Health Education as a core course for Teachers’ Education: to enhance the Mental Health of students
Akintunde, P. G. (Ph.D)
Department of Vocational & Special Education
University of Calabar
Calabar, Cross River State, Nigeria
Olanipekun, O. Fola
Olabisi Onabanjo University
Ago-Iwoye, Ogun State, Nigeria
This paper is primarily concerned with the role of teachers in enhancement of mental health of students. It discuses the factual picture of the functions of the teachers in a changing social and education environment, identifying the social community in the actualization of the human need (mental health) that are otherwise ignored. It highlights the complex expectation of the public from the role of teachers. The expectation makes the duties of teachers diffused; they in some measures serve as social workers and perform in addition to duties other than classroom teaching. Their responsibilities for social training in a changing environment, particularly in the misconception of mental health are discussed and recommendation made.
Key Words: Health education for teachers’ education, educating teachers in mental health, health education a necessity for teachers.
The World Health Organization (WHO) (1946) adopts a definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”, at the International Health Conference, New York; 19-22 June, 1946 signed on 22 July 1946 by the representative of 61 States (WHO official records No.2 100). It enters into force on 7th April 1948, thereby declaring health as a fundamental human right.
The complex nature of public expectation of teachers’ duties necessitates the need for them to have a social training that will make them meet the challenge resulting from changing environment. School health education aims at constituting healthy learning experiences, healthy environment (physical and mental health) and positive interpersonal relationships between Teachers and students, students and students inside and outside the school environment.
Healthful school living which consists of emotional health, healthful interpersonal relationships, among others provide a safe and healthful environment. The three fold goal of environmental school health education is healthy people in healthy communities in a healthy environment.
Health lies in the functional interaction of the individual and his environment and not determined in terms of the individual isolation. A clinical picture shows the interplay of psychological, physiological and structural factors. The moment a man falls ill, he regresses in an infantile type of psychological condition, a type of adoption neurosis which is normal part of the patient’s reaction to his illness (Canestrari, 1963).
However, understanding of mental health by individual teacher and the society at large would be helpful in the conversion of weird and wild experience at early stage to greatness and responsibility in later life. Teachers are expected to have motivational impact on their students. Teachers have more vital role to play in student stress management. Students need to be educated on the effects of stress on achievement, and understand human behavior and how it affects other people in the environment (Olanipekun, 2006).
Key Words: Health education for teachers’ education, educating teachers in mental health, health education a necessity for teachers.
Mental health is a term to describe either a level of cognitive or emotional well-being or an absence of mental disorders. It may include an individual’s ability to enjoy life and procure a balance between life activities and efforts to achieve psychological resilience (About.com, 2006). It is regarded as expression of ones emotions which signifies a successful adaptation to a range of demands.
World Health Organization (2005) defines mental health as “a state of well-being in which the individual realizes his/her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his/her community”. However, the organization recognizes the fact that a complete definition may not be available because of cultural, religion and general environmental influences on determination, recognition of mental health and disorders. World Health Research (2001) explains that definition of mental health depend on cultural differences, subjective assessments, and competing professional theories because they all affect how mental health is defined.
The definition of mental disorders is a key issue for mental health and for users and providers of mental health services. Most international clinical documents use the term “Mental Disorders” and some define it as a psychological or behavioral pattern associated with distress or disability.
Mental disorders are conceptualized as disorders of the brain circuits likely caused by development processes shaped by a complex interplay of genetics and experience. It is psychological or behavior pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture (Yolken and Torrey, 1995).
The recognition and understanding of mental health condition has changed over time and across culture, there are still variations in the definition, assessment and classification of mental disorders, although standard guideline criteria are widely accepted. Diagnoses are made by psychiatrists or clinical psychologists using various methods, often relying on observation and questioning in interviews. Treatments are provided by various mental health professionals.
Yolken and Torrey (1995) records that there are some diagnoses, such as childhood conduct disorder or adult antisocial personality disorder or psychopath, which are defined by or inherently associated with conduct problems and violence. There are conflicting findings about the extent to which certain specific symptoms, notably some kinds of psychosis (hallucination or delusions) that can occur in disorder such as schizophrenia, delusional disorder or mood disorder, are linked to an increased risk of serious violence on average.
