We all have ‘Mental Health’ – it’s what you do with it that counts

This is a Chapter from James Hollinley’s book which is available on this site.

 

Within the media, there is a growing awareness and publication around ‘mental health’. Over the years, the terminology has changed and, more recently, so has perspective. As such, it is important to understand the link between history and present when looking at mental health.

A very, very brief history and why it is important

For the larger part of history, those with poor mental health were treated very poorly. In medieval times, it was linked to witchcraft and demons – mostly leading to attempted exorcism or burning at the stake. The scientific approach was through the drilling into the skull (trephining) to release the spirit. Before these times of ‘medical’ practice, it was linked to making gods angry.

The 1600s saw the growing introduction of lunatic asylums e.g. Bedlam, that saw the vulnerable removed from communities and kept in dismal, prison-like conditions including shackles and beating – seemingly a refuge for them with a focus on keeping them in. The 1800s started to see treatments such as rotation therapy in which a chair was suspended, and the patient was spun in a circular

We all have ‘mental health’ – it’s what you do with it that counts

Motion until they promised the staff that they would get better. Over time these changed from being places in which those less affluent could be watched by visiting public to being redefined by the early 20th century as ‘mental hospitals’ with a more medical approach – the most common being electroconvulsive therapy and lobotomies being brought in within the 1930s until popular banning in the ’50s.

In the 1970s many of the asylums or mental hospitals closed in growing favour of therapy, converting to what is now commonly known as short-stay hospital placements – this was aided by the development and popularity of anti-psychotic medication and further understanding of therapeutic support. In both the UK and US, the percentage institutionalised decreased in 40 years by 90%, between 1950 and 1990. However, we are still in an age in which some generations of society experienced the large stigma of asylums and institutions – many of those most affluent would pay for these services in secret. Those who could not afford private placements would make up stories of holidays and visiting family. No wonder there is such mystery and stigma, only now beginning to be challenged – this will take anything from a decade onwards to educate society and convince communities and employers that it is okay to have a mental health condition.

We have a very long way to go. Last week, I spoke to a lady from Africa who hides her epilepsy from her family because they believe she is possessed. It has cost her a marriage and her children. Her medication is hidden from her family in fear of further isolation. In turn, this has brought on depression and anxiety. If a very common medical issue such as epilepsy is still misunderstood within some British communities, then a person with a mental health condition that is even less understood – such as bipolar, psychosis or Schizophrenia – will certainly face a tougher challenge to feel complete within society, hold employment or a successful relationship.

Schools

In schools, teachers, support staff and school leaders all have their own experiences of children with a wide range of issues that they can recall – usually stemming around ‘behavioural difficulties’. The prevalence of mental health in social media states astronomical situations. You will see statistical headlines such as:

  • The Mental Health Foundation (2003) stated that over ‘450 million people worldwide have a mental health problem’.
  • Time to Change stated that ‘1 in 4 people will have a mental health problem this year, but too many people are made to feel isolated and ashamed as a result’.

The Mental Health Foundation (2003) stated that over '450 million people worldwide have a mental health problem'. Click To Tweet

With ‘mental health problems’ being so apparently prevalent, it can be clearly stated that having poor mental health is all part of the human condition at some point in many people’s lives and, due to its commonality in humans, should have no stigma attached. It is an unfortunate but perfectly natural thing to happen to any person at any point in one’s life. As Harris (2017) states: ‘If we stop assuming that good mental health throughout a lifetime is the norm, we can get a much sharper idea of why those who are fortunate with their mental health are able to stay well.’

Teachers would benefit, therefore, from taking a child and looking at whether they show signs of good mental health. This is detailed by Gunnar (2017), at the Institute of Child Development:

  • They are curious and interested in the world.
  • They are willing and wanting to learn.
  • They can sit and reflect at times about what is going on.
  • They have the ability to experience love, affection and emotions.
  • They get upset when things are upsetting them and bring themselves back to a level state without needing intense intervention. Nature and nurture
  • Mental health impairments can develop in early childhood. Shonkoff (2010) stated that it is scientifically proven that ‘at a molecular level, ALL aspects of brain function are the result of interaction between genetics and experience’. As such, it is our genes, together with experiences, that set up the operating systems in our brains.
  • The Center on the Developing Child at Harvard University refers to three kinds of responses to stress. This is very clear for practitioners and can aid school professionals to understand the workings of the brain.

Stress response system

Examples of situations

Effects

Positive stress

Positive stress response is characterized by brief increases in heart rate and mild elevations in hormone levels.

  • … First day with a new caregiver
  • … Receiving an injected immunisation

Positive stress response is a normal and essential part of healthy development.

Tolerable stress

Tolerable stress response activates the body’s alert systems to a greater degree as a result of more severe, longer-lasting difficulties.

Toxic stress

Toxic stress response can occur when a child

experiences strong, frequent, and/or prolonged adversity.

  • … The loss of a loved one
  • … A natural disaster
  • … A frightening injury
  • … Physical or emotional abuse
  • … Chronic neglect
  • … Caregiver substance abuse
  • … Caregiver mental illness
  • … Exposure to violence
  • … The accumulated burdens offamily economic hardship …without adequate adult support.

If the activation is time-limited and buffered by relationships with adults who help the child adapt, the brain and other organs recover from what might otherwise be damaging effects.

Without reducing instability quickly and effectively through the correct support, the above situations can weaken developing brain architecture and cause ‘early adversity’ in which the body’s stress response systemis permanently set on high alert. This can have lifelong effects on the person’s physical and mental health.

