MindMatters Panel: Module 4.4 Helping individual students 

Julia Zemiro:
Hello, I'm Julia. Welcome to the MindMatters Panel. In previous conversations, we've talked about general ways in which schools can help students. But now, let's get to the pointy end. What do you do as a staff member when you're concerned about a student's mental health? To help answer this, we are joined by Young and Well Cooperative Research Centre Managing Director, Dr. Michael Carr-Gregg, Brain and Mind Research Institute, Executive Director and Professor of Psychiatry, Professor Ian Hickie, National Centre of Excellence in Youth Mental Health, Senior Research Fellow, Dr. Alex Parker, school psychologist, Sarah Innes, and teacher, Martin De Clercq. But before we hear from the panel, let's check out the Eagleton way.

Eagleton High clip:

PHILLIP
As part of our early intervention program, we need to have proactive conversations but a lot of students aren't very comfortable approaching staff, and a lot of staff aren't very confident talking to students. So we've been working on something called the "safe space". It's a warm, inviting space that says there's no judgement here, only connection. What's on your mind, Chris? 

CHRIS
I'm bummed.

PHILLIP
Oh, why? 

CHRIS
Girlfriend dumped me.

PHILLIP
That's no good, mate. You see, the safe space... Wait a minute, which girlfriend? 

CHRIS
The one you set me up with.

PHILLIP
Jemma? Oh no. You were perfect for each other. What happened? 

CHRIS
I don't know, ask her.

PHILLIP
What did you do, mate? I worked so hard on that, I need to take a walk.

Julia Zemiro:
Aww, that didn't end well, did it? Got a new special friend, though. But look, seriously, how can you effectively check-in with students to see if they are okay? 

Sarah Inness:
I think it's about a few things, looking and listening without judgement and giving the student a space to talk where you are listening rather than putting your own advice on top of them. And Phil misses the mark completely there with that. It becomes about him, he personalises it, he makes some judgement calls about Chris' involvement in the relationship and making it break up. So it's about letting someone just talk and share. Think about how you would like to be listened to, I think. We all want to be given the space, a safe space but a space where we're not judged.

Julia Zemiro:
Who does the checking and does it always have to be a counsellor, Martin? 

Martin De Clercq:
No, no. Whoever the student identifies with and is comfortable talking to. It depends the way the school's set up. Sometimes pastoral roles, so home group teachers, a teacher, it can even be an instrumental teacher or a sports teacher. It could be an official role like a house head or a coordinator.

Julia Zemiro:
So when you do check in, what kind of concerns are you looking out for? What sort of things will you be talking about? 

Sarah Inness:
Pretty much what the student wants to bring to the conversation. But I guess if you're initiating the conversation as a teacher, it could be about the behaviours that you've noticed. And that's where you're starting to separate the behaviours that you worry about from the person, not labelling them. So it might be, "Look, I've had some people expressing concerns about you. They're just saying that you're not really happy so much around or you're not involved in this or you're sitting away from your friends now. What's going on? Is there something that you want to have a chat about?" and giving them a space to talk about. And then, just really being led by the student in that conversation.

Professor Ian Hickie:
Well, I think one of the key things here is about different roles. The opportunity arises for someone you know well, the opportunistic chance, checking in because you are concerned. And I think you should actually study things about their behaviour: not spending time with friends, withdrawing from things, not doing so well in class, etcetera. So things that would be the obvious subject of conversation within the school environment that a teacher could legitimately raise with their students as part of their normal interaction. Particularly, if they already have an established relationship. And that's kind of important. If, out of the blue, the deputy head master comes along and says, "What's wrong with you?" It probably isn't gonna work. Not help. As distinct from those who are connected, know the person, and is already in an agreed sort of situation. And the subject is legitimately one that a teacher would normally discuss, not suddenly into a whole other psychological world.

Julia Zemiro:
Will you be able to have conversations about sex though and body issues? Can it go that far? 

Sarah Inness:
I think it can. Martin, you would have come up across that before? 

Martin De Clercq:
Yeah. Again, it depends on the relationship you have with the student in terms of how comfortable they are talking about things. And especially if... In today's day and age, those things are discussed in the classroom, so you'll have sex education. So especially, if you've... the one that's been having those conversations in class and the student might feel comfortable talking afterwards. Which is a common situation where you talk about contraception or you talk about something to do with sex education and then afterwards, a student might linger and ask a question they're too embarrassed to ask in the class setting.

