Children and youth today are experiencing stress and anxiety more than ever before. Various factors contribute to this increased stress during adolescence, and include use of technology, social media, peer pressure and bullying at schools. One of the consequences of this increased stress and anxiety is a corresponding increase in mental health problems in young people. Research shows that that when young people have the knowledge, attitudes and competencies to understand mental health and wellbeing and how it impacts their lives, they are better able to help themselves and others.
Research also shows that mental health issues in adults can be prevented if there is a proactive approach taken from a young age. It is thus very important for us a society to equip young people with the right knowledge and tools from a young age. This means that schools, both primary and secondary, are key to addressing this issue of mental health. This is recognised by the Government, as evidenced by portions of the curriculum designed to address this, but delivery of the well-being programmes have been so disjointed and incoherent that they are ineffective. A new way is required in our approach to teaching mental health in schools.
Background: Youth mental health
The World Health Organisation (WHO) describes the adolescent years of age 10-19 as a uniquely formative time, during which young people are most vulnerable to mental health problems. The adolescent brain is still growing during this age, and the prefrontal cortex, that part of the brain that controls self-regulation, is still immature meaning adolescents have limited ability to exert control over their impulses. Simultaneously, they are experiencing major physical, emotional and social changes, all of which have a direct impact on mental wellbeing. This impact can be negative, especially when other factors like poverty, abuse, or violence are also at play.
While there is not one single factor that determines whether or not an adolescent will have mental health problems and to what degree, experts agree that multiple risk factors exist and the more risk factors adolescents are exposed to, the greater the potential impact on their mental health. These factors include the excessive use of technology, and social media. Researchers have found that there is a strong correlation between screen time and teen mental disorders. The fact that adolescents are spending more time on media screen activities and less time on non-screen activities is believed to account for the increases in depression and suicide, as the former takes time and energy away from meaningful and resilience building activities like inter-personal relationships, education, and extracurricular activities. Covid-19 has further heighten these issues. Other factors include a decreased ability to cope with challenges and increased attention to social media with its unrealistic portrayal of life, which has become a major source of anxiety and depression for young people. Bullying in schools is also a widely recognised factor.
The most common mental disorders in adolescents include:
- Anxiety disorders
- Social phobias
- Stress-related disorders
- Mood disorders
- Obsessive-compulsive disorders and
- Disruptive behavioral disorders
Irish adolescents are not immune to this common trend. According to research by the Royal College of Surgeons of Ireland, by the age of 13 years, 1 in 3 young people in Ireland are likely to have experienced some type of mental health difficulty. By the age of 24 years, that rate had increased to over 1 in 2. The same study showed that young Irish adolescents in the 11-13 year age range have higher current rates of mental health disorders than similarly-aged young adolescents in both the USA and the UK.
More recently, while speaking at a National Policy Forum seminar about the provision of mental healthcare for Irish children, Senator Joan Freeman drew attention to the fact that Irish 11-15-year-olds are the second-highest group in Europe to present with emotional issues on a weekly basis.
The largest ever study of mental health in Ireland’s youth found equally alarming results. Led by University College Dublin (UCD) School of Psychology and the National Centre for Youth Mental Health, the study involved over 19,000 young people across Ireland and was a follow-up of a 2012 study. The results, presented in My World Survey 2, found that the proportion of adolescents reporting severe anxiety had doubled from 11% in 2012 to 22% in 2019. It also found that there had been an increase in the proportion of adolescents who fell into the severe and very severe categories for depression, from 8% in the first survey to 15% in the new one.
An oft-quoted report by UNICEF further highlights the depth of the problem: According to a UNICEF Report Card on child well-being, Ireland has the fourth highest teen suicide rate in the EU/OECD region. Ireland has an above average international (10.3) suicide rate amongst adolescents aged 15-19 per 100,000 population, leading to a ranking of 34th out of 37 wealthy nations surveyed.
