Received: 29 November 2020
Accepted: 29 December 2020
Abstract: The adverse outcomes of society's mental health require questioning and rethinking the school's traditional role, especially the teachers' role facing this crucial dimension of the students' development. These professionals collaborate every day on the students' progress through the teachers' practices in the classroom, and the relations established every day in the educational context. Therefore, this collaboration must go beyond the contents and skills related to traditional disciplines included in the schools' curricula. This article's objective is to propose action lines, addressing the practices and possibilities that teachers' training could offer addressing the support of the students in the mental health dimension, divided into three axes through a literature review. These establish the teacher-student relationship, including strategies that foster a positive school climate and detect possible communication issues in students with the corresponding network. For this, it is required an approach of the school as a community that supports the students' mental health's enhancing processes, but mostly the inclusion of pre and in-service teachers' training processes. The primary purpose is to offer more tools that allow the development and early intervention facing possible issues linked to this dimension.
Keywords: Mental Health, Students, Teacher Training, Teacher Role.
Resumen: Los índices negativos de salud mental en la sociedad requiere cuestionar el rol tradicional de la escuela, y especialmente de los profesores. A través de las prácticas docentes en el aula, estos profesionales contribuyen a diario en desarrollo de los estudiantes, por lo que es crucial que su aporte vaya más allá de los contenidos y habilidades relacionadas a las disciplinas tradicionales incluidas en el currículo escolar. A partir de la revisión de la literatura, con el presente artículo se busca proponer líneas de acción que abarquen las prácticas y las posibilidades que la formación docente podría ofrecer para el apoyo de los estudiantes en el área de la salud mental, las cuales se dividen en tres ejes: el establecimiento de la relación profesor-estudiante, la inclusión de estrategias que velen por un clima escolar positivo y la detección de posibles problemáticas en los estudiantes para una comunicación con las redes correspondientes. Para el logro de estas tres propuestas, se requiere una visión del espacio educativo como una comunidad que apoya los procesos de fortalecimiento de la salud mental de sus estudiantes, pero fundamentalmente la inclusión de procesos de formación inicial y continua de los docentes, con el fin de que estos cuenten con más herramientas que permitan el desarrollo y la intervención temprana frente a posibles problemáticas asociados a esta dimensión.
Palabras clave: salud mental, estudiantes, formación de profesores, rol del profesor.
1. A new vision of schools’ role: the focus on students’ mental health
In the past, the schools targeted the skills’ development related to the academic and cognitive field (Suldo, Friederich & Michalowsky, 2010), offering an approach based on a narrow vision of human development, where expectations in students and the role of the school were only focused on the future of children immersed in the job world. Concerning mental well-being and mental health, there would be a lack of interest in the first instance, which could have led to a hard time defining a frame of the necessary skills to help human development as a “good human being” (Morris, 2015).
Mental health is an important issue present in children’s lives: as an example, in Chile, one study found a 27.8% prevalence of psychiatric disorders mixed with psychosocial disability in children between 4 and 11 years old (De La Barra, Vicente, Saldivia & Melipillán, 2012). More specifically, clinical depression is one of the most expanded mental health problems worldwide, including young people’s rates of this disease, which can persist until their lives as grown-ups (Martin & Cohen, 2000).
Why should this issue concern the school practices? From an approach that considers children as integral and multidimensional human beings, mental health, and wellness issues among young people are essential development elements. This affects boys' and girls’ lives and their families’ and other environments where they regularly participate, like educational institutions. Therefore, students with low levels of mental health or well-being can experience difficulties that could lead to problematic behaviors and unsatisfactory outcomes (Weist, 2003; Feinstein, 2015). Students also intervene in school dynamics with problems in the emotional field because of the construction based on social interactions between teachers and students, and among classmates (Weist, 2003). Their social relations can also disturb the school climate and the whole class process (Rothi, Leavey & Best, 2008; Vieira, Gadela, Moriyama, Bressan & Bordin, 2014).
During the last years, the World Health Organization (WHO), in collaboration with UNESCO, has called attention to children and adolescents' health, covering the physical dimension and the mental health and well-being associated with it (World Health Organization, 2018).