Recently, the field of Global Mental Health has emerged, defined as ‘the area of study, research and practice that places a priority on improving mental health for all people’ (Patel and Prince, 2010). The mediating factors of violence acts, however, are most consistently found to be mainly socio-demographic and socio-economic factors such as age, gender, lower socioeconomic status and in particular substance abuse (including alcoholism) to which some people may be particularly vulnerable (Stuart, 2003).
Types of Mental Disorders
Mental disorders are in categories. There are many facets of human behaviors and personality that can become disorder. This paper sum them from the classifications given by Yolken and Torrey (1995), Kitchener and Jorm (2002) and Keyes (2002).
Anxiety disorder: when anxiety or fear interferes with normal functioning. This may include phobia, generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsession, compulsive disorder, and post traumatic stress disorder.
Affective disorders: Affective (emotion/mood) process can become disorders. These are mood disorder (unusual intense and sustained sadness, melancholia or despair) known as major depression or clinical depression (milder but still prolonged depression can be diagnosed as dysthymia).
Bipolar disorders (manic depression): It involves abnormally “high or pressured mood states, known as mania/hypomania, alternating with normal/depressed mood. Yolken and Torrey (1995) states that whether unipolar and bipolar mood phenomena represent distinct categories of disorder or whether they usually mix and merge together along a dimension or spectrum of mood is under debate in the scientific literature.
Pattern of belief, language use and perception can become disorder. Examples are delusion, thought disorder, and hallucinations. These are referred to as psychotic disorders (schizophrenia and delusional disorder).
Schizoaffective disorder: It is a term use for those individuals showing aspects of both schizophrenia and affective disorders.
Personality disorders: paranoid, schizoid and schizotypal, antisocial, borderline, histrionic/narcissistic, avoidant, dependent/obsessive-compulsive.
Adjustment disorder: This is an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated.
Eating disorder: anorexia nervosa, bulimia nervosa, exercise bulimia or binge eating order.
Sexual disorder: gender identification disorder, dyspareunia, and ego-dystonic homosexuality.
Sleep disorder: insomnia
Tic disorder: Tourette’s syndrome, kleptomania, pyromania, gambling, substance dependence or abuse or addiction is in this category.
Conduct disorder: Inability to behave normally with expected discipline in the society. If this continues into adulthood, it may be diagnosed as anti-social personality disorder (psychopath).
Mental disorders are common world wide. WHO (2000) records that one out of three people in most communities report sufficient criteria for at least one at some point in their life.
Sanfford (1978), states that many children have behaviors that conflict with a reasonable school environment which could not be described as a healthful one and invariably affects their performance and the adaptation of others to them. Carter, Briggs-Gowan, and Davis (2004) exclaims that many children exhibit a deviation from age appropriate behaviors which interferes with child’s own growth and development and/or the issue of others.
Causes of mental disorders
Mental disorders can arise from a combination of sources. In many cases there is no single accepted cause currently established. It is commonly belief that mental disorder results from genetic vulnerabilities exposed by environmental stressors.
WHO (2000) reveals that there is a strong relationship between the various forms of severe and complex mental disorder in adulthood and abuse (physical, sexual or emotional) or neglect of children during the developmental years. According to the report ‘children sexual abuse’ alone plays a significant percentage of all mental disorder in adult females, most notable example being eating disorder and borderline personality disorder.
Jefferoate (1969) explains that environment can cause or trigger physical or mental ill-health while psyche influences the development of organic disease in remote parts of the body, and illness begets anxiety and this in turn begets illness. The mental health of an individual depends on the continuous satisfaction of specials requisites in the pattern of his psychological stimulation, the opportunity to give and receive love and affection, to be dependent and be depended upon. When one or more of these is/are missing the level of mental soundness is altered resulting in mental illness.
The following are considered as contributing factors or causes of mental disorder (WHO, 2000; Steadman, Mulvey, Monahan, Robbins, Appelbaum, Grisso, Roth, and Silver, 1998; and Kitchener and Jorm, 2002):
Studies have shown that genes often play an important role in the development of mental disorder, although the reliable identification of connections between specific genes and specific categories of disorder has proven more difficult.
Environmental events surrounding pregnancy and birth have been implicated.
Traumatic brain injury may increase the risk of developing certain mental disorder.
There has been some tentative inconsistent links found to certain viral infections, to substance misuse, and to general physical health.
Social influences have been found to be important, including abuse, bullying and other negative/stressful life experiences.
