Awkward Behaviour is not a Mental Illness

“It is our firm belief that if we want to change things the school has to be the place to do it.” This statement from the Mental Health Foundation publication Bright Futures indicates unequivocally the interest health agencies are showing in the role schools can play in helping to identify and deal with children’s mental health difficulties.

The recent Children’s National Service Framework Standard 9 – devoted to the mental health and psychological well-being of children and young people – is also enthusiastic about joint working between child and adolescent mental health services (Camhs) and schools, particularly for vulnerable pupils.

Mental ill-health is a global issue – between 10 and 20 per cent of people are affected worldwide. So a school could expect a fifth of its pupils to be experiencing problems at any one time, from minor adjustment difficulties to substantial problems such as self-harm. So what should they be doing to help these pupils?

One implication suggested in the national service framework is that child mental health services could be delivered in a school location, which might result in better take-up and engagement with helping agencies. It would also reduce the stigma of clinic attendance for mental health rather than physical health reasons. On the face of it, this is an encouraging idea which would bring a more effective delivery of help or relief to pupils and families.

But a number of issues need clarification before Camhs relocates some of its activities to schools.

The first issue to resolve is that of language. At the easy end of the scale is the confusion over terms such as “primary” and “secondary”, which have totally different meanings in health and education. At the thornier end are terms such as “depression” and “conduct disorder”, which would worry most teachers but leave them with little idea of how to respond to the pupil’s needs.

Another issue involves mental health concepts and diagnosis, such as depression and conduct disorder. Teachers are used to clear, objective descriptions relating to the school curriculum, or pupil performance and behaviour. Vague, ill-defined or ambiguous-sounding terms do not fit easily into this frame of reference, although teachers are becoming more accustomed to ideas about emotional health and well-being as a result of, for example, the Healthy Schools initiative.

There is a deeper problem, though. Mental health difficulties and mental/emotional health and well-being are not necessarily opposite sides of the same coin. The problems in defining these terms are long-standing, and definitions of illness and wellness may stem from totally different perspectives.

Perhaps the biggest problem to people working in the education system is the danger of pathologising and so stigmatising what may be normal reactions and processes. Education has steadily moved away from medical diagnosis since 1981, and the inclusion agenda is continuing this process.

Education is seeking to include rather than exclude or segregate pupils, and labelling more pupils as having conduct disorders is unlikely to help this process. A replacement of categories by descriptions, or understanding of the effects on the pupil, and how best to deal with the problem is a process that a multi-disciplinary team would need to grasp if school-based work is to make a positive impact.

Despite these reservations, there are grounds for optimism. Drawing attention to the idea of mental or emotional well-being raises the issue of the emotional atmosphere within schools. A happy, settled school staff, able and willing to cope with the ups and downs of school life, has many benefits for pupils, so a focus on the well-being of staff is essential in creating a positive atmosphere in schools.

One spin-off for pupils would be to increase their feeling of belonging and to reduce disenchantment, a necessary condition for dealing with any particular individual needs they may have, and which may involve specialist personnel.

This brings us to a need to focus on systemic improvements to the school organisation such as encouraging positive actions. It also means focusing on solutions rather than problems, and on owning difficulties rather than blaming others. Multi-agency teams would have to address these issues, but the potential for making a real impact on the lives of pupils is enormous.

To operate a mental health initiative effectively in schools would require careful planning, preparation and management. A common framework evolved with the school, not apart from it, with shared language, ideas and practices would have a much better chance of success than a collection of individuals acting in isolation.

These resources are in short supply. Relocation of existing Camhs services to most schools would spread the provision thinly. How to make sure schools get equal access to resources is an important question for national policy-makers. Mental health in childhood and adolescence is precious, and a national priority. Attention to detail and funding must match the intentions.

• John Gott is an educational psychologist for Lancashire Council. His opinions are submitted in a personal capacity