Sarah Inness:
Nothing takes you by surprise too what students might talk to you about. So I've had students come in about a very innocuous question and I'm off on this tangent, working with them. And then, out of the blue, it might be, "I think I might be attracted to girls or I might be attracted to boys". And that conversation comes up and I'm not even expecting it. I have had physical complaints of the gynaecological nature that I'm not equipped to deal with, but it still comes up because I provide that safe space and I would think that I'd be the least likely person, for a boy, especially asking about...

Professor Ian Hickie:
Maybe you have the knowledge, you know what I mean? 
[laughter]

Sarah Inness:
That's true. That's true.

Professor Ian Hickie:
Who else is worth asking? You know what I'm saying? I mean, teachers do have a critical role. They're adults, they're not parents, and they're not necessarily gonna say it's all about them. I mean, the value of all these relationships is exactly that. It's a great compliment, really...

Sarah Inness:
Absolutely.

Professor Ian Hickie:
If a student actually feels they can ask you that stuff.

Julia Zemiro:
Absolutely.

Dr Alex Parker:
And picking the right time for that, too. I mean, obviously in that video is that idea of creating a safe space, and we know that obviously in Sarah's office, students would know that that's a safe space. But, for some, particularly if you've got that relationship with them, it might be catching up with them during break time, going for a walk with them around the oval. For a lot of younger people, particularly males, that walking side by side, not looking at each other directly can really help in them opening up and sharing information. It can be a bit confronting: you sitting down and staring at each other face to face. So, thinking about being flexible about when you will approach a young person to check in with them as well.

Julia Zemiro:
Michael, what kind of online services can a teacher or a school staff member recommend? 

Dr Michael Carr-Gregg:
I think a really good thing for all of the school staff to think about is, "Is there a headspace in their local area?" Because that's really your one-stop shop for all the sorts of problems. You don't need a Medicare card to go there. It's free, so it's not going to be a cost thing. If there's not, it's really great for schools to have an established relationship with a youth-friendly GP. Somebody who's not fussed about Medicare cards, who's not fussed about bulk billing, that sort of stuff. So, having that pre-existing relationship's crucial. There are, of course, online facilities like e-headspace where you can literally log on, type, and have a conversation with a skilled person who might be able to send you to local resources. And then, of course, there's the telephone stuff. The 1800-55-1800 Kids Helpline. All of those are very useful. From a clinical point of view, and I know I'm talking to a technophobe, there's...

Julia Zemiro:
You know what, I think I'm coming around.

Dr Michael Carr-Gregg:
Good one...

Julia Zemiro:
I think I might just go and plug in somewhere.

Dr Michael Carr-Gregg:
You'll love this. You'll love this. There is a piece of research which has just been done which shows, if you give a kid an iPad, and you give them one of the headspace psychosocial screening questions on the tablet, they reveal 40% more information than they would face to face. That has enormous implications for us as clinicians, because it's actually going to really improve our diagnostic formulation. It's gonna really improve our treatment plan. And if you told me that 10 years ago, I just wouldn't have believed you. Extraordinary.

Julia Zemiro:
What if I'm a teacher and I don't feel confident in having a conversation with a student? 

Sarah Inness:
I think having a bit of a plan before you go in, not thinking going in either, thinking you're gonna solve problems and be able to take everything away and make the pain stop for the student. But, certainly having a key plan. Possibly, if you're not sure about that plan, checking in with a colleague or, as we do at the school, we talk to each other about it before we go much further. And I might have a conversation with Martin about a student before they come in to see me, so I have a better picture about what their understanding of counselling is. It would be the same for a teacher. Thinking about, "What is it that you actually want to achieve here?" Giving them a space to talk, and then maybe offering some ideas on how to help, and where you can go for that help. So it doesn't have to be a big deal. I think it sounds scary, but if all you're doing is listening rather than having to provide answers immediately, that's absolutely the easiest thing you can possibly do.

Julia Zemiro:
Alex, is talking out loud about a problem enough? 

