Child and adolescent mental health care have been a growing concern in schools around the world.   Suicide, which is mostly caused by psychological illnesses, is the second leading cause of deaths among those aged 15–29 in India. Another common condition young people face nowadays are attention-deficit/hyperactivity disorder (ADHD), mood disorder and major depressive disorder. As these youngsters enter the more competitive part of their student life, their conditions, if left untreated for long, lead to more serious problems.

Students suffering from such health conditions have different needs and require complete support, especially in school. According to World Health Organization, in less developed countries like India, the treatment gap (the difference between the prevalence of mental illnesses and the treated proportion of people) is high as 76-85 percent. With all these statistics at hand, educators are required to be the first line of defence in dealing with identifying mental health issues in their students, as teachers are in the unique position of interacting with and observing the youngsters on a daily basis.

However, this article, in no manner claims to be an authority, but just a cursory guideline to help teachers understand and possibly identify the signs of such a malady in their students. For confirmed diagnosis and intervention, qualified psychologists or psychiatrists must be approached by the proper guardians.

First Step — Understanding Symptoms

Because mental health issues are still a taboo subject, identification of behavioural markers for mental health issues in the classroom would be challenging for teachers. But knowing how to support one’s own mental health and wellbeing, and that of their students’, is essential in providing a supportive learning environment. Most students would be hesitant to share their concerns with anyone. However, there are warning signs that a teacher can always look out for. It is important to remember that any one of these in isolation, or if it lasts only a short time is normal. But the teachers must always be on the lookout for repetitive behavioural patterns in your students. If some of these signs last more than a couple of weeks, they need some outside help.

Identifying issues among students involves understanding ‘externalizing’ and ‘internalizing’ behaviours exhibited by students who may be struggling with mental health issues. Furthermore, an understanding of behaviours that may not necessarily be problematic to classroom instruction, but ultimately impact student outcomes in school and life outside of school, is also needed.

Externalizing Behaviour

This refers to those behaviours directed outward toward the social environment. Typically associated with these behaviours are conduct disorder, oppositional defiant disorder, and ADHD. Students who exhibit aggression, a difficult temperament, or behaviour impulsivity may be considered as showing externalizing behaviour. These behaviours may be easily identified in the classroom, as they are disruptive to the class environment.

Aggression often manifests itself as deliberate verbal threats toward peers and school staff, physical actions (e.g., hitting, kicking, biting) that cause physical harm, and severely damaging the property of others. According to American Psychological Association, difficult temperament typically is manifested in two different ways. The first form involves students engaging in behaviour that persistently defies established rules such as classroom guidelines (e.g., sitting in assigned seats, asking to use the restroom, remaining quiet during instruction) and school campus etiquettes (e.g., walking in the halls, truancy, using appropriate language). The second form involves persistent argumentative behaviour or tantrums related to perceived unreasonable demands by the child/youth. Tantrums may involve screaming, crying, whining, arguing, throwing items, hiding under desks, hitting, kicking, biting, or spitting.

Behaviour impulsivity often is manifested as sudden aggressive outbursts or inattention and disorganization. These outbursts may involve property destruction, screaming, hitting, or kicking. Inattention is defined as trouble sustaining attention to tasks for prolonged periods of time, difficulty providing details in describing events, and responding to discussions with off-topic statements while ‘disorganization’ is the lack of ability to perform tasks requiring multiple steps.

Internalizing Behaviour

This refers to behaviours directed inward, toward the individual. Historically, internalizing disorders include major depressive disorder, persistent depressive disorder, specific phobias, separation anxiety disorder, social anxiety disorder (social phobia), generalized anxiety disorder, panic disorder, selective mutism, obsessive-compulsive and related disorders and post-traumatic stress disorder.

These disorders and behaviours often go unnoticed because of their subtle nature but there are some common observable behaviours that may be noticed in the class or school. Often, when a school staff discovers self-harm or drug and alcohol abuse among students, the behaviour is viewed as criminal offence and the students involved are penalised severely. However, viewing it from a socio-psychological perspective, such behaviours are most of the times symptomatic of internalizing disorders and punishing them would only makes things worse for the students.

This behaviour may be the students’ attempts to cope with disturbed family environments and emotional changes they do not understand. Internalizing behaviour disorders are categorised into anxiety-related disorders and mood disorders.

Anxiety-Related Disorders – these are disorders characterized by the onset of fight or flight behavioural and psychological responses to people or situations that are non-life-threatening. Observable behaviour related to anxiety include skipping class, truancy, or leaving class for long periods of time.

Mood Disorders – They are characterized by disturbances in mood that affect overall functioning of the individual. These children/youth may exhibit observable behaviour such as difficulty completing school work, rapid increase or decrease in their weight, complaining of stomach pains, or becoming disinterested in activities they previously enjoyed. It is crucial to be aware of these behaviours as these students often are at an increased risk for suicide.

Educators must be aware that externalizing behaviours may occur along with internalizing behaviours. Students who exhibit both internalizing and externalizing behaviours simultaneously are at a particularly high risk for developing further mental health issues.

Next Step — Reaching Out to the Student

To begin with, teachers must openly talk about mental health issues in the classrooms and encourage their students to be self-analytical to find their own behavioural markers. Building trust-based relationships with students is also a good start. Once students are convinced that they are in a safe environment, some students may be willing to reach out to their teachers in private and let them know they are going through. In such cases, teachers could keep some of the following tips in mind:

  • When a student turns to you for help, remember it is because they trust and respect you. Respect their privacy unless urgent and authoritative intervention is required. Even then, you must let the student know that would be your next course of action.
  • Give them time and attention. Having a trusted adult to talk to is an important protective factor for the student. Many may not be receiving this at home.
  • Be patient and be prepared to listen and understand what is happening to the student.
  • Be objective, compassionate, non-judgmental and accepting. The student may be reluctant to talk about their problem because they don't want to upset anyone. But the students need to know and be made aware that is the correct path forward for: talking to someone.
  • Know how and when to go to others for help. Encourage the student to seek help themselves. They may feel supported if you offer to go with them when they speak with a school counsellor or welfare advisor.
  • If you feel out of your depth, don't try dealing with the situation by yourself. If you feel the problem is serious, or you have concerns for the student's welfare you must report it to the school principal and the child’s guardians.

If you do have concerns for the welfare of a student then don't be afraid to raise your concerns with them. They will probably be relieved that someone has noticed and cares enough to ask how they are doing. If the student does have problems as you suspected, then it is important to inform the appropriate staff within the school to ensure that the student receives the help and support they need to stay safe. The school can then decide how to contact and include parents in the intervention solutions for the student. Always remember, regardless of the mental health issue a student may be experiencing, identifying that a student may need assistance for a mental health issue is what is most important. And that is where teachers can help.