How to talk to pupils about mental health problems

Talking about mental health issues is vital, says Tara Porter. So it can help to consider the five Ws

Adult and teenager, having serious conversation

We are all getting more used to talking about mental health. A generation ago, when I was at school, I remember someone’s mum having “a nervous breakdown”. It was only spoken about in whispers; it was a shocking thing, not to be referred to openly.

A generation on, we are, thankfully, more open. However, there is still stigma, and there is still uncertainty about what is the right or wrong thing to say. 

There is no excuse for the former, but there is a reason for the latter. Knowing what to say to someone with a mental health problem can be a complicated business, because there is no one right answer. It depends very much on the circumstances. 

However, the costs of saying nothing are also high. Research highlights that connectedness to teachers can be a protective factor in avoiding suicidal activity.

But the implications are wider than that. If we say nothing, we make mental health shameful and secretive again. And, of course, the stigma and the silence are inextricably linked. 

The five Ws

In trying to help children create a good piece of writing, teachers may introduce them to the five Ws: who, what, where, when and why. This can help structure interrogative or journalistic writing, or an introduction to a narrative. It can also provide a useful structure when you are worried about a child’s mental health and are scratching your head about what to do. 

Asking yourself these five questions can help you think through the issues and find the best solution for you and the young person. 

1. When should you talk to a young person about mental health?

Teachers are ideally placed to notice changes in pupils’ mental health. So please try to talk to them when you are worried about them. This might be because you’ve noticed a change in their behaviour, emotions or school performance, or because there’s been a deviation from their normal developmental trajectory. 

Sometimes signs that a conversation needs to happen are more obvious – for example, self-harm scars or a refusal to eat

Often their friends will approach a teacher. Indeed, often the friend is desperate to tell someone, as they are burdened by the secret and desperately worried. 

And, of course, you should talk to them about mental health when they approach you in a crisis.

2. Who should talk to them when you are worried about their mental health?

In mental health, we have a concept of “epistemic trust”. This is the person who understands the young person the best. 

It might not be the most senior or experienced member of staff. Indeed, usually it isn’t, because they have a less close relationship with pupils than younger staff members. 

Less-experienced staff may feel worried about talking about mental health. But they don’t need to have all the answers. 

It is generally important to avoid having different conversations with lots of members staff, as what is helpful and reparative is having one good relationship. It’s probably not a good sign if the young person is offloading on multiple adults, as it could mean that they are not attached to any.

So one person can tackle the conversation, but not in isolation – talk to the pastoral team for advice

3. Where should you talk to them?

Conversations about mental health are not to be rushed, and are best done in private.

Few of us can answer the question “How are you?” fully and honestly, the first time it is asked. We say we are fine, not that we are feeling sad or worried. 

The true feelings often come slowly and in waves, sometimes over several years. Obviously, it is best if the conversation happens somewhere calm, quiet and private, but that is often difficult in a busy school environment. Do what you can.

4. Why are you having the conversation?

Whenever I write about mental health in schools, I get one or two comments that it is not teachers’ jobs to sort out mental health, and why can’t they just get on and teach. 

To some extent, I sympathise with this view. It is not teachers’ job to diagnose, solve, treat or provide therapy. 

However, mental health cannot be separated from the rest of the child, and it is inevitable that some of what is happening will emerge in a school context. 

Teachers, school nurses and school leaders should keep the conversation limited. Being clear about the purpose of the conversation, and keeping that purpose in mind during any conversations will help you keep focused. 

The purpose may be to calm down the immediate crisis. It may be to touch on coping techniques or signpost the pupil to further help. Talking to a young person can also protect their friends and peers, preventing contagion from spreading around the school, as the young people see adults taking charge. 

5. What to say?

There are three key elements to conversations about mental health. 

Honesty and openness
Remember your limited brief, and be honest and open about not knowing all the answers. Don’t draw children into confidences, and remember your school’s safeguarding procedure. Being clear about who you need to tell and why helps children feel safe and secure. 

Curiosity
Talking to young people about mental health is generally not about knowing stuff, it is about trying to understand. Curiosity is nonthreatening and opens up conversations rather closes them down. Curiosity often leads to sentences such as: “I noticed…”, “I was wondering…” or “Tell me how it is for you”.

Empathy
Empathy is the equivalent of a mental health ice pack. It is helpful in nearly all mental health situations, and can do little harm. 
Empathy is a vastly different state to sympathy: it is based on understanding someone, rather than feeling sorry for that person. 
Empathy is not just about being kind and making a connection, although that is obviously the first step. The experience of having someone understand you, and being with you in your pain, seems to open up opportunities for things to be different. It’s as if the process of sharing the burden allows the space for a different solution to the burden to emerge. 
Empathy is the magic ingredient of therapy, but can also be used safely and effectively in schools and colleges. 

The five Ws form part of the mental health awareness training that is being rolled out nationwide by the Anna Freud National Centre for Children and Families. If you want to find out more, please visit annafreud.org/mhat

Dr Tara Porter is a clinical psychologist at the Royal Free London NHS Trust and Anna Freud National Centre for Children and Families, as well as Tes' mental health columnist. She tweets as @drtjap. The views expressed are her own

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