In view of the foregoing, it is important that any efforts to address mental health issues among young people must take into consideration the avenues and methods by which those interventions are delivered. For young adolescents, one of the most important settings for the promotion of mental health and well-being is the school.
The role of schools
Schools play a vital role in the promotion of positive mental health in adolescents. Often schools can be the setting for the stresses that lead to mental health struggles – bullying, academic struggles, lack of school connectedness – all these are stressors that young people may deal with on a daily basis. At the same schools present a unique opportunity to address mental challenges and equip adolescents to cope. Students spend about one-third of each day and about half the year in school. This represents a significant chunk of the child’s life, which can be leveraged to build mentally healthy young people who grow into mentally healthy adults.
Schools can also provide a safe and supportive environment for building life skills and resilience and a strong sense of connectedness to school. Listening to the voice of the child and fostering healthy relationships with peers, teachers and school staff are essential to children’s positive experience of school and their cognitive and emotional development. The needs and well-being of school staff are also of paramount importance.
Current research clearly identifies the importance of mental health to learning, as well as to students’ social and emotional development. Students who experience positive mental health are resilient and better able to learn, resolve problems better, develop psychologically, emotionally, socially, intellectually, spiritually, build healthy inter-personal relationships and achieve success. Given the important relationship between positive mental health and academic success, schools have an important role in nurturing students’ positive mental health and well-being.
There is no doubt that the Government recognises both the challenges associated with youth mental health and the role that schools can play. The Department of Health and the Department of Education and Skills have either developed or collaborated with other relevant actors on a range of efforts designed to bring increased attention to mental health and to promoting health and wellbeing in schools. These have found outlets through policies including the Framework for Developing a Health Promoting School, Well-Being in Post-Primary Schools Guidelines for Mental Health Promotion and Suicide Prevention, and Responding to Critical Incidents: Guidelines and Resource Materials for Schools.
Efforts have been made to meet the challenge head on through the creating on inclusion of Social, Personal and Health Education (SPHE) as part of the core curriculum of the primary and secondary school system. SPHE has been a part of the curriculum for five to 14 year olds since 1999, and became a mandatory curriculum subject for 15- 18 year olds from September 2004. Aspects of wellbeing are present in several curriculum areas of the SPHE as well as in and physical education. The wellbeing component of SPHE is designed to facilitate health and wellbeing and equip students to maintain supportive relationships. It provides opportunities for teaching and learning directly related to health and wellbeing and is designed to provide a unique opportunity where students can develop the skills and competences to learn about themselves, to care for themselves and others and to make informed decisions about their physical, social, emotional and spiritual health and wellbeing. The physical education aspect, on the other hand is designed to facilitate wellbeing through the promotion of physical activity and a range of other experiences.
Wellbeing is also central to the Aistear: Early Childhood Curriculum Framework. These policy frameworks and curriculum contexts have made a significant contribution to the growing awareness of the importance of schools in promoting wellbeing.
Limitations of approach
Despite these important steps, the approach to teaching mental health in schools suffers from a critical flaw: There are no standard teaching materials to ensure uniformity or comparability of outcomes. The Department of Education leaves it to schools to decide how they wish to implement the well-being programme into schools. Each school has the autonomy to design its own programme drawing on the different components set out in the curriculum.
No doubt the intention behind this approach is well meaning. The goal, it seems, in leaving the responsibility with the management authority of each school to design its own wellbeing programme, within set guidelines, is to ensure that each programme adopted suits the needs and interests of its students.
However, this goal is not being met as schools often do not have the time, resources or expertise to develop such programmes, and therefore resort to third parties who may not be able to offer that school-specific perspective that this individual approach is meant to achieve. The result of this approach is that schools run with lots of different programmes supplied by a wide range of actors with varying levels of expertise and knowledge in the field of mental health. These course content providers span all sectors, including not-for-profits, private companies and even individuals.
