In my work treating mentally unwell adolescents in London, I spend a lot of time trying to introduce, coax, encourage, challenge and on some occasions drag them to a more balanced position in the way they think and the way they act.
Balance: it isn’t cool and it isn’t exciting. It smacks of the mundane and the boring – concepts that teenagers rightly reject. Teenage years are typically times to pull to the edges: taking risks, challenging the status quo. However, it is the adult’s job to bring some balance into the extremity of those teenage years.
Their parents, teachers and any other significant adults should, of course, be encouraging them to spread their wings: it is from their youthful exuberance and creativity that the next advances in science, medicine, the arts will come. But teenagers also need containment. Wilder excesses need to be reined in a bit. Those suffering with mental illness have often gravitated into excess in their thoughts and behaviour, and that can cause or exacerbate their difficulties.
And so, we return to the distinctly unsexy concept of balance. It is a concept that is likely to feature regularly in this column. The question I will keep asking is whether – and, if not, how – teachers promote a balanced approach for their pupils, without squashing their spirit. Because a balanced approach is likely to be best for mental health.
For example, how do teachers promote balance towards hard work? We can all agree that we want children to learn good work habits, to apply themselves, to earn qualifications. But surely we can also agree that children need a work-life balance, that we don’t want them to burn out or to live in a constant state of stress. And, from inside Camhs, it seems that there are too many children who haven’t got this balance.
Extreme and relentless
Most of my patients are suffering with anxiety, depression and eating disorders. We don’t know the combined incidence of these conditions, but we might estimate 8-10 per cent of any Year 10-13 cohort might be suffering in these ways at any time.
Many of these patients have an extreme and relentless inner critical voice, which tells them they are hopeless, useless, and never good enough. To cope with these feelings, they work all the time, don’t eat, vomit or self-harm. Their constant A grades are a ball and chain to them: they must always live up to them, but never feel proud of them.
My clinical work during the summer holidays generally involves trying to encourage these teenagers into self-care, relaxation, downtime, fun and non-productive activity. I try to stop them reading every book on next year’s reading list before term starts, and stop them setting their alarm for 7am, so they can watch foreign-language films or the news for their university interviews.
Fun and relaxation are good for mental health. Nobody can work 24/7, 365 days a year and stay mentally well.
We make some progress over the summer: the alarm gets put back to 8am, perhaps. And then, on 2 September, their head of year tells them that this is “the most important year of their school career”. They need to “work harder than they have before”, “do their very best”, “work as hard as they can” and not “throw away their future”. I’m not sure this a particularly balanced or helpful approach to getting the best out of pupils.
My depressed, anxious and eating-disordered patients take this very literally. They might set their alarm at 4.45am; they continue studying even when they are eating; they learn the whole of the Letts revision guide by heart. And yet they never feel they have done their best, because they took time off to go to one party.
Sadly, I am not making any of these examples up. They get straight A*s or 9s – but at the cost of their mental health.
Blah, blah, blah
At the other end of the spectrum are those doing no work. They may have behaviour or attendance issues, or may be involved in substance misuse or crime. They already feel disenfranchised by the increasingly academic exams of the Gove reforms.
I am not sure the “you need to work harder than you have ever worked” message has any positive impact on them either. For these pupils, the head of year’s speech probably sounds like: “Blah, blah blah.” They are too far behind already; they are too scared of failing or not looking cool, or they just can’t see the point. Telling them to work harder does nothing to help them get out of the hole they are in.
Most teachers go into each teaching day wanting to motivate and inspire their pupils. But I fear some are at best missing the mark and, at worst, contributing towards mental illness.
I’m not saying that a head of year shouldn’t give a motivational speech. I’m just saying that they should draw on psychological theory and research when doing so.
Can I suggest that heads of year look to the seminal work by Prochaska and DiClemente on cycles of change and motivational interviewing? Can I suggest that they craft a speech based on the idea that not all children are the same? Some may need to work less hard and have some fun; others may be stuck and not know how to begin.
Cycles of change
Prochaska and DiClemente suggest that, in any major action – such as working towards GCSEs – pupils should move between the following five stages:
- Pre-contemplation: not really planning to do anything.
- Contemplation: thinking they will do some work, but not doing anything about it yet.
- Preparation: have bought highlighters and watched the movie of their key text).
- Action: getting down to work regularly.
- Maintenance: done all the work and now just need to remember it.
A clever head of year will try to speak to young people at all of these stages, and not just give a broad “work harder” or “do your best” message. There is a whole therapeutic approach called motivational interviewing based on this, which the interested among you can explore.
In brief, my top tips would be:
- Acknowledge that pupils are all at different stages in their work. Some young people are doing too much, and may peak too early or make themselves sick. Others may be sick with panic because they’ve done nothing. It’s all OK – we’ve got a year to work on it.
- Get them to visualise their goal: ask them to close their eyes and imagine what they want for themselves during and after the next year. Embrace academic and non-academic goals.
- Get them to think about whether their goals are realistic (is playing four hours of Fortnite a day going to lead to top grades?) or even necessary (being determined to get all 9s in your GCSEs, for example).
- Write down or talk about goals and how to commit to them.
- Break a goal down into day-by-day steps.
All change involves loss. If children are going to work more or work less, they will lose something. Facing that loss at the start will make it more likely that they keep their commitment.
For example, many boys spend hours building up levels on computer games. Working more will mean they lose their level. Understanding that, as a form teacher or Sendco, will help you to support them, with the long-term goal at the expense of the short-term gratification that these games offer.
For the more anxious over-workers, work-life balance means not working all the time. There will be a loss involved for them in this too: the occasional B grade will provoke short-term anxiety. The pay-off to their long-term mental health of relaxing, having some fun and living in the moment will hopefully be worth it.
I hope the teaching profession can support them to have this balance in their life.
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. The views expressed are her own