Do they know where to turn?

9th November 2007 at 00:00

Hannah Frankel finds out if it's dangerous or appropriate for teachers to get involved with mentally troubled pupils. It does not bode well for the future that 10 per cent of five to 15- year-olds have a clinically diagnosed mental disorder, ranging from anxiety to depression and autism. To put it crudely, they are four times more likely to have psychosis than diabetes.

This disturbing picture, courtesy of the most recent figures from the Office of National Statistics, is confirmed elsewhere. Earlier this year, a report from Unicef on childhood well-being found that out of 21 developed countries, British children are the unhappiest. And, according to figures from the Institute for Public Policy Research, last year 24,000 young people tried to kill themselves. One every 22 minutes.

Now Mind, a mental health charity, is trying to hit back. It has produced a booklet called My Name is Pete, which presents information about psychosis and its symptoms in a comic-book style. For Emily Wilcox, the book's designer, teachers and pupils need to be able to identify problems early, and then know where to turn to for help.

"If you break your leg, a child of five would know what to do next, but with mental illness there's a sort of silence," she says. "It's such a woolly subject. Pupils don't know who to tell and teachers aren't sure either. There's very little knowledge or expertise in schools."

Hugh Weldon, a former teacher from north London, failed to spot the signs exhibited by an 11-year-old boy at his secondary school. "He was a nice, sensitive kid," he says. "He would come and speak to me at the end of the class; I just thought he was a bit of a loner."

So it was a complete shock to everyone when this thin, quiet boy killed a three-year-old girl. "I'd never have identified him as violent or mentally unstable," says Hugh. "Things like this need careful handling and the pastoral staff need clear training in how to identify these pupils and respond appropriately."

This is an extreme case, but mental disorders can and do shatter lives in far less visible ways. Christine, 21, had been abused all her life, but had never told anyone. At 15, she was ready to talk, but the teachers she turned to didn't know how to help. "I started to self-harm in the classroom," she says. "One teacher saw me do it, but she just completely blanked it. She didn't want to know."

Despite other teachers' best intentions, all they could suggest was that she see her GP. "I wanted someone to listen and acknowledge what I'd been through," says Christine. "Instead teachers told me that it was just my hormones, that I'd been through a lot and that I'd get over it."

In fact, Christine had clinical depression and was eventually hospitalised. A practice nurse and a youth worker then gave her the support she needed, but she wishes her teachers had done more.

"They made me feel like I was wrong, that I shouldn't be talking about it," she says. "In the end they put me in the referral room to keep me away from the other pupils, but that just isolated me further and added to the rumours."

However, not all teachers feel comfortable taking on a mental health role. "I believe that meddling with something as complex as mental health issues without the appropriate training is dangerous," says a teacher from Leeds, who wishes to remain anonymous. "I refer it on, not because I live in fear of legal consequences, but because I don't know what to do for the best."

Training for teachers does exist, but is patchy. When Barbara Herts, the chief executive of Young Minds, a mental health charity, did her training in 1979, she learnt all about child development and the psychology behind educational and behavioural difficulties. Now it has all but disappeared from teacher training courses, she says.

"We run courses for teachers that help them distinguish between emerging mental health problems and normal adolescent behaviour. Sometimes the symptoms of a serious problem, such as poor concentration, irritability or non-attendance, can seem like your typical average teenager. Teachers are often the first port of call though, so it's crucial they can spot the warning signs."

Staff should first talk to pupils they are concerned about, Barbara suggests. Depending on the situation, they can then refer on to the school's pastoral team, educational psychologist or local Child and Adolescent Mental Health Services (CAMHS).

Parts of the country with Behaviour and Education Support Teams (BEST) - which were introduced in 34 areas in 2002 - are often at an advantage. These multi-agency teams draw together a range of professionals to provide pupils and their parents with tailored support.

But Barbara says a shortage of educational psychologists means prescription drugs are more widely available than important "talking therapies".

Indeed, prescriptions handed out to children under 16 for mental health disorders have quadrupled in a decade, official figures indicate, even though the number of cases has not markedly increased.

"Across three of the four nations (in the UK), school based counselling support for students is progressing rapidly, with Scotland, Northern Ireland and Wales having an increasing commitment to this type of intervention with financial resources to match," says Karen Cromarty, lead adviser for children and young people at the British Association for Counselling and Psychotherapy. "Sadly, in England the Government is not ring-fencing funding to enable schools to have similar levels of support."

The Department for Children, Schools and Families (DCSF) would disagree. In July, Ed Balls, Secretary of State, announced an extra pound;60 million over the next three years to support schools working with mental health practitioners.

"This funding will enable more schools and local authorities to introduce effective early intervention services in and close to schools," a DCSF spokeswoman says. However, details about how the money will be spent are still hazy, and there are concerns that health professionals without specialist knowledge will fill the void. In the meantime, pupils with mental issues will continue to slip through the net. According to the National Institute for Clinical Excellence, only 25 per cent of children with depression are detected.

To counter the problem, a report released last year by the NHS Confederation and the Association of Directors of Social Services among others, suggested that mental health and well-being should be included in the curriculum. To date, schools may cover it in personal, social and health education or within the increasingly popular Social and Emotional Aspects of Learning (SEAL) programme, but it is not compulsory.

Unless time is set aside to allow pupils to talk about subjects such as depression and anxiety, the scale of the problem - and its related stigma - will increase, the report warns.

Pupils in Taunton and west Somerset have the opportunity to openly discuss the subject with Emily Wilcox. She goes into secondary and primary schools as part of a preventative project called Minder, which explores common misconceptions and gives pupils "clues" about how to spot and support someone with mental health problems.

But teachers also need to be more aware, Emily says. "At the moment, teachers are worried that they will be opening a can of worms. They need the tools to identify and intervene before problems get out of hand."

As important as it is to help the individual, however, Kairen Cullen, an educational psychologist based in London, warns that a wider view needs to be taken as well. Although a pupil may be predisposed to anxiety, for instance, stress stemming from exam pressure, bullying or social isolation can all exacerbate the problem.

"Where a young person is labelled as having mental health problems, it can mean that less effort is made to change the context and situation in which they are having problems," she says.

"The potential for a never ending stream of young people with mental health problems is therefore increased."


Tina, now in her twenties, did not expect her teachers to have all the answers when she was feeling depressed as a teenager, but she did expect them to listen.

"It's not rocket science," she says. "All I needed from teachers was a friendly shoulder to cry on." Tina's depression materialised following a flu-like virus when she was 15. She had trouble sleeping and eating and felt tired and lethargic for much of the time, but she was good at masking her symptoms and carried on achieving at school.

"I remember gradually realising something was not quite right," she says. "It got to the stage where I was wishing that I was dead and I started to self-harm. I was hospitalised when I was 18 and attempted suicide."

Tina is thankful to her form tutor who "listened without trying to fix me", but says negative stereotypes need to be tackled in schools if pupils are to get the help they need.


- Create a school environment where pupils can talk to teachers without risk of stigma.

- Ensure pastoral staff have enough time to offer meaningful support. A sympathetic ear is often more important than solutions.

- Include mental health in the PSHE syllabus.

- Maintain frequent links between teachers and parents.

- Provide teacher training in mental health issues.

- Ensure staff know where to turn for professional back-up or referrals - has a directory of services.

For information and advice on pupil mental health, contact MindinfoLine on 0845 766 0163.

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