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How to support children with mental health conditions

The number of children with mental health issues is increasing. This is worrying because good mental health is essential to healthy child development. It enables children to reach developmental milestones, develop positive relationships and cope with problems.

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The rising prevalence of mental health issues in children and young people leaves a widening gap between the mental health needs of children and young people and the services available. Specialist mental health services are overstretched and increasingly other services, including schools, are being called upon to help. So, as a teacher what can you do to spot and support children with mental health conditions in school?

In 2020, one in six children aged 5 to 16 years were identified as having a probable mental health disorder. In 2017 this figure was one in nine. Source: NHS Digital

It isn’t necessarily easy to know whether a child is angry or upset about something for a while but essentially coping or experiencing mental health issues. This is a guide to how teachers can use noticing and naming to interpret children’s behaviour and emotions, what they can do to support mental health conditions in school, and when to call on specialist agencies.

How to spot when a child has a mental health issue

Firstly, look for significant changes in a child’s behaviour. For example, you might notice that a child is withdrawing or has become very quiet, or the complete opposite when a child who isn't usually loud start having angry outbursts or becomes outspoken. You might notice that a child is withdrawing from social situations, not wanting to join in with play, wanting to sit by themselves or trying to avoid coming to school.

It might be that the child doesn’t want to do things that they’ve enjoyed before. They are not joining in. They are disinterested, like they can’t be bothered with anything, but not in an aggressive way.

When children are really stressed, their cognitive load becomes too much and they revert to basics. They want to know they’ll be fed, safe, warm, looked after and loved; but they can't take on anymore, like fronted adverbials or bus stop maths. They might appear not to be interested, but what is actually happening is that they can't take on what they’re expected to do in the lesson. They switch off because they've got too many other things going on around them. This is essentially Maslow’s Hierarchy of Needs in action, to find out more check out our introduction to child mental health theories.

Other early signs of a mental health condition include a marked decline in concentration levels, ability to focus or the child regularly expressing low or negative opinions about themselves. In addition, if you learn that the child is having sleeping difficulties or observe a lot of tiredness then that's a big clue because mental health problems can lead to very erratic sleep, this is again because of what is going on in the child’s mind.

If it escalates then some children start to self-harm because that's a release for them. They may do where it can’t be seen, but when they're crying out for help some children will deliberately reveal where they've been self-harming because they so desperately want somebody to notice.

Remember that everybody feels low or angry at times. You’re looking for signs that are ongoing. If something is significantly affecting the child and lasting for a long time, that's the time to call on outside expert services.

How to support a child who has a mental health condition

The child needs someone to listen to them, to do that you first need to build a relationship with them. Check-in regularly, asking how they're doing. They’ll get used to talking about how things are going and how they feel about it, whether things feel good or bad at the time. Keep this up and they’ll come to know and trust that there is someone there to listen, if they want to be listened to. In time you’ll tune in to them and find it easier to spot when things are difficult for them, even when they're a little bit shaky about telling you.

Alex Parks, Lecturer on child mental health at Plymouth Marjon University, who previously worked with excluded children and those with mental trauma, describes what an effective relationship looks like: “Building relationships is key, and that takes time. It's a slow process because they must learn to trust you. Be positive in whatever is being said, even if the child is doing something that is undesirable. Talk through it positively and don’t admonish them or shout because the things we say as teachers can make the child feel a whole lot worse about themselves.

"What looks like bad behaviour can be due to mental health conditions; the child can't cope with or talk about what's going on in their life, so things come out in other ways.”

Alex goes on to explain how to use noticing and naming to deal with undesirable behaviour in a positive way: “Let’s take an example where a child with a mental health condition pushes another child. The best way to handle this is to say something like: “I noticed that you just pushed Alfie and what we need to do is just talk back through that later”. You’re noticing and naming it straight away; the child knows that you know but you're not admonishing that child in the in front of all the other children. This helps to build a trustworthy relationship with them, and it also gives them some time to cool off and reflect before you talk it through together. The child may later feel willing to say that they are sorry to the other child. But be aware that sometimes the actual words of asking the child to say sorry is a trigger for children who've been abused at home.”

It helps to be able to recognise the triggers. A trigger is more than just feeling uncomfortable, it is anything that leads to an increase in or return of the symptoms. Every child is going to have different triggers based on their experiences. It might be a physical gesture or word that reminds them of something. It could be something in an image or text that reminds them of the traumatic experience. For example, seeing a child vomiting in class could trigger a child who has a history of throwing up due to an eating disorder. Triggers also come from similar feelings, so something could happen in class that reminds them of past feelings. For example, shame may be triggered in a student who has been abused when they are told off by their teacher. It’s important that a triggered child has a safe space to go to. This could be a quiet corner or a separate space, or older a child may be allowed to say a single word to leave the classroom and go seek support from their mentor or SENCO.

Specialist agencies can help the teacher to establish what the child's needs are, understand the child’s triggers and work out how to get that child back into class and settled again after they are triggered.

Take what children say seriously. If a child says they’re feeling down and upset, then hear that. In the past, many teachers might have said: “Never mind. We’ll do something else and then everything will be fine”. But when a child has mental health problems it doesn’t work to say don't worry and it’ll all go away soon. Instead, you want to open a conversation by saying “I hear what you're saying, it's really hard when you feel this way. Let's talk about things that we can do to try and make things better for you”.

When talking to young children it can help to have pictures to point to that express their feelings. They may not yet have the means to articulate it themselves. Likewise, with young children, it helps to look out for clues in their play as to what is going on in their worlds. For example, if you observe a worrying behaviour in play, like a child aggressively shaking a doll and shouting at it, that may be a clue that the child has witnessed this somewhere.

Build positive routines for children. This might mean introducing regulating routines for them in the classroom and encouraging them (and sometimes their families) to eat healthily and do regular exercise. Also, collaborate with parents on routines and signpost them to help where you can, for example, if the child isn’t sleeping that has a knock-on effect to parents who then get very tired, which may exacerbate an already challenging situation.

As a teacher, you’re part of a team and your school will have a process for supporting children with mental health conditions. Do your part by noting any concerns, typically into safeguarding software such as CPOMS. This enables schools to link up multiple instances of worrying behaviour to quickly see the bigger picture of what is going on with a particular student.

How do I protect own wellbeing whilst supporting children with severe mental health conditions?

We’re all different, so our personal responses to being faced with a child's mental health concerns will be diverse, but you should expect it to affect you somehow. If you’re finding it difficult or upsetting to support a child with their situation then don’t think for one moment that you’re weak, and don’t compare your own reaction to that of other colleagues. You just do you.

Sometimes you’ll hear some traumatic things about what might be going on at home. It will help you to talk things through. You need someone to talk to about it in your school setting, this could be your mentor or manager or simply a trusted colleague. Some teachers find that talking about it at school helps them to not bring it back home. Seek advice from your GP if necessary. Other coping strategies include eating well, exercising regularly, catching up with friends, getting out in nature, deep breathing, meditation practice, not working too long hours and keeping yourself well-rested.

Back to Alex for some closing advice on how to cope when supporting children with mental health trauma: “You want to be noticing and naming what is happening, getting to know your children, and building those trusted bonds. Also, you need to share information and involve the expert agencies where necessary, but then there's nothing more that you can really do. That's your job. Some new teachers especially worry that “I'm not doing enough and wish I could do more”. I certainly did but remember there is a process for these things and it is there to help the child.

"Get to know that process and go with it. That way you’ll be doing the best you can for your student whilst also looking out for your own wellbeing”.

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