Mental Health in Schools

A Guide to Pastoral & Curriculum Provision

Mark Prever

• Publisher: SAGE Publications Ltd
• Year: 2006
• Print ISBN: 9781412923316, 9781412923309
• eBook ISBN: 9781446232811
• Edition: 1
• Topic: Education
• Subtopic: Education Counseling

?A clearly written, well-structured and practical account of how to help and support children and young people with mental health problems, and those at risk of developing such problems... The book concludes with an excellent listing of organisations and resources? - SENCO Update

?A highly practical and impressive book... I like the short introductions and the concise summing up within each chapter... The book is suitable for teachers as well as counsellors and outside agencies involved in school referral work... deserves to be widely read and to have its ideas put into practice? - Therapy Today

?I feel the book should be compulsory reading for everyone who works with young people, but especially pastoral heads and senior teachers with responsibilities in this area? - Janine Phillips, Class Teacher

Mental Health is now a mandatory component of the PSHE (Personal, Social and Health Education) curriculum. This book is a practical guide for teachers, explaining the difference between counselling and counselling skills, as well as looking at how mental health issues affect children?s behaviour, self-esteem, motivation and achievement and so on, and what the school can do about this.

Issues covered include:

- the difference between counselling, and counselling skills

- employing a counsellor in schools

- how to set up and run counselling provision in a school

- information on counselling, psychotherapy and talking therapies

- when to refer

- peer support

- mental health and emotional intelligence in the curriculum

- lesson ideas and plans for PHSE

CHAPTER 1

Introduction

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This chapter will show that:

Young people in difficulty may have underlying mental health issues. Schools need to look beyond the behaviour to understand what might be going on for that young person. Narrow behavioural approaches are sometimes limited and may make matters worse.

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Perhaps the best place to begin is with the following case studies, which introduce us to some of the main issues to be explored throughout this book. These young people do not of course exist, but they represent an amalgam of some of the young people I have known during the last 30 years. While reading, you may recognise elements of some of the pupils you already work with. If I have learnt anything in my years’ working with young people, it is the complexity of their lives, the stresses they face, the loss they experience, the violence they encounter. Sometimes I ask myself: how would I cope in their situation? Do I really understand? Can I even begin to feel what they are feeling now?

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Carl

Carl is a Year 8 pupil, small for his age. His junior school transfer information shows that he has had problems with his behaviour since Year 4 when his mother and father’s relationship reached an all-time low and domestic violence became a feature of the relationship – violence which Carl witnessed daily. Carl has attention-deficit and hyperactivity disorder (ADHD), but his doctors find it difficult to judge the correct levels of medication to enable him to negotiate successfully the school day. There are problems at school, and he has spent many hours in the school’s ‘time-out’ facility, offering respite to his teachers and classmates. His mother and father are now separated, and Carl feels let down by his dad, who rarely agrees to see him and often cancels at the last moment. Carl feels rejected and takes this frustration to school. He is aware of his ‘condition’ and is willing to talk about it; indeed, he is keen to do so. The school is aware of his special needs and has made real efforts to take them into account. However, the situation is deteriorating, and some of his teachers feel he is ‘getting away’ with too much. They have questioned how much of his difficult behaviour is due to his ADHD, and therefore understandable, and how much is simply bad behaviour. This has introduced inconsistency into their approaches to him, and Carl is now confused and resentful of any intervention that is part of the school’s behaviour code. Carl has been allocated a mentor, who meets with him regularly, and SMART targets for ‘negotiated’ behavioural improvement. To redress the school’s apparently lenient approach to him, Carl has recently received a number of fixed-term exclusions so that he understands where the line is drawn. He has problems relating to other pupils and is consequently the subject of bullying, as other pupils react to his aggression and anger. They also resent the way teachers treat him differently and that he appears to be handled more sympathetically by his head of year.

