Schools are inevitably on the frontline when it comes to dealing with mental health issues in the young. What other professionals are so well placed to pick up a problem, or so much on the spot in supporting troubled youth?
It is a heavy responsibility, and one for which teachers and many school support staff have little training or material support. Perhaps provision of counsellors and other experts will dramatically increase across our schools one day, but in the meantime...
Early recognition of mental health problems is vital. How confident are you that you would be able to spot the difference between a normal, “everyday” adolescent angst and a genuine mental heath problem?
Sometimes an individual’s behaviour or reactions are so very aberrant, so very dysfunctional that it is completely obvious that there is something wrong. A teenager who is “hearing voices”, develops bizarre ideas, becomes paranoid, shows entirely inappropriate emotional reactions, has extreme mood swings, becomes very aggressive, confused or profoundly withdrawn, is plainly in real trouble and may well have a major mental illness (MMI), even a psychotic illness. The minute you suspect such a problem, get expert help.
Even with an MMI, the early signs can be subtle and elusive or even deliberately hidden by the sufferer, making identification hard. It’s worth bearing this in mind whenever you have concerns about an individual. And in the case of lesser mental health problems (which can nonetheless be serious and need a response), diagnosis can often be a tricky business.
For a start, the borderline between normality and abnormality is fuzzy. There is no clinical definition of psychological normality. We tend to accept as “normal” the kind of behaviour that is not too far from the average. But how far from the average is too far?
For example, is that exceptionally, raucously extravert individual just very high spirited – or manic (potentially a sign of MMI)? Is that timid, painfully shy teenager just lacking in confidence – or on the verge of a debilitating social anxiety disorder? Even experts can disagree over exactly where you draw the line in diagnosing mental illness.
How is the poor teacher to manage, faced with the tricky task of deciding whether an individual has a mental health problem or not? The problem in the classroom may be further compounded by the many different cultures from which our students come: to use an oversimplified example, believing in magical powers may be normal in one culture, but a sign of hallucinatory thinking in another.
Vigilance
The first advice is to be vigilant: mental health problems are far more common in the teenage years than we generally suppose. A mind-set that monitors the emotional wellbeing of students is a strong foundation for spotting problems as they arise.
Look out not only for the more obvious signs of an MMI, but for the subtler signs of milder mental health problems: a change in behaviour, something out of the ordinary that looks less adjusted than what was typical for that individual before (a lively individual who becomes withdrawn, for example, or a balanced individual who becomes angry and aggressive).
And of course, look for signs of distress or depression, poor concentration and/or social withdrawal. Listen for comments that may suggest a problem. Anything out of the ordinary is worth your attention.
Ask questions
When you have a concern about an individual, find a private moment and ask the young person what is going on in his or her life. Of course, there will always be teenagers who rebuff such an advance (though you may be able to identify someone else they would talk to).
But surprisingly often adolescents in distress will be relieved to have a chance to talk. Real psychological distress can be an isolating, lonely experience, and is all too often ignored, written off as “normal teenage angst”.
Take it slowly
Any counsellor knows that the real issue is unlikely to be the first thing the young person produces. That first thing is a test piece – something less sensitive than the heart of the matter, produced to test how well you will listen, how sympathetic you are. A very common mistake is to leap in, assuming that the first problem proffered is the problem and focusing on solving that. You’ve failed the listener test and the real issue is unlikely to ever emerge.
Take the problem seriously
No matter how it seems to you, it is real to the individual. Offering solutions is a tricky business; better by far to support (empower) the individual in finding their own solutions than to rush in with a fix, which can seem either disrespectful or disempowering.
Encourage practical solutions
Many mental health problems are triggered by life circumstances. Empowering the young to find ways to manage the situation or their reactions to it better, rather than sinking into depression/becoming aggressive (and so forth) may nip things in the bud.
Be alert to the possibility of a mental health problem that needs more than the solution to a practical problem. This can be a tricky distinction to draw. For example, many normal teenagers are shy and insecure – but the worries they report are very similar to those reported by individuals sliding into a serious social anxiety disorder.
Often, the difference between “normal” and not is just a matter of degree of distress, and degree of malleability of the problem. Normal shyness, for instance, should not be disabling, and should be possible to overcome by learning effective social strategies. A social anxiety disorder is much more disabling, and much harder to change.
Trust your instincts
As a society we have rather lost confidence in our own intuitive reactions. But if your gut feeling is that something is wrong with one of your pupils, then it very well might be. It is better by far to be over-sensitive to a possible problem than to miss it. If you suspect that there is a problem, it is time to get help.
Alert whoever is responsible for student welfare in your school early on. Consider with your colleagues whether you should involve the family too.
Good families may be the best support for troubled teenagers; sadly, not all families are supportive (and some are the problem). And there is a tricky tightrope to walk in respecting a teenager’s confidences when involving parents. Trust is vital, if one is to help. It’s easily lost and hard to regain.
Get expert advice
If you are seriously worried that a teenager is in trouble, spiralling down, or likely to be a danger to themselves or others, it is urgent to get appropriate expert help from the health services as soon as possible.
There are also a variety of resources that may be useful in recognising when problems are serious, and in providing practical tips for supporting troubled teenagers.
For example, the charity Young Minds has a helpline offering advice and support (see further information for all links). This helpline is advertised as a helpline for worried parents, but enquiries reveal that in fact, many teachers also use it. Their website has useful information about specific kinds of problem.
Another very useful resource set up in 2014 is MindEd. This website offers expert advice on assessing a wide range of mental health problems in the young, and a wealth of e-learning sessions on mental health issues. It is designed for all and is free to use. And the Royal College of Psychiatrists has helpful online factsheets too.
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Dr Stephanie Thornton is a chartered psychologist and former lecturer in psychology and child development.
- YoungMinds: www.youngminds.org.uk and the telephone helpline is 0808 8025544 (Mondays to Fridays, 9:30am to 4pm).
- MindEd: www.minded.org.uk
- Royal College of Psychiatrists’ factsheets: www.rcpsych.ac.uk/healthadvice.aspx