School mental health: mind the young minds

“What I saw was a wet eye

For a moment I stood to wonder why;

The child sat alone and lost

He mattered to nobody

Nobody to him;

A dialogue I tried to initiate

No response though I kept on with my wait;

His eyes! They said so much

Looking up forlorn

As though talking to his God

There was trauma, there was trouble and there was pain

No connect seemed possible, all but in vain

He had become a loner sad and silent

He vented his anger, hurt himself most

His little hands witness to the pain

The injuries he probably bore

An agonised little child that he was

I wish someone had tried to reach the cause

I woke up one day to the news

This child had jumped off to end his pain

A family, a mother had lost precious life

Ignorant to her son’s constant strife

A failure I was as I had failed to recognise

Despair and despondence in this child

He was waiting for love and acceptance

In that small a wish he lost his life

A beautiful young child sleeps in his grave

A memory of a life we could have saved.”

Mental health refers to a person’s thoughts, feelings, his actions by virtue of what he thinks. How this individual behaves especially in trying times is of utmost importance.

Schools, being the prime institutions to impart education among children, can and are actually powerhouses of effective grooming of young minds. They, therefore, are the ideal and primary clinics for mental health programmes as they touch each and every single child in a very special way, almost encompassing his entire persona. This impact of a school can be both positive and negative too. The endeavour should be to try and leave a positive influence on every child who enters the gates of these schools as a child spends these influential years of his life within its four walls, in fact it is this particular environment in the school that makes him the person he or she turns out to be as adults.

Schools and parents can and should work in collaboration with each other to become the clinics of sound mental health for our youngsters.

In the Indian context, however, the focus on school mental health is still at a very nascent stage and a lot needs to be done. However the process has begun and the thought, awareness and efforts in this field are gradually increasing.

It is important to note that child oriented mental health services are mainly restricted to the metropolitan centres, e.g., NIMHANS-Bangalore, PGI-Chandigarh, AIIMS-Delhi, Mumbai and Chennai.

Given the enormity of our country and the percentage of school going children, it becomes imperative to gradually spread our wings and establish such vital centres in rural and semi-urban centres as well. Though it would not be wrong to say that even in the metropolitan schools and educational institutions in the big cities, massive awareness campaigns are needed to sensitise the people, parents and teachers.

In the present context it has been noticed that all young children and adolescents face significant stress in their lives, sometimes due to hormonal and growth related changes, changes in relationships with their parents, peers and society at large. It would be interesting to note that these young people often show amazing resilience and are able to negotiate these stresses with varying degrees of brilliance, maturity and mastery.

According to an estimate, nearly one in five children/adolescents is ailing from a behaviour or an emotional disorder at sometime during his/her growing years. The impairments are usually manifested in a variety of ways, such as: academic failure, learning disability, low self-esteem, poor self-image, substance abuse, severe depression, suicidal tendency and thoughts, obsessive-compulsive disorder, attention deficit syndrome and social dysfunction.

In most of the countries around the world, families and schools are the strongest and the most influential social institutions in a child’s life. Therefore schools play a very vital role in their development especially when the family fails to do so due to various reasons. Then it would not be wrong to say that intervention at the school level is most important and effective too.

Schools as an important intervention agency

With the concept of universal education catching up globally, school but naturally adopt the role of importance in improving, forming and transforming the lives of young children. As a result of this, it is, therefore, most important to incorporate health services in all schools and educational institutions and lay maximum emphasis on mental health services.

Why schools and educational institutions?

Almost all children at some point in their lives attend school, at least a large majority. Schools do have a profound influence on young minds, their families and the community as a whole. Schools eventually become the major support system of children and their immediate families. Schools usually act as a safety net by virtue of learning, teaching and development in various fields. Schools play a pivotal role in undermining/building a child’s self-esteem and give them a sense of competence and achievement.

The aim of school mental health programme should be to provide an experience to the children enabling them to cope with stress, deal with their insecurities and also with various disadvantages as a part of growing up. These interventions can be environment centred or child centred or one can lead to the other.

School environment refers to the living and learning climate of the school and thereby making it conducive to learning for each child, it would entail the following then: structuring of the school day, structuring of the play activities, decoration of the classrooms, thereby improving the atmosphere of their immediate environment.