Challenges with SPHE
While the Department of Education has made major strides in incorporating mental health teaching into schools, the current approach needs to be revamped as it is counterproductive. Questions about the effectiveness of schools’ mental health programmes are getting louder, with experts asserting that what we are seeing as a result of these programmes is considerable growth in awareness and conversation about young people’s mental health, an over-emphasis on well-being, but not effective teaching and not necessarily in a manner conducive to helping young people. There is no doubt that the piecemeal, incoherent manner in which the mental health is approached plays a big role in these questions about the effectiveness of the mental health curriculum. To make matters worse, wellbeing classes (through SPHE) are squeezed into 30 minutes a week, which is clearly insufficient. There is no evidence that the SPHE curriculum is achieving its purpose. On the contrary, research, including those earlier cited shows it is not working.
In fact, even the Department of Education’s own research shows this. As part of an ongoing evaluation of curriculum implementation, the Inspectorate conducted a thematic evaluation of SPHE in forty primary schools. Teaching and learning were observed by inspectors. Teachers, management and pupils were also interviewed, and parents and senior pupils were surveyed in order to gain insight into what was happening in the provision of SPHE.
The results showed that while much progress had been made in the implementation of the SPHE curriculum, several challenges remain:
- While all schools evaluated had a whole-school plan for SPHE, signification variation was found in both the quality of the plan and in the level of consultation engaged in with the education partners in the plan’s development. Just over half the plans were judged to be of a competent standard.
- Piecemeal lesson planning by individual teachers was identified, and the report pointed out that there was scope for development in whole-school planning in almost one-third of schools inspected. The inspectors had found that in these schools, there were no clear programmes of work for individual class levels or guidelines to inform teachers’ around individual planning and reporting. As a result, there was obvious potential for ad hoc, uncoordinated delivery of themes to occur at each class level.
- In almost all schools evaluated, the teaching staff developed plans for SPHE. The plans were then presented to and ratified by the board of management and communicated to varying extents to the school community using a variety of means.
- Class teachers were found to draw significantly from a wide range of commercially produced resources to support the implementation of the SPHE curriculum. Concern was expressed in some instances where teachers were found to be teaching to the commercially produced SPHE resource rather than basing their teaching more specifically on the curriculum objectives for their class. The inspectors found that, as a result of fewer resources being readily available to deal with some areas of SPHE, those areas were addressed less regularly and less thoroughly.
The report addressed the concern around piecemeal lesson planning by including a recommendation for whole-school planning to be the norm. It further recommended that SPHE resources should be selected for use in the school following a careful review of their suitability by the teachers. According to the report, there is a need for all schools to ensure that they are providing a broad and balanced SPHE programme in which continuity and progression in the pupils’ learning is assured. Other areas for development include building the capacity of schools to evaluate their own effectiveness and to use the outcomes of self-evaluation to promote improvements in teaching and learning and pupils’ achievement in SPHE.
The need for coherence
It is clear from these findings and recommendations that leaving it to schools to decide what they want to do is not the most effective means of equipping young people with knowledge and information (education) on mental health issues or arming them with the necessary life skills.
There is a need for more coherence and greater collaboration at Government level. The Department of Education in collaboration with the Department of Health (Health Promotion Unit) need to develop a comprehensive education programme to be delivered into schools by the Department of Education, rather than leaving it to the not-for-profit sector and private companies to address this shortfall and having lots of different programme. Well-being needs to be a well-articulated and well-defined subject driven by the Department of Education in much the same way that other subjects like English, Maths and Irish are.
The Path forward
There is no doubt that Ireland has strong foundations in place for supporting students in the area of mental health. The Department of Education has used the school system to grow awareness and conversation about mental health in young people. However, what is evident from the foregoing is that more needs to be done to ensure that schools are effectively equipped to deliver on curriculum goals.
- For one, the SPHE curriculum has not been updated for over 20 years, running the risk of obsolescence in view of the rapid changes the world has experienced in that time. It is important that the curriculum keeps pace with developments.