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Sunita

Sunita is a diminutive 11-year-old pupil who has struggled throughout Year 7. Her mother despairs over Sunita’s refusal to go to school. Her attendance at junior school is just about satisfactory, although some concern had been expressed. Sunita’s mother brings her to school, but the terrified child clings to the gate and cries. She begs her mother to take her home, promising to go to school ‘tomorrow’. The learning mentor at the school has encouraged Sunita to enter the school on occasion, assuring her that she can spend the day alongside her, but the mentor knows this is not a long-term solution. When encouraged to go to lessons, albeit on a limited timetable, Sunita cries loudly, and her desperate appeals disturb others. When in school, she inevitably complains of stomach pains and headaches, and occasionally she has to be escorted to the toilet to be sick. The head of year is under pressure to improve Sunita’s attendance, and the education social worker has been involved. Everything has been tried: encouragement and rewards, threats of court action, and the possibility of transfer to another school. Sunita has a very close relationship with her mother, and Sunita’s crying has made it hard for her mother to maintain firm boundaries. At times, it is easier to allow Sunita to stay at home. Her mother is herself depressed and feels guilty about her role, as she had been hospitalised for a good part of Sunita’s first few years of life. She remains intermittently unwell, and Sunita is worried that her mother will die as her aunt did.

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Zoe

Zoe does not appear to be interested in school at all. Her Years 7 and 8 end-of-year reports showed an average student whose behaviour was within the normal range. Now, in Year 10, Zoe’s coursework is non-existent. Constant phone calls home do not appear to make a difference. Her teachers are frustrated because they feel she is ‘wasting her ability’. They are also concerned that her aggressive behaviour toward teachers and dinner supervisors is a bad example to others. Other students look up to Zoe and she occupies a position of power within her peer group. She has sometimes resorted to punishing those who challenge her superiority and status, by excluding them from the friendship group. Zoe spent just over a year on the child protection register when her 20-year-old brother interfered with her sister. While there was no suggestion that he had touched Zoe, social services established the risk. This affected the family in acute and profound ways. For Zoe, there were issues about her parents’ failure to protect her sister and their defence of her brother, which hurt her deeply. The situation at home has reached crisis point and Zoe does not want to stay there. She habitually runs away. Zoe is self-harming and recently was hospitalised briefly after taking 10 paracetamol tablets in the playground, an event that caused great anxiety in the school. Periodically, Zoe goes a whole day without eating, causing her friends concern. Zoe is often in detention at school because of her ‘attitude’ and occasional rudeness. School uniform remains an issue, and the school is determined that she should dress the same as others. She has been excluded on three separate occasions for fighting and smoking. There is a suggestion, but no evidence, that she is smoking illegal substances.

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Mohammed

Mohammed comes from what appears to be a very settled and caring home. He has two brothers who successfully attended his school without incident. Both gained good A levels, went to university and now have excellent jobs. Mohammed’s parents show a great deal of interest in Mohammed, always attend parent consultation evenings, and comment in his ‘school planner’. At school, Mohammed’s behaviour is exemplary. He receives many ‘credits’ but rarely collects them. His attendance is faultless and he is often commended for the quality and accuracy of his uniform and preparedness for school, evidenced by his bulging pencil case. Mohammed is difficult to engage, although staff know he is highly articulate. He told his concerned form tutor that he has lots of friends, but he is rarely seen with them, preferring to sit alone in lessons and occupy the library at lunchtime. No one bullies him – he rarely attracts the attention of any adults or pupils in the school. He mostly goes unnoticed, although his teachers have high hopes that he will attain at least eight grade A–Cs. Mohammed is an asset to the school and his parents are proud of him and communicate their high expectations of him.

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These four case studies represent the kinds of issues faced by schools every day. In all parts of the country, not just in the inner city, school staff grapple gallantly with young people whose behaviour is causing concern in various ways. To a large extent, the school’s response is a behavioural one, because schools have traditionally operated in a behaviourist way, emphasising behavioural and cognitive approaches over models that place feelings at the fore. This may have a lot to do with the way we train teachers now, with less emphasis on philosophy and psychology, and more on practice and learning from experienced teachers in schools. We would do well to question the distinct lack of the ‘pastoral’ in the development of our teachers – a strange phenomenon when we consider the inherently human nature of teaching.

