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Promotion of School Mental Health Programme in Pakistan - A Whole School Approach
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Asima Mehboob Khan, Rachel Jenkins, Stuart Lancashire, Rizwan Taj, Zenab Ayub Department of Psychiatry, Pakistan Institute of Medical Sciences, Islamabad, Pakistan Kings College, London |
| Abstract: Background: Whole -school approach is a mental health promotion program in schools, which will provide a framework for mental health promotion in Pakistani schools. Its objectives are to facilitate exemplary practice in the promotion of mental health; and develop mental health education resources which are appropriate to a wide range of schools, students and learning areas. It encourages the development of partnerships between schools, parents and community support agencies to promote the mental wellbeing of young people. Objective: To find out the perception of Pakistani teachers on whole-school approach. Place and Duration of the study: Trainings were held at department of Psychiatry, PIMS in collaboration with British council, THET, federal directorate of education and Kings College, London. Duration of training workshop was eight days from 20th Nov 2011- 27th Nov 2011. Design & Method: This study involved 60 subject / class teachers, heads of school, officers from the ministry of education and school counselors of both government and private sector schools. Data was collected with the help of instruments i.e., pre designed pre and post – tests for the assessment of their knowledge regarding mental health and whole school approach before and after training. Results: Results of the study revealed an overall mismatch between teachers’ beliefs about a whole-school approach, childhood mental health problems and their perceived school reality and mental health issues. A whole-school approach was not seen as practiced in majority of these schools. Conclusion: Whole school approaches encompass how to use school policies, systems and structures to create an environment that promotes mental wellbeing. Key Words: Whole-school approach, mental health, schools |
Introduction
Schools have an important role in promoting mental health among children and young people, and much of this is about creating the right environment for them to learn and thrive. When young people were asked what made them feel good, a common response was "doing well in school". Whole-school approaches provide schools with a structured process through which educators make choices about using available interventions or programs (Butler et al., 2002).
A whole-school approach offers a way to address young people’s health and social, emotional and intellectual development holistically. Individuals within the school environment may be experiencing particular emotional difficulties, but a whole-school response generates benefits for everyone by providing a supportive context for targeted actions. It recognises roles for all members of the school community. The strategy operates at each of the following levels: Classroom (including teaching and learning environments and relationships); whole school (including the policies, programs and practices of the school, and the physical and social environments); and Links with the community (including school, home, and community organizations). The process of implementing the whole-school intervention strategy is coordinated by a team established from within the school. This enables schools to examine their policies, programs and practices, and identify priority areas for reducing risk factors and enhancing protective factors for positive health and educational outcomes. It allows schools to address these priorities systematically, and actively seek training for members of the school community.
There are seventeen studies that evaluated interventions that included all pupils and aimed to promote some aspect of positive mental health or prevent some aspect of mental illness. The review included only controlled trials with at least 40 individuals in each condition – that is, intervention or control – and with less than 30% lost to follow-up. The interventions studied ranged from programmes offering only to develop classroom skills (through participation in community helper activities and changes to the school social environment) to comprehensive programmes lasting several years with whole school and parental involvement, which aimed to change the ethos of the school as well as offer classroom teaching. The interventions covered the resolution of conflicts, antisocial behaviour, prevention of depression and suicide, and promotion of self-esteem and emotional literacy.
Evidence of the effectiveness of an intervention was obtained for programmes that adopted a whole school approach and included key elements of the health promoting schools approach, such as changing the school environment, developing personal skills in class, involving parents and the wider community, and actively involving the school. The review suggested that programmes that fell short of a whole school approach were more likely to be effective if they were implemented continuously for more than a year and were aimed at promoting mental health rather than preventing mental illness (Wells et al., 2003).
Recently, attention has been given to the importance of a young person's sense of attachment or belonging in their social environment. A sense of connectedness to family is central to emotional well-being, but it is also clear that the school social environment can directly influence emotional well-being and health. Resnick et al (1997), for example, found that a sense of belonging to both family and school are the major protective factors against health risk behaviors in young people.
Whole school mental health Project has addressed this need for prevention programmes in early adolescence. It has brought together a team of professionals with backgrounds in education, health promotion, welfare, psychology, psychiatry and public health. It has developed and evaluated a comprehensive whole school strategy to promote social environments in which young people feel secure, have a sense of belonging and feel positively regarded (Butler et al., 2002).
Method
Two sets of Primary mental health care master trainer workshops for schools were held in November 2011. It was organized by department of psychiatry, PIMS, in collaboration with British council, THET, Kings College London and federal directorate of education. Each training workshop was for four days. Eight days were for interactive discussions and trainings on whole-school approach and concepts of child mental health problems. Structured pre-training and post-training tests were designed for participants to assess their knowledge about whole school approach and child mental health problems. 60 teachers were invited for training; they are randomly selected from Islamabad, Mirpur (AJK) and KPK. Duration of the training was 8 days (20th Nov - 27th Nov 2011). They were class teachers, heads of schools, school counselors and representatives of ministry of education dealing with schools. After teaching each course participants were given assignments in small groups. At the end of each workshop strategies were made to implement whole school approach in their respective schools.
