Parents' communication to primary school-aged children about mental health and ill-health: a grounded theory study

How to Approach a Child About Concerns for Their Mental Health and Seeking Help: A Delphi Expert Consensus Study to Develop Guidelines on Mental Health First Aid for Supporting Children

BACKGROUND

Adults who live or work with children are an important source of support and are gateways to professional help when a child is experiencing a mental health problem. This study aimed to develop consensus-based guidelines on how adults such as parents, educators or health professionals should approach a child aged 5-12 years to discuss concerns about the child's mental health and seek help.

METHODS

A Delphi consensus method with three rounds was used. Experts were recruited from six countries to form three panels: health professionals, educators and people with lived experience (parents and carers, and young people with mental health problems). Statements to be rated were sourced from an online search of websites designed for adults who live or work with children. Further suggestions for statements came from panellists. Statements that reached 80% consensus across all panels were included in the guidelines.

RESULTS

132 participants completed the Round 1 survey, reducing to 54 by Round 3. A total of 248 statements were presented to panel members, with 151 being endorsed and included in the guidelines.

CONCLUSIONS

These guidelines represent the first recommendations developed for members of the public providing mental health first aid to children aged 5-12 years.

PATIENT OR PUBLIC CONTRIBUTION

Lived experience advocates (i.e. those with lived experience of a mental health problem in childhood and/or caregiving experience of raising a child with a mental health problem) were involved at two stages of this research: As part of the Advisory Group for the project and as expert panel members. Advisory Group members provided input into the conduct of the study and the content and design of the research outputs. Panel members provided their expertise to review every item to be included in the guidelines, proposed new items to be included, and reviewed and approved the finalised output documents.

“We could end up in a lot of trouble”: teachers’ communications with young children about mental health

Purpose

– Stigma towards people with mental health problems is a significant problem and appears trenchant despite recent anti-stigma campaigns. Attitudes develop in young children, and may be stronger and less malleable in adolescence. Early intervention may be important for mental health education and stigma prevention. Theory, evidence and practical considerations all suggest that teachers’ involvement is key. By exploring communication about mental health between teachers and young children, it will be possible to elaborate how stigma develops and may be ameliorated. The purpose of this paper is to explore teachers’ accounts of this communication and the factors that influence it.

Design/methodology/approach

– Semi-structured interviews with 15 primary school teachers were transcribed and analysed using a grounded theory approach.

Findings

– Discussions about mental health were largely absent from the classroom, due to teachers’ anxiety. Teachers felt the need to protect children from exposure to people with mental health problems and even from information about the topic, believed they lacked the necessary expertise, worried that such discussions were outside their remit and were anxious about parents’ reactions.

Originality/value

– This was the first study to interview teachers on this topic and suggests that a significant opportunity to address fear and stigma is being missed. Teachers’ silence may reinforce that mental health problems are taboo, and prevent children from developing knowledge and a language to talk about mental health. The inclusion of teachers in early mental health education and could promote better understanding and more inclusive attitudes, especially if supported by educational policy and curriculum.