools. Don’t worry… normal service should be resumed next week although this does rather depend on what iniquities life continues to throw at me!
In the UK one in 10 young people aged 5 to 16 suffer from a diagnosable mental health disorder. Nearly 80,000 children and young people, and over 8,000 children under age 10, suffer from severe depression. This number has nearly doubled in the past two decades. One in every 12 children and adolescents deliberately self harm. This figure, too, represents a huge increase in the past 10 years. Nearly 300,000 young people have an anxiety disorder, and one in 10 boys and one in five girls suffer from depression. There has been a near doubling of hospital admissions for teenagers with eating disorders in the past four years. And only 14% of suicides of those under 20 had been in contact with specialist mental health services.The World Health Organisation (WHO) estimates that 10-20% of children and adolescents worldwide experience mental disorders. Half of all mental illnesses begin at the ages of 14-24 years.
There can be little doubt that, in the UK, we are facing a crisis in mental health care. And at the sharp end of that crisis are Britain’s children, adolescents and young people. The problems they face are not new to those of us at the Institute of Psychiatry, Psychology and Neuroscience nor to those involved in mental health across the country either as researchers or practitioners. Of course many problems stem from inadequate funding – you can find out how much your local health authority spends child and adolescent mental health services (CAMHS) here.
Failure to identify mental health problems at an early age exacerbates problems into adulthood. There is a renewed emphasis from research funders in the UK to understand and develop early interventions for mental health problems. The UK government promises a Green paper on mental health in young people this year including the idea of training “mental health first aiders” for all schools. However, there is a clear gap in resources for the delivery of mental health services that cannot be met by research and re-training alone. So, one imagines, the UK government is exploring ways of delivering more mental health provision at a lower cost. An obvious way to do this is to charge schools with responsibility for prevention, identification, and perhaps also support for school pupils with mental health problems.
There is also work needed for schools to address the issue of stigma in mental health. Developmental and social psychological research has learnt a good deal about effective interventions to change attitudes and behaviour in areas such as racial and gender attitudes. However a recent review of interventions to address young people’s beliefs about mental health suggests only patchy positive outcomes. There is an issue of emphasis here: a Royal College of Psychiatry review argues that interventions need to last at least four weeks, that societal contact is not necessarily beneficial, and that whole school and senior leadership support is required for lasting success. Pernicious media representations of mental health influence many people’s beliefs and attitudes towards the mentally ill. In adolescence these representations merely compound stigma and the isolation many young people feel.
Schools and teachers also have a role in assessing whether the pressure of expectations felt by young people are helpful in their education. The adolescent world, for sure, is awash with expectations: social, academic, family, personal, peer, physical…The transition to university or to work is often a difficult one and schools ought to take some responsibility for preparing their pupils for these transitions. That means not just building resilience but also helping young people to be aware of their own and others’ mental health and how to manage it.
My view is that schools should not be operating at the front line of mental health services; if they are to do so that requires significant resource. Of course, all the teachers I meet care deeply about the young people in their schools and many offer excellent support to their pupils. However, caring for children’s and young people’s mental health is not the purpose of school. The purpose of school is, at least as I was led to believe, to educate. But herein lies a different and more difficult challenge. Because with a current emphasis on academic achievement at all costs schools (and universities) have participated in creating an environment where getting the grades is an end in itself. Parents and the young people themselves participate in this too, but it is the children who face the sharp end of this culture and internalise a pressure cooker environment with inevitably negative consequences for many.
So perhaps the greatest challenge is to start to rethink what our schools should be doing. Should they be pressure cookers for academic excellence? Have we lost a sense in which learning should be fun and that school should be an education not just of facts and grades but about oneself, one’s aptitudes? And the flip side of this, reconciling oneself with inevitable failure at some point… The best schools I have seen, and there are many, are fundamentally communities for mutual support and learning where children and adolescents enjoy their education without the pressure of achieving the highest grades at all costs. They are places where pupils love learning and feel happy and safe.
I promised a list of resources associated with this talk. Here they are, in no particular order:
WHO Atlas: Child and Adolescent mental health resources
Mental Health in International Schools
Reducing stigma about mental health in schools
Young Minds BOND initiative
British Psychological Society Promoting Mental health in Schools
King’s, IoPPN website