If you follow the issue in the media, it is relatively easy to conclude that we are seeing an increase in young people with mental health problems.
Whether we are seeing an increase in mentally ill children in our schools is a different issue, however. There is a crucial difference between our mental health, mental health problems and mental illness.
I just want us all to be utterly clear about what is a mental health problem, what is a mental health illness and what are merely the ups and downs of being a teenager.
Making those demarcations is difficult to do if, on the other hand, we want to help those students with genuine mental health problems to feel able to disclose their concerns and gain access to expert support.
Yet, if we can do that, then we have a good chance of doing two things: first, channelling mental health support to those children most in need, and, second, supporting those who are experiencing the sometimes excruciatingly painful emotions of their teenage years.
I have no doubt that the pressures of modern life are having a negative impact upon our children. I just think that all of us working in the field, and writing about this issue, should make responsible utterances when we discuss young people’s mental health.
So, there is mental health, mental health problems and mental illness, and they are three different things. This distinction matters because conflating mental health problems and mental illness means, ultimately, that nobody is interested in the chronically mentally ill as limited resources are diverted elsewhere, to those who have mental health problems.
The other thing I want us to do is to stop conflating happiness and mental health. Most philosophers and psychiatrists would argue that happiness is largely beyond our individual control.
Better to think like Frank T McAndrew, who says that “recognising that happiness exists, and that it’s a delightful visitor that never overstays its welcome, may help us appreciate it more when it arrives”. We certainly don’t have a right to being happy and nor can policy-makers “give” children happiness.
One of the most difficult things for a headteacher to do is to speak out against the zeitgeist and some might claim that we should hold the line and really encourage the young to get over their difficulties and not give in to them.
Indeed, feeling worried about impending examinations is probably a healthy emotional response, but one easily labelled as anxiety disorder and consequently categorised as a mental health problem. Therein lies one of the key debates: is the rise in children and young people’s mental health problems a matter of loose definitions?
Well, as a headteacher, I think there has been a definite increase in the number of children with mental health problems. What is causing that increase, however, is highly debatable.
I sat on a panel with Professor Sir Simon Wesseley at the Battle for Ideas conference last November. He confirmed that more than one in four (26 per cent) of women aged 16 to 24 had anxiety, depression, panic disorder, phobia or obsessive compulsive disorder, as reported in the government-funded Adult Psychiatric Morbidity survey published in September 2016. These figures represent a significant increase over the past decade. The professor went on to say that what has caused that increase is utterly unclear.
There is no simple reason why children and young people’s mental health problems are on the increase. I have come to understand that young people’s mental health is a multi-factorial issue. I would argue that there are 12 different reasons why more young people are suffering from poor mental health:
- The increase in the number and difficulty of high-stakes examinations.
- The implementation of performance-related pay in schools has added to the pressure on teachers, which is easy for them to pass onto their students like a toxic gift.
- The increase in social media use which can have a negative impact upon young people’s sense of their own worth.
- The increase in parental anxiety which can have a negative impact upon students.
- The significant funding cuts which have led to the emaciation of Child and Adolescent Mental Health Services (CAMHS).
- The levels of inequality in our country which are at their highest since Victorian times as the rich get richer and the poor get poorer.
- The increasing number of students who feel that they have an entitlement to be happy, which is so strong that adults can end up infantilising the young.
- The increase in openness about all things, including our own mental health.
- The rise in pressure to secure good qualifications in order to secure good jobs in a shrinking jobs market.
- The influence of programmes like The X Factor where fame is available without the hard graft.
- The risk-averse culture we have created where young people are finding it hard to learn how to manage risk.
- The way desperate parents, who see a CAMHS referral as the panacea to their child’s mental health ills, seek a diagnosis to access clinical support.
Whichever way you look at things, we have an increase in the number of young people with mental health problems. And as Professor Tanya Byron says, “we have just got to get on with the business of trying to address this challenge of increasing mental health problems in young people”.
Five possible solutions?
Here are five things we do in my school to support our students’ mental health.
The role of school staff
We are at a stage where every single member of staff needs to take responsibility for being aware of students’ mental health.
People working in schools should have it in the back of their minds at all times that students have a mental health. We all have a mental health as well as a physical health, and if we can acknowledge that simple fact this will help our students significantly.
We have introduced the role of a School Wellbeing Worker, shared across a network of 10 schools. Some school staff would perceive that mental health issues such as self-harm are beyond their expertise. But if, through the School Wellbeing Worker, we can provide some clinical support to enable that consistent, trusted relationship to support the child on an on-going basis then that could have a real impact.
I think what’s really important is the clinical guidance. Do we actually need a highly paid psychologist or psychiatrist to be in a school 24/7? Well, probably not. But we need somebody like a School Wellbeing Worker to give that on-going support within a school setting. That way we can provide clinical support within the school setting while not relying on the highly specialist resource from CAMHS.
Mental Health Champions
We ensure that every child has a Champion. We have made the form tutor the central figure in a student’s school life – they now “champion” the student in that they have the overview of the individual student’s academic progress and emotional and physical wellbeing. They spend time consciously developing good relationships across the form group through structured conversations with individuals. The conversations encourage the student to reflect upon his or her goals, effort levels and the learning tools he or she needs to develop to be successful.
Whether there is a children’s mental health crisis or not, evidence and experience both suggest that changing structures to encourage better relationships between teachers and students, to ensure that every child has a “champion” and to know “who owns the child” is a healthy thing for all of us working in schools.
Philosophy for Life
We have introduced a Philosophy for Life course in year 10. We go back to the Greeks and the Stoic philosophers, looking at what they thought both on an intellectual level and on a kind of how to live life level: how to cope and how to find meaning. We have created a course that meets some of the challenges of our time that people face in terms of mental health and wellbeing, which simultaneously brings in lots of philosophy.
Mental health checks
The last strategy is a simple way for form tutors to appraise the mental health of their tutees. It is based upon the Apgar test for newborns. It was practical and easy to calculate and gave clinicians at the bedside immediate feedback on how effective their care was. Its impact was hugely significant and is celebrated as an innovation which has saved the lives of thousands of babies since 1952, when it was introduced to maternity delivery rooms across the world.
Apgar’s innovation started me thinking about a young form tutor, a couple of years into his teaching career, faced with the responsibility of supporting the wellbeing of 30 tutees.
How would he or she, with little life experience, feel able to gauge whether all the students in the form were feeling generally well, psychologically?
If only we had a measure which was practical and easy to calculate, which gave tutors an immediate assessment of their tutees’ emotional wellbeing.
Well, I have invented the Huntington School STATAA Wellbeing Test. The simple test has been developed to aid tutors in determining if a student may be in need of a Huntington-style structured conversation. It is scored as follows:
A student who scores a 7 or higher is considered to have good emotional wellbeing, while a score of 3 or lower indicates the need for a structured conversation with the tutor. While the STATAA Wellbeing Test is in its infancy, early reports are encouraging.
Ultimately, supporting our young people to manage their mental health more effectively is a huge challenge. Telling them that they don’t have to believe everything they think is sometimes enough. If we can support students to manage their low-level mental health problems, then, in straitened times, we might just ensure that the small number of mentally ill children in our schools can access the resources they so desperately need.
- John Tomsett is head teacher at Huntington School in York and is the author of This Much I Know About Mind Over Matter: Improving mental health in our schools, published by Crown House Publishing (priced £16.99).