MindMatters Panel: Module 4.1 How schools help students

Julia Zemiro:
Hello I’m Julia. Welcome to the MindMatters Panel. Here to talk about how schools help students is: 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. Alexandra Parker, we’ll call her Alex for short; School Psychologist, Sarah Inness; and teacher – and may I say teacher extraordinaire, because all the others have these very long titles – Martin De Clercq. But first let’s see how Phil tries to help his students at Eagleton.

Eagleton High clip:

PHILLIP
Mental health difficulties are a part of everyday life. Which is why we have to remain open to different ways to help our students. 

What’s on your mind, Chris?

CHRIS
I’m bummed.

PHILLIP
Why’s that?

CHRIS
My girlfriend dumped me. 

PHILLIP
Oh no. How long had you been going out?

CHRIS
Two weeks.

PHILLIP
Two weeks?! 
I mean that’s terrible.
And Jemma, what’s on your mind?

JEMMA
Failing chemistry. I hate it. Nothing makes sense.

PHILLIP
Common problems that affect our mental health. And what we want to do as a school is to prevent these things from escalating by boosting protective factors – like resilience or relationships.

Chris, you did chemistry last year, right?
How did you go mate?

CHRIS
I got an A.

PHILLIP
Did you?

Jemma, have you ever thought about getting a tutor?
Oh by the way, have you met Chris?
Chris, Jemma. Jemma, Chris. 

I’m just going to go and check a few emails. 

Julia Zemiro:
Ohhh, a biscuit will always help the situation – and yeah no, I don’t understand chemistry either. Now look, this is a serious topic. What types of student mental health difficulties do schools normally deal with? 

Dr. Michael Carr-Gregg:
When we look at the high prevalence disorders in schools, we certainly see anxiety, depression, substance abuse on one level. But, when you look at the research about what troubles kids, three things come up all the time. One is, coping with stress that they’re not very good at, the second is the whole issue of body image, and the third one is actually dealing with the stress of school, coping with study.

Professor Ian Hickie:
There are normal emotional responses to all sorts of stuff. So the fact that someone gets upset or if something goes wrong in their life. We need to know how to deal with that. We all get upset. And then to recover, to get back on track.

Julia Zemiro:
How can school staff help students when they see these problems?

Martin De Clercq:
There’s the official level where there’s education, in terms of ways to cope with stress, drug and alcohol education, and education about mental illness. But there’s the unofficial stuff just listening, referring on. We are lucky enough at our school to have a psychologist at school, so, to be able to pick up those warning signs early, to check in with students, just being aware.

Julia Zemiro:
What about early intervention? Is that something that you target?

Sarah Inness:
We have a school that – with staff who are naturally connected to the students, and so know them very well and can identify maybe when they’re not doing so great, and when something is out of the ordinary. So, when we’re looking for mental health difficulties at school, we’re often looking for behavioural signs. And staff need to know their students pretty well and, you know, who their friendships are, what subjects they do very well in, what their activities are. So that when they start avoiding friendships or feeling excluded from friendships, they can recognise that they are no longer sitting with those friends at lunch time or they might see that perhaps they are sitting somewhere differently in the classroom away from their friends. Or that they know that they’re normally very good at chemistry and probably now are no longer performing so well in that. So I think that’s where early intervention can come in very quickly.

Professor Ian Hickie:
The goal here isn’t to turn teachers into psychologists. You know, early detection, as you were saying, by students, by the school, by the parents, is a little bit different to moving into actually formally intervene in a particular situation. So the whole issue of everyone being able to recognise an issue and then the next critical thing for kind off everyone to work out is kind of, ok, at what point what kinds of interventions actually become relevant.

Dr. Michael Carr-Gregg:
I think a useful model to have for teachers is a developmental task paradigm, which is really simple and that is: there are four things kids need to do growing up. One is emancipate from their mum and dad, have some level of independence. The second is basically to figure out the answer to the question  “Who am I?” and that involves some healthy risk taking, to actually figure out the purpose of being at school and to make that connection, and most importantly, to develop peer relations. I think if you’ve got a problem with any one of those four, that’s when you go to the higher life form. That’s my view.

Julia Zemiro:
The higher life form, I love that. What were you going to say, Alex?

Dr. Alexandra Parker:
I was just going to add in to say that also to the teachers not to feel like that they need to think about what is the next step. The first step in an intervention can be asking that question, checking in – “are you ok?” – And just being prepared to listen to start with, to see what’s happening. Then think about what next. So you don’t have to have a plan before even doing that first phase.

