mental health and wellbeing role of teachers

Mental Health and Mental Health and WellbeingWellbeing

Role of Teachers Role of Teachers

Chamindra WeerackodyChamindra Weerackody Project Lead, Trauma and Global Health ProgrammeProject Lead, Trauma and Global Health Programme McGill University, Canada & People’s Rural Development McGill University, Canada & People’s Rural Development

AssociationAssociation

Faculty of Education, University of ColomboFaculty of Education, University of Colombo2222ndnd June 2010 June 2010

Mental Health and Mental Health and WellbeingWellbeing

‘‘Health is a state of complete physical, Health is a state of complete physical, mental and social mental and social well-beingwell-being and not and not merely the merely the absence of diseaseabsence of disease’ ’ (WHO, 2008 (WHO, 2008 – Mental Health) – Mental Health)

WellbeingWellbeing: Reflects values, norms : Reflects values, norms human needs etc. as perceived by human needs etc. as perceived by people themselves people themselves (Diener and Suh, 2000; (Diener and Suh, 2000; Prlleltensky Prlleltensky et alet al. 2000; Myers et al. 2005).. 2000; Myers et al. 2005).

Mental Health and WellbeingMental Health and Wellbeing

Understandings of ‘mental health’ and Understandings of ‘mental health’ and ‘mental illness’ determined by meanings ‘mental illness’ determined by meanings given to experiences and feelings in a context given to experiences and feelings in a context of people’s culture of people’s culture (Marsella and White, 1982; Kakar, 1984; (Marsella and White, 1982; Kakar, 1984; Kleinman, 1988a,b; Gaines, 1992; Fernando, 2002).Kleinman, 1988a,b; Gaines, 1992; Fernando, 2002).

Mental health is not just a Mental health is not just a technicaltechnical matter matter but connects with ways of life, values, and but connects with ways of life, values, and worldviews that vary across cultures.worldviews that vary across cultures.

Understanding of ‘wellbeing’ (in development Understanding of ‘wellbeing’ (in development studies) reflects range of human experience - studies) reflects range of human experience - social, mental, spiritual, material. social, mental, spiritual, material. (Chambers 1997).(Chambers 1997).

Community perceptions of Community perceptions of mental health and wellbeingmental health and wellbeing

Material wellbeing Material wellbeing Social wellbeing Social wellbeing Security Security Physical, mental and Physical, mental and

moral/spiritual wellbeing moral/spiritual wellbeing

Material wellbeingMaterial wellbeing

having stable having stable employment/livelihoodsemployment/livelihoods

having stable cash incomes having stable cash incomes access to adequate landaccess to adequate land having permanent, secure and having permanent, secure and

spacious house spacious house

Social wellbeingSocial wellbeing

providing good education and socialization providing good education and socialization for childrenfor children

caring for childrencaring for children unity and harmony within family unity and harmony within family unity and harmony within community unity and harmony within community unity and harmony with neighbouring unity and harmony with neighbouring

communities/host communities communities/host communities

Social wellbeingSocial wellbeing

access to services access to services self-respect and dignityself-respect and dignity clean and free environment clean and free environment free of alcohol and drug abuse free of alcohol and drug abuse

Security Security

a secure environment for their living a secure environment for their living without fear and outside threats without fear and outside threats

a secure physical environment and a secure physical environment and protection from natural disasters and protection from natural disasters and conflictsconflicts

free movement and living without being free movement and living without being subject to suspicionsubject to suspicion

SecuritySecurity

a a peaceful peaceful atmosphere free of regular atmosphere free of regular checks and intimidation from security checks and intimidation from security forces.forces.

secure and strong houses to prevent secure and strong houses to prevent intrudersintruders

houses that ensure privacy and personal houses that ensure privacy and personal safety safety

community members coming together to community members coming together to intervene and resolve problems and issuesintervene and resolve problems and issues

Physical, mental and moral Physical, mental and moral and spiritual wellbeingand spiritual wellbeing

living without illness and sufferingliving without illness and suffering having mental happiness having mental happiness having good thoughts/feelings towards others having good thoughts/feelings towards others living with courage/endeavour, self-initiative and drive living with courage/endeavour, self-initiative and drive living with wisdom (not acting on emotions/rational living with wisdom (not acting on emotions/rational

behaviour)behaviour) moral behaviour of community members moral behaviour of community members careful spending careful spending living religiouslyliving religiously

