Frank O’Hagan
A real-life scenario (amended to ensure confidentiality)
Assessment, observations and background information of the primary school child clearly indicated that she was experiencing worrying features of adverse childhood experiences (ACE) and confusion. During her early years, she had been severely neglected by her natural parents. Some of the treatment to which she had been subjected could be described as akin to torture. As a result, she had been taken into care. Both the child’s new parents and school were perturbed by the scarcity of professional backing available to help them in their endeavours to address her evident distress. Her mother, when interviewed, concluded a moving description of concerns about her adopted daughter’s mental health by saying, ‘We thought that love was all that was needed to put things right. But love is not enough.’ The power of her affectionate, yet despairing, poignant remark has remained with me.
Things can only get better?
The subject of provision has been and remains a fraught and troubled topic with many issues requiring to be investigated and settled in a satisfactory manner. I hold it to be a scandal that so many young persons are denied crucial direction and left to fend for themselves. A brief sample of pertinent questions would include the following. Has too much emphasis been given to medication at the expense of psychological contributions and care? Can educational inputs bring about significant changes for the better? How far can resources be moved from institutional settings to community-based services? How should society develop effective intervention and rehabilitation strategies across families, schools and communities?
In recent years, there has been considerable criticism of what has been called the ‘medical model’ or ‘disease model’ as having placed excessive concentration on diagnosis followed by associated types of prescriptions. In this conceptual framework, problems pertaining to mental health have tended to be viewed as an illness in search of pharmaceutical remedies. Convincing arguments have been put forward to beware of medical domination at the expense of relevant alternative factors. For instance, there have been serious misgivings about the levels of drug use recommended for childhood depression or disruptive behaviour, especially when not accompanied alongside supportive therapies. In contrast, an ‘individualised psychosocial approach’ would place a sharper alertness on sensitive and nuanced judgments which are more tailored towards meeting personal, emotional and social prerequisites. It suggests that there are dangers in treating mental pain as if it was merely a bodily ailment which can be ‘cured’. Better to listen to what individuals want to convey and to take a holistic stance by focusing on their overall wellbeing and burdens, upbringing and educational attributes, interests and friendships. This latter school of thought also highlights the roles of positive family and community alliances and participation.
Psychosomatic upset can occur in various contexts such as inadequate parenting, physical or sexual abuse, victimisation, racism, substance dependency or other traumatic mishaps. There is little doubt that the force of environmental ills, including deprivation and inequality, can have a devastating impact on welfare and feelings of security. However, the causal effects are not always apparent as individuals might respond differently within similar situations. Nonetheless, regardless of the origins or causes, society ignores the necessities of vulnerable young people at its peril. The outcomes of abandonment pose hazards not only concerning their futures, safety and happiness but also because of long-term communal and economic consequences. The good news is that there appears to be an increasing acceptance of the fact that there has been a lack of attention given to the requisites of children and young persons who are experiencing mental suffering. Their struggles rightly are being considered with disquiet from both national and global perspectives by many commentators.
Promoting good mental health
Education authorities have indispensable duties to undertake in ensuring that schools and colleges are compassionate and empathetic organisations with staff adroit in identifying and assisting students who are living through unresolved or previously hidden anxieties. At the same time, it would be absurd to keep piling additional tasks relating to mental wellbeing into the remits of educationalists without ensuring that there are sufficient means and opportunities for continuing professional development. Adequate funding, training and supervision must be made accessible, particularly for those engaged in pastoral care, in order to acquire effectual skill sets.
Staff are frequently the first to raise their apprehensions about the emotive state or unusual mannerisms of a pupil in turmoil. They can provide an insightful starting point for feedback from parents and external experts in a process of healing and restoring an attitude of belonging. Usually, early intervention is highly desirable as is proficient communication among all those involved, including the young persons and their families. Three common approaches – focusing on counselling, cognitive behaviour therapy and mindfulness respectively – can be effective. Very general descriptions of them are outlined in the appendix. It should be noted that they do not suit everyone and may take different forms when employed in separate settings. Of importance is regarding personal, biological and psychological aspects holistically rather than responding as if these were isolated features. Furthermore, scarcity of resources and delays in referrals underline the value of having community-centred schemes which advance advocacy and teamwork.