As a solution to the rising rates mentioned above, the Feinstein (2015) highlights emotional education as a process where the whole community can help prevent the high levels of mental issues among young people. This idea could lead to benefits seen in settings as their families, friends, and schools. This proposal could be supported by the World Health Organization initiative of enhancing mental health promotion among younger people in the educational contexts where children and adolescents usually interact (World Health Organization, 2018).
Nowadays, the mentioned institution is focused on promoting healthy practices between the youngest part of the population, supporting the idea that the earliest interventions on children and adolescents are more effective when reducing the exposition to risky elements for the development and healthy future life (World Health Organization, 2016). More specifically, today is generally agreed that many mental health problems that have begun in the first stages of life endure through the years or emerge lately during adult life (Vieira et al., 2014).
In the first decades of the 21st century, schools have been identified with a critical role in promoting and protecting children's well-being and mental health. Public policies and strategies focus on them mainly due to the high rates of students attending, the long period they spend there through the day and the year, and their families' relation with the institution (House of Commons, 2017; Long & Huebner, 2014; World Health Organization, 2018; Wyn, Cahill, Holdsworth, Rowling & Carson, 2000). Besides, schools can connect with other professionals, organizations, and institutions related to students' mental health (Moor, Magiure, McQueen, Wells, Elton, Wrate & Blair, 2007).
As an example of the importance that schools have gained, General Practices (GPs) in the UK were usually the most common places where mental health was promoted and where problems in that field could be detected at first instance. Nevertheless, GPs have lost in part this role to concede space to schools to promote and detect problems in the well-being sphere (Leavey, Rothi & Paul, 2010; Rothi et al., 2008). This transformation of the traditional role of education and the institutions related to this field makes the invitation to open the question proposed by White (2007) about schools' current function. With this new frame, the current role could be turning to integrate other spheres of human development.
For Atkins, Hoagwood, Kutash & Seidman (2010), to accomplish this new aim, the efforts should be addressing the integration of education and mental health; one of the principal objectives of schools must be fostering adequate levels of mental health in students. Other authors even propose the importance of incorporating students’ happiness as one of the principal achievements in schools (White, 2007). The enhancement of the importance of well-being and mental health in schools could benefit from the “maximization of the flourishing of the students and staff that comprise them” (Morris, 2015, p. 14).
The transition to a more integrated frame in education would need changes in the educational system structure. It is necessary to conduct part of the attention to enhance practices in schools with a focus on the promotion of well-being between students and the support for those with special needs in this area, considering not only the inclusion of students in this process but also their parents (Atkins et al., 2010). This focus could enhance a systemic approach, where the student is not the only one involved in the problematic, but part of a community that fosters his/her well-being and support.
To the World Health Organization (2018), the importance of schools as a critical role in promoting health is connected with two principal factors: the first, the possibility of children of being in a healthy environment inside of schools, and the second, the developing of skills to promote healthy practices in the students’ lives. According to this organization, both aspects are proved to guarantee a future life that leads students to mental well-being.
With the agreement of the importance of the presence of objectives in schools related to boost students’ mental health and well-being, different approaches have studied the best ways to incorporate strategies inside educational institutions (Atkins et al., 2010). Thus, many school-based programs have been created to improve those “alternative skills” that could strengthen younger people’s mental well-being (Weist, 2003). This strategy could be related to the theory of human-ecological systems created by Bronfenbrenner (Weist, 2003), which presents schools as one of the most important places where children develop their cognitive and social skills due to their permanence there for several years. This exposition makes schools places with a significant influence on young people’s lives.
Following the ideas of Bronfenbrenner, authors like Weist (2003) propose schools as small communities inserted and connected in more prominent communities, where educational institutions and other organizations could work together creating and implementing strategies to enhance students' mental well-being. Bronfenbrenner's theory's influence can also be seen in Wyn, Cahill, Holdsworth, Rowling & Carson (2000) and the whole-school model's proposal to create interventions to reinforce students' mental health. According to the authors, the whole educational community and practices should be incorporated when developing a space to promote well-being, including "the quality of the relationships with parents, students, and with community agencies; the school ethos and the nature of school policies” (Wyn et al. 2000, p. 595).