What reduces community What reduces community mental health and mental health and wellbeing?wellbeing? political violence and natural disasterspolitical violence and natural disasters displacement displacement povertypoverty poor housing conditionspoor housing conditions conflicts within family and communityconflicts within family and community social exclusion and isolationsocial exclusion and isolation

What reduces community What reduces community mental health and mental health and wellbeing?wellbeing?

injustice and discrimination injustice and discrimination urbanization urbanization communicable diseases communicable diseases work stresswork stress alcoholism, drug abuse and alcoholism, drug abuse and

sexual abusesexual abuse

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

Factors affecting Factors affecting mental health & mental health & wellbeing wellbeing

Implications for Implications for mental health & mental health & wellbeing wellbeing

Cultural abuse, destruction and Cultural abuse, destruction and collapsecollapse

Confusion and conflict Confusion and conflict

Oppression and domination Oppression and domination Anger, hate & domination Anger, hate & domination

Humiliation Humiliation Rage and revenge Rage and revenge

PowerlessnessPowerlessness Helplessness and despair Helplessness and despair

Poverty Poverty Hopelessness and misery Hopelessness and misery

Denigration Denigration Low esteem and worthlessnessLow esteem and worthlessness

Racism, sexism and agesim Racism, sexism and agesim Fragmentation and restrain Fragmentation and restrain opportunity and denies choiceopportunity and denies choice

Stigma Stigma

People with mental health problems (studies in UK)People with mental health problems (studies in UK)

84 % experience problems in getting jobs, healthcare, 84 % experience problems in getting jobs, healthcare, mortgages mortgages

(Mind survey, 2004)(Mind survey, 2004)

55 % young people would not want anyone else to know about 55 % young people would not want anyone else to know about illnessillness

(NUS and Rethink, 2001)(NUS and Rethink, 2001)

49% have been harassed or attacked 49% have been harassed or attacked (Mind, (Mind, Not Just Sticks and Stones, Not Just Sticks and Stones, 1986)1986)

33% report having been dismissed or forced to resign from jobs33% report having been dismissed or forced to resign from jobs(Read and Baker, 1996)(Read and Baker, 1996)

Source: Dr Suman FernandoSource: Dr Suman Fernando

Stigma – researchStigma – research

Stigma absent when mental illness is Stigma absent when mental illness is attributed to ‘spirit possession’ (in Sri attributed to ‘spirit possession’ (in Sri Lanka)Lanka) (Waxler, 1974)(Waxler, 1974)

‘‘brain-disease’ view of mental health problems brain-disease’ view of mental health problems increases stigma (in Germany)increases stigma (in Germany)

(Angermeyer and Matschinger, 2005)(Angermeyer and Matschinger, 2005)

‘‘bio-genetic cause’ view of mental health bio-genetic cause’ view of mental health problems positively related to stigmaproblems positively related to stigma


Social costs and stigmaSocial costs and stigma

Social costs of illness are high in terms of family breakdown, Social costs of illness are high in terms of family breakdown, isolation, disharmony, poverty and deprivation isolation, disharmony, poverty and deprivation

Social stigma prevented many patients and their families seeking Social stigma prevented many patients and their families seeking treatment from ‘Angoda hospital’treatment from ‘Angoda hospital’

Many patients preferred to go to general hospitals (psychiatry Many patients preferred to go to general hospitals (psychiatry units) or private hospitals/doctors to avoid getting them labeled units) or private hospitals/doctors to avoid getting them labeled

Forceful admissions result in anger and hostile relationships Forceful admissions result in anger and hostile relationships between patient and families between patient and families

Source: Dr Rasitha PereraSource: Dr Rasitha Perera

Care givers were reluctant to take the Care givers were reluctant to take the patient home and desired a long stay patient home and desired a long stay when patients:- when patients:-

were aggressive at homewere aggressive at home do not take treatment as prescribeddo not take treatment as prescribed mess up family/home affairsmess up family/home affairs do not have a care giver at homedo not have a care giver at home