Teachers will realise that life in school can give rise to detrimental strains such as unwanted or dishonest demands from peer groups or excessive expectations to achieve high grades in national examinations. Some staff will be highly adept in managing procedures and coordinated processes with respect to individualised safeguarding and child protection. For instance, they can contribute to assessing risks, keeping records and formulating oversight of clearly stated objectives. However, without extra collaboration from external agencies, there often will be no irrefutable guarantee that their efforts will lead to fitting and faultless courses of action.
Making educational inputs more beneficial?
It is a given that education’s role is to provide stepping stones towards establishing and maintaining learners’ esteem and dignity – and certainly not to contribute in any way towards erecting potential stumbling blocks. Many elements of a school’s curriculum offer useful platforms to investigate ways in which the societal stigma associated with mental health might be reduced. Relevant inputs enable pupils to come up with ideas about how to extend empathy and tolerance in both school and the wider community. Topics on personal, social and health education can convey clarification and guidelines on how to manage difficulties pertaining to anxiety, tension, hostility and hurt.
Engagement in activities dealing with composure, competences and decision-making all have a place in strengthening emotional buoyancy. Together, inspirational teaching and authentic learning advocate and promote: satisfying lifestyles; sensible eating habits; staying fit; self-compassion; affirmative relationships; connectedness within society; and skills in obtaining necessary support. Age-appropriate projects – for instance, on healthy routines, citizenship, relaxation exercises or confidence-building – also present those in need with opportunities to come to terms with particular dilemmas which might perturb them. Membership in sports, art, dance and other interest groups during recreational periods can do much to foster mutual understanding, empower resilience and endorse a sense of camaraderie. Well-delivered lessons, discussion sessions and contributions from visiting specialists offer diverse outlooks and challenges to enhance self-worth and to boost fortitude during times of stress.
There have been snags with the introduction and continuity of contemporary forms of assistance as teenagers grow older, move on from school and enter adulthood. These too ought to be highlighted and settled. Designated teachers with responsibilities for informing adolescents of services which are available for care and back-up after leaving formal education are essential. One conceivably vulnerable cluster of youths running the risk of experiencing long-term behavioural problems or mental health discomforts are those not in education, employment or training (a recommendation – let’s render the unfortunate acronym of ‘NEET’ obsolete). Productive routes for action including work placements and follow-up programmes to evaluate progress are required. Without a comprehensive strategy, an unacceptably high cohort of young adults with budding abilities and talents could be marginalised.
Depending on circumstances, traumatic incidents – such as a tragic event in a learning community or its catchment area – may have an enduring impact on an individual or a peer group. An important factor is how well key staff respond with sympathy and proficiency in their tactics when dealing with such challenges. Can they discern the ordeal and its level of pain as perceived by students? Probe, and if apposite, share views and enable them to detect possible solutions? On occasions, from a very testing and tense state of affairs, both learners and staff can discover personal capacities and inner strengths of which they previously had been unaware.
Getting by with a little help from our friends?
All forms of curative or restorative endeavours profit from sensitivity, kindness, flexibility and, critically, an attentiveness to the prospective risk of adverse effects. Skilled practitioners are well placed to cooperate with staff in schools, for example by introducing tried and tested counselling methods with teenagers. What frequently has been missing is consistent, joined-up partnerships across strategic groupings – including teachers, social workers, police, psychologists and psychiatrists – involved in the general guardianship of those exhibiting onerous quandaries. Institutional rigidity is a perilous occurrence. So often, in official reports on breakdowns regarding the proper protection of vulnerable children, the lack of adequate communication is cited as one of the reasons for failures. Conversely, the stimulus of effective solidarity can result in advancing shared goals, reducing complex and bureaucratic protocols, and extending best practices.
Through responsive styles in tackling the challenges encompassing an individual’s or a family’s pressures and predicaments, combined support teams can reach a speedy consensus on planning and in delivering beneficial advice and direction. Ideally, they will operate through evidence-based policies, deal with links between physical and mental health, and be in a position to restructure provision to match identified requirements. In this process, a well-placed teacher may have the principal tasks of closely monitoring variations such as behavioural improvements during the school day and of reporting back on progress. If additional supervision is necessary, nominated personnel can take steps to ensure that they are ready and willing to unite forces with those who appreciate their expertise. All have to be aware of who is acting as ‘lead coordinator’ and of the implications of shouldering collective responsibilities.
Reasons to be cheerful?