Julia Zemiro:
Michael, what are some practical things that schools can do to help students in the classroom for instance? 

Dr. Michael Carr-Gregg:
Well, particularly, mindfulness has really taken off. Now, mindfulness is a way of meditating, so that you are literally at one with the environment, and the latest research around doing just even 10 minutes of mindfulness each day is just so extraordinary, in terms of boosting academic performance, reducing stress, reducing anxiety and I also think that sleep tracker that we talked about earlier to help kids monitor their sleep, understand the importance of it and also of course doing exercise, which will all make a difference long term.

Julia Zemiro:
Talking here today, it sounds like we’re expecting school to be this magical place all the time. That’s not what you can offer, and that’s not what it is. What else can school be?

Sarah Inness:
School’s just a place where I guess at the very least it offers normalcy or role models on how to cope with everyday challenges and a support network. So, school can provide that normalcy or that regular touch base.

Professor Ian Hickie:
It’s also great, it’s filled with challenges. Academic challenges, social challenges, success, failure. All the normal developmental things. So, really the real issue is skills and levels of being able to cope through relationships or how to do those things. So you know, it is a safe environment in one way and you deal with all that stuff.

Dr. Alexandra Parker:
That structure and routine but you deal with all those challenges as well, yeah.

Julia Zemiro:
What are some of the roles and boundaries for staff?

Martin De Clercq:
Their role is to be there, like I said before, to listen and support. I mean there are boundaries, it was said before: teachers aren’t psychologists.

Sarah Inness:
Yeah, I think that’s absolutely right. Our staff, I think we’ve done a great job over the years, talking about what responsibilities and limitations are of that. We have a great system where we would have somebody like Martin whose role is to look after students’ welfare. Teachers can go to Martin and ask him if he’s got any concerns with a specific student and if it seems just that little bit too much, he can come and chat to me. So, we’ll often have conversations. So there’s is a tiered support network around teachers at our school.  

Dr. Alexandra Parker:
I think just tapping into what Michael has also mentioned just before, about the importance of the lifestyle-type intervention. So support that with young people – having some structure, routine, the importance of sleep, diet and exercise. Because all of those have been shown to be modifiable risks factors for developing depression or developing anxiety disorders. There’s things that those young people can change and have some control over.

Julia Zemiro:
Michael, I’d like to ask you something. What other ways can schools use technology – because you’re so our tech man today, it’s so exciting – with mental health difficulties?

Dr. Michael Carr-Gregg:
There’s some wonderful websites now. For example, beyondblue has the K10, which you might not be familiar with. But it is a way in which young people can fill out something, which takes 2 minutes and it will actually help them decide whether or not what they are feeling is sad, or whether or not they might have some depressive symptoms, which would warrant going to see a GP. So, that’s brilliant, you’ve got that online available for everybody. There are also fantastic apps to help young people with the type of therapy we do, called Cognitive Behavioural Therapy, so we’ve got now– 

Julia Zemiro:
Oh, I’ve been to a couple of therapists, don’t you worry I know exactly what tree you are barking up with cognitive therapy. It’s alright. Go on. Back to you. Yup, I think I am alright. I’m here. I have turned up here on time.

Dr. Michael Carr-Gregg:
So, Australia probably lead the world in wonderful online programs like ‘Mood Gym’, which is where we can help kids identify irrational ways of thinking, get them to label their thinking as irrational, challenge those thoughts, and replace them with better, more productive ways of thinking. Now, that is extraordinarily brilliant, because you’ve got kids who don’t necessarily have psychological services to go to, they might be in rural and remote communities. So suddenly, we’ve got an intervention, which actually has an evidence base that actually works. There is a number of randomised control trials that show it works. We’ve now got apps that kids can download. There’s one particular one that I use a lot in my clinic, which is called ‘Mood Kit’, which enables kids to do this stuff. So, we’ve now got a plethora of different technological interventions and the challenge for us is to make sure that the schools and the school psychologists know about them. Because otherwise it’s very difficult for kids to navigate that mental health ecosystem.

Dr. Alexandra Parker:
Well I think that all of those things can at early phases, when someone, when a young person is starting to have some difficulties and struggling of course to know which reliable safe online things that they can use to help as maybe a first step before they see whether they need to get or see someone else for a different type of intervention.