Dr Alex Parker:
It can be, yes. I mean, it can be depending on what the situation is. I mean, if we're talking about young people that are generally well functioning, everything's going pretty okay, and perhaps there's been a significant event... Stressful event that's occurred, and they're struggling with dealing with that, talking through, processing their emotions, sharing it, just knowing that they're being heard might be enough. That might be the intervention. But then, for others, it may be that if that sort of distress continues, if it leads to big changes in behaviour or how they're functioning at school, that's when you start to think, "Well we need to ramp it up a bit more and do something else. Do some more investigating. Linking them in with someone else." But certainly, depending on the nature of the issue, sharing and knowing you've been heard can be enough.

Julia Zemiro:
If you're having a conversation, what should the expected outcome be? Is there one? 

Dr Alex Parker:
I think that it's hard to pre-determine, 'cause you don't know what the young person's gonna reveal in that conversation.

Julia Zemiro:
You might not solve it within that 10-minute, 15-minute, hour even, obviously.

Dr Alex Parker:
That's absolutely right. That's absolutely right. But I think just knowing that you're someone that they can return to if they need to, knowing that if it is an issue that you need to check in again, that you're going to do that. You're not going to leave them in the lurch once you've actually asked them about it. But then also just being aware of your backup plan. So you know you can consult with colleagues, you can consult with your welfare staff at school, so you just know where to go if it leads to somewhere where you're feeling that you're not comfortable or you don't know the answers.

Professor Ian Hickie:
We know from training health professionals a lot, that this issue about training and confidence about what you're gonna do strongly affects whether you're ever gonna do it. So you made the interesting comment before, teachers might not speak. I was kind of thinking, "How does a teacher not speak?" But people won’t talk about issues if they don't have confidence that they can actually deal with what's gonna happen next. And part of that is understanding you don't have to solve the problem. You tell me something. Many people, health professionals, but teachers immediately feel they're gonna solve the problem. Take an hour. Do or... there's lots of problems you can't solve. But people need to be confident about that, what they can do, what their legitimate role is, who else to get involved. Because that assists them to start the conversation or be willing to put themselves in a situation where they're willing to have that conversation. So I think the reality is, there are lots of kids who want to speak, but they'll speak to the teachers who've got some confidence that they can cope with it, they're not gonna have a panic attack themselves when a kid brings up a difficult issue.

Dr Alex Parker:
Absolutely. I think that's the biggest thing, to remain calm in your own reactions, be non-judgemental in your response. But also we know, too, that it's much better to ask and check in, even if you're worried about what the answers are gonna be. If there's risk issues or if there's self-harming, it's better to ask the young person and then help them get the support they need than to not ask at all.

Julia Zemiro:
So if you're having conversation with a student, and you can see that the problem is really escalating and you do need to refer it to someone else, Michael, how would you wrap that conversation up? 

Dr Michael Carr-Gregg:
I think 75% of the worth of the conversation is, as Ian says, the listening, because sometimes they just need to be heard. What I then believe you should do in wrapping up is let them know that you actually have not just heard, but also understood. That you may or may not have a plan about what you're going to do next, but that you are going to do something, and if you know what that is, then tell them. But also I'd build in, particularly if you're worried about their safety, build in a safety plan, and again, there are apps for that. But the most important thing is that you've listened, you feed back to them what you've heard, because that in itself is hugely therapeutic.

Sarah Inness:
Reflective listening is really important, isn't it? 

Professor Ian Hickie:
One of the things is not to get in over your head in the first place. In all these conversations, you're not really taking on an hour or something, or committing to a particular thing. You're having some off-the-cuff conversation. Stuff's getting a bit difficult...

Julia Zemiro:
Yeah, it's escalating, yeah.

Professor Ian Hickie:
You wanna actually pretty quickly not get into being the pretend therapist or the skilled psychologist in that situation. Most situations, if you really think it's out of control, you need to back up pretty quick, we need to get other people involved, and not suddenly be right over your head. The only teacher left there at five o'clock with the kid, now what do I do?  

Julia Zemiro:
Wrap it up for us, Ian. What is the one piece of advice you would give to staff attempting to help an individual student? 

Professor Ian Hickie:
They are helping in the conversation. So in fact, it's very therapeutic. Just the conversation itself is big help. So this willingness to have the conversation, the critical issue. From there, you're not the therapist, you're not the psychologist. For the hard stuff, get other people involved early.