Unfortunately, there is no ‘magic bullet’ or straightforward Holy Grail to pursue when responding with thoroughness and commitment to all those children and adolescents who are encountering difficulties in connection with mental health. As suggested earlier, it would be a mistake to regard their setbacks as simply an illness; their everyday environments and debilitating lived experiences also must be taken into account. Nevertheless, a central aim of this article has been to indicate that much can be achieved by dedicated staff in learning communities. Effective therapeutic networks will help to lessen inflated demands to ‘fix’ or ‘cure’ troublesome situations through untested or unavailable interventions. Constructive contributions offering hopeful pathways can bring about life-enhancing changes. These include:
- building and augmenting ‘can do’ mindsets through providing a positive and optimistic interwoven mix of an empathetic learning ethos, effective pastoral care and well-judged tasks and leisure activities
- avoiding fads and concentrating on reliable and advantageous tactics which cultivate and refuel confidence, decision-making and self-worth
- celebrating both small and significant steps forward, particularly when young persons are going through periods of discomfort and darkness
- arranging successful involvement and events in conjunction with external organisations – health practitioners, sports clubs, charities, voluntary societies, and so forth – to ensure suitable ongoing assistance at weekends and during holidays.
Concluding comments
So, was that young caring mother correct when she implied that love was not enough? Love is certainly of immense value but its impact can be greatly enriched when parents are aided by schools and appropriate professionals. Medication can be worthwhile but undoubtedly more reinforcement is needed to: help distraught youths to accept and understand their noticeable or hidden hardships; attend to the disturbing conditions in which they find themselves; enable them to overcome undesirable or injurious habits; participate profitably in relevant therapies; and reach a secure position where traumas, substance dependency or intra-personal conflicts can be dealt with successfully. Schools, along with families and external agencies, can and do commit themselves to embarking on productive efforts within the overall process of making life more tolerable and affirming. There are trustworthy and genuine strengths in the collaborative endeavours of united and altruistic teamwork. Often this ’collective love’ is what is really essential.
Appendix: Very brief summaries of three common supportive approaches worthy of further investigation and consideration
There are many forms of therapeutic interventions. In practice, distinct variations occur within and between them so different descriptions and styles exist. Care and training are strongly recommended in order to implement them competently and successfully. However, at times, it is advisable for individuals not to take part.
Counselling is sometimes described as a ‘talking therapy’ although I prefer to deem it to be a ‘listening and talking’ one. It is a dynamic, two-way interaction which is liable to suffer if both aspects are not functioning effectively. Young persons usually benefit from encouragement to be at ease, open up and join meaningfully in these sessions. When they do, they can develop a deep relationship and trust with their counsellor. Well-targeted use of questions may be employed to enable obstacles to be clearly expressed. Through welcoming the opportunity to discuss and examine their own personal dilemmas and distress, individually or in groups, participants can seek and hopefully find their own ways forward. Depending on the circumstances and the wishes of the young persons, this work can be undertaken in school or other locations.
Cognitive behaviour therapy is an umbrella term for a range of therapeutic methods which, as the term implies, focus on improving specific features of an individual’s processes of cognition and unsolicited behavioural impulses or outcomes. Proponents contend that mental health problems, while being linked with set patterns of behaviour, are also influenced by emotional and cognitive factors. In general, they aim to clearly address difficulties arising from habituated and conditioned behaviours and spurious thoughts, ideas, moods and feelings. Their action-based practices are widely used to assist those experiencing a variety of psychological matters such as panic, suppressed anger, depression and eating disorders. Success can be achieved though challenging negative beliefs and enhancing positive thinking.
Mindfulness has much in common with Buddhist and meditational practices. It is associated with the development and cultivation of a person’s or group’s active, continuous, open and non-judgemental awareness. This state of mind is maintained and ‘flows’ from moment to moment as if in an ocean of peacefulness and contemplation. Attention is given to techniques relating to breathing, inner consciousness and relaxation. Advocates of this approach stress its usefulness in amplifying wellbeing and in alleviating various personal hindrances such as anxiety and constant worry. Both relevant guidance and extended, well-directed practices are recommended to reap the full advantages of its usage.
(Frank O’Hagan previously was the Adviser of Studies to Bachelor of Education students at the University of Strathclyde. Later, he was a member of Her Majesty’s Inspectorate of Education.)
Improving Care and Education 