Child Mental Health: Fear and Sadness in the Classroom

Stroppy, irritable and inattentive pupils don’t endear themselves to their teachers. Withdrawn, quiet, uncommunicative children can be equally unrewarding to have in a classroom. But both groups may be showing symptoms of depression. The condition has, until recently, gone largely unrecognised in a school setting, but experts in child and adolescent mental health fear it is on the increase.

A conference on how to prevent and manage teenage depression was held in London last Thursday, bringing together speakers from the Healthy Schools Programme, the child mental health charity Young Minds, and professionals including school nurses and counsellors, who explained how to recognise the symptoms and what to do to help.

The 2001 census showed that 0.9% of five- to 15-year-olds were depressed. That may not sound like a lot, but it translates to around 68,000 children. More recent studies put the prevalence of serious depression in over-12s at between 1.4% and 5%.

At the Young People’s Unit in Edinburgh, the head of adolescent psychology, Dr Cathy Richards, says depression has a negative effect on learning, damages self-image and affects social skills. “Children can have mild, moderate and severe depression, just like adults. And because depression will affect concentration, that clearly impacts on their academic performance.” It often means they are perceived as being awkward.

“An average episode of depression,” says Richards, “will last five to seven months, and can impair their sense of who they are at exactly the time when that is forming. They can end up thinking, ‘I’m a person who’s unable to interact with other people’, when that isn’t accurate. If an adult becomes depressed, they know from experience what they are usually like and take some comfort from that, but a young person won’t have that experience.”

Richards says for some young people a diagnosis of depression offers some relief. “It makes sense to them, and we can explain that it’s treatable and that it can change.”

Why do children get depressed? Experts say they can simply have too much to deal with: complex family situations, the unrelenting pressure to be slim, take drugs, have sex, and constant academic challenges. Depression, they say, is the mind’s logical response to a situation that has become unbearable.

At the East Kent hospital school service, to which children are referred if they are medically unable to attend mainstream school, the headteacher, Ros Eastwood, has seen an increase in the numbers of emotionally vulnerable young people coming through her door.

“The biggest proportion of children we get are here because of mental health problems. A lot of it I think is because of the pressures in schools now. A child might be able to develop strategies to cope with dad leaving, or a bereavement, or something bad going on at home, but then they go into school, with all the testing and pressure to achieve, and it’s too much.”

One of the barriers to helping children get better, she believes, is the reluctance of doctors to acknowledge that children can suffer from depressive illnesses. “If I went to my GP and read out a list of the symptoms that I have observed in one boy we’re working with at the moment, I’d be signed off with severe depression, but he’s diagnosed with ‘lethargy’.” Andrew McCulloch, chief executive of the Mental Health Foundation, agrees. “I think people want to deny mental health problems in young people, and describe them as behavioural problems instead. But if you have a classroom with one or two self-harmers, two depressed children and one with a conduct disorder, then that isn’t going to be good for the other children either, so it’s in everyone’s best interests to try to help them recover.”

Depression has an impact on the whole family, says Hazel, the mother of 13-year-old Elliot (name changed), who attends the East Kent hospital school service. “A year ago he was at a grammar school, and then he just stopped going. He was diagnosed with separation anxiety and school phobia, but that’s never been a definite diagnosis.

“He has very bad panic attacks and doesn’t like change. At times I would say he does suffer from depression. Even getting out of the car when we arrive at school can be hard for him. ‘I just can’t be arsed,’ comes out. Coming here, where the teachers understand and can give him one-to-one attention and structure a timetable specially for him, has been a lifeline.

Can teachers be expected to spot mental illness? Do they have the time to notice the symptoms? “You could say ‘do they have time not to’, if they’re interested in the welfare of children,” says Lee Miller, the training manager for Young Minds, who designs and delivers training in mental health awareness for schools.

“We don’t want them to think that they have to start diagnosing, but there are basic signs that a child is in distress: a change in normal patterns of behaviour, not doing homework, loss of interest in friendships, irrational fears and anxieties.”

Teacher training doesn’t cover mental health awareness in any depth at present and Young Minds believes there should be modules on the topic in PGCE courses.

Peer support

One school that takes the emotional health of its students seriously is Acland Burghley in north London. A peer support programme has been developed over the past eight years by Vavi Hillel, who recruits and trains volunteers from all year groups to offer an informal listening service to their fellow pupils.

Social support from their peers is crucial to helping a young person recover from a period of depression, and Rosie Crouch, 13, who has been a peer counsellor for the past 18 months, says that students often feel more comfortable talking to someone their own age than they would going to a teacher.

“It’s scarier to go to a teacher, because they’re so much older and you’d be worried about them telling other people about it. I think they find it easier to come to us because we’re a similar age. They trust us.”

Her classmate and fellow counsellor, Rachel French, says: “People often come to see us because they find it hard to make friends. You can feel very isolated in school sometimes. We give them a place to go – we play games with them and offer company when they don’t feel comfortable being with other pupils.”

Awareness is gradually increasing, and teachers are often keen to know more, says Richards. But she believes up to 90% of those suffering depression in schools aren’t receiving any help at all.