Reward and punishment, the bedrock of behavioural approaches, leads teachers sometimes to address a pupil’s behaviour without really understanding the causes. The caring teacher who puts pressure on the underachieving pupil by establishing targets and offering rewards may, in fact, be adding to the stress and anxiety of that child. If we concern ourselves with the overt behaviour of young people, we end up punishing the sad pupil whose depression manifests itself as aggression. We may end up dealing with Carl in incoherent ways because we do not quite understand what is happening to him in the classroom and corridor, and fail to support him with the confusion, rejection or shame he may be feeling. We caringly put pressure on Sunita to get into school because we know ‘what is best for her’ without recognising the underlying causes of her fear, thereby exacerbating her anxiety all the more. We become frustrated and then angry with Zoe, whose behaviour challenges our own professional sense of worth. In doing so, we fail to support her through her understandable anger and her need to control her immediate environment and relationships. We focus on her violence without really understanding her pain and hurt. When she deliberately harms herself and threatens to take her life, she generates fear in the adults who care for her, and this leads to a belief that she ‘needs help’ of a kind that is beyond the resources of the school. The reality is that Zoe will indeed need additional support from other professionals, but she remains a student at the school until she is permanently excluded – the most likely outcome.

Mohammed represents the many students who may be experiencing a mental health difficulty but whose behaviour does not cause concern or, if it does, it remains a lower priority for an overstretched pastoral system. It would be difficult to guess what might be happening for Mohammed, but his withdrawn and isolated behaviour should be a concern for the vigilant teacher and the school that recognizes that early intervention prevents the development of more serious consequences in subsequent years.

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Reflection box

• Thinking about the young people you currently work with, do you recognise any dimensions of the pupils described in these case studies?
• Looking beyond the behaviour, can you identify what might be happening for Carl, Sunita, Zoe and Mohammed?
• What might each young person be feeling?
• When reading the case studies, what were you feeling? Did you feel sympathetic to each pupil?
• Think about a time when you were at school and you felt confused, unhappy, anxious or even despairing. What did you need from your teachers and the adults with whom you came into contact?

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Schools and mental health

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Key points

Schools have an essential role to play in promoting young people’s mental health, and teachers and other professionals working in schools are often in the front line. Schools should embrace these new responsibilities because attending to mental health and well-being will have a positive and profound effect on learning and pupil behaviour.

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There is nothing new in the idea of being concerned about the mental health and emotional well-being of young people in schools. Teachers have always understood that young people bring a multiplicity of problems into the classroom, and that this affects their ability to engage with the curriculum in a purposeful way. The converse to this idea – that mental health difficulties act as a barrier to learning – is that mental health and well-being are a prerequisite for academic success. However, positive terms such as ‘mental health’ have not always been employed by school-based professionals, who traditionally have worked from a different frame of reference, using the currency of ‘behaviour problem’, ‘disaffection’ and ‘dysfunctional’.

This is understandable: teachers and mental health professionals undergo completely different training and their role is differently defined. Katherine Weare (2003) has highlighted the differences between these two spheres of activity, seeing mental health professionals as being concerned with individual troubled, troublesome and ‘special needs’ students, while teachers have mostly been concerned with developing a student’s intellectual, logical, technical and sometimes creative powers, but rarely their emotional capacity. She continues: Those in education have tended to view what happens in the black box of ‘mental health’ as at best mysterious and medical, and at worst rather frightening and off-putting.

Schools, of course, have a long history of trying to support teachers and help pupils in difficulty, and the roles of the educational psychologist, behaviour support teacher, social worker and, more recently, the learning mentor are testimony to these efforts.

There are those who argue strongly that it is the role of the school to educate. They insist that teachers and other school-based staff are not in the mental health business and that these concerns should be left to properly trained professionals with experience in the field. Schools, they assert, are there to teach our children and to facilitate learning. However, I believe it is important to see education as more than the passing on of knowledge and skills through a subject-based curriculum. In the push toward a greater emphasis on teaching and learning – however much that is to be applauded – it is important that we do not neglect what is at the core of education: a concern for a child’s development in the widest sense.

This book celebrates a multiagency approach and collaboration between schools and mental health workers, but it also wishes to suggest that a concern for mental health and well-being is not incompatible with the traditional aims of the school, notably academic outcomes. Indeed, ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Dedication
• Acknowledgements
• About the Authors
• Preface
• 1 Introduction
• 2 Mental health and young people
• 3 Risk and resilience
• 4 What are the causes of mental illness in young people?
• 5 Specific mental health problems in children and young people: how schools can help
• 6 A whole-school and multiagency approach
• 7 The mental health curriculum
• 8 The listening school
• 9 Useful organisations and resources
• References
• Index