How should Schools Perceive ‘mental health’?

It is easy for schools to get lost in the whole ‘do they or don’t they have poor mental health’ debate. Instead, it would be easier for schools to develop a ‘mindset’ that there are three types of poor mental health. The reason we should do this is that schools can potentially tackle poor wellbeing, whereas ‘mental health problems’ and ‘major psychological disorders’ they certainly cannot and need specialist support. You can split ‘mental health’ into three main subsets – please note that the extensive list of mental health conditions is far larger – however, these tend to be the most prevalent in schools and provide a firm example for discussion:

Type

Condition

Initial response

Major psychological

disorders

There is suggested evidence that these are traceable to the same genetic variations.

Autism – early*

ADHD – early*

Clinical depression – late Bipolar disorder – late Schizophrenia – late

*Autism and ADHD are more commonly diagnosed in the primary years and have a heavier involvement with the SENCO, whereas those ‘late’ are more prevalent in secondary schools and in need of clinical help.

Mental health problems

Needing referral

More likely to be a result of environmental factors**

Post-Traumatic Stress Disorder Eating disorders

Anxiety

Depression

Obsessive Compulsive Disorder Paranoia

Self-harm

Suicidal thoughts/tendencies

Referral to Lead for Wellbeing who should refer this to EWMHS – previously known as CAMHS.

Wellbeing

Actions and states of wellbeing as a result of events

Loneliness

Panic attacks Low self-esteem Stress

Anger

Also referral to Lead for Wellbeing – wraparound meetings with parents and other professionals. These can be tackled within the school environment with professional advice where needed.

Nationally, those needing ‘clinical’ support (referral to EWMHS, doctors, clinical psychologists) are those not being able to access quick support, and are occasionally rejected for support due to not ‘meeting thresholds’. This debate aside, schools are placed in ever-increasing circumstances in which they have to provide support within their establishment. Onsite bought in counselling services (later discussed in this book) are growing to become a more popular solution.

Nationally, those needing ‘clinical’ support (referral to EWMHS, doctors, clinical psychologists) are those not being able to access quick support, and are occasionally rejected for support due to not’ meeting thresholds’. This debate aside, schools are placed in ever-increasing circumstances in which they have to provide support within their establishment. Onsite bought in counselling services (later discussed in this book) are growing to become a more popular solution.

Teachers are there to teach…

The primary role of a teacher is to educate and deliver lessons. In many ways, an effective teacher will ensure that the pastoral care and emotional wellbeing of a pupil in their care is also high on their agenda – that is why so many schools are good and so many children and young people feel safe at school. The question is not regarding the role of the teacher (as this is to teach, role model and care for those in their school), rather about the role of a school itself. Teachers and schools are not mental health specialists and must stay clear of diagnosing or trying to solve mental health problems. Schools also vary widely in regards to ethos, focus and expectation of pupils and staff.

The primary role of a teacher is to educate and deliver lessons. In many ways, an effective teacher will ensure that the pastoral care and emotional wellbeing of a pupil in their care is also high on their agenda Click To Tweet

A successful school develops an ethos and structures that encompass the proactive development of the whole child. Some primaries look after pupils very well but do not necessarily look at what is needed to make them well rounded or are often stretched to cope with academic pressures. It is, therefore, of utmost importance that the ethos of a school focuses on the development of the whole child with a purposeful focus on academics and, equal to this, wellbeing for later life.

It is not just the children

Staff can also find themselves in a situation in which they have poor mental health – this is increasingly prevalent as more practitioners find the courage to actively speak out. It is also important for teachers and school leaders to be aware of what makes a school a successful and encompassing environment in which those struggling are supported and given the necessary help and understanding.

The creation of a positive working environment not only helps staff but filters down to the pupils. This must come from headteachers and governors to carefully consider the work-life balance and the culture of the school – those that do not, risk not only the wellbeing of staff but that also of children and young people. Adults who model positive working relationships and communication are essential in building a community that enhances and embraces positive wellbeing for all. 

The first, large step

In short, embrace wellbeing, together with increasing resilience, as this will aid in developing positive mental health now and later in life. When it comes to immediate mental health problems – always seek guidance from professionals. How schools do this will very much depend on their specific intake and need against financial ability and priorities.

A positive step for schools would be to look at individuals, question what they need in order to be well-rounded persons able to cope with what life will throw at them e.g. are they shy, withdrawn in group situations, in need of seeking too much attention, lacking in social circles, fearing failure, grossly overweight and so on. Plan how to provide individuals with the necessary experiences or tools and then execute these in the same gusto as many execute booster classes for academic development. Aim for successful individuals in all aspects and the common purpose will not only make a significant difference in future years but also will have the buy-in and support from staff.

References

Center on the Developing Child at Harvard University. (2017): Toxic Stress. Available at: developingchild.harvard.edu/science/key-concepts/toxic-stress/ (Accessed 29 July 2017).

Gunnar, M. (2017): Center on the Developing Child. In Brief: Early Childhood Mental Health. Available at: developingchild.harvard.edu/resources/inbrief- early-childhood-mental-health (Accessed 20 June 2017).

Shakoff, J. (2010): Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy in Child Development. Washington, D.C.: The Society for Research in Child Development, Inc. Vol. 81, no. 1, p. 357-367.

Time To Change (2018): Be in your mate’s corner and change a life – men urged in new mental health campaign. London: Time to Change. Available at: www.time-to-change.org.uk/news/be-in-your-mates-corner (Accessed 1 January 2018).

WHO (2003): Investing in Mental Health. Geneva: The World Health Organisation.

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