- Secondly, it is important that mental health and wellbeing studies are accorded more importance in the curriculum. Rather than cramming a multitude of issues into 30 minutes classes it is important that, similar to any other school subjects, wellbeing in the curriculum is specifically planned for, so that it is allocated its own time and space on the timetable and is accompanied by educational standards. This will communicate to students, parents and teachers that mental health is an important area of learning and should be taken seriously.
- It is important to introduce an enhanced mental health and well-being programme that equips and educates and is embedded in the curriculum for both primary and secondary schools. This programme needs to be driven by the Department of Education and Department of Health and utilise a standard set of resources across all schools. This will eliminate the disparity inherent in the current approach of having teachers either develop their own resources or picking and choosing from a wide variety of commercial and non-commercial resources with varying levels of usefulness.
The Cycle Against Suicide mental health school programme
While many different programmes on mental health exist from which schools can choose, one of the most popular and most widely used is the Cycle Against Suicide programmes. Our secondary schools’ programme – HEADSTRONG, which up to day, is being delivered into 618 schools across Ireland. Our primary schools’ programme which has launched in September has 890 primary schools so far signed to deliver this programme. Cycle Against Suicide schools’ programme enjoyed strong popularity due to the way it effectively integrates with the mental health curriculum of SPHE. It is delivered through a variety of pathways shown to improve engagement, learning and retention. These include:
Robust toolkits addressing important learning points, focusing on the evidence-based interventions to supporting well-being. It covers specific issues like including what mental health is, resilience, problem solving, mind-set, emotions, friendships, kindness, peer pressure, gratitude and other areas which are key.
1. Primary Schools
The Primary Schools’ Programme ‘Mind Me – Mind You’ is designed in line with the well-being curriculum to support teachers in building the foundations of good mental health education and well-being in children. It fosters the creation of healthy relationships, personal development and skills central to maintaining future health and well-being.
‘Mind Me – Mind You’ provides teachers with the resources needed to fulfil the new requirements, supporting children’s learning and development in a planned and structured manner. The programme features videos and full lesson plans for all class groups which embed a framework of values, attitudes, understanding and skills in the mindset of children that will inform their decisions and actions which impact social development and personal well-being.
Aligning with the primary schools’ well-being curriculum, this child-centred programme promotes resilience and social and emotional competence, equipping children with the knowledge and skills needed to address a multitude of life situations throughout their development.
2. Post Primary evidence-based Programme
HEADSTRONG is our secondary school programme designed as a whole school approach to mental health. It supports mental health education in schools, reduces stigma, promotes resilience and fosters a sense of belonging among young people.
Teachers are given access to a series of lesson plans and creative ideas for teaching students about the different themes and activities that coincide. These can be used in transition year, fifth year and 6th year, such in Guidance and SPHE as well as cross curricular and outside of class. It includes a strong peer-to-peer education component.
Relevance to SPHE Curriculum
Cycle Against Suicide School Programmes strengthen the four components of the school mental health curriculum in the following ways:
- Component 1:Develop students’ confidence and competence to act in support of mental health and wellbeing:
Cycle Against Suicide schools programmes help teachers and students understand mental health in all its dimensions. It uses unique learning tools to break down the nuances and intricacies of mental health issues and conditions by providing information in a way that is relatable and understandable. With knowledge that goes beyond mere familiarity with the name of conditions, teachers and students become fully competent and confident to discuss how to optimise and maintain good mental health.
- Component 2:Develops students’ self-awareness about the attitudes, values and beliefs that underpin health, personal lifestyle behaviours and choices:
Cycle Against Suicide schools’ programmes help develop practical rather than theoretical understanding of mental health. While the curriculum takes a broad strokes approach that provides general information, our programmes are designed to help students look inward, using the information in the curriculum to identify and understand how the behaviours, attitudes and values they hold or come across each day affects their mental health and those of others.