Approaches that consider schools as a community support the idea of practices related to well-being introduced in the whole school processes since all the actors have an active role in creating an environment focused on mental health (Wyn et al., 2000). The accent in the collaborative work is essential, especially when talking about mental well-being, because to Splett, Fowler, Weist & McDaniel (2013), an interdisciplinary approach is more substantial and more complete when thinking on the whole process of enhancing students’ mental well-being.
Besides, mental health programs focused on schools’ target most of their efforts to enhance skills that allow children to strengthen their mental health state rather than emphasizing problems, as traditional interventions have done (Weist, 2003).
Most of the initiatives proposed to incorporate mental health interventions inside of schools, besides considering these institutions as communities, bear in mind the importance of these processes being carried out by actors belonging to schools as a condition to be successful (Weist, 2003). Following this idea, Weist (2003) states the importance of recognizing the crucial actors responsible for implementing the reforms to introduce the enhance of students' well-being to schools. He states that "the most obvious change agents in schools are teachers, as they control the setting of primary importance to children's learning, classrooms" (Atkins, Frazier, Leathers, Graczyk, Talbott, Jakobsons, Adil, Martinez-Lora, Demirtas, Gibbons & Bell, 2008).
2. The role of teachers in students’ mental health
To achieve the new approach of the education supporting the well-being and the mental health sphere, schools have had to rethink the ways they work and the role of the professionals that face this new objective with the students, and the methods to create a supportive community. Hence, even when teachers' importance has always been central in education, nowadays must also be explored concerning their students’ needs in alternative fields.
According to Moor et al. (2007), one of the characteristics that make teachers' role so crucial is that they have daily contact with their students, unlike other professionals. Furthermore, though the relation between students and teachers is the most obvious and can be noticed right away, these professionals usually interact with their parents who assist in their classes. This fact gives them the possibility to deliver and receive first-hand information about different aspects of students, such as their well-being and mental health (House of Commons, 2017).
Besides the relationship that teachers can develop, they have always been connected with their principal function: to teach. This is an important fact when we talk about new horizons in schools’ objectives and how they can be incorporated into students’ lives in educational institutions. Also, teachers spend a considerable amount of time with students in their classrooms, where they have the possibility of visualizing the development of children from day to day (House of Commons, 2017).
Therefore, as we rethink schools' role in children and young people's mental well-being, it is fundamental to rethink the role, consequences, and possibilities that the teachers offer to support their students in what is related to academic issues.
2.1. The teacher-student relation
The students and their teachers' daily interaction has an incommensurable power: they can establish a relationship between teacher and students that could play a vital role in the students’ mental health development. These last decades, researchers have been studying how this bond could affect students' lives, not only in their learnings but expanding the studied effects to children's development in other areas (Sabol & Pianta, 2012).
Sabol and Pianta (2012) have studied different approaches used to analyze the relation teacher-student. The developmental systems theory proposes educational actors as different elements that are interrelated in proximity and impact each other: the children would be part of a dynamic group of systems, which allows the interaction with other components of these systems. These interactions influence children on different levels, depending on their proximity. Therefore, teachers and children would impact each other due to the proximal level, and through the daily relation, they develop at the school (Pianta, Hamre & Stuhlman, 2003).
Last research tendencies on teacher-student relationship have included in their frames the attachment theory approach (Spilt, Koomen, Thijs & van der Leij, 2012; Sabol & Pianta, 2012), originally orientated to the study of the relation between children and their parents or, otherwise, their principal caregivers. This could be an example of the relevance that the teacher-student relationship is gaining in the educational field. Following this tendency, Howes (2001) analyzed the relation teacher-student based on two theories: an adapted version of the attachment to teacher-student relationship and the social contextual theory, founding that, even when coming from a non-secure attachment relationship with their parents, students could build a secure attachment with teachers at early years (Howes, 2001, p.193).
With the constant interaction in the educational environment, teachers can even take the “significant other” role to their students (Morris, 2015). This relation could become even tighter when the students are in the middle of problems that concern their families, especially neglecting parents: students could search for support in alternative actors (Leavey, Rothi & Paul, 2010).
