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Introduction

The World Health Organisation defines mental health as: “A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of live, can work productively and fruitfully, and is able to make a contribution to her or his community,” (World Health Organisation, 2012, para. 1).

The graphic above, taken from the UK’s Mental Health Foundation website, illustrates not only the numbers of  children and youth who live with mental health challenges, but also the fact that people who experience mental health issues are afraid of being stigmatized.

Many people who are worried about their mental health delay getting treatment or avoid it all together because of self-stigmatisation, meaning they have internalised the stigmas about mental illness (Hinshaw & Stier, 2008). In a 2012 study, researchers found that children as well as adolescents provided negative and stigmatising responses, when filling in a questionnaire on how they perceived a (fictional) peer with Attention-deficit / hyperactivity disorder (ADHD) or depression (O’Driscoll et al).

Stigma around mental health can be the result of:

• lack of knowledge
• lack of understanding mental illness and where it comes from
• fear, as it is unknown (Hinshaw and Stier, 2008).

Common Mental Health Issues in Primary School

Parents

Approximately one in ten people have a diagnosed mental illness (Data and Statistics on Children’s Mental Health, 2020). In a class of twenty children with approximately forty parents, at least four of the children in the classroom could have a parent with a mental illness. The effects of parental mental illness on children can range from genetics predispositions to exposure to unhealthy behaviours and thinking (Manning & Gregoire, 2006).

Parental mental illness can affect nearly all areas of child development, such as attachment, cognition, as well as social, emotional and behavioural development (Manning & Gregoire, 2006). Due to this it is incredibly important to not only be aware of mental illnesses in young children, but also how to talk to them and prevent them from adopting the stigma and negative attitude surrounding mental illness. Intervening early, and teaching children about mental illness when they are young, has been shown to help them adapt a more positive point of view and decrease negative thoughts associated with the mentally ill (Greenwood et al., 2016).

Mental illness presents differently in everyone and seeing any of the symptoms in someone does not automatically make them mentally ill. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DMS-5, 2013) has been used as reference for the symptoms and behaviours. While the DSM-5 has its shortcomings, it gives a simple overview over symptoms and diagnostic criteria, which is why it was used as a reference in this chapter.

Common Mental Health Diagnoses in school-aged children

According to the CDC (2020), the most common mental illnesses diagnosed in three-to-seventeen-year olds in the US are:

1. ADHD (9.4%)
2. Anxiety disorders (7.1%)
3. Depression (3.2%)

Anxiety and depression are also the top mental illnesses among adults, though followed by bipolar disorder, rather than ADHD.

For a diagnosis of anxiety and depression, symptoms must be present for on average at least six months, and in various settings (American Psychiatric Association, 2013). Only professionals can and should give a diagnosis. As primary school educators, it is important to be aware of, and understand the behaviour which children or their parents may display, but no attempts at diagnosing should be made. If there are signs for concern, it is recommended to contact a school psychologist, or another expert on school level.

Defining our Terms

Depression: These behaviours would need to be presented for prolonged period of time and in multiple settings (home, school, peer group) in order for a child to receive a diagnosis of depression. In addition, the behaviours would not be attributable to the physiological effects of a substance or to another medical or neurological condition.

Some, but not all, of the diagnostic criteria:

• Severe temper outbursts (verbal or physical) that are out of proportion to the situation or provocation, e.g. rejection, mistakes, etc.
• Depressed or disinterested moods – not wanting to take part in any activity
• Low energy, physical complaints
• Feelings of worthlessness

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What does this mean in the classroom?

A depressed student may struggle to express themselves and explain their actions. Due to the mood changes students may find it very hard to concentrate on tasks, classes, or conversations. The outburst may make it complicated for a student to socialise with others and to make friends. They may fall behind in their academics or even be held back a grade level due to their behaviour being uncharacteristic for their age. The distress caused by this will likely cause them to fall deeper into their depression, further worsening their academics and social interactions. Students with depression may also miss class.

What does this mean for students with a parent living with depression?

A parent with depression may struggle to support their child academically and socially, due to their low energy. They may find it challenging to manage their own and their child’s schedules and daily lives and may find it hard to communicate with their child’s teacher and other parents, due to the feelings of worthlessness. Depending on how heavy the depression is, the parent will not be able to support the child at all on some days and the child may need to become a caretaker for their depressed parent. This may cause the child to be tired, late to classes, preoccupied with other thoughts and make them struggle to focus in class. A child with a depressed parent may also miss classes.

Anxiety:  Mental health issues such as social phobia or other phobias, separation anxiety and selective mutism all fall under the anxiety category (American Psychiatric Association, 2013). Most anxieties develop in childhood and continue being present into adulthood if they are not treated (American Psychiatric Association, 2013).

For easier understanding, this section will only focus on generalized anxiety disorder, as it is common within children and adults, and, according to the DSM-5 (2013), many other anxiety disorders present with similar symptoms as well.

Some, but not all, of the diagnostic criteria:

• Excessive anxiety and worrying that is difficult to control and makes it difficult to function.
• Restlessness, difficulty concentrating, irritability
• Difficulty sleeping

What does this mean in the classroom?

A student with anxiety may be unable to focus on classes and work. They may often complain about feeling tired. An anxious student may be mentally absent for periods of time, not being able to focus on their work or even people speaking to them.

Students with anxiety may experience anxiety attacks; these can present in various ways from crying and screaming to just going completely silent. An anxious student may react aggressively or loudly to certain triggers, such as being spoken to or being touched.

Due to this inability to focus, a student with anxiety can easily fall behind in their academics and may find it hard to socialize with other students.

What does this mean for the student with a parent living with anxiety?

A parent with anxiety may be seen as overprotective. They might worry about every little detail of their child’s life and academics. An anxious parent may be unable to support a child fully in their academics due to their own inability to focus or concentrate. A parent with anxiety may experience anxiety attacks, which can range from loud outbursts to complete withdrawal. A child witnessing these will be affected and impacted by this modelled negative behaviour. Depending on the type of anxiety, a parent may find it hard to make phone calls, communicate with the teacher, or even leave the house. This can cause a lot of frustration between the teacher and the parent. A child of an anxious parent may have a hard time making friends due to their overly worried parent. They may imitate their parents worries and negative behaviour, further complicating their relationship with others.