April, 2019 - Renaissance Wellbeing Services

As part of my masters of mental health studies, I was required to write a newsletter-style report about a mental health issue directed at a specific group of professionals. I chose to write about depression, adolescence, and education for teachers:

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It is estimated that, on average, there are at least two students in every class who are suffering from depression at any given point. This often goes unrecognised due to sufferers concealment attempts and carers are not being aware of symptoms. The repercussions of this can be great, as left unattended it impacts learning and leads to lower school attendance. Further, it has been associated with self-harm, eating disorders, substance abuse, and suicide. By being aware of the signs of depression teachers can, potentially, interweave preventative and curative interventions into the classroom to help reduce the amount of suffering. This following aims to provide some basic information, generate awareness, and promote further discussion of a school’s role in students’ mental health.

Causes

Depression is a complex condition that can occur on its own or with other conditions. It can be sub-categorised in the following ways: physical (e.g. anaemia, thyroid dysfunction, candida), situational (e.g. bullying, family disharmony, relationship conflict), or as part of a broader mental health condition (e.g. post traumatic stress disorder, anxiety, grief, adjustment disorder, loss). Irrespective of the underlying cause, all forms of depression share some common symptoms.

Symptoms

Normal challenges in adolescent years, coupled with hormone changes and social pressures, can lead to a mild depression which teenagers drift in and out of as they develop their sense of identity and place in the world. Depression, however, as a serious mental health condition, goes beyond this. Official diagnosis dictates that at least five symptoms are present for at least two weeks, and that these interfere with student’s normal functioning.

According to an Australian Government report:

“Symptoms of major depressive disorder may include significant weight loss or weight gain, loss of appetite, insomnia or hypersomnia, restlessness, fatigue and loss of energy, feeling of worthlessness and inability to concentrate.”1

Practical examples of how this may present in the classroom include: students isolating themselves, disengagement, slow bodily movements, not submitting work, aggressive outbursts, teariness, and other challenging behaviour.

Obstacles in getting help

Ideally, once a student has been identified with depression, they would be to referred to a counsellor or psychologist for professional guidance and diagnosis. Unfortunately this is not always possible as students often do not feel that talking to anyone will help. To meet this, simple strategies from teachers and school administration can be useful.

Myth busting

There are many myths surrounding depression which can impede teenagers getting the support that they need. This includes some well meaning philosophies such as positive motivational strategies. Whilst reframing things in a positive light may be useful in some circumstances, it is not an exclusive approach that cures all. In the case of someone who is depressed it can be counterproductive because they are not making a conscious choice to be depressed, hence, motivating them to be more positive can lead to worsening feelings, such as guilt and shame when they cannot achieve this. Emerging research suggests that students who are susceptible to mood and behavioural problems lack skills, not motivation, to cope with life challenges.

What teachers can do

It is unethical to expect teachers to diagnose students, however, as depression can have such a negative impact on learning and other areas, it is appropriate for them to have an awareness for what to look for and how best to approach it.

Individually, teachers can make a difference to a student’s mental state. Depression contains the element of low self-esteem, therefore, by giving encouragement for efforts, rather than final product, self-improvement is more effectively inspired. Self-esteem building in this way comes across as genuine care and builds confidence in abilities due to the praise being given for the process, not end product.

Primarily, students who are suffering depression need empathy and understanding. This can be a difficult ask when teachers are pressured to achieve target goals and a student presents as not putting in sufficient effort. It can create a difficult situation in which the teacher does not know if the student is being lazy, doesn’t not understand what was expected of them, (i.e. possible learning disorder), or is suffering depression. In one-off incidents this is made even more challenging. A possible solution is for teachers to develop culture where it is normal to check in on students when returning work, opposed to handing it back without saying anything. Conversations could look like this:

Teacher: “Jesse, you seemed to have struggled with this assignment. Is there a reason?”

Jesse’s reply could then be an indicator of either supporting or dismissing the probability of depression. For example Jesse replies: “I rushed it at the last minute,” then suspicions can be reduced. Whereas if there is no reply at all (depressed students often avoid answering questions) or gives a simple response such as: “I don’t care what mark I get,” then further investigation may be deemed necessary.

What schools can do

Preventive measures are best; supportive school communities which promote growth mindsets, mindfulness, and anti-bullying programs, are sound approaches.

Cultivating a professional culture in which staff confer and collaborate with each other if they suspect a student is at risk of depression is one such way in which this could occur. This could be viewed much the same as mandatory reporting of child abuse conversations are expected take place. This practice could be done informally or extended to a formal systematic checking on students demeanours through digital surveys. A Melbourne based school approaches this by requiring all staff to fill in an online questionnaire once a month for every student. Three identifiable markers; mood, social interactions, and workload accountability, are checked across the board. The simple tick-a-box processes ensures that all students are looked out for and no individual teacher is responsible for reporting a student who is struggling. A central coordinator compares the information and follows up as required. This approach, which only requires a few minutes per class, could easily be adapted to most schools without adding too much extra work onto teachers.

Taken to another level, schools can adopt global approaches to intervention by being trauma-informed, and cultivating connection, and a community atmosphere. These provide excellent prospects for recovery and prevention. Included into such models are skilled based lessons on emotional regulation, relationships and conflict resolution skills, and self-identification and labelling of feelings. In such environments students are better situated to work through personal issues, like depression, or ask for help, if needed.

Social researcher, Brene Brown, encapsulates this beautifully in her quote:

“A deep sense of love and belonging is an irreducible need of all women, men, and children. We are biologically, cognitively, physically, and spiritually wired to love, to be loved, and to belong. When those needs are not met, we don’t function as we were meant to. We break. We fall apart. We numb. We ache. We hurt others. We get sick.”2

Happy, healthy school communities, create happy, healthy students.