One of the necessary consequences of establishing this positive relationship between the teacher and the student is its impact on students' mental well-being. Some authors state that this relation directly impacts a student's mental health when support is its main characteristic (Hamre & Pianta, 2001). This "new attachment" provided by the teacher could offer other profits connected to improving the learning process and outcomes of children and their social skills, peer relationships, and even in the improvement of disrupting performances (Pianta & Stuhlman, 2004). Other positive effects of this bond could be a decline in students' levels of aggressivity (Hughes et al., 2000). The relationship as a protector factor to children in challenging environments, showing promising results in research involving aggressive surroundings, neglecting parents, and racial discrimination, among other issues (Meehan, Hughes & Cavell, 2003; Sabol & Pianta, 2012).
2.2. The promotion of mental health in the classroom
Traditionally, the teachers’ role has been the “delivery” of content to students about different disciplines that can improve their academic skills regarding their entrance to the work system. Lately, the practice has been introduced in schools to reinforce learnings in a combination of theory and practice. To Morris (2015), the teaching of mental well-being practices in schools should have a similar process:
we should be teaching the students how to be well, how to do well-being (…) we have to get the students to experience it. When teaching about the benefits of exercise, teachers have to get the students to exercise to see those benefits for themselves. Suppose someone is teaching cognitive skills (such as those on resilience). In that case, the teacher has to get the students practicing them and applying them in real-life situations: it is no good just talking about it or handing over a worksheet (p. 14).
In schools, creating spaces and practices to enhance students' well-being is one of the crucial functions of teachers, doing collaborative work with the school community's planning to aboard this subject (Wyn et al., 2000). Thus, promoting students' mental well-being in the classroom would be related to creating and maintaining a positive classroom climate.
In this kind of support from the teacher, the community's spirit can be reflected because creating a climate that promotes mental well-being in students is done at a group level (Mælan et al., 2018).
A research carried out in Norway by Mælan, Tjomsland, Samdal & Thruston (2020) revealed that teacher practices aiming to promote mental well-being in the classroom caused students' positive feelings and perceptions. It included a sense of belonging, actions that made them feel supported emotionally, and the possibility of strengthening bonds between classmates.
2.3. The detection of mental health problems
Among all the new possibilities that open with the new perspective proposed, “The use of schools as a platform for increasing awareness, facilitating early detection and referring cases to mental health care has been highlighted as a promising alternative" (Vieira et al., 2014, p.2).
In the United Kingdom, GP surgery was historically the first place to consult about mental health, specifically diagnosing a possible clinical depression (Maag, Rutheford & Parks,1988). As an “everyday” figure in children’s lives, and as an essential part of the educational community, teachers nowadays have a platform to observe the changes that students could present as symptoms that something is not going well with them concerning mental well-being, among other dimensions.
Teachers could be among the first persons in hearing the alarm call of students with problems affecting their well-being and even identify some of the signals they send, and that sometimes could be ignored at home (House of Commons, 2017). For Vieira et al. (2014), this could happen because schools are one of the principal places where students could express their struggles related to their mental health state, and this makes teachers privileged witnesses due to their contact in the classroom.
Unruly behavior in the classroom climate, problems in the social sphere between students with mental health problems and their peers, and difficulties or radical changes in their academic outcomes may indicate issues in the students' mental well-being (Rothi et al., 2008).
The quotidian coexistence could, as an example, allow teachers to recognize signals of mental health issues as depression due to symptoms that could be shown in the educational environment and that could be attributed to characteristics related to changes appearing during the teenage years (Puura, Almqvist, Phia, Moilanen, Tamminen, Kumpulainen, Räsänen & Koivisto, 2003).
Due to the relationship that teachers can establish with parents through their children's education, parents also see teachers as a resource to look for support or advice when they have doubts about their children's mental well-being (House of Commons, 2017).
Thus, the teachers' role is crucial as the first door of the students identifying specific symptoms to receive professional attention in the mental health sphere. They can prevent students' exposition to dangerous situations or support them in getting help to prevent a possible mental breakdown.
With the premise of Weist (2003) of schools as communities inside more prominent communities, the contact of schools and organizations or professionals working in mental health intervention allows teachers to become a bridge between educational and health institutions. With this, the visualization of mental health problems gains ground to issues related directly to academic performance issues:
there is evidence that youth presenting “internalizing” disorders such as depression, anxiety and trauma, interpersonal issues, and developmental problems may be referred for services less often. In contrast, students showing acting-out behaviors, attention deﬁcit hyperactivity disorder, or obvious academic problems are more likely to be referred (Splett et al., 2013, p.250).
