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Mental Health and Wellbeing Role of Teachers Chamindra Weerackody Project Lead, Trauma and Global Health Programme McGill University, Canada & People’s.

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Presentation on theme: "Mental Health and Wellbeing Role of Teachers Chamindra Weerackody Project Lead, Trauma and Global Health Programme McGill University, Canada & People’s."— Presentation transcript:

1 Mental Health and Wellbeing Role of Teachers Chamindra Weerackody Project Lead, Trauma and Global Health Programme McGill University, Canada & People’s Rural Development Association Faculty of Education, University of Colombo 22 nd June 2010

2 Mental Health and Wellbeing ‘ Health is a state of complete physical, mental and social well-being and not merely the absence of disease ’ (WHO, 2008 – Mental Health) ‘ Health is a state of complete physical, mental and social well-being and not merely the absence of disease ’ (WHO, 2008 – Mental Health) Wellbeing: Reflects values, norms human needs etc. as perceived by people themselves (Diener and Suh, 2000; Prlleltensky et al. 2000; Myers et al. 2005). Wellbeing: Reflects values, norms human needs etc. as perceived by people themselves (Diener and Suh, 2000; Prlleltensky et al. 2000; Myers et al. 2005).

3 Mental Health and Wellbeing Understandings of ‘mental health’ and ‘mental illness’ determined by meanings given to experiences and feelings in a context of people’s culture (Marsella and White, 1982; Kakar, 1984; Kleinman, 1988a,b; Gaines, 1992; Fernando, 2002). Understandings of ‘mental health’ and ‘mental illness’ determined by meanings given to experiences and feelings in a context of people’s culture (Marsella and White, 1982; Kakar, 1984; Kleinman, 1988a,b; Gaines, 1992; Fernando, 2002). Mental health is not just a technical matter but connects with ways of life, values, and worldviews that vary across cultures. Mental health is not just a technical matter but connects with ways of life, values, and worldviews that vary across cultures. Understanding of ‘wellbeing’ (in development studies) reflects range of human experience - social, mental, spiritual, material. (Chambers 1997). Understanding of ‘wellbeing’ (in development studies) reflects range of human experience - social, mental, spiritual, material. (Chambers 1997).

4 Community perceptions of mental health and wellbeing Material wellbeing Material wellbeing Social wellbeing Social wellbeing Security Security Physical, mental and moral/spiritual wellbeing Physical, mental and moral/spiritual wellbeing

5 Material wellbeing having stable employment/livelihoods having stable employment/livelihoods having stable cash incomes having stable cash incomes access to adequate land access to adequate land having permanent, secure and spacious house having permanent, secure and spacious house

6 Social wellbeing providing good education and socialization for children providing good education and socialization for children caring for children caring for children unity and harmony within family unity and harmony within family unity and harmony within community unity and harmony within community unity and harmony with neighbouring communities/host communities unity and harmony with neighbouring communities/host communities

7 Social wellbeing access to services access to services self-respect and dignity self-respect and dignity clean and free environment clean and free environment free of alcohol and drug abuse free of alcohol and drug abuse

8 Security  a secure environment for their living without fear and outside threats  a secure physical environment and protection from natural disasters and conflicts  free movement and living without being subject to suspicion

9 Security  a peaceful atmosphere free of regular checks and intimidation from security forces.  secure and strong houses to prevent intruders  houses that ensure privacy and personal safety  community members coming together to intervene and resolve problems and issues

10 Physical, mental and moral and spiritual wellbeing  living without illness and suffering  having mental happiness  having good thoughts/feelings towards others  living with courage/endeavour, self-initiative and drive  living with wisdom (not acting on emotions/rational behaviour)  moral behaviour of community members  careful spending  living religiously

11 What reduces community mental health and wellbeing? political violence and natural disasters political violence and natural disasters displacement displacement poverty poverty poor housing conditions poor housing conditions conflicts within family and community conflicts within family and community social exclusion and isolation social exclusion and isolation

12 What reduces community mental health and wellbeing? injustice and discrimination injustice and discrimination urbanization urbanization communicable diseases communicable diseases work stress work stress alcoholism, drug abuse and sexual abuse alcoholism, drug abuse and sexual abuse