Further support

Teachers and schools wanting to seek further information can do so here:

Student Mental Health and Wellbeing. (2017). Education.qld.gov.au. http://education.qld.gov.au/studentservices/protection/mentalhealth/index.html

Lawrence, D., Johnston, S., Hafekost, J., Boterhoven de Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. (2015). The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Published By The Australian Government. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf

Fallot, Ph.D., R., & Harris, Ph.D., M. (2009). Creating Cultures of Trauma-Informed Care (CCTIC):A Self-Assessment and Planning Protocol. https://www.healthcare.uiowa.edu/icmh/documents/CCTICSelf-AssessmentandPlanningProtocol0709.pdf

Footnotes

1. Pg.35 Lawrence, D., Johnston, S., Hafekost, J., Boterhoven de Haan, K., Sawyer, M., Ainley, J., & Zubrick, S. (2015). The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Published By The Australian Government. https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf

2. Brown, B. (2016). The Gifts of Imperfection. [United States]: Joosr Ltd.

Bibliography

Bennett, M. (2017). Episode 1: Our Trauma-Informed Journeys. [podcast] http://connectingparadigms.org/podcast/episode-1/

Brown, B. (2016). The Gifts of Imperfection. [United States]: Joosr Ltd.

Kidsmatter.edu.au. (2017). Cognitive Behavioural Intervention for Trauma in Schools (CBITS) | kidsmatter.edu.au. [online] https://www.kidsmatter.edu.au/primary/programs/cognitive-behavioural-intervention-trauma-schools-cbits

Making SPACE for Learning Australian Childhood Foundation Trauma Informed Practice in Schools. (2010). [ebook] Ringwood VIC: Australian Childhood Foundation. https://www.theactgroup.com.au/documents/makingspaceforlearning-traumainschools.pdf

Moss, R. (2013). A Clinical Biopsychological Theory of Loss-Related Depression. [online] The Neuropsychotherapist. http://www.neuropsychotherapist.com/loss-related-depression/.

Schwartz PhD, A. (2016). The complex PTSD workbook. Berkeley, California: Althea Press.

Student Mental Health and Wellbeing. (2017). Education.qld.gov.au. http://education.qld.gov.au/studentservices/protection/mentalhealth/index.html

What is Art Therapy?

Art therapy, also sometimes referred to as art psychotherapy, is a counselling approach that incorporates the creating of artwork into the therapeutic process. Creating art provides a means of directly tapping into the subconscious mind and in doing so provides insights and directions for conversations that could be otherwise missed. Art therapy also enables traumatic experiences and associated thoughts and feelings to be processed in a safe and efficient manner which talking alone cannot achieve.

What does trauma-informed mean?

A lot of mental health issues, such as depression and anxiety, stem from traumatic experiences in one’s personal past or their family system. By acknowledging this, core issues can be address as well as the symptoms that they create. In a trauma-informed space, safety, collaboration, and awareness of triggers are of the utmost importance; hence, these are respected and incorporated into the therapy process.

Benefits of trauma-informed art therapy

Art therapy and healing trauma go hand in hand. This relates back to neuroscience principles; for a general overview of this read the article Art Psychotherapy and Neuroscience. More specifically, when someone experiences trauma, the brain that controls cognitive functions (ie. reasoning, memory, attention, and language) doesn’t work as efficiently as it could. The brain can switch to automatic and fight, flight, fawn, or freeze responses dominate. Basically, the nervous system’s takes over and either pumps adrenal so as quick movements to escape real or perceived dangers can be made, or the body becomes rigid and cannot move as an alternative means of protection. Simply “moving on” or “letting go” of traumatic experiences solemn works. Such approaches are often glorified repression tactics which result in trauma symptoms still being present days, weeks, months, or years later. Bessel van der Kolk, an expert in trauma describes phenomena in detail in his book The Body Keeps the Score. Further, he stipulates that reminders of traumatic events have a way of interfering with one’s life until that are suitably addressed. Van der Kolk (and other researchers) suggests that simply talking about traumas is often ineffective. On a physiological level, this is due to a break in the connection between the thinking and feeling parts of the brain. Art therapy bypasses this problem by not relying on cognitive functions. By mark making, hand modelling (clay, wax, or plasticine), and being creative in other ways, trauma can be expressed and released in an effective manner, thus improving mental health and wellbeing. While participating in any artistic activity can be beneficial, doing so with the support and guidance of a professional therapist, means a greater level of healing can be achieved.

When discussing trauma it is useful to keep in mind that there are two main types. There are big “T” trauma events which are life-threatening occurrences and there are small “t” events that impact one’s confidence and self-agency. Below is a table that provides examples of each. While most people automatically think of big T trauma events as being of significance, little t traumas that remain unaddressed can have drastic long term effects on mental health. Once trauma has been processed via the emotional part of the brain – which it does so when someone is being creative in art therapy – then cognitive functions begin to improve.

Examples of big “T” trauma

Physical, sexual, verbal assault
Vehicle accidents
Natural disasters
Difficult divorce or death situations
War-related experiences
Child abuse; neglect and other intrusions on safety

Examples of little “t” trauma

Being bullied
Passive-aggressive treatment from family, friends, work, etc
Rejection
Ridicule
Invalidation

Both forms of trauma can have serious impacts on a person’s mental health and lead to PTSD symptoms such as: nightmares, insomnia, intrusive memories, flashbacks, lack of concentration, feelings of helplessness and hopelessness, irritability, rage, anger, dissociation, self-destructive tendencies, avoidance, mistrust, poor memory, negative self-image, guilt, shame, and hyper-vigilance.

BIBLIOGRAPHY

Kolk, B. van der. (2015). The Body Keeps the Score. Penguin.

Month: April 2019

Depression, Adolescence, and Education