Therefore, to Vieira et al. (2014), it is essential to enhance teachers’ skills to help them identify between their students whose mental well-being could be presenting difficulties and generate the community's links for a practical intervention with mental health professionals.
This third proposal for the teachers’ role might be the most polemic of all those presented due to the reluctance of professionals in the educational ground to “label” students as they recognize themselves as education and not mental health professionals. Teachers may lack the competencies to point to the key of the problem the student could be presenting. Besides, other teachers could be against including mental health issues between their tasks (Morris, 2015). However, this proposition does not intend to transform teachers into mental health professionals, but tools that help them catch some clues about their students’ well-being.
Some authors also mention teachers' bias in making referrals alluding to mental health problems focusing only on their worries about children's academic outcomes (Vieira et al., 2014), without paying attention to other spheres that could typically be functioning. This could lead to extreme outsourcing of responsibility when connecting the causes of the students' failures to inexistent difficulties related to their mental well-being.
Finally, even considering the importance of teachers' participation in detecting students with struggles related to mental well-being, another reason to oppose this new function could be associated with the possible failures in the implementation of strategies in the classroom. They are related to the lack of teachers' domain when talking about mental well-being and mental health (Severson, 2007).
3. Teachers’ training in student’s mental health issues
3.1 The rationale for teacher’s training
There is no doubt about the importance of the role of teachers related to students’ mental health. Nevertheless, it is essential to take this issue seriously when we talk about our students. So, it would be crucial to open the question: are teachers prepared to attend situations related to their students’ mental health issues?
For the House of Commons, an ideal school would be that one where mental well-being was supported and immerse “throughout the culture of the school and curriculum as well as in staff training and continuing professional development” (House of Commons, 2017, p. 3). This process could enhance the changes perceived in children and young people’s mental well-being. Teachers are essential to agency change in children because classrooms allow intervening risk or actual situations. Therefore, the training to carry out this labor is essential (Sabol & Pianta, 2012, p. 222). According to Graham, Phelps, Maddison & Firzgerald (2011), “Whilst teachers are now expected to be responsive to a wide range of student needs and circumstances, they receive little in their pre-service and subsequent teacher education to adequately prepare them for such realities” (p. 479).
During the implementation of the program "Health Promotion Schools," the World Health Organization found insufficient policies and budgets and school personnel with low skills and knowledge about mental health between the principal obstacles inside schools to enhance students' mental well-being rates (World Health Organization, 2018). Other authors also present a lack of knowledge in mental well-being in professionals working in education, especially in teachers (Weist, 2003; Feinstein, 2015).
The value of teachers' training in mental well-being goes beyond the importance of their role in education and the perception of authorities and other institutions about their competencies. Their value is also connected to their own skills' perception. Atkinson and Hornby (2002) found that teachers felt a lack of confidence in their skills when coping with situations related to their students' mental well-being.
Following the idea mentioned above of schools immerse in communities, teachers' training in mental health aspects could help them make better and more accurate descriptions of their students and their circumstances when in need of attention in specialized mental health institutions. This could enhance the work alliance between different institutions working to benefit children and young people (Feinstein, 2015). To the House of Commons, "Strong partnerships between the education sector and mental health services improve the provision for children's mental health and well-being" (House of Commons, 2017, p. 3).
Another possible effect that training could have on communities and teachers is their approach to students who struggle with mental health issues. Weist (2003) explains that the mental health field has been traditionally focused on psychopathologic regard to children's issues. Nonetheless, the formation of teachers in this area, if well-executed, could make a move from this emphasis and help teachers to enhance his work into the promotion of mental well-being in students, without ignoring the knowledge of children's psychology to act successfully when in need of detection of any problem.
In an experiment carried out by Bostock and Kitt (2011), the authors found that teachers, in their Postgraduate Certificate in Education (PGCE), were more motivated to receive formation and include mental health practices well-being for students than more experimented teachers. This could be related to the novelty of incorporating the subject in education, which gives the new generations a better acceptance of different role functions due to its advantages.