Results
The finding of the study indicates that there is an improvement in post test scores of participants in both groups. Participants got the percentages of 58.65% on pre-test and 74.8% on post-test.
Table 1 – Age of participants |
Age (Years) |
Frequency (n) |
Percentages (%) |
20-30 |
15 |
25 |
31-40 |
40 |
66.7 |
41-50 |
3 |
5 |
Above 50 |
2 |
3.33 |
Total |
60 |
100 |
Table 2 - Gender of participants |
Gender |
Frequency (n) |
Percentages (%) |
Male |
6 |
10 |
Female |
54 |
90 |
Total |
60 |
100 |
Table 3 - Educational qualifications |
Qualification |
Frequency (n) |
Percentages (%) |
Graduation |
10 |
16.67 |
Masters |
47 |
78.33 |
M.Phil |
3 |
5 |
PhD |
0 |
0 |
Total |
60 |
100 |
Table 4 - Role of participants as teachers |
Role |
Frequency (n) |
Percentages (%) |
Class teacher |
20 |
33.33 |
Subject teacher |
20 |
33.33 |
School counselor |
1 |
1.67 |
Education department |
9 |
15 |
Principle / Head |
5 |
8.33 |
Vice principle |
5 |
8.33 |
Total |
60 |
100 |
Discussion
In the last two decades, adolescent mental health has become a major public health focus. Mental health problems in adolescence can have a profound impact on the development of social relationships, educational attainment, and subsequent employment and health risk behaviours (Zubrick et al., 1997).
Whole-school approach has been developed with the understanding that it is indeed part of the ‘core business’ of schools to promote the mental health and wellbeing of their students (and personnel) (Commonwealth Department of Health and Family Services, 1996).
This study investigated Pakistani teachers’ perception of a whole-school approach to guidance and its practice. Findings of the study revealed that there was a difference on pre-test and post-test scores of both groups of participants. It was also observed that teachers perceived a whole-school approach as fostering student development and as a system of management. Teacher dedication, communication, and team spirit were considered as facilitating factors for its implementation.
After receiving training in the use of whole-school approach material many teachers commented that they had been ‘least familiar’ with mental illness, and feel a lot more comfortable with the whole notion now. In particular, teachers appreciated ‘getting some precise information about the different types of illnesses and some new teaching methods’. Working with one issue enabled schools to start the process of whole- school change.
The whole-school approach aims to bring ‘large benefits’ to school communities, enhancing the development of school environments where young people feel safe, where they belong and where they develop the skills needed to participate fully.
The focus on the social environment in promoting mental health parallels the work of Durkheim, one hundred years ago in which he explored the relation-ship between alienation and suicide (Hassan, 1998). Durkheim put forward the argument that suicide is directly related to the social conditions pertaining in a society and that different milieu will produce different suicide rates. Contemporary researchers refer to the need to address the alienation of young people from school and from society also drawing attention to the public or social dimensions of individual wellbeing (Mau, 1992).
This training enabled teachers to come up with their own plans to implement in their schools as master trainers.
As a result of brainstorming by the team the final decision were made containing a range of areas identified as needing to be worked out. They emphasized on; Student friendly environment, Promoting relation with community members, role of media; model good and respectful intervention; Promoting parent teacher meetings; Promoting group discussions, group activities and sharing concepts in students (Sharing lunch, stationary etc.); Developing whole school and class room rules according to age of student; Involving school bus driver and conductor to avoid bullying in the bus and rewarding those students who maintains discipline; infrastructure of school building and many other implementable plans for their respective schools.
The social environment of the secondary school assumes importance, not just because young people spend so much time there, but also because it provides the major setting in which young people develop new and different relationships with peers and adults. Rutter et al (1979), in an extensive study examining the effects of schools on emotional well-being and behavior, confirmed that the quality of a school as a social institution was of paramount importance. Resnick et al (1997) found that what mattered most to young adolescents was a school environment in which they felt that they were treated fairly, were close to others, and were part of the school (Whitehead, 1996).
Whole-school approach provides a framework for enhancing young people’s mental health in the school setting. It provides a framework within which educators can provide curricula to develop skills and educate young people about mental health. This framework is designed to identify targeted interventions which provide support and referral for the small group of young people who have serious mental health conditions. For school communities, the key issue is to ensure that the balance between whole school and targeted elements of mental health promotion is right.
References
WHITEHEAD, M. 1996. Evidence-based education Health Education Journal 55, 1-2.