Wider community vices/problems such as unemployment/employment problems, socio economic inequality, and lack of socio cohesion have been attributed also to mental disorder.
Society response to mentally ill people
Response of people to mentally ill persons or people with nervous breakdown is pathetic and unhealthy. A study reported by Times Online (2009) note that assistance given by extended families that often help and supportive religious leaders who listen with kindness and respect often contrast with usual practice in psychiatric diagnosis and medication. Due to lack of proper education and ignorance on causes of mental illness and emotional problems, prevention approach and treatment, the public fail to understand the true nature of many of these mental illnesses and fail to seek the available services. Thus rather than helping to reduce/cushing the effect of the problem or the cause of the problem, the condition of the affected individuals are worsen. Some conditions are not as bad as people look at them and if they are well handled the situation may change for better.
Murray, Lopez, and World Health Organization (1996) reports:
“The burden of mental illness on health and productivity throughout
the world has been profoundly underestimated. Data developed by
the massive Global Burden of disease study, conducted by the WHO,
the World Bank, and Harvard University revealed that mental illness,
including suicide, rank second in the burden of disease in established
market economics, … It further revealed that nearly two third of all
the people with diagnosable mental disorders do not seek treatment. It
is believed that when people understand that mental disorders are not
the result of moral failings or limited will power, but are legitimate
illnesses that are responsive to specific treatments, much of the
negative stereotyping may dissipate”
They report further that the 10 leading causes of disability (counting lost years of healthy life) at age 15-44 were: major depression, alcohol use, road traffic accident, schizophrenia, self inflicted injuries, drug use, bipolar disorder, obsessive-compulsive disorders, osteoarthritis, and violence.
Thompson (2010) in his study ‘Addressing Suicide: is treatment more important than therapist?’ reports a study by Dr. Marsha Linehan at the University of Washington who suggested that “type of treatment may make a big difference for people who have borderline personality disorder (BPD), a chronic condition associated with difficulty in effectively managing one’s emotions., multiple suicide attempts, physical self harm (e.g. cutting on oneself) and impulsive, often destructive actions.”
Stigma remains a serious problem, with many cases of human rights violations like chaining or beating experienced by people with mental illness. Perpetrators are rarely brought to justice.Royal College of Psychiatrist reported that research has shown that there is stigma attached to mental illness.
There are on-line psychiatric or mental illness self-diagnose available now stating the weekly changes in individual mental health and quality of life. Report has it that annual expenditure on health in Nigeria is less than 3% of Gross Domestic Product, amounting to $7 per capita, mental health services received only a very small part of this total health budget.
Factors underlying people’ behavior towards mental ill people
Many factors have been attributed to uncaring attitude of people to the mentally ill people. These include:
Predisposition factors: The antecedents to behavior. What provide the rationale or motivation for the behavior (e.g. knowledge, beliefs, values, attitudes, confidence, and existing skills).
Enabling factors: The conditions in the environment that enable the motivation to be realized. These factors may be availability, accessibility to facilities for caring for the affected (finance, psychiatric care, etc).
Reinforcing factors: What follow the behavior (acceptance of the patient that he/she needs help).
Knowledge: It is necessary for a conscious action to take place; knowledge can be gained from information provided by health professionals, parents, teachers, books and mass medial or other sources through experience.
Belief: A conviction that a phenomenon or object is true or real. Most of them are derived from parents or other respected people in the life of the beholder.
Values: The value given to things tends to cluster within ethnic group and across generations of people sharing a common history and geographical identity.
Attitude: This reflects likes/dislikes towards certain categories of objects, persons/situation. It is sometimes based on limited experience. It may be formed without understanding the whole situation.
Relationships and morality: Clinical conceptions of mental illness also overlap with personal and cultural values in the domain of morality, so much so that it is sometimes argued that separating the two is impossible without fundamentally redefining the essence of being a particular person in a society.
Tilbury and Rapley (2004) and Karasz (2005), agree that in clinical psychiatry, persistent distress and disability indicate an internal disorder requiring treatment; but in order context, the distress and disability can be seen as an indicator of emotional struggle and the need to address social and structural problems. The poor economic situation has affected the standard of living of many people especially those we can class as poor.
The unchecked wide gap between the rich and the poor has resulted in some cases to family disintegration, with adverse effect on children who are being abused. These and other factors have led to increase in mental illness of many young ones within school age.