After the experience of delivering a workshop for teachers about depression in children and adolescents, Moor et al. (2007) found that teachers were more comfortable and self-assured when they had to cope with students battling with clinical depression. According to Weist (2003), the possibility to know more in deep the emotional needs and how to support them could change their tolerance and comprehension of this kind of issue between students.
Due to the benefits that this knowledge could bring to professionals in the educational field, many authors present ideas about how teachers' training should be carried out. For Feinstein (2015), the development of skills connected to mental health and well-being should be incorporated in the initial training curriculum. Since teachers daily work with children and adolescents, it seems urgent to place mental health and well-being as a permanent subject of teachers' training instead of an alternative to develop in their careers.
The institution mentioned above also considers the importance of continuous training in this field for teachers during their active years, idea is also supported by Bostock et al. (2011). They believe that postgraduate formation is crucial, especially for teachers with a lack of experience. Without a doubt, they will find cases that require this kind of knowledge during their functions in schools.
Anyhow, considering schools as communities, the reinforcement of school-based professionals' skills like teachers should be incorporated to improve students' mental health. For Weist (2003), “there is a clear need for interdisciplinary efforts that alter paradigms to focus more on environmental factors, enhancing strengths and promoting mental health in natural environments such as schools” (Weist, 2003, p. 80).
3.2 Possible obstacles involving the teachers’ training
Even when, in general, the importance of mental well-being has received a positive response from the education field, it is still possible to find barriers in the path to their full introduction in educational communities.
Weist (2003) explains that one of the difficulties that teachers’ training could find could be the lack of resources that schools have in general. Also, the absence of time in schools could be a barrier, especially between teachers, to attend to this kind of formation due to the many accomplishments that they must reach (Weist 2003; Rothi et al., 2008). Those factors, among others, could trigger negative feelings in teachers. The mix of aspects could contemplate time, overloading of responsibilities, the skills they should acquire to cope with new subjects as mental health, and the resources schools offer to these professionals to undertake this new function (Ekornes, 2017).
According to Rothi et al. (2008), resistance could be present between some teachers because they could feel that this kind of formation would install blurred lines between the core of their schools' functions and those belonging to mental health professionals.
As a relief from the situation above, Weist (2003) mentions mental health professionals' assistance in schools that could assist teachers in students' attention, instead of training them, which would add more responsibilities and tasks to their quotidian. This way could be an alternative to teachers who show some opposition to receive systematic mental health training.
Even with the assumption of teachers' positive attitude to the introduction of mental well-being subjects in their jobs, other problems could interfere in the implementation. The priority of cognitive and academic skills and contents concerning classroom time can also affect teachers' perception and the action of getting involved and trained in mental health. Some teachers may perceive that time spent in mental health activities could be used in the traditionally more important subjects to the curriculum and have a more significant impact on the evaluation of their work (Ekornes, 2017).
Finally, another factor that must be considered a possible barrier is the institutional culture, traduced as difficult for authorities to adopt a whole-school approach when thinking about enhancing their students’ mental health (Dumond & Istance, 2010). This obstacle would be significant when recalling the idea of a mental health improvement supported by the whole community instead of isolated interventions.
Students' mental health and well-being is an issue that has been incorporated in education in the last decades to make an entrance in children’s every day as a subject of study and practice. As a community, schools should work to promote practices associated with the prevention of issues in this sphere. Due to the time spent with students, the teacher's role becomes crucial to accomplish this aim.
This work has proposed the contribution that teachers can make to their students’ mental well-being by incorporating new tasks into their everyday. Even when the possibilities of action are unlimited, this article has focused on three principal contributions.
The first contribution could be made through the relation that teachers and students develop since teachers could generate a secure attachment with children—the second talks about promoting healthy practices in students in their quotidian schools and classrooms. The third one is teachers' possibility to be observers of signals that could talk to them about mental health issues that their students could be experimenting with.
To accomplish these three new requirements, teacher training in mental health and well-being is a must, considering the possible lack of knowledge of these subjects. Authorities perceive this difficulty in the field, but it also exists the belief between teachers of a lack of skills to become actors able to support their students in promoting and preventing aspects that could affect their mental well-being.
Nevertheless, it is essential to pay attention to the possible barriers that could difficult the development and implementation of teachers' training and practices related to their students’ mental health, like the lack of time and teachers' attitude to this new focus on education has taken.
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