Mental health in schools is a hot topic at the minute – the government has announced funding towards teacher mental health training.
We have become the first country in the world to roll out mental health first aid training to every secondary school – but is it too little too late?
Why are we suddenly fixating with mental health in schools? 1 in 10 children has a diagnosable mental health condition, equates to roughly three in every classroom! Even more shockingly, half of all cases of mental health illness takes root before the age of 14.
We know early intervention massively increases the chances of making a good recovery – but only if we become much better at spotting and dealing with problems earlier.
Anxiety is one of the most common mental health concerns for school staff, and statistics reinforce that it is a growing epidemic amongst children and young people in the UK. The Mental Health Foundation reports that as many as 1 in 10 children and young people have a diagnosed mental health condition, and it is important to note that this figure does not account for the children and young people who haven’t yet made a disclosure or been identified as needing additional support.
Anxiety is believed to affect as many as 1 in 6 young people. The pressure this applies to teaching and support staff to identify and support pupils who may be suffering from anxiety is significant, and more needs to be done to equip front line staff to effectively and confidently work alongside pupils for whom anxiety is a real and debilitating experience.
There is a drastic difference between anxiety and having an anxiety disorder – they are as poles apart as having a cough and pneumonia. Anxiety is a normal emotion experienced by everyone to a certain degree, and there are times when anxiety is to be expected, such as around exam season or when transitioning between schools.
Anxiety is a feeling of fear or panic experienced by most people in response to stressful situations; however, it becomes a problem when the anxious feelings stay or get stronger once the situation has abated. Anxiety can have adverse effects on learning at school, tolerance to stress, confidence, motivation and personal relationships.
Anxiety disorders are often treated with cognitive behavioural therapy – a form of talking therapy that helps patients understand the sources of their anxiety and construct coping strategies. Some patients may be treated with medication if their problem with anxiety does not improve.
Spotting the signs
The symptoms of anxiety the sufferer may experience include:
- Constantly feeling nervous, panicky or frightened.
- Feeling down or depressed.
- Difficulty sleeping.
- Lack of appetite.
- An inability to focus.
- Tiredness and irritability.
- Palpitations (heart racing).
- Dry mouth.
- Headaches, stomach cramps and/or diarrhoea.
- Fidgeting and frequent use of the toilet.
Pupils, especially young children, may not be able to tell you that they are suffering with anxiety and, unless a pupil confides in you that they are experiencing the above symptoms, they could be difficult to spot from the outside looking in; however, you may be able to spot some behaviours that might indicate a pupil is experiencing anxiety.
Young pupils may complain about headaches or feeling sick, or may become tearful and irritable – their parents may mention that their child has started to wet the bed or have disturbed, unrestful sleep.
Older pupils may:
- Have frequent outbursts of anger.
- Show problems with eating or sleeping.
- Have difficulty paying attention.
- Avoid everyday activities, e.g. attending school.
- Seem to repeatedly think bad things are going to happen and be unable to let go of negative thoughts.
Support strategies in school
Sadly, there is no ‘one-size-fits-all’ solution to anxiety amongst children and young people, but here are some practical suggestions that schools can apply:
Feeling anxious is normal, and it is important children and young people understand this. Anxiety stops being ‘normal’ when it interferes with everyday life on more days than not, for a prolonged period of time – how we look after ourselves makes a huge difference.
Start with staff
If teaching staff are stressed or expressing anxiety about SATs, GCSEs or A-levels, then that will cascade down to pupils. On an aeroplane, passengers are always told to affix their own oxygen mask in an emergency before helping someone else, and the same applies here. Address the wellbeing of staff first and that will reflect on pupils.
Identify the pupils who are most at risk or already diagnosed
Identify the pupils who are most at risk, or already diagnosed as having a significant issue with anxiety, and offer additional support.
This may take the form of mentoring or having a safe space to retreat to when the school environment feels overwhelming. Not all anxiety will be based on school stress – it may be related to social issues, rooted in self-esteem or stemming from a specific phobia.