- Component 3:Develop students’ capacity to empathise with others through a greater understanding of different life experiences, motives and feelings of other individuals and groups:
Stigma is a major challenge facing those who struggle with mental health issues. Cycle Against Suicide schools’ programmes advance this element of the curriculum through a strong focus on reducing stigma, advancing the curriculum goal of empathy rather than stigma, and breaking down the shame associated with mental ill health. This sets students free to be open about their struggles and also to understand the struggles of friends or classmates.
- Component 4:Examine the factors which impact on mental health and wellbeing and develop young people’s ability to act on behalf of personal and group health and wellbeing.
Cycle Against Suicide schools; programmes enable students to put the information they learn through the curriculum to use in practical ways. It provides tools that helps each student take the right action by teaching them how to identify when they need help and where to seek help, how to help others, as well as the right coping skills and treatments for each disorder. Practical tools that Cycle Against Suicide and its diverse partners have used and proven effective are provided
Adolescence is a crucial period for developing and maintaining social and emotional habits important for mental well-being. As we are coming through Covid-19 and its legacy which includes increased mental health struggles, it is of vital importance to promote mental health and well-being in adolescents to protect them from the adverse experiences they have had due to covid-19 and other factors. Without the necessary support and knowledge equipment the negative impact on their ability to thrive will be compromised, affecting their well-being through adolescence and into adulthood.
Cycle Against Suicide calls on the Minister for Education, the Department of Education and the Department of Health to take the necessary step to ensure the curriculum and the education around mental health is improved and supported with uniformly effective schools’ resources such as Cycle Against Suicide’s school programmes. This is of crucial importance as it can save lives and help turn the tide of the dire statistics earlier referenced in this paper. As a society we have an obligation to support our young ones.
 World Health Organisation, Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
 Twenge JM, Joiner TE, Rogers ML, Martin GN. Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time. Clinical Psychological Science. 2018;6(1):3-17. doi:10.1177/2167702617723376
 Cannon M, Coughlan H, Clarke M, Harley M & Kelleher I (2013) The Mental Health of Young People in Ireland:
a report of the Psychiatric Epidemiology Research across the Lifespan (PERL) Group Dublin: Royal College of Surgeons in Ireland.
 Lisa Molloy, Irish Times, We need a co-ordinated approach to mental health in schools https://www.irishtimes.com/opinion/we-need-a-co-ordinated-approach-to-mental-health-in-schools-1.3777938
 Dooley, B, O’Connor, C, Fitzgerald, A, & O’Reilly, A, My World Survey 2 The National Study of Youth
Mental Health in Ireland. http://www.myworldsurvey.ie/content/docs/My_World_Survey_2.pdf
 UNICEF, Ireland’s Teen Suicide Rate 4th Highest in EU/OECD – UNICEF Report Card https://www.unicef.ie/2017/06/19/irelands-teen-suicide-rate-4th-highest-euoecd-unicef-report-card/
 Catholic Primary Schools Management Association, Guidelines on promoting positive mental health in primary schools published https://www.cpsma.ie/guidelines-on-promoting-positive-mental-health-in-primary-schools-published/
 Alexander, T (2002) A Bright Future for All – Promoting Mental Health in Education. www.mentalhealth.org.uk/publications. DfES (2005) Developing Emotional Health and Well-Being: A Whole-School Approach to Improving Behaviour and Attendance. www.standards.dfes.gov.uk
 Byrne, Mary & Barry, Margaret & Sheridan, Anne. (2004). Implementation of a School-Based Mental Health Promotion Programme in Ireland. The International Journal of Mental Health Promotion. 6. 17-25. 10.1080/14623730.2004.9721927.
 Dooley, B, O’Connor, C, Fitzgerald, A, & O’Reilly, A, My World Survey 2 The National Study of Youth
Mental Health in Ireland. http://www.myworldsurvey.ie/content/docs/My_World_Survey_2.pdf
 Department of Education, Inspectorate. Social, Personal and Health Education (SPHE) in the Primary School https://assets.gov.ie/25318/7fecd698c3244a1ea0131f25060deb52.pdf