13 Psychosocial context of mental health and wellbeing (source: Prof. A.J.Marsella) Factors affecting mental health & wellbeing Implications for mental health & wellbeing Cultural abuse, destruction and collapse Confusion and conflict Oppression and domination Anger, hate & domination Humiliation Rage and revenge Powerlessness Helplessness and despair Poverty Hopelessness and misery Denigration Low esteem and worthlessness Racism, sexism and agesim Fragmentation and restrain opportunity and denies choice

14 Stigma People with mental health problems (studies in UK) 84 % experience problems in getting jobs, healthcare, mortgages (Mind survey, 2004) 55 % young people would not want anyone else to know about illness (NUS and Rethink, 2001) 49% have been harassed or attacked (Mind, Not Just Sticks and Stones, 1986) 33% report having been dismissed or forced to resign from jobs (Read and Baker, 1996) Source: Dr Suman Fernando

15 Stigma – research Stigma absent when mental illness is attributed to ‘spirit possession’ (in Sri Lanka) (Waxler, 1974) ‘brain-disease’ view of mental health problems increases stigma (in Germany) (Angermeyer and Matschinger, 2005) ‘bio-genetic cause’ view of mental health problems positively related to stigma Source: Dr Suman Fernando

16 Social costs and stigma Social costs of illness are high in terms of family breakdown, isolation, disharmony, poverty and deprivation Social costs of illness are high in terms of family breakdown, isolation, disharmony, poverty and deprivation Social stigma prevented many patients and their families seeking treatment from ‘Angoda hospital’ Social stigma prevented many patients and their families seeking treatment from ‘Angoda hospital’ Many patients preferred to go to general hospitals (psychiatry units) or private hospitals/doctors to avoid getting them labeled Many patients preferred to go to general hospitals (psychiatry units) or private hospitals/doctors to avoid getting them labeled Forceful admissions result in anger and hostile relationships between patient and families Forceful admissions result in anger and hostile relationships between patient and families Source: Dr Rasitha Perera

17 Care givers were reluctant to take the patient home and desired a long stay when patients:- were aggressive at home were aggressive at home do not take treatment as prescribed do not take treatment as prescribed mess up family/home affairs mess up family/home affairs do not have a care giver at home do not have a care giver at home Dr Rasitha Perera Family response to persons with mental illness

18 Care givers were reluctant to take the patient home and desired a long stay when patients:- are dependent on others / lack of productivity are dependent on others / lack of productivity misuse psychoactive substance misuse psychoactive substance show hostility show hostility maintain poor self care maintain poor self care Source: Dr Rasitha Perera Family response to persons with mental illness

19 Illness was the major cause for many patients to remain single, separated or divorced Illness was the major cause for many patients to remain single, separated or divorced 50% of the patients experienced disharmony with their families 50% of the patients experienced disharmony with their families 1/3 rd of the patients were considered a burden to the family 1/3 rd of the patients were considered a burden to the family Only 1/4 th of the patients received better family care Only 1/4 th of the patients received better family care 1/3 rd of the care givers were not satisfied with the current status of the patient 1/3 rd of the care givers were not satisfied with the current status of the patient Source: Dr Rasitha Perera Family response to persons with mental illness

20 Promoting mental health and wellbeing InterventionsSocial Medical (treatments) Strengthening resilience and support IndividualFamilyCommunity Promoting recovery ( ‘ recovery approach ’ ) Developing hope Overcoming barriers Social inclusion Source: Dr Suman Fernando

21 Mental Health Interventions Medical model:  Problems identified by symptoms of individuals  ‘ Illness ’ represents bio-medical pathology Source: Dr Suman Fernando

22 Mental Health Interventions Medical model:  Help is via individual treatments - Biological (medication, ECT) - Psychological (e.g. ‘ talking therapies ’, CBT )  Environmental manipulation e.g. therapeutic communities, advice, education, family support Source: Dr Suman Fernando

23 Mental Health Interventions Social model:  Origin / cause of MH problems are social  ‘Illness’ is socially constructed  Help is via social interventions and support involving family, community, living conditions etc. Source: Dr Suman Fernando

24 Healing systems accessed by people in Sri Lanka Western medicine including psychiatry Western medicine including psychiatry Ayurvedic, siddha and sinhala medicine Ayurvedic, siddha and sinhala medicine Astrological consultation – palm/ horoscope reading Astrological consultation – palm/ horoscope reading Healing rituals – bodhi pujas, exorcism Healing rituals – bodhi pujas, exorcism Practical advice based on dhamma – pirith chanting, medication Practical advice based on dhamma – pirith chanting, medication Healing at temples, churches and mosques Healing at temples, churches and mosques