If their society cannot accommodate them, schools have no choice, and they cannot be discriminated against. Every child has right to education in Nigeria. Therefore schools should learn how to accommodate and integrate them into the system.
Psychotherapy involves a variety of treatment techniques, often used along with medication. There are many ways of treating mental disorders, some of which are stated below (general and specific):
Individual: involving only the patent and the therapist.
Group – involving two or more patient in the therapy at the same time. It gives them the opportunity to share experiences and learns and appreciates how others feel too.
Marital or couples: helping spouses and partners understand why their loved one has a mental disorder, what changes in communication, how behaviors can help and what they can do to cope.
Family/relation: Involvement of family or a close relation that has influence or has much information on the patient in improving the condition of patient is vital and recognized. They need to understand what their loved one is going through, how they themselves can cope, and what they can do to help.
Psychoanalytic – the first approach, the patient’s thoughts are verbalized including free associations, fantasies, and dreams, from which the analysis formulates the nature of the unconscious conflicts which are causing the patient’s symptoms and character problems. It addresses the underlining psychic conflicts and defenses.
Behavior therapy/applied behavior analysis – focuses on changing maladaptive patterns of behavior to improve emotional responses, cognitions, and interactions with others.
Cognitive behavioral therapy – It is based on modifying the patterns of thought and behavior associated with a particular disorder. It seeks to identify maladaptive cognition, appraisal, beliefs and reactions with the aim of influencing destructive negative emotions and problematic dysfunctional behaviors.
Psychodynamic – a dept psychology with primary aim to reveal the unconscious content of a client’s psyche in an effort to alleviate psychic tension. It gets its root from psychoanalysis.
Existential therapy – It is based on the existential belief that human beings are alone in the world. This association leads to meaninglessness, which can be overcome only by creating one’s own values and by meanings. It is philosophically associated with phenomena.
Systemic therapy or family therapy – a process where a net-work of significant others as well as an individual are addressed.
Humanistic Approach – a psychological approach that is a value oriented, holds a hopeful, constructive view of human beings and of their substantial capacity to be self determining, guided by a conviction that intentionality and ethical values are strong psychological forces, among the basic determinants of human behavior.
Eclectic/integrative approach – a combination of two or more therapy techniques for treatment of mental disorder.
Counseling and co-counseling – a psychological approach too but in this case advice and suggestion are given base on the observation and information available to the counselor(s).
Psycho education – This program provides people with the information to understand and manage their problems.
Creative therapies – This involves art works such as music and drama therapies.
Lifestyle adjustments and supportive measures – personal adjustment to situations.
School connection and nature of teachers’ duties
WHO (2000) reveals that there is a strong relationship between the various forms of severe and complex mental disorder in adulthood and the abuse (physical, sexual/emotional/neglect of children during the developmental years); and records that sexual abuse of children alone plays a significant percentage of the mental disorder in adult females, most notable examples being eating disorders and borderline personality disorder should be a thing of serious concern to our education institutions. There were records of various abuses of children in our environment, many of which could have been averted if they were well enlightened on how to relate in the society, the self protection or prevention of some of the vices in our society and even counseling for victims.
The socio economic and family problems has made many school children and even the grown ups exhibit some emotional and behavioral problems. Children are the life wire of schools. Therefore, identification and management of emotional and behaviorally disturbed children is very important since teachers are dealing with them directly in schools (Akintunde and Akintunde, 2010)). It is not economically possible for each school to have a psychiatrist as a permanent staff. This inability to have such specialist necessitates equipping teachers with essential knowledge capable of assisting in identifying and administering mental health problems to some extent (Akintunde, 2007).
The more teachers know about how to identify the children mental problems the better and easier for them to deal with such situations when they arise. Their relationship with the students and the community will improve and help tremendously in improving the performance of the students. They will even be in position to enlighten parents of these children and the public in general (Akintunde, 2007).
Educating student teachers on mental health through school health education will go a long way not to assist both students and teachers. Teachers are also part of our community; they also operate under the same condition as their students and people in the community. Therefore they are faced with many challenges as those in the community.
Teachers have their personal problems that stress them up upon which they are still expected to accommodate students’ problems most of which are related to mental health problems. In order to make their job easy, they should be armed adequately with enough skills to handle those problems (Sanfford, (1978)).
