SCHOOL MENTAL HEALTH

Janaki Sankaran MD (Psychiatry): DPM School couselor - Bhavan's Vidya Mendir, Elamallara, Cochin

INDRODUCTION
 The mental health of children needs attention for various reasons:
  •  All young people today face significant stresses in their lives;
  •  10% of all children have mental disturbances with serious associated impairments at some time in their childhood;and
  •  Academic failure and social rejection often have lasting consequences.
 In most places, families and schools are the strongest social institutions in the child's life. School have a central position in many children's lives and a strong potential to play a pivotal role in their development. Therefore, schools, for many children may be the most sensible point of intervention. This is because:
  •  Most children attend school for some part of their lives;
  •  Schools have a profound influence on children, their families, and the community;
  •  Schools are often the strongest social and educational institution available in the lives of children;
  •  School mental health programs are effective in improving learning, mental well-being, and in treating mental disorders;
  •  When teachers are actively involved in mental health programs, the intervention can reach and impact generations of children.
 School Matters
 The aim of school based interventions is to help strengthen the coping abilities of children. School based intervention may be:
  •  Environment centered or
  •  Child centered
 Environment centered approaches aim at improving the educational climate so that children can find healthy role models. Environment centered programs also work to enhance the ability of the school staff to deal with specific areas of emotional or behavioural disturbances, and to understand how to utilize the services of other agencies which work for children.
 Child centered activities include individual mental health constitutions, specific problem focused interventions and classroom activities to improve coping skills, social support, and self esteem.
 Introducing an innovative mental health program in schools can be both an exciting and frustratingly complex challenge at the same time. For a program to be successful it should be :
1. an organized service;
2. a continuous, dynamic process;
3. concerned with the whole individual; and
4. meant for everyone
 The service has to be provided by trained professionals though most teachers can - and do-provide modest mental health services.
Successful models of Intervention can be found at four levels:
 Comprehensive school mental health program level of intervention
Promoting psychosocial competence
 1. Integrated into school curriculum
Mental health education
 2. Part of general health curriculum
Psychosocial interventions
 3. Students needing additional help in school
Professional treatment
 4. Students needing additional mental health interventions.
 Levels 1 through 4 are similar to primary, secondary and tertiary prevention efforts. Levels 1 and 2 look at primary prevention and health promotion (interventions that promote health behaviours and prevent a disorder from developing); levels 3 is the secondary prevention levels which addresses persons at risk; and level4 (tertiary prevention) targets people with the intent of treatment, reducing impairment and preventing relapes.
So what is to be done ?
SPTEPS FOR PROGRAM DEVELOPMENT AND IMPLEMENTATION
Step 1: Establishment of a team
 The ideal team, which addresses the mental health needs of a school, should include school personnel, family, community, mental health professionals and students.
Step 2 : Assessment of school and community environment
 This included a detailed assessment of the strengths and the resources available, as well as the weaknesses and the risk factors involved. It would be beast if the school personnel and administrators are actively involved in the assessment process. This has two benefits
the school feels a sense of ownership and belonging to the program; and
the school does not feel that the mental health program is a faultfinding mission.
Step 3 : Development of a plan
 A project plan needs to be drawn up with clearly defined objectives, which are in keeping with the ground realities of the school environment. Responsibilities also need to be assigned-and all the team members should be clear as to their roles, what is expected of them and what is clearly not part of their assigned role. If this is not done at the initial stage roles and responsibilities can get blurred leading to confusion and mistrust.
Step 4 : Monitoring and evaluation
 Monitoring and evaluation has to an ongoing process. Monitoring of the program helps address problems as and when they occur so that corrections and modifications can be made. The process of evaluation can be internal or external-what is important is that the evaluation report be shared with all the team members and that feedback is clearly and sensitively given.
Step 5 : Co-ordination and modification
 These steps have to be seen as an ongoing process-with the team members learning what works and what does not, modifying objectives as needed and looking at innovative ways of achieving the project objectives. The program is likely to gain acceptability if it is part of the school system and is based on the felt needs of the school community.
 For maximum effectiveness, a school mental health program has to :
 be relevant to the population of the school;
 be generalizable to different student populations;
 involve students, families, school staff and mental health professionals;
 have a central coordinating mechanism;
 focus also on teacher training and parent training and sensitization programs; and
 be evaluated for both process and content regularly.
Check this - and half the battle is won
INTEGRATING MENTAL HELTH PROGRAMS INTO SCHOOLS
 Do your homework - Identify key personnel, get one administrative staff to be aliaison, investigate all mental health prevention and intervention programs already in place, discuss what has been successful and identify ways of enhancing these.
 Clarify the role and purpose of program and provider - Define roles and establish boundaries and limits regarding the type of service.
 Put confidentiality first
 Forge strong working alliances with school staff - Educate school staff about mental health issues and develop a referral systems that best fits with the way in which the school functions.
 Develop a comprehensive referral base - Have regular classroom presentations on mental health issues and teacher in service training programs and workshops for parents.

The bottom line Academic success

Self esteem

Social skills

Classroom behaviour

Improved

SCHOOL

MENTAL

HEALTH

PROGRAMS

Reduced

School violence

Aggression

Emotional disturbances

Behaviour problems

Risk-taking behaviour
 The mental health program needs to be seen as a collaborative effort between mental health professionals and the  educational system. The basic function of a  school is to provide education-and mental health professionals who work within the school system must remember this at all times and be sensitive to the school culture, values and belief systems. At the same time such a program can be seen as a working partnership between people who are working towards the  welfare of children. Improved knowledge and skills about mental health interventions in school will ultimately result in better overall care of children and adolescents.