Keep pupils in school
It is better for a pupil to be in school for as little as one hour a day rather than not at all, so consider the following ways to keep pupils attending school:
- A reduced timetable
- Somewhere quiet to eat lunch
- Regular contact between the school and their parents
- Opportunities for the pupil to have a say and express what they feel they need
- Accommodating interventions that may make school a more manageable experience (e.g. opportunities to go outside, listen to music, leave class if they need to, providing safe spaces at lunch/break times if the playground is too overwhelming)
It is vital that pupils feel supported, but it is also of huge importance that they are encouraged to look after themselves as much as possible, so they can develop self-care skills and learn how to build resilience. Here are some suggestions of ways to do this:
- Being still – encourage pupils to take 10 minutes a day to do nothing except sit and breathe (no phone, tablet, music, television or other electronics).
- Having a routine – a school timetable can be of huge benefit, but how do pupils schedule their time at home to make sure they fulfil all their homework and leisure commitments and when do they have proper time off? Some anxious children may be overly conscious, and will benefit from having permission to rest.
- Finding ways to communicate that work – not all children and young people are comfortable with talking, and may not have the emotional vocabulary to do so, alternatively could they write to you, email or draw how they feel?
- Finding coping mechanisms that work – develop a ‘tool box’ of things they can turn to when needed. A tool box may contain playlists of helpful music, reminders of breathing techniques, affirming and reassuring statements, apps on their phone – a coping mechanism may be in the form of a distraction, such as mindfulness colouring.
Explaining big changes in advance
Pupils with anxiety may react strongly to sudden change – it may help to offer an explanation for any big changes within the school or pupils’ routines in advance, covering what is going to happen and why.
There are many books and games available to help children and young people understand upsetting events, such as bereavement, divorce, etc. – consider stocking these in your school library or making them available in other ways.
Some pupils may benefit from reassurance and practical help from an adult, such as a teacher or the school nurse – make sure that pupils know that their teachers and the school nurse are available to them to talk.
The Charlie Waller Memorial Trust have free wellbeing resources for schools that may be of help in identifying pupils at risk, and for assisting all pupils to develop self-help strategies, as well as a document to assist in making a disclosure. More details can be found here.
Child and Adolescent Mental Health Services (CAMHS) referral
As a school, revisit how and when you make referrals to CAMHS – if you are concerned about a pupil, then make a referral. Don’t be discouraged from making a referral based on the availability of services – the greater demand for mental health services will reinforce the need for increased funding. Work collaboratively with families to find out whether the anxiety you see at school is consistent with what is seen at home, and vice versa.
Anxiety UK (2015) ‘Young people and anxiety’ <https://www.anxietyuk.org.uk/our-services/anxiety-information/young-people-and-anxiety/> [Accessed: 21 June 2017]
Charlie Waller Memorial Trust (n.d.) ‘Resources for schools, young people and parents’ <https://www.cwmt.org.uk/resources> [Accessed: 21 June 2017]
Mental Health Foundation (2017) ‘Children and young people’ <https://www.mentalhealth.org.uk/a-to-z/c/children-and-young-people> [Accessed: 21 June 2017]
NHS (2016) ‘Anxiety in children’ <http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/anxiety-in-children.aspx?mc_cid=1faed9f151&mc_eid=660950c82e#signs> [Accessed: 21 June 2017]
Royal College of Psychiatrists (2017) ‘Worries and anxieties – helping children to cope: information for parents, carers and anyone who works with young people’ <http://www.rcpsych.ac.uk/healthadvice/parentsandyouthinfo/parentscarers/worriesandanxieties.aspx?mc_cid=1faed9f151&mc_eid=660950c82e> [Accessed: 21 June 2017]
Young Minds (2017) ‘Anxiety’ <https://youngminds.org.uk/find-help/conditions/anxiety/?mc_cid=1faed9f151&mc_eid=660950c82e> [Accessed: 21 June 2017]