Promotion of mental health & wellbeing in schools

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Dr Jitendra Nagpal
Program Director, Expressions India—The National Life Skills, Values, Community and School Wellness Program, New Delhi

It has been stated by the WHO that nearly 20 percent of children and adolescents suffer from a disabling mental illness worldwide. In India, few available epidemiological studies show diagnosable psychiatric disorders are found among a section of adolescent population.

Some epidemiological studies in India indicate that nearly 10-15 percent of young people in the age group of 16 years and below suffer from a diagnosable psychiatric disorder. Of them, 5 percent have a significant disability attributable to mental disorders. Suicide rates among them appear to be quite higher than anywhere else in world, accounting for 25 percent of deaths in boys and 50-75 among girls aged 10-19 years.

Most mental health problems, though manageable, are not identified or formally diagnosed at an appropriate time of child development. Therefore, as parents, teachers, educators and professionals dealing with the future of tomorrow, it is imperative to consider mental health of a child and an adolescent as a necessary priority for the healthy development of societies.
Education holds the power to transform fortunes within the human lifespan. Education is progressively seen with an inclusive perspective, symbolising a strong emphasis on integrated learning, especially in the context of RTE guidelines in place.

Role of schools

Schools must recognise and respond to the diverse mental health & wellbeing needs of students, accommodating both different styles and rates of learning thereby ensuring quality education to all through appropriate curriculum, organisational arrangements, teaching strategies and resource support. Children with learning difficulties or poor academic performance should not be labeled as per preconceived notion.

In this context, schools have an unprecedented opportunity to improve the lives of young people. Progressively, schools are finding it necessary to expand their role in providing services for overall child development and wellbeing. As a powerful socialising agent, the school plays a crucial role in the transformation of cognitive, linguistic and psychosocial competencies and creating happy, healthy and harmonious schools for mental health wellness of children, who are crucial demographic dividend and the most important national asset.

Facts to note

According to the WHO, here are some facts and figures related to mental disorders among adolescents.

  • Depression alone accounts for 4.3 percent of the global burden of disease and is among the largest single causes of disability worldwide.
  • Suicide is the second most common cause of death among young people worldwide.
  • Between 76 percent and 85 percent of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries.
  • ICMR statistics reveal 20 percent of children and adolescents suffer from a disabling mental illness worldwide.
  • 12.8 percent children suffer from mental & behavioural disorders.

The alarming statistics by WHO and ICMR are in sync with the objectives of Global Mental Health Action Plan, which are as follows (2013 – 2020):

  • To strengthen effective leadership and governance for mental health.
  • To provide comprehensive, integrated and responsive mental health and social care services in community-based settings.
  • To implement strategies for promotion and prevention in mental health.
  • To strengthen information systems, evidence and research for mental health.

Integrating the crucial aspects of mental health in the global vision of a ‘Health Promoting School’:

  • One that is constantly strengthening its capacity as a healthy setting for living, learning and working.
  • It focuses on creating health and presenting important causes of death, disease and disability by helping school children, staff, family and community to care for themselves.
  • It equips school children to take informed decisions over circumstances that affect their health and create conditions that are conducive to health. (WHO – 2008)

Counseling skills as tool for change

While counseling as a skill has been thought to involve basic communication and talking, it is more than that. According to American Counseling Association, professional counseling is a ‘professional relationship’ that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education, and career goals. Thus, it is essential that professionals and educators willing to help children and adolescents are trained professionally and have the necessary skills that equip them with both theoretical and practical information to bring positive changes with regards to mental health in the children community.

It is to be noted from the perspective policy and practices that India yet does not have a comprehensive approach to school mental health promotion. The child mental health policy is nonexistent and behavioural and emotional aspects of children with special needs are a completely ignored area. The five year plans, until recently, have set aside only a few crores for mental health of the entire country with the child’s mental health promotion receiving a very low priority. Lot of complexities exist in multiplicities of laws related to child mental health or associated disabilities.

Schools play a large role in development of children and adolescents and provide a room and scope for interventions at all levels of the schooling span. There is a need to train manpower in child and adolescent mental health at various levels of schooling, especially the role of teachers and student peer group as first aid counselors, mentors and peer educators. The existing counselors need constant upgradation in their role and responsibility for school mental health promotion and special education for the disability group of children. Child and adolescent research has not received the deserved attention so far. There is a great need to coordinate our efforts. The non-governmental organizations (NGOs) have an important role to play in advocacy, awareness and comprehensive and continuous training of manpower.

Key recommendations

When it comes to some innovation for mental wellbeing promotion in schools, here are some imperative recommendations.

