Evaluation of secondary school teachers' knowledge about psychosis: a contribution to early detection

A survey of suicide literacy in Japanese school teachers

School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students' suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher's responsibility. Intention to ask about students' suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s-60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers' suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

Mental health knowledge and classroom experiences of school teachers in Aragon, Spain

Background

Research shows that many mental disorders begin in childhood but are sometimes not diagnosed until later years. School-age children spend much of their time in schools and have daily interactions with school teachers.

Aim

Examine school teachers' experiences of mental disorders in school going children and adolescents and their associated mental health training needs.

Method and sample

A descriptive cross-sectional study was carried out with teachers in Infant-Primary and Secondary Education-Baccalaureate schools.

Results

A convenience sample of 685 teachers responded to the online survey. Participants worked in both urban and rural areas and in Infant-Primary and Secondary Education-Baccalaureate schools. Over half of participants reported classroom experiences of learner mental disorders such as ADHD, anxiety, conduct disorders or autism. Most participants acknowledged a training need, both in recognition of symptoms of mental disorders and in care resources and processes. However, 80% of respondents reported having not received any training in this regard. Participant preferences for training included face-to-face or hybrid - combined online learning. Participants also considered the management of their own mental health to be deficient, therefore any training should incorporate personal mental health awareness and self-help strategies.

Conclusion

In Aragón (Spain), teachers of children and adolescents with mental disorders, recognize a need for training in the identification of symptoms and other aspects of mental healthcare, such as availability and access to services. Protocols for early identification and referral would promote mentally healthy school environments and reduce stigma which could be a barrier to timely intervention. In addition, any training should include mental health self-care for teachers.

A survey of mental health literacy in Japanese high school teachers

BACKGROUND

School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers.

METHODS

Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students.

RESULTS

The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%).

CONCLUSIONS

MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems.

Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review

AIM

Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment.

METHOD

This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school.

RESULTS

In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature.

CONCLUSION

Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.

Mental health literacy programs for school teachers: A systematic review and narrative synthesis

AIM

The prevalence of mental disorders increases sharply during adolescence. Therefore, school teachers are in a good position to provide initial assistance to students with mental health problems. Although effects of a number of mental health literacy programs aimed at teachers have been reported, they have not yet been reviewed in a systematic manner. This study conducted a systematic review of the effectiveness of mental health literacy programs for teachers.

METHODS

PubMed, PsycINFO, CINAHL, ERIC, Web of Science and reference lists of included studies were searched in September 2018. Studies that quantitatively measured at least one of the main components of mental health literacy, including (a) knowledge of mental illnesses, (b) stigma towards mental illnesses, (c) confidence in helping students, and (d) behaviour of helping students, were included regardless of study design. Risk of bias was rated for each included study according to the Cochrane tool for randomized studies and the Cochrane tool, for raondomized studies, and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS), for nonrandomized studies.

RESULTS

Sixteen studies met the inclusion criteria, including 1 randomized controlled trial (RCT), 2 cluster RCTs, 1 controlled before-and-after study and 12 case series. Most of the studies claimed significant improvement of knowledge, attitudes, behaviour and/or confidence. However, the overall quality for all outcomes was relatively low; 15 studies had high/unclear risk of bias due to lack of allocation concealment, not controlling for confounders, and/or inadequate analysis for attrition.

CONCLUSIONS

More high quality evidence is required before the effectiveness of mental health literacy programs for teachers can be established.

Secondary school teachers and mental health competence: Italy-United Kingdom comparison

AIM

The aim of this study was to evaluate the differences between teachers' knowledge about early psychosis among three different Italian cities and a UK sample.

METHODS

The sample consisted of 556 secondary school teachers from three different cities in Italy (Milan, Rome and Lamezia Terme) and London (UK). The research was based on the Knowledge and Experience of Social Emotional Difficulties Among Young People Questionnaire. The Italian version of the questionnaire was used in Italy.

RESULTS

Overall, 67.6% of English teachers, 58.5% of Milan's teachers, 41.8% of Rome's teachers and 33.3% of Lamezia Terme's teachers were able to recognize psychotic symptoms from a case vignette. Logistic regression analysis showed that 'city' was the only independent variable significantly related to the correct/wrong answer about diagnosis.

CONCLUSIONS

We found statistically significant differences between the three Italian samples and the UK sample regarding teachers' knowledge about first signs of psychosis. English teachers showed a better knowledge than Italian teachers in general. Teachers from Milan, where a specific early detection program was established in 2000, seemed to be more familiar with early signs of psychosis than teachers in the other two Italian towns.

Use of the Theory of Planned Behaviour to assess factors influencing the identification of students at clinical high-risk for psychosis in 16+ Education

BACKGROUND

The longer psychotic disorders are untreated the worse their prognosis. Increasing the awareness of early psychosis by professionals who come into regular contact with young people is one strategy that could reduce treatment delay. As teachers engage with students on a daily basis, their role could be exploited to increase awareness of the early signs of psychosis. This study employed the Theory of Planned Behaviour (TPB) to identify and measure factors that influence identification of students at high-risk (HR) of developing psychosis in 16+ educational institutions.

METHODS

An elicitation phase revealed beliefs underlying teachers' motivations to detect HR students and informed the construction of a preliminary 114-item questionnaire incorporating all constructs outlined in the TPB. To define the determinants of teachers' intention to identify HR students, 75 teachers from secondary and further education institutions in 12 counties surrounding Cambridgeshire completed the questionnaire. A psychometric model of item response theory was used to identify redundant items and produce a reduced questionnaire that would be acceptable to teachers.

RESULTS

The final instrument comprised 73 items and showed acceptable reliability (α  = 0.69-0.81) for all direct measures. Teacher's confidence and control over identification of HR students was low. Although identification of HR students was considered worthwhile, teachers believed that their peers, students and particularly their managers might not approve. Path analysis revealed that direct measures of attitude and PBC significantly predicted intention, but subjective norm did not. PBC was the strongest predictor of intention. Collectively, the direct measures explained 37 % of the variance of intention to identify HR for psychosis.

CONCLUSIONS

This research demonstrated how the TPB can be used to identify and measure factors that influence identification of students at HR of developing psychosis in 16+ educational institutions and confirmed the feasibility, reliability and acceptability of a TPB-based questionnaire for teachers. Consideration of the key determinants of identification in schools will facilitate the design of successful educational intervention strategies with the potential to reduce treatment delays for HR students.

Promoting Mental Health Literacy Among Educators

Teachers and other school staff play key roles as partners in the prevention, identification, and intervention of mental health difficulties among children and youth. However, it is essential that teachers are equipped with sufficient mental health literacy to engender effective practices in these areas. This article reviews the literature related to mental health literacy with respect to the perceived preparedness of teachers as well as approaches that have been taken or are under way to improve literacy. A specific focus on bullying is also highlighted. Finally, suggestions emerging from current research as to the elements of effective approaches to teacher preparation are explored as well as recommendations for future research in the area.