Mental Health Education and School Aged Children: A Literature Review
The social work profession works to enhance human wellbeing and to help meet the basic needs of all people, specifically those who are vulnerable (NASW Code Of Ethics, n.d.). Children are one population that are considered vulnerable, and therefore deserve greater protection. Despite this need for protections, the amount of research conducted on children and adolescent’s mental health is much less than that of adults. The research that has been conducted shows that over 20 percent of children currently have, or have had at some point in their life, a seriously debilitating mental disorder (Any Disorder Among Children, n.d.). It has also been discovered that half of all lifetime cases of mental illness begin by age 14, and over one-third (37%) of students age 14 and older with a mental health condition drop out of school – the highest dropout rate of any disability group (Mental Health Facts Children & Teens, n.d.).
Given these statistics, it seems crucial to examine the mental health status in children and adolescents, as well examine what is being done to educate children on how to cope with stress, burnout, and other mental health issues. This review will examine research literature relating to the following themes: school burnout and stress, the impact on the mental health stigma by students and teachers, and existing mental health education curriculums.
School Burnout and Stress
There are multiple research articles that examine the effects of school itself on students (1,2,3,4). Murberg and Bru (2007) discovered that both neuroticism and daily stress in school are risk factors for consecutive somatic symptoms in adolescents. Since daily stress is a threat to the wellbeing of adolescents, it is argued that intervention programs aiming to develop coping skills could be incorporated in junior high school curriculum (Murberg & Bru, 2007). Such a program could encourage the student’s use of different coping skills in response to school-related stressors, thereby decreasing the amount of somatic symptoms in adolescents (Murberg & Bru, 2007).
Salmela-Aro and Tynkkynen (2012) examined the effects of educational track and gender on school burnout. It was discovered that the academic track, which focuses on competition, is more detrimental to students compared to the vocational track, which promotes competence (Salmela-Aro & Tynkkynen, 2012). The duo also discovered that girls experienced more overall school burnout than boys. This was explained by stating that girls may turn the stress inward and feel inadequate, whereas boys may direct it outwards towards and feel cynical (Salmela-Aro & Tynkkynen, 2012). Salmela-Aro and Tynkkynen (2012) argue that early interventions should target adolescents who exhibit increasing levels of burnout in order to prevent an accumulation of problems, such as depression or dropping out of school.
Tuominen-Soini and Salmela-Aro (2014) discovered that high school students show different patterns of school engagement and burnout, which they categorized into four different groups: engaged, moderately engaged, exhausted, and burned-out. After recognizing these different patterns, the duo argued that schools should consider alternate ways of confronting students’ needs. Instead of highlighting social comparison and competition, schools should pay attention to students with different types of adjustment problems and risks in order to support their well being in high school, and even to promote their long-term educational attainment and adjustment (Tuominen-Soini & Salmela-Aro, 2014).
Student and Teacher Impact on Mental Health Stigma
Stigma towards those with mental health issues is a significant problem that develops in young childhood (11,12). Corrigan, Watson, Otey, Westbrook, Gardner, Lamb, & Fenton (2007) studied whether stigma models developed for adults are similar to the stigma experiences of children. Their findings were consistent with Weiner’s (1995) attribution theory, as children who viewed others as responsible for their mental illness expressed more anger and pity towards them, and were less willing to help them (Corrigan et al., 2007). Further, children who viewed people with mental illnesses as dangerous were more likely to be fearful of and try to avoid them (Corrigan et al., 2007). Based on these findings, Corrigan et al. (2007) argued that programs meant to diminish stigma should be implemented, as they could enhance the quantity and quality of interactions between children who are labeled mentally ill and their peers.
Cooke, King, and Greenwood (2016) evaluated communication about mental health between teachers and young children in order to examine how stigma develops and how it can be improved. Through semi-structured interviews, it was found that discussions surrounding mental health were largely absent from classrooms settings. This was primarily due to teachers’ anxiety and their feelings of needing to protect children from exposure to those with mental health problems (Cooke et al., 2016). Other reasons for this absence of discussion were the teachers’ belief that they lacked the necessary expertise, the fear that these discussions were out of the teachers’ scope of practice, and the fear of how the parents would react (Cooke et al., 2016). Cooke et al. (2016) argued that teachers’ silence reinforces the idea that mental health problems are taboo, and may prevent children from learning and talking about mental health. The inclusion of teachers in early mental health education could promote a better understanding of mental health and more inclusive attitudes by their students (Cooke et al., 2016).
Mental Health Education Curriculums
Various mental health curriculums have been developed and implemented across the country (6, 7, 8, 9, 10, 13). Parker et al. (2013) created an educational intervention in order to raise health awareness and tackle stigma in adolescents in the United Kingdom, which they referred to as ‘headucate.’ This intervention was created in order to tackle stigma and empower adolescents to recognize signs of poor mental health. It also teaches adolescents how to access services appropriately (Parker et al., 2013).
Yael et al. (2014) examined the impact of the ‘HeadStrong’ program: a school-based educational intervention on mental health literacy, stigma, help seeking, psychological distress, and suicidal ideation. The program was found to be effective, however the effects weakened over time, suggesting that supplementary teaching throughout the year would be necessary (Yael et al., 2014). The study resulted in positive findings for both mental health literacy and stigma, however it did not significantly impact the students’ attitudes towards help seeking, psychological distress, or suicidal ideation.
Banks (2011) analyzed the use of Rational Emotive Behavior Therapy (REBT) as a mental health educational curriculum. REBT is a cognitive-emotive-behavioral system of therapy that incorporates changes to thought processes and behaviors (Banks, 2011). Banks argues that REBT can be effective in disputing irrational beliefs, such as those surrounding mental health issues, in children and adolescents. From a REBT perspective, an effective mental health program should increase rational thinking, leading to a reduction in emotional disturbances (Banks, 2011).
Weisman, Kia-Keating, Lippincott, Taylor and Zheng (2016) examined the Mental Health Matter (MHM) program. MHM is a mental health curriculum that is integrated with English language arts and taught by a trained volunteer in order to increase knowledge and decrease stigma towards individuals with mental health disorders (Weisman et al., 2016). The participants rated the MHM program as highly acceptable, as their knowledge of mental health was increased while their levels of stigma decreased (Weisman et al., 2016). During the following school year, students who participated in the MHM program were compared with those who had not. At that time, those who had participated in MHM had significantly more mental health knowledge than their peers, however there were no differences in stigma (Weisman et al., 2016). Researchers state that MHM appears to be an acceptable model for students and teachers, but that further research needs to be conducted on the long-term effectiveness of the program.
Woolfson, Woolfson, Mooney, and Bryce (2008) examined how students themselves view mental health education. Focus groups and questionnaires revealed that young people have clear views on how mental health education should be administered (Woolfson et al., 2008). Researchers discovered that students prefer that a familiar person to deliver the education, that this education should be administered in every grade, and that both preventative as well as reactive techniques be taught. There were various different responses between girls and boys, as well as across grades (Woolfson et al., 2008). Taking these responses into account will allow for a mental health education program to be created that is tailored to the self-identified needs of the students.
Conclusion
School stress and burnout are huge factors to consider when evaluating mental health in children. It is also important to consider the impact of students and teachers on the continuation of the stigma held against those with mental health problems. Due to the lack of mental health education provided for students, along with the increasing stigma against those with mental health problems, I am interested in studying the effect of a mental health education program in young children. Specifically, I am interested in the long-term effects of such a program. It is my belief that the implementation of a mental health education program during childhood will lead to an increase in the number of adolescents reporting and seeking help for mental health issues.