Mental health of teenagers – schools can
play a role
Sarah Edelman and
Antony Kidman
The problems faced by young people during their adolescent years is an area of concern for many of us. Adolescence is a period of transition, with significant changes happening in different facets of a person's life. These include physical and emotional changes, as well as changes in perception of oneself and others. It is a time of striving for independence and a sense of identity, while at the same time seeking approval and acceptance from one's peers. Young people today are attempting to succeed in an increasingly competitive environment. The development of technology – especially computers, Internet and mobile phones, has revolutionised access to information and communication, but has brought with it new challenges and changed expectations of how we should live. Growing affluence has generated higher expectations, not only in relation to material possessions but also academic performance and career choices. For this reason the final year of school takes on a particularly critical and burdensome significance for most students.
In spite of growing affluence there is little evidence that adolescents, or adults for that matter, are any happier than before. In fact, an increasing proportion of teenagers experience mental health disorders during their years at school. Studies conducted by the National Survey of Mental Health and Wellbeing (ABS 1998) indicate that 20% of those aged between 12 and 16 years experience a mental health disorder, with anxiety and depression being the most common. (Other disorders include eating disorders, substance abuse disorders and psychotic illness). Other studies estimate psychological disorders at between 11-15% for younger children (aged 13 or younger), and 13-17% amongst adolescents (aged 14-18). The frequency of depression and other psychological problems peaks in middle to late adolescence.
Adolescent depression has received much attention in the popular media, not only because of its growing frequency, but because it is a risk factor for suicide. In Australia, the youth suicide rate has increased substantially over the last two decades, with depression being the strongest single risk factor. Depressed teenagers also have poor self-esteem, and are more likely to develop problems with social adjustment, academic performance, substance abuse, unsafe sexual practices and disruptive behaviours.
A number of factors contribute to the development of mental health problems amongst teenagers. Stressful life events such as family conflict, marital separation, bereavement, failure at school, rejection by peers and physical or sexual abuse are common risk factors. In addition, the individual's personal characteristics and coping resources are also important. Students who lack effective interpersonal skills, who have negative thought processes or who suffer poor self-esteem are more likely than others to develop psychological difficulties. This is particularly the case for those who are also dealing with stressful life events.
Of course, there is a limit to what schools can do. Undoubtedly, the most important influences on student's psychological adjustment and behaviours are their family relationships and the quality of parenting they receive. Lack of caring relationships, insecure attachment, inconsistent discipline practices and inadequate supervision increase the risk of emotional and behavioural problems. However schools can also play a role. Schools are an important source of social and emotional development for young people and can influence their self-image and psychological outlook. The quality of relationships that students have with their peers and teachers has a major effect on their sense of wellbeing. Negative experiences such as social isolation, repeated failure, bullying and verbal abuse produce feelings of inferiority, worthlessness and despair. Schools can help to encourage healthy relationships by creating a supportive and nurturing environment. A school philosophy that consistently promotes mutual respect and consideration for others can have a salutary effect on the lives of vulnerable students. Interestingly, even students who are in an unhappy family situation are less likely to get depressed if they have a confiding relationship with at least one adult outside the family, or if they receive recognition for school or community activities.
In recent years both Federal and State Governments have recognised the importance of psychological health of young people, and have taken initiatives to promote mental health programs in primary and secondary schools. On the Federal level the “ MindMatters ” project, developed in 1998 is a major initiative under the Mental Health Promotion and Prevention National Action Plan. The project aims to integrate mental health policy and education into the curriculum of secondary schools, and includes the provision of materials for classes and a professional development program for teachers. It is a “universal” program, in that it targets mental health promotion at the whole school level. Principals at secondary schools have been sent a copy of the MindMatters resource kit, and funding has been provided for piloting of the program at a number of focus schools (see http://online.curriculum.edu.au/MindMatters ).
The Resourceful Adolescent Program (RAP) program, developed by researchers at Griffith University is another example of a universal program designed for implementation in the classroom as part of the school curriculum for students in years 7 to 9. The program aims to build resilience to depression through cognitive behavioural and interpersonal approaches, and focuses on cognitive restructuring, self-esteem, problem solving, making and keeping the peace and building support networks. Materials for the program are available for purchase by individuals who have completed the training course (see http://www.gu.edu.au/school/psy/rap ).
A number of “selective” intervention programs have also been developed and evaluated in various states. Selective programs target subgroups of students who are considered to be at increased risk for developing psychological problems such as anxiety disorders and depression. Students are identified via screening questionnaires or referred to the program via school counsellors. These programs are usually conducted in small groups, for between five and eight weekly sessions. The majority are based on the Cognitive Behaviour Therapy model, and contain both educational components (such as life skills, adaptive thinking and communication) and supportive discussion. Examples of selective programs for secondary school students include the ACE program (Adolescents Coping with Emotions), which targets 13-15 year olds experiencing depressed mood, and the “Friends” program, which targets clinically anxious adolescents aged 12 to 16 years. Participants' and leaders' manuals for these programs have been developed and are available for purchase (see contact details below). Although some programs are still in the process of evaluation (including our own “Taking Charge” program, run at University of Technology Sydney with senior school students), the majority have been found to be helpful, particularly for students experiencing high levels of distress.
While it is very heartening to see a growing interest in the psychological wellbeing of young people, we are still at the early stages of delivering mental health programs to the classroom. To date only a small number of schools have participated in running such programs. Insufficient funding, lack of awareness of available resources and the view that students' mental health is a family rather than school responsibility are some of the possible reasons.
Schools that are interested in taking up the challenge need to dedicate time and resources for identifying appropriate programs, and training teachers and counsellors in their implementation. An excellent starting point is the MindMatters package, which comprises a complete set of resources for incorporating psycho-educational training into the whole school curriculum, as well as building a supportive and caring school community. In addition, some schools may choose to run targeted interventions for students who are already experiencing psychological difficulties. In order for this to happen, school counsellors and specialist staff once again need to undergo training programs, and sufficient time needs to be allocated for them to prepare and run the sessions, alongside their other teaching duties. School counsellors also need to maintain extensive connections with specialist mental health agencies within the community in order to make appropriate referrals for students who are dealing with more serious psychological problems. While most city-based schools have a reasonable range of agencies to call on, this is not always the case for country and outer suburban schools.
Few people today would regard the role of schools as just a training ground for academic achievement. Schools play an important role in many aspects of students' lives, including the development of social skills, ethical values, cultural interests, a sense of community and concern for others. Schools can also play an important role in fostering the psychological wellbeing of students and building their sense of self-worth. This can be done directly through the curriculum by teaching life skills (such as communication, conflict resolution, problem solving and adaptive thinking) and providing targeted programs for students who are already experiencing psychological difficulties. It can also be done indirectly, by creating a caring environment based on mutual respect and co-operation. A number of programs have been developed in the last few years to help schools achieve these objectives. The challenge now is for schools to look at some of these programs, and to consider allocating staff and resources towards their implementation.
Other useful resources:
ACE Resources are available via: ace@doh.health.nsw.gov.au or call 02 9887 5570.
Taking Charge program: ph 02 9514 4309 or email rachael.murrihy@uts.edu.au
HeartMasters: www.inyahead.com.au/Publications/Publications.html
Information about resources for the “Friends program” is available on www.friendsinfo.net
MoodGYM – an internet based CBT program targeting young people. http://moodgym.anu.edu.au
Climate TV (Clinical Management and Treatment
Education): A cartoon based patient education
program for use by GPs, but also a good resource
for counsellors. www.climate.tv
Kids Help Line: 1800 55 1800 |
