Mental Health and Wellbeing Role of Teachers

1. Mental Health and WellbeingRole of Teachers Chamindra Weerackody Project Lead, Trauma and Global Health Programme McGill University, Canada & People’s Rural Development Association Faculty of Education, University of Colombo 22nd June 2010

2. Mental Health and Wellbeing • ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease’(WHO, 2008 – Mental Health) • Wellbeing: Reflects values, norms human needs etc. as perceived by people themselves (Diener and Suh, 2000; Prlleltensky et al. 2000; Myers et al. 2005).

3. Mental Health and Wellbeing • Understandings of ‘mental health’ and ‘mental illness’ determined by meanings given to experiences and feelings in a context of people’s culture (Marsella and White, 1982; Kakar, 1984; Kleinman, 1988a,b; Gaines, 1992; Fernando, 2002). • Mental health is not just a technical matter but connects with ways of life, values, and worldviews that vary across cultures. • Understanding of ‘wellbeing’ (in development studies) reflects range of human experience - social, mental, spiritual, material. (Chambers 1997).

4. Community perceptions of mental health and wellbeing • Material wellbeing • Social wellbeing • Security • Physical, mental and moral/spiritual wellbeing

5. Material wellbeing • having stable employment/livelihoods • having stable cash incomes • access to adequate land • having permanent, secure and spacious house

6. Social wellbeing • providing good education and socialization for children • caring for children • unity and harmony within family • unity and harmony within community • unity and harmony with neighbouring communities/host communities

7. Social wellbeing • access to services • self-respect and dignity • clean and free environment • free of alcohol and drug abuse

8. Security • a secure environment for their living without fear and outside threats • a secure physical environment and protection from natural disasters and conflicts • free movement and living without being subject to suspicion

9. Security • a peaceful atmosphere free of regular checks and intimidation from security forces. • secure and strong houses to prevent intruders • houses that ensure privacy and personal safety • community members coming together to intervene and resolve problems and issues

10. Physical, mental and moral and spiritual wellbeing • living without illness and suffering • having mental happiness • having good thoughts/feelings towards others • living with courage/endeavour, self-initiative and drive • living with wisdom (not acting on emotions/rational behaviour) • moral behaviour of community members • careful spending • living religiously

11. What reduces community mental health and wellbeing? • political violence and natural disasters • displacement • poverty • poor housing conditions • conflicts within family and community • social exclusion and isolation

12. What reduces community mental health and wellbeing? • injustice and discrimination • urbanization • communicable diseases • work stress • alcoholism, drug abuse and sexual abuse

13. Psychosocial context of mental health and wellbeing(source: Prof. A.J.Marsella)

14. Stigma People with mental health problems (studies in UK) 84 % experience problems in getting jobs, healthcare, mortgages (Mind survey, 2004) 55 % young people would not want anyone else to know about illness (NUS and Rethink, 2001) 49% have been harassed or attacked (Mind, Not Just Sticks and Stones, 1986) 33% report having been dismissed or forced to resign from jobs (Read and Baker, 1996) Source: Dr Suman Fernando

15. Stigma – research Stigma absent when mental illness is attributed to ‘spirit possession’ (in Sri Lanka) (Waxler, 1974) ‘brain-disease’ view of mental health problems increases stigma (in Germany) (Angermeyer and Matschinger, 2005) ‘bio-genetic cause’ view of mental health problems positively related to stigma Source: Dr Suman Fernando

16. Social costs and stigma • Social costs of illness are high in terms of family breakdown, isolation, disharmony, poverty and deprivation • Social stigma prevented many patients and their families seeking treatment from ‘Angoda hospital’ • Many patients preferred to go to general hospitals (psychiatry units) or private hospitals/doctors to avoid getting them labeled • Forceful admissions result in anger and hostile relationships between patient and families Source: Dr Rasitha Perera

17. Family response to persons with mental illness Care givers were reluctant to take the patient home and desired a long stay when patients:- were aggressive at home do not take treatment as prescribed mess up family/home affairs do not have a care giver at home Dr Rasitha Perera

18. Family response to persons with mental illness Care givers were reluctant to take the patient home and desired a long stay when patients:- are dependent on others / lack of productivity misuse psychoactive substance show hostility maintain poor self care Source: Dr Rasitha Perera

19. Family response to persons with mental illness Illness was the major cause for many patients to remain single, separated or divorced 50% of the patients experienced disharmony with their families 1/3rd of the patients were considered a burden to the family Only 1/4th of the patients received better family care 1/3rd of the care givers were not satisfied with the current status of the patient Source: Dr Rasitha Perera

20. Promoting mental health and wellbeing Interventions Social Medical (treatments) Strengthening resilience and support Individual Family Community Promoting recovery (‘recovery approach’) Developing hope Overcoming barriers Social inclusion Source: Dr Suman Fernando

21. Mental Health Interventions Medical model: • Problems identified by symptoms of individuals • ‘Illness’ represents bio-medical pathology Source: Dr Suman Fernando

