Module 2: Teacher Perspectives on Health Needs

Approximately 80% of the world’s children live in developing countries. Their well-being as adults depends heavily on the education they receive.(1) WHO has defined a Health Promoting School as "a school that constantly strengthens its capacity as a healthy setting for living, learning and working and which fosters health and learning with all measures at its disposal."(2) There is considerable emphasis on engaging health providers, educational officials, and teachers in planning and designing the policies and interventions to make the school a healthy place.(3) Much of the success of school-based health programs is based on the commitment of teachers, which in turn relies on their personal perceptions of the health needs of students. Teachers witness the effects of poor health on children’s academic performance, a problem that may often be neglected at home or simply accepted as a part of life. Teachers in many developing countries are well-respected leaders and viewed as role models by students and their families, and they therefore have an important impact on students’ learning and actions. Teachers can be given basic training that allows them to provide health interventions that are essential for better performance in school. Additionally, teacher perspectives on health needs are essential for developing effective health programs.(4)

Teachers’ Perspectives on Mental Health Needs

Many studies show a strong association between poverty, poor physical health, and mental health. “Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health” place a large emotional burden on poor individuals, increasing vulnerability to poor mental health. (5)(6) This emotional burden is often neglected in children. The school environment has been recognized as an ideal place for dealing with child mental health issues. Despite inadequate knowledge, skills, or resources needed to effectively intervene, teachers in developing countries witness the significant mental health problems in school-age children due to a variety of biopsychosocial factors, and the teachers play an important role in intervention. In a study assessing teachers’ perspectives on children’s mental health needs in Nigeria, it was identified that the mental health issues resulted from a lack of primary support systems, poverty, spiritual factors, medical illnesses, and genetic vulnerability. Children living in resource-poor settings endure extreme and difficult circumstances that place them at high risk for mental health issues.(7) “There is sufficient evidence to demonstrate significant morbidity from child mental health disorders in the developing world”.(8)(9) Research also shows that half of adult mental disorders begin before age 14.(10)

Despite the presence of mental health issues, many developing countries do not have a mental health policy or a means of addressing mental health issues. There is also often a large stigma associated with mental health issues, which causes the symptoms and illnesses to be ignored. However, early intervention in childhood mental illness can prevent and reduce more serious adult mental disorders later in life.(11) Thus, school-based mental health services are effective and necessary.(12) Schools are accessible to children and families and may be less intimidating than hospitals or clinics. Providing mental health services in schools can help to remove emotional and behavioral barriers to learning, thereby enhancing the students’ potential for academic success.(13) Teacher-student relationships have been shown to be among the most influential school psychosocial influences on student mental health.(14)

While teachers often have knowledge about a student's health needs, the signs and symptoms are oftentimes not evident to the family. Focus groups involving teachers in Nigeria collected valuable information about the perceptions of mental health issues in children that could be addressed through a school-based program. Poverty was highlighted by the majority of teachers not only as a cause of mental illness, but also an important barrier to care. Cultural influences were also evident during interviews, as teachers highlighted that spiritual problems contribute to mental illness in children. This is an aspect that is deeply ingrained in the cultural and spiritual beliefs of the area. The majority of the teachers in the Nigerian study by Ibeziako et al. believed that schools are an important avenue for addressing mental health problems in children, and the teachers felt that they are in the best position to identify these issues. It was reported that children spend more time with teachers at school than with their own parents, as parents spend a large portion of their time trying to provide for the family. It was also emphasized that many parents look up to teachers and defer to their authority, which is also the case in many developed countries. “The willingness of elementary school teachers to deal with mental health issues in schools despite their limitations creates a favorable climate for the development of school-based mental health programs.”(15) With training opportunities, teachers would be able to act as community health resources, facilitating sustainability for this type of program. School-based mental health programs also have the potential to reduce the stigma associated with mental health issues.

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Footnotes

(1) Glewwe, Paul, and Michael Kremer. 2006. "Schools, teachers, and educational outcomes in developing countries." In Handbook of the Economics of Education, edited by Eric A. Hanushek and Finis Welch. Amsterdam: North Holland: 943-1017.

(2) WHO (2008) What is a Health-Promoting School? Accessed 5 August 2010.

(3)Ibid

(4) Ibeziako P, Bella T, Omigbodun and Belfer, M (2010) Teachers’ perspectives of mental health needs in Nigerian schools. Journal of Child & Adolescent Mental Health. 21(2): 147-156

(5) Ibeziako P, Bella T, Omigbodun and Belfer, M (2010) Teachers’ perspectives of mental health needs in Nigerian schools. Journal of Child & Adolescent Mental Health. 21(2): 147-156

(6) Patel, V. and Kleinman, A. Poverty and common mental disorders in developing countries. Bull World Health Organ [online]. 2003, vol.81, n.8 [cited  2010-08-05], pp. 609-615. ISSN 0042-9686.  doi: 10.1590/S0042-96862003000800011.

(7) Robertson B, Mandlhate C, Seif El Din A and Seck B (2004) Systems of care in Africa. In: Remschmidt H, Belfer ML, Goodyer I (eds), Facilitating Pathways: Care, Treatment and Prevention in Child and Adolescent Mental Health. Berlin: Springer. pp 71–88

(8) Ibeziako P, Bella T, Omigbodun and Belfer, M (2010) Teachers’ perspectives of mental health needs in Nigerian schools. Journal of Child & Adolescent Mental Health. 21(2): 147-156

(9) Rahman A, Mubbashar M, Harrington R and Gater R (2000) Annotation: Developing child mental health services in developing countries. Journal of Child Psychology and Psychiatry 41: 539–546

(10) Kessler RC, Berglund P, Demler O, Jin R, and Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62: 593–602

(11) WHO (2004). Prevention of Mental Disorders: Effective Interventions and Policy Options Summary report. Geneva: World Health Organization

(12) Durlak JA and Wells AM (1997) Primary prevention mental health programs for children and adolescents. American Journal of Community Psychology 26: 775–802

(13) Walter HJ, Gouze K and Lim KG (2006) Teachers’ beliefs about mental health needs in inner city elementary schools. Journal of the American Academy of Child and Adolescent Psychiatry 45: 61–68

(14) Undheim AM and Sund AM (2005) School factors and the emergence of depressive symptoms among young Norwegian adolescents. European Child and Adolescent Psychiatry 14: 446–453

(15) Ibeziako P, Bella T, Omigbodun and Belfer, M (2010) Teachers’ perspectives of mental health needs in Nigerian schools. Journal of Child & Adolescent Mental Health. 21(2): 147-156