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Where school is a haven of normal life

Teaching is about team work, especially when the pupils have acute psychiatric difficulties. Eleanor Caldwell reports on Glasgow's hospital education service

Terms such as "severely psychotic", "extremely depressed" and "suicidal" go far beyond "behaviourally challenged and demotivated". When such medical terms are part of primary and secondary teachers' everyday vocabulary, it's clear that their pupils have entered a dark tunnel from which they can only hope to emerge with the help of expert psychiatric treatment.

For a few of the most seriously mentally ill children, admission to Yorkhill Department of Child and Family Psychiatry or Gartnavel Royal Hospital adolescent unit, both in the west end of Glasgow, becomes an urgent necessity.

Caledonia House at Yorkhill hospital has been newly extended to offer seven-day care for children aged under 12 from the west of Scotland who are in psychological extremis. Teachers Christine Campbell and Helen Kirkpatrick are an integral part of the therapeutic team which includes psychiatrists, psychologists, nurses and social workers. They are party to all medical information on the children, attend regular case meetings and are regarded as equal key workers in each child's care.

In a bright and cheerful building, the teachers work every day with their pupils on all areas of the primary curriculum. The school is on the floor above the ward and has comfortable, small classrooms with all the usual wall displays, paints and reading books. The children, who may have attempted hanging or paracetemol overdose or have a severe eating disorder (a condition which is seen in ever younger children), settle to individual programmes of work on a one-to-one basis with a teacher.

"We take a lot of cues from the nursing and medical staff," says Mrs Campbell. "For example, we'd be told if a child, suffering from psychosis, has been experiencing hallucinations or hearing voices and will know to take things quietly that day."

It is rare, she says, for a child to "act out" in class. "The children tend to see school as a haven with a wee bit of normality."

In the event of a child experiencing problems in class, the teachers can telephone the nursing staff.

Both teachers emphasise the importance of liaison with each child's mainstream school. After a pupil is admitted, they visit the school - whatever the distance - collect the child's records of work and maintain contact with their class teacher throughout the child's stay at Caledonia House.

Ward manager David Harkins says: "We rely very heavily on the co-operation of everyone who has been involved with the child. We try to trace their progress right back from nursery." Early indications of the onset of an eating disorder, for instance, may be traced back to before an acute anorexic condition presented in the child.

Absolute confidentiality is paramount, he emphasises.

He says the Yorkhill teachers are "highly valued" and of key importance to the therapeutic process. "Sometimes teachers will see behaviour that other clinicians don't and report back to the medical staff," he points out.

Clinical psychologist Judy Thomson agrees, adding that the transitory nature of children's stay at Yorkhill makes liaison essential. The ultimate aim is to get children well enough to live at home again.

Mrs Cmpbell says she jokes with the children "It's lovely to see you but I wish you weren't here", backing the positive therapeutic approach of the medical team.

Class teachers visit their pupils in hospital, cards are sent from classes, and groups of children on occasions visit a classmate. As the therapeutic treatment progresses, children are able to spend weekends at home, and the Yorkhill staff can accompany a pupil back to school for a settling-in period.

Mrs Campbell admits that she can find it difficult working with a child with a severe eating disorder. "When a child is almost at death's door, it's very distressing," she says. "You can feel so helpless."

Staff development, she says, is essential and a lot of personal development time is spent on training from the medical team on psychiatric conditions. Her colleague Helen Kirkpatrick, who previously taught in the main hospital school at Yorkhill, agrees about the importance of detailed clinical training.

Gartnavel Hospital school takes teenagers from all over the west of Scotland who suffer from psychiatric conditions such as anorexia, psychosis and obsessive compulsive disorders. Here some patients work towards Standard grades and Highers. With capacity for 10 young people, the adolescent unit is soon to be refurbished and extended to accommodate almost double the number of patients.

Linda Brown, assistant co-ordinator for Glasgow City Hospital Education, says that apart from design and technology, for which there is currently no teacher, the whole curriculum is taught at Gartnavel. For pupils suffering from anorexia, physical education is dropped from the timetable in favour of physiotherapy.

Work with textiles can be incorporated into activity sessions with a hospital occupational therapist.

Home economics is a popular subject. Teacher Gillian McCalman feels that, when sensitively planned and taught, sessions on food preparation with some tasting can contribute to effective therapy for children with eating disorders. Recent collaborative work with the staff of a Glasgow health food shop also gave pupils new perspectives on nutrition.

Work with the city's Streetlevel Photo Gallery has brought added impetus to art and design classes. The school also hopes to be given the go-ahead for a garden project in which pupils can transform a patch of the hospital's grounds.

The classes are of mixed age groups and socially, not academically, selected. While the aim is to give pupils the chance to study a full secondary curriculum, Ms Brown emphasises that clinical treatment always comes before academic considerations. "It's more important to get better, than to get academic grades. Pupils may be entered for exams if they would like to."

She is proud of last year's pupils' successes: three pupils got seven or eight Standard grades each and one gained a Higher.

Peter Feeley, co-ordinator of Glasgow's Hospital Education Service who is responsible for recruitment, says: "I look primarily for good teachers who teach well and can work effectively in a tight team." Teaching a young person described as "floridly psychotic", who experiences visual and auditory hallucinations, takes much more than just a knowledge of a subject. Significantly, the turnover of staff at both schools is low. Stability in therapy is paramount.

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