Although a lay man look at teaching as a job that any man can handle, forgetting that it is a 24hours job, not ending in school hours but continues as carry over after closing hour, the teacher has to prepare for the next day job and also finish assessment/marking of any assignment given to students as home work. The same person has domestic responsibilities to attend to.
In fact he has little or no time for himself talk less of recreation to recuperate him. If he does not know how to manage the situation, he may end up a psychiatric patient. The knowledge of symptoms, identification, management and therapy of mental disorders or illnesses will help him cope and adjust.
The knowledge of mental health will enable the teachers to know how far they can push the students in terms of discipline, academic activities, co-curricular activities and what to do to assist or step down the effect of mental illness on students. There are times that the attitude of some teachers (especially the untrained or half baked ones) can be very tormenting to the life of students. This is getting worse now that teachers indulge in all sorts of corruptions in schools.
Problems associated with integration of children with mental disorders into school system
According to WHO (2000) virtually everybody seems to experience mental disorder at one time or the other. All agents of enhancement of mental health are equally affected mentally too either directly or indirectly. Stress which is a booster of mental illness strikes on everyone; thus, there is need for all and sundry to understand and know how to manage stress.
Guardians’ services render by teachers stops in school but students still interact with the environment outside the school where the school is not in the knowing of the nature of the interaction. What happen to the child after school is not under the control of the school. This condition is worse now that almost all schools are operating as day school except few private schools. There is every possibility of the effort of school being rendered useless by counter interaction of the larger society.
The problem in our society is too heavy for individual to carry; talk less of adding another person’s problem. As a result of this, there is insufficient value base for a committed ethic of care in our society. Thus committed teacher are rare to find.
The differences in background, ethnicity, culture and other attribute that makes individual unique couple with the general society concept and stigma associated with mental illness/disorders makes individual nature complex.
If teachers are to be carried along in alleviating the problem of mental illness in our society, it means a change in teachers’ training curriculum. This is always a problem because generally people do not give in to changes easily. Before you know it Government will also give excuse of lack of money to finance the little alteration the change in curriculum will bring.
Some teachers are bad examples to students and they rather add to the existing problem than solve or reduce it. Whoever cannot manage himself cannot manage others or be a brothers’ keeper. Those in this category needs attention themselves and schools should take appropriate step to help them out before they influence the students.
There is no problem without solution. Sanfford (1978) adopts and adapts some psychotherapy techniques to suggest the following ten aids for teachers to actualize a healthy school environment:
Objectivity – To be objective about self and what to do towards what the student does.
Sharing – To share problems and experiences regularly with colleagues, parents and administrators, through conference, formal and informal meeting.
Feedback – Obtain feedback from observation of the child and suggestions from parents, teachers and administration.
Consultation – Where necessary consult expert like psychologist.
Collaboration – Loan out the child for sometime with other teachers, class and environment, then collate feedback on particular trait being addressed.
Observation – Use some observational techniques such as feedback interaction, analysis and other objective recording system.
Be artistic – Literature, theatres, good films, music and art, may somehow become more meaningful to the teacher when it comes to the issue of their children. People in different community are gradually getting used to using these media as tools for integration and communicative models.
Sense of humor – Maintain sense of humor.
Be Professional – maintain a strict sense of professionalizing while remain the personality the teacher is.
Reinforce – Seek reinforcement and assurance from the children in order to provide them with assurance and solid ground to fall on.
Benefit of making health education a core course for teacher education
The awareness and ability to understand the causes and problems associated with mental disorders goes a long way to prevention, management and treatment of these problems, making teaching and learning conducive, effective and enjoyable. Therefore there are lots to benefit from introducing school health education with emphasis on mental health into teachers curriculum. The summary of the benefits are these:
Teachers will be able to discover themselves and relate well with their colleagues and students.
It will enable teachers to understand their students’ inadequacies and problems.
Teachers will find it easy to assist their students in reducing the effects of their problems on their academic and relationship with other people inside and outside the school.
Students will have confidence in discussing their problems with their teachers, sharing their dreams with them with the aim of getting valuable advice and support from them.
Relationship between teachers and students will be more cordial, helpful and effective.
Both teachers and students will develop the ability to come to terms with the environment, adjust to situations and blend with people, their inadequacies not withstanding.
All these are attributes that can improve on teaching learning and lay solid foundation for development of a whole man in a child to meet society expectation.
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