22. Mental Health Interventions Medical model: • Help is via individual treatments - Biological (medication, ECT) - Psychological (e.g. ‘talking therapies’, CBT ) • Environmental manipulation e.g. therapeutic communities, advice, education, family support Source: Dr Suman Fernando

23. Mental Health Interventions Social model: • Origin / cause of MH problems are social • ‘Illness’ is socially constructed • Help is via social interventions and support involving family, community, living conditions etc. Source: Dr Suman Fernando

24. Healing systems accessed by peoplein Sri Lanka • Western medicine including psychiatry • Ayurvedic, siddha and sinhala medicine • Astrological consultation – palm/ horoscope reading • Healing rituals –bodhi pujas, exorcism • Practical advice based on dhamma–pirith chanting, medication • Healing at temples, churches and mosques

25. Mental health promotion • develop ‘balanced care’ = hospital care + community care (mixture of medical and social models) • Work as multi-disciplinary teams • support traditional healing systems • promote family and community support • integrate with community development • social inclusion and participation • reduce risk factors

26. Recommendations for developing community-based mental health services Principles: • Bottom-up approach:- ‘home-grown’ • Involve local community organizations (e.g. schools, temples, churches, mosques, etc. ) • Culturally and socially acceptable/sensitive • Include marginalized groups • Integrate local knowledge with outside ‘expertise’ Ref: Weerackody and Fernando, 2009

27. Factors affecting mental health and wellbeing of children • Lack of access to education and facilities • Child neglect, ill-treatment and poor care • Malnutrition • Traumatic experiences – loss of family members, displacement, detention, physical injuries • Substance abuse • Sexual abuse and child prostitution • Child trafficking and labour • Domestic violence

28. Factors affecting mental health and wellbeing of children • Family break downs e.g. divorce, separation, desertion • Recruitment as child soldiers • Parents working abroad • Competition and pressures for ‘achievement’ • Disabilities

29. Mental health problems of children (1) May present as: • emotional problems such as phobias, excessive anxiety, depression, irrational fears • Unusual behaviour / conduct such as aggressiveness, timidity • Inattention / overactivity at school or home

30. Mental health problems of children (2) May present as: • Difficulties / delay in acquiring certain skills such as speech, writing, reading • Problems in attachment to parents or caregivers such as not showing or responding to affection (when severe may be autism) • Food fads / eating problems such a refusing to eat, induced vomiting (may be anorexia)

31. Mental health problems of children (3) • sleeping problems such as excessive sleepiness, insomnia (may be sign of more severe illness) • Post traumatic problems such as re-living traumatic incidents (may become ‘post traumatic stress disorder’ – PTSD)

32. Dealing with Mental health problems of children Try to pick up: • Special needs that child may have such as early learning difficulties, dyslexia (recognition of words and writing letters), hearing loss (early deafness), visual impairment • Problems in the child’s interactions with other children, teachers and others in authority

33. Dealing with Mental health problems of children • Family problems at home • Difficulties in socialisation (not mixing, isolating)

34. How can the teachers help? • Paying more attention to children with special needs or ‘problems’ (20-30 percent of children) • Providing a safe context for children to talk • Listening and talking to children

35. How can the teachers help?(2) • Making referrals to relevant specialists (e.g. children with severe emotional disturbance, post traumatic states, eating disorders, deafness, autism, family issues) • Enabling children to develop appropriate life-skills, self-esteem and resilience

36. Prevention of mental health problems (1) • Acquiring professional skills in understanding child development and mental health • Creating a supportive school environment that is conducive to learning and developing life skills • Providing mental health education, knowledge, attitudes and behaviours to all children

37. Prevention of mental health problems (2) • Educating parents and community members on risk and protective factors of mental health • Identifying factors that place children at risk and reinforcing protective factors

38. Challenges for teachers • How can we provide a safe and supportive environment in which all students can maximize their learning? • How can we remain accessible and responsive to their needs? • How can we assist our students to develop their ability to cope with challenges and stress?

39. Providing supportive context for children • Liaising with families, parents and care-givers e.g. home visits • Fostering partnerships between school and community agencies, service providers etc. • Strengthening community support networks

40. Factors that enhance resilience among children • Positive role models • Positive self-esteem • Supportive relationships with teachers and friends • A sense of hope and purpose • Belief in one’s self • Strong social skills • Good peer relationships

41. What are Life-Skills? Skills that enable people to: • Live in harmony with parents, teachers and others in authority • Live in harmony with peers from various communities and social classes • Make socially & culturally appropriate relationships • Make decisions that are in keeping with social and cultural norms (ethical values, expectations of kith and kin, worldviews, etc.) • Maintain a sense of self-worth as well as respect for others • Deal with adversity in socially acceptable and culturally appropriate ways

42. Specific Life-Skills • Specific skills would depend on social and cultural context in which the person lives – so would vary and the specifics of the skills required would change as society changes and / or person moves (e.g. migrates)

43. Western and Non-Western Understandings of Life Skills

44. Western and Non-Western Understandings of Life Skills