  • Mental Health & Life skills as abilities for adaptive and positive behaviours need to be mandated for helping children and adolescents to effectively deal with demands and challenges of everyday life. Integration of age appropriate life skills throughout the schooling period of 12-13 year imbibes a rounded development of children as a lifelong human resource for self and the environment and the nation at large.
  • The policy should encourage ongoing ‘comprehensive curriculum’ for sensitisation of principals, teachers, managers and all students towards Gender Issues, Substance Abuse Prevention, Understanding and Management of Aggression and Violence, Promotion of Emotional Health, Safety & Positive Citizenship. School systems must organise sequential age appropriate programmes and campaigns to spread awareness and responsibility about all dimensions of health.
  • Peer educators (adolescent students), play a vital role in becoming ‘life skills and wellbeing ambassadors’ of the school and the nation at large). Teacher supported and peer educators driven life skills, health, values and wellbeing programmes should be implemented for all groups of students in schools, so that they feel aware, responsible & empowered for all aspects of their personality development and well integrated with the paradigm of health and wellbeing.
  • School counselor and special educators and/or trained teacher counselors should be appointed for every school to facilitate effective guidance and counseling for students and their families, across the entire span of schooling. This is to help them cope-up better and plan the choices in academics and co-academic areas effectively.
  • The components of the school mental health programme must be an integral part of ‘Health and Physical Education’. In fact health and nutrition programmes should form the basis for health and nutrition education rather than just focusing on ‘Creating Awareness’ in children about what they should eat, especially when a large percentage of children do not have access to adequate food.
  • Make all early childhood education and care programmes from 0–6 years sensitive and responsive to the children with special needs, including training of community teachers, family volunteers and anganwadi workers in the identification of the needs of the children with disabilities, use of age-appropriate play and learning materials and the counseling of parents and teachers.
  • Removing physical barriers & reviewing barriers created by admission procedures (screening, identification, parental interaction, selection and evaluation), this should include private schools. Making the curriculum flexible and appropriate to accommodate the diversity of school children, including those with disability in both cognitive and non-cognitive areas and all types of slow learners.
  • Gear up for all Teacher Education Programmes (both pre-service and in-service) to developing the pedagogical skills required for mental health & inclusive classrooms for integrating the EWS (Economically Weaker Sections ) and the complete range of CWD’s (Children with Disabilities) and SEN (Special Educational Needs) children.
  • All teacher education courses must include ‘health’, esp. mental health, yoga and physical education as a compulsory subject. For effective implementation of this subject, advocacy is required at different levels of the education and health systems—primary, secondary & tertiary care. It is strongly recommended that the appropriateness of design, materials and pedagogy be looked into for health programmes as interventions in the school curriculum.
  • For children with special needs and all slow learners, the following are must:# Early detection and intervention of common developmental problems and disorders is imperative as part of the specialised support to these children. In this, majority of schools find co-morbidity of learning problems of school children such as conduct disorders, childhood depression, autism, attention deficit disorders, slow learners, etc.

    # Focus should also increase on the adolescent group with concerted programs of life skills, stress management, drug abuse prevention, reproductive health and allied areas.

    # Coordinated efforts of mental health professionals, educationists, school counselors and employees from government, voluntary and self-help groups are urgently required for this massive task.

    # Individualised home and education plans for behavioural modification, occupational therapy and sensory integration, speech therapy and remedial education esp. in the semi-urban and rural setting with the help of local educational and health care providers.

  • Positive parenting sessions in the context of child mental health and resilience and responsible child care. Capacity building for teachers and non-teaching staff, ensuring entire school awareness and sensitivity for child abuse (including the POCSO Act 2012) and all the other legal instruments important for the schooling systems.
  • Encourage government & non-government organizations (NGOs) working in these fields to develop state and national level trainers and master trainers for positive school mental health promotion and coaching of school leadership for all principals, teachers, senior students and education leaders of the community.
  • To position a measurable and sustainable Monitoring and Evaluation System (MES) for effective implementation of the life skills, school mental health, values, behavioral and wellbeing programmes with markers and indicators that are dynamic in nature and in the context of the changing scenario of the society, culture and educational needs of the country.
  • Mental health services should be included in Individualised Educational Programs (IEPs) for child clients enrolled in a special education programme.
  • Outcomes-based research should be performed on the effectiveness of various school-based mental health models that are designed to improve psychosocial and academic outcomes.

…Many of the things we need, can wait. The children cannot…Right now is the time his bones are being formed, his blood is being made and his senses are being developed to him we cannot answer “Tomorrow”. His name is “Today”.
–Gabriela Mistral

Dr Jitendra Nagpal is Program Director of Expressions India—The National Life Skills, Values, Community and School Wellness Program (New Delhi), which was launched to create awareness responsibility and empowerment among school-going adolescents, their parents and teachers. Expressions India has more than 2500 training sessions, seminars organised regularly at national and international levels for promotion of child and adolescent life skills, values, gender and school wellbeing. Having been an empanelled agency for the CBSE over the last five years and a technical support provider to NCERT for a decade, Expressions India has been associated with a number of schools and institutes for technical supports in terms of advocacy, training and enrichment. Dr Jitendra Nagpal is also Senior Consultant Psychiatric and In-Charge at Institute of Child Development and Adolescent Health, New Delhi.