Professor Ian Hickie:
Technology in mental health is a god-send. You can get in there, in private, connect, find out information, treat yourself, monitor yourself. The technology’s going ahead in leaps and bounds. So, we’re going to see not just mindfulness, you know. We are going to see this in a public health way in Year 7, as you go into high school, as you deal with issues. Learning things but not just learning them, actually practising the skill. So, you know, you actually learn stuff about problem solving, or stress management, or relationship issues, just like you would in other public health things. Just as much as putting condoms on bananas and learning about sexual health. You’ll learn stuff about controlling anxiety and what strategies work, and then seeing they work for you, like ‘This one really works for me’. We all need to learn that, it’s actually all of us understanding when we get aroused about something, what happens with our concentration, the effect if you don’t sleep you can’t think straight the next day, you know in various kinds of ways. So, I think these things should not just be the weird and the wonderful. It’ll be the introduction into schools in a more public health kind of way, education way, because your brain’s not so easy to track. If you run upstairs and you get breathless, you’re not very fit, you know. You see other things. The way your brain works is not so obvious in everyday life, but it is affecting your performance in the maths test or whether you actually can make friends easily and deal with stress.

Julia Zemiro:
Alex, diet and exercise of course, another big part of sort of staying mentally healthy.

Dr. Alexandra Parker:
Absolutely. Exercise interventions definitely do help with depression and anxiety, but there’s some evidence to show that diet and or healthy eating and exercise can prevent the development of these disorders as well.

Dr. Michael Carr-Gregg:
The diet stuff’s so interesting because in ah primary school, the data says 63% of kids have their required fruit and vegetables. By the time it gets to middle school, it’s 1%. So we’ve clearly dropped the ball in terms of making that connection that Ian talked about being so important about how to manage your wellbeing through diet.

Professor Ian Hickie:
We’ve done monitoring of these things in schools. What if kids sit for eight hours in school, you’d think they’re dead, nothing’s happened. They go well actually I went to this class and went to that class, very well behaved at school, I attended all those things. You go, hang on, if you’re going to sleep well at night, you’ve got to be active during the day, you know, during those particular things, so your body rhythm depends as much on the daytime activity… So part of the problem, you know, cause normally a teenager goes to bed later, but if you’ve been very inactive during the day with a strong, traditional focus on academic performance and school based work, and the school itself hasn’t incorporated that in, you’re going to have trouble sleeping. You know, if you’re trying to teach teenagers high level maths at 8:30 in the morning, or if you’re having some special class at 7:30 in the morning, forget it. Their brain’s in another place, another planet, you know. So the more we know about these things, making the physiology of the situation actually match, I think unfortunately, greater and greater emphasis on academic performance, people think more time focusing on books, on your own, is efficient, it’s incredibly brain inefficient, in fact. You’ve got to be active, you’ve got to make the timing work. So what you’re doing during the day, which unfortunately is largely under school’s control, does really matter to a lot of these phenomena. 

Dr. Michael Carr-Gregg:
One thing that one school did that I’m very closely associated with is that it decided to change the start time of school to 10am – 

Julia Zemiro:
Brilliant.

Dr. Michael Carr-Gregg:
– finish at 4. They had a 15% increase in academic performance and a 30% decline in bad behaviour. So it actually taps into exactly what Ian’s talking about.

Julia Zemiro:
Are they allowed to do that? How can you just decide to do that? Can you do that?

Dr. Michael Carr-Gregg:
Well, they actually were a behaviour problem school –  

Julia Zemiro:
Ok, yeah right.

Dr. Michael Carr-Gregg:
–  in the first place, and they were a private school so they didn’t have to check out with Government, so it was relatively easy for them to do. For a state school to do that, I think it would be very much more difficult.

Professor Ian Hickie:
Well I go further – in the US there is good evidence about mood, anxiety, suicidal ideation. You drag a lot of later teenagers out of bed early in the morning all of those problems go up. You let them sleep, you know, it’s kept under control. There are issues like emphasising physical activity in the morning, sunlight exposure to set their body clock in a particular kind of way. That’s the physiology you’re kind of dealing with, and it’s changing rapidly during different stages of adolescence and early adult life. So we’ve got to update a lot of the school practice to what the modern physiology is.

Julia Zemiro:
When it comes to helping people, we can all learn from W. H. Auden, who once said, ‘We are all here on earth to help others. What on earth the others are here for, I don’t know.’