Dr Rasitha PereraDr Rasitha Perera

Family response to persons with mental illness

Care givers were reluctant to take the Care givers were reluctant to take the patient home and desired a long stay patient home and desired a long stay when patients:- when patients:-

are dependent on others / lack of productivity are dependent on others / lack of productivity misuse psychoactive substancemisuse psychoactive substance show hostilityshow hostility maintain poor self caremaintain poor self care



Illness was the major cause for many patients to remain single, Illness was the major cause for many patients to remain single, separated or divorcedseparated or divorced

50% of the patients experienced disharmony with their families 50% of the patients experienced disharmony with their families

1/31/3rdrd of the patients were considered a burden to the family of the patients were considered a burden to the family

Only 1/4Only 1/4thth of the patients received better family care of the patients received better family care

1/31/3rdrd of the care givers were not satisfied with the current of the care givers were not satisfied with the current status of the patient status of the patient



Promoting mental Promoting mental health and wellbeing health and wellbeing InterventionsInterventions

SocialSocialMedical (treatments)Medical (treatments)

Strengthening resilience and supportStrengthening resilience and supportIndividualIndividualFamilyFamilyCommunityCommunity

Promoting recovery (‘recovery approach’)Promoting recovery (‘recovery approach’)Developing hopeDeveloping hopeOvercoming barriersOvercoming barriersSocial inclusionSocial inclusion


Mental Health Mental Health Interventions Interventions

Medical model:Medical model: Problems identified by symptoms of Problems identified by symptoms of

individualsindividuals ‘‘Illness’ represents bio-medical Illness’ represents bio-medical

pathologypathology


Mental Health Mental Health InterventionsInterventionsMedical model:Medical model:

Help is via individual treatments Help is via individual treatments - - Biological (medication, ECT)Biological (medication, ECT)

- Psychological (e.g. ‘talking therapies’, CBT- Psychological (e.g. ‘talking therapies’, CBT ) )

Environmental manipulation e.g. Environmental manipulation e.g. therapeutic communities, advice, therapeutic communities, advice, education, family supporteducation, family support


Mental Health Mental Health Interventions Interventions

Social modelSocial model:: Origin / cause of MH problems are Origin / cause of MH problems are

socialsocial ‘‘Illness’ is socially constructedIllness’ is socially constructed Help is via social interventions and Help is via social interventions and

support involving family, support involving family, community, living conditions etc.community, living conditions etc.


Healing systems accessed by Healing systems accessed by peoplepeople

in Sri Lankain Sri Lanka Western medicine including psychiatry Western medicine including psychiatry Ayurvedic, siddhaAyurvedic, siddha and sinhala medicine and sinhala medicine Astrological consultation – palm/ Astrological consultation – palm/

horoscope readinghoroscope reading Healing rituals – Healing rituals – bodhi pujasbodhi pujas, exorcism , exorcism Practical advice based on Practical advice based on dhammadhamma – –

pirith pirith chanting, medication chanting, medication Healing at temples, churches and Healing at temples, churches and

mosquesmosques

Mental health Mental health promotionpromotion develop ‘balanced care’ = hospital care + develop ‘balanced care’ = hospital care +

community care (mixture of medical and community care (mixture of medical and social models)social models)

Work as multi-disciplinary teamsWork as multi-disciplinary teams support traditional healing systems support traditional healing systems promote family and community supportpromote family and community support integrate with community development integrate with community development social inclusion and participation social inclusion and participation reduce risk factors reduce risk factors

Recommendations for Recommendations for developing community-based developing community-based mental health servicesmental health services

Principles:Principles:

Bottom-up approach:- ‘home-grown’Bottom-up approach:- ‘home-grown’ Involve local community organizations (e.g. Involve local community organizations (e.g.

schools, temples, churches, mosques, etc. ) schools, temples, churches, mosques, etc. ) Culturally and socially acceptable/sensitiveCulturally and socially acceptable/sensitive Include marginalized groups Include marginalized groups Integrate local knowledge with outside Integrate local knowledge with outside

‘expertise’‘expertise’