The school environment can further be improved by encouraging parents participation in support of school activities as is the case in Yale model of teaching, i.e., by constituting a mental health team comprising of parents, teachers, administrators, school support staff so that problems at every level can be identified and then device mechanisms to solve these problems to the best possible.

Child centred activities

Child centred activities include tackling of issues by virtue of consultations and interventions pertaining to a particular child or a family facing difficulties.

Issues of well-being and psychological competence affect the entire school community including students, teachers, administration and also the surrounding community, so when specific mental health programmes are devised to address these issues one gets to see a remarkable reduction in levels of stress and an improvement in coping skills in the children.

It is of utmost importance to identify children with psychological problems early and target them for quick interventions so as to be able to nail the problems at an early stage. It is important to do so since these problems, if not detected in schools, can and usually do pose very serious issues later in life and can make an individual dysfunctional. Some symptoms of dysfunctionality are: school failure, school dropouts, too early pregnancy, drug and substance abuse, alcoholism, delinquency, anti-social traits.

It has been established that children who are not doing well in schools may be suffering from poverty, domestic violence, hopelessness, failed interpersonal relationships within family and outside, poor bonhomie between parents, verbal or physical abuse or both. Such children usually exhibit varying degrees of poor mental health, acute stress symptoms, sadness and are unlikely to perform well in school and often later in their adult years too.

In a few more cases some children can develop serious mental disorders, some show up with medical ailments such as diabetes, cancer in rare cases and most commonly asthma. Here the role of a receptive, supportive and empathetic school environment becomes most important.

A comprehensive school mental health programme needs to be integrated at four different levels.

School mental health programme: Promoting psychosocial competence, mental health education, psychosocial intervention and professional treatment.

Levels of intervention: Ideally at school curriculum level, part of general health curriculum, students needing additional help in school and those in need of additional mental health intervention.

Steps for development of mental health programmes and their implementation: The approach, methodology and ideologies in the development of mental health programmes vary from region to region due to individual dynamics of that particular area so these methods have to be somewhat tailor made after much research and deliberation.

1.Establishment of a team: A complete and a comprehensive school mental health programme must collaborate with the school personnel, family members, community and generate an effective team willing to work together which is productive, positive and supportive.

The most important for a child’s development is the home. Parents and family members need to be sensitised about their role and the impact they and their conduct has on a child, directly and indirectly. By doing this they will have a fuller understanding of their role play and also help in understanding as to how to tie up with schools and help in promoting their children’s well-being.

Next are the teachers, who with family support, can be the key to successful implementation on this mental health programme.

Next in line are the mental health professionals who have a very important role to play. They can serve as an effective conduit for teachers and parents and also consultants and resource persons both for the parents and the teachers to efficiently deal with impending problems.

2. Assessment of school and community environment

3. Development of a plan: A very specific plan of action should be chalked out including clearly stated objectives of the team assignments, responsibilities, timeline and other co-ordinations needed.

Having a stable financial support for such a programme is of utmost importance. Pooling of resources wherever necessary should be done.

4. Monitoring and evaluation

5. Co-ordination and modification of programme: Developing a comprehensive and an integrated mental health programme in schools is an ongoing process requiring regular attention, evaluation and adoption.

Recommendations

According to a study conducted by World Health Organization (WHO), the prime focus of school mental health programme should be the well-being of the youth. All countries should develop school mental health programmes as part of their national health/mental health plans. The school mental health programme needs to be integrated with the national mental health programmes. In countries where some mental health programmes do exist, the endeavour should be to expand them to reach wider geographic regions so as to benefit maximum children. As a part of this programme, promotion of the value of healthy lifestyle and improvement of the ethos of the school and educational atmosphere should be prime. Mental health training should be mandatory at the level of teacher training capsules, should be carried out for school teachers, social workers and parents too. Staff members should be provided with ample opportunities to consult a child psychiatrist or clinical psychologist to explore specific difficulties and trying situations, behavioural issues so as to help them optimally. Confidentiality of health information should be maintained. These programmes should be extended to children and young adults who are not able to attend schools and colleges, school dropouts, children who are poverty stricken, rag pickers and street children. The role of non-governmental organisations (NGOs) should be of prominence.

In the end I would like to say yet again that a school environment is the most ideal place to begin with mental health needs. It offers a simpler and a more cost effective way of reaching to the youth of today.