Ref: Weerackody and Fernando, 2009Ref: Weerackody and Fernando, 2009

Factors affecting mental Factors affecting mental health and wellbeing of health and wellbeing of children children

Lack of access to education and facilitiesLack of access to education and facilities Child neglect, ill-treatment and poor careChild neglect, ill-treatment and poor care Malnutrition Malnutrition Traumatic experiences – loss of family Traumatic experiences – loss of family

members, displacement, detention, physical members, displacement, detention, physical injuriesinjuries

Substance abuseSubstance abuse Sexual abuse and child prostitution Sexual abuse and child prostitution Child trafficking and labour Child trafficking and labour Domestic violence Domestic violence

Factors affecting mental Factors affecting mental health and wellbeing of health and wellbeing of childrenchildren

Family break downs e.g. divorce, Family break downs e.g. divorce, separation, desertion separation, desertion

Recruitment as child soldiers Recruitment as child soldiers Parents working abroad Parents working abroad Competition and pressures for Competition and pressures for

‘achievement’‘achievement’ Disabilities Disabilities

Mental health Mental health problems of children problems of children (1)(1)May present as:May present as:

emotional problems emotional problems such as phobias, such as phobias, excessive anxiety, depression, irrational excessive anxiety, depression, irrational fears fears

Unusual behaviour / conduct Unusual behaviour / conduct such as such as aggressiveness, timidityaggressiveness, timidity

Inattention / overactivity Inattention / overactivity at school or at school or homehome

Mental health Mental health problems of children problems of children (2)(2)

May present as:May present as:

Difficulties / delay in Difficulties / delay in acquiring certain skills acquiring certain skills such as speech, writing, readingsuch as speech, writing, reading

Problems in attachment Problems in attachment to parents or to parents or caregivers such as not showing or responding caregivers such as not showing or responding to affection (when severe may be autism)to affection (when severe may be autism)

Food fads / eating problems Food fads / eating problems such a refusing such a refusing to eat, induced vomiting (may be anorexia)to eat, induced vomiting (may be anorexia)

Mental health Mental health problems of children problems of children (3)(3)

sleeping problemssleeping problems such as such as excessive sleepiness, excessive sleepiness, insomnia insomnia (may be sign of more severe (may be sign of more severe illness)illness)

Post traumatic problems Post traumatic problems such as such as re-living traumatic re-living traumatic incidents (may incidents (may become ‘post traumatic stress become ‘post traumatic stress disorder’ – PTSD)disorder’ – PTSD)

Dealing with Mental Dealing with Mental health problems of health problems of children children Try to pick up:Try to pick up: Special needs that child may have Special needs that child may have

such as early learning difficulties, such as early learning difficulties, dyslexia (recognition of words and dyslexia (recognition of words and writing letters), hearing loss (early writing letters), hearing loss (early deafness), visual impairmentdeafness), visual impairment

Problems in the child’s interactions Problems in the child’s interactions with other children, teachers and with other children, teachers and others in authorityothers in authority

Dealing with Mental Dealing with Mental health problems of health problems of childrenchildren Family problems at homeFamily problems at home Difficulties in socialisation (not Difficulties in socialisation (not

mixing, isolating)mixing, isolating)

How can the teachers How can the teachers help?help?

Paying more attention to children Paying more attention to children with special needs or ‘problems’ with special needs or ‘problems’ (20-30 percent of children)(20-30 percent of children)

Providing a safe context for Providing a safe context for children to talkchildren to talk

Listening and talking to childrenListening and talking to children

How can the teachers How can the teachers help?help?(2)(2) Making referrals to relevant specialists Making referrals to relevant specialists

(e.g. children with severe emotional (e.g. children with severe emotional disturbance, post traumatic states, disturbance, post traumatic states, eating disorders, deafness, autism, eating disorders, deafness, autism, family issues)family issues)

Enabling children to develop Enabling children to develop appropriate life-skills, self-esteem and appropriate life-skills, self-esteem and resilienceresilience

Prevention of mental Prevention of mental health problems (1)health problems (1) Acquiring professional skills in Acquiring professional skills in

understanding child development understanding child development and mental healthand mental health

Creating a supportive school Creating a supportive school environment that is conducive to environment that is conducive to learning and developing life skillslearning and developing life skills

Providing mental health Providing mental health education, knowledge, attitudes education, knowledge, attitudes and behaviours to all childrenand behaviours to all children

Prevention of mental Prevention of mental health problems (2)health problems (2) Educating parents and Educating parents and

community members on risk and community members on risk and protective factors of mental protective factors of mental health health

Identifying factors that place Identifying factors that place children at risk and reinforcing children at risk and reinforcing protective factorsprotective factors

Challenges for Challenges for teachers teachers How can we provide a safe and How can we provide a safe and

supportive environment in which all supportive environment in which all students can maximize their students can maximize their learning?learning?

How can we remain accessible and How can we remain accessible and responsive to their needs?responsive to their needs?

How can we assist our students to How can we assist our students to develop their ability to cope with develop their ability to cope with challenges and stress? challenges and stress?

Providing supportive Providing supportive context for childrencontext for children Liaising with families, parents and Liaising with families, parents and

care-givers e.g. home visits care-givers e.g. home visits

Fostering partnerships between Fostering partnerships between school and community agencies, school and community agencies, service providers etc. service providers etc.

Strengthening community support Strengthening community support networksnetworks

Factors that enhance Factors that enhance resilience among resilience among childrenchildren Positive role modelsPositive role models Positive self-esteemPositive self-esteem Supportive relationships with Supportive relationships with

teachers and friends teachers and friends A sense of hope and purposeA sense of hope and purpose Belief in one’s selfBelief in one’s self Strong social skills Strong social skills Good peer relationships Good peer relationships

What are Life-Skills? What are Life-Skills? Skills that enable people to:Skills that enable people to:

Live in harmony with parents, teachers and others in Live in harmony with parents, teachers and others in authorityauthority

Live in harmony with peers from various communities and Live in harmony with peers from various communities and social classessocial classes

Make socially & culturally appropriate relationshipsMake socially & culturally appropriate relationships

Make decisions that are in keeping with social and cultural Make decisions that are in keeping with social and cultural norms (ethical values, expectations of kith and kin, norms (ethical values, expectations of kith and kin, worldviews, etc.)worldviews, etc.)

Maintain a sense of self-worth as well as respect for othersMaintain a sense of self-worth as well as respect for others

Deal with adversity in socially acceptable and culturally Deal with adversity in socially acceptable and culturally appropriate waysappropriate ways

Specific Life-SkillsSpecific Life-Skills

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

Western and Non-Western and Non-Western Understandings Western Understandings of Life Skillsof Life Skills

WesternWestern Non-westernNon-western

Decision-making and problem solving Decision-making and problem solving analyzing information and analyzing information and

experiences objectively and experiences objectively and making decisions based on making decisions based on facts facts

adherence to cultural norms adherence to cultural norms and seeking guidance from and seeking guidance from elders and spiritual influenceselders and spiritual influences

CommunicationCommunication ability to express views and ability to express views and

opinions directly opinions directly indirect expression of views, indirect expression of views,

respecting views of other respecting views of other people, and dependence on people, and dependence on familyfamily

IndependenceIndependence Depend on oneself primarily Depend on oneself primarily

and maximize self-confidenceand maximize self-confidence respecting opinions of others respecting opinions of others

and more accepting of and more accepting of dependence on othersdependence on others

Western and Non-Western and Non-Western Understandings Western Understandings of Life Skillsof Life Skills

WesternWestern Non-westernNon-western

Coping with emotionsCoping with emotions

Recognizing emotions, Recognizing emotions, controlling emotions and controlling emotions and expressing emotions in expressing emotions in acceptable waysacceptable ways

wide cultural variation in wide cultural variation in expression of emotions and expression of emotions and need to control emotionsneed to control emotions

Coping with stressCoping with stress

Understanding causes of Understanding causes of stress and controlling stress stress and controlling stress

cultures vary a great deal cultures vary a great deal in ways of dealing with in ways of dealing with stress – some prefer stress – some prefer acceptance of controlacceptance of control

mental health and wellbeing role of teachers

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