25 Mental health promotion develop ‘balanced care’ = hospital care + community care (mixture of medical and social models) develop ‘balanced care’ = hospital care + community care (mixture of medical and social models) Work as multi-disciplinary teams Work as multi-disciplinary teams support traditional healing systems support traditional healing systems promote family and community support promote family and community support integrate with community development integrate with community development social inclusion and participation social inclusion and participation reduce risk factors reduce risk factors

26 Recommendations for developing community-based mental health services Principles: Bottom-up approach:- ‘home-grown’ Bottom-up approach:- ‘home-grown’ Involve local community organizations (e.g. schools, temples, churches, mosques, etc. ) Involve local community organizations (e.g. schools, temples, churches, mosques, etc. ) Culturally and socially acceptable/sensitive Culturally and socially acceptable/sensitive Include marginalized groups Include marginalized groups Integrate local knowledge with outside ‘expertise’ Integrate local knowledge with outside ‘expertise’ Ref: Weerackody and Fernando, 2009

27 Factors affecting mental health and wellbeing of children Lack of access to education and facilities Lack of access to education and facilities Child neglect, ill-treatment and poor care Child neglect, ill-treatment and poor care Malnutrition Malnutrition Traumatic experiences – loss of family members, displacement, detention, physical injuries Traumatic experiences – loss of family members, displacement, detention, physical injuries Substance abuse Substance abuse Sexual abuse and child prostitution Sexual abuse and child prostitution Child trafficking and labour Child trafficking and labour Domestic violence Domestic violence

28 Factors affecting mental health and wellbeing of children Family break downs e.g. divorce, separation, desertion Family break downs e.g. divorce, separation, desertion Recruitment as child soldiers Recruitment as child soldiers Parents working abroad Parents working abroad Competition and pressures for ‘achievement’ Competition and pressures for ‘achievement’ Disabilities Disabilities

29 Mental health problems of children (1) May present as: emotional problems such as phobias, excessive anxiety, depression, irrational fears emotional problems such as phobias, excessive anxiety, depression, irrational fears Unusual behaviour / conduct such as aggressiveness, timidity Unusual behaviour / conduct such as aggressiveness, timidity Inattention / overactivity at school or home Inattention / overactivity at school or home

30 Mental health problems of children (2) May present as: Difficulties / delay in acquiring certain skills such as speech, writing, reading Difficulties / delay in acquiring certain skills such as speech, writing, reading Problems in attachment to parents or caregivers such as not showing or responding to affection (when severe may be autism) Problems in attachment to parents or caregivers such as not showing or responding to affection (when severe may be autism) Food fads / eating problems such a refusing to eat, induced vomiting (may be anorexia) Food fads / eating problems such a refusing to eat, induced vomiting (may be anorexia)

31 Mental health problems of children (3) sleeping problems such as excessive sleepiness, insomnia (may be sign of more severe illness) sleeping problems such as excessive sleepiness, insomnia (may be sign of more severe illness) Post traumatic problems such as re-living traumatic incidents (may become ‘post traumatic stress disorder’ – PTSD) Post traumatic problems such as re-living traumatic incidents (may become ‘post traumatic stress disorder’ – PTSD)

32 Dealing with Mental health problems of children Try to pick up: Special needs that child may have such as early learning difficulties, dyslexia (recognition of words and writing letters), hearing loss (early deafness), visual impairment Special needs that child may have such as early learning difficulties, dyslexia (recognition of words and writing letters), hearing loss (early deafness), visual impairment Problems in the child’s interactions with other children, teachers and others in authority Problems in the child’s interactions with other children, teachers and others in authority

33 Dealing with Mental health problems of children Family problems at home Family problems at home Difficulties in socialisation (not mixing, isolating) Difficulties in socialisation (not mixing, isolating)

34 How can the teachers help? Paying more attention to children with special needs or ‘problems’ (20-30 percent of children) Paying more attention to children with special needs or ‘problems’ (20-30 percent of children) Providing a safe context for children to talk Providing a safe context for children to talk Listening and talking to children Listening and talking to children

35 How can the teachers help? (2) Making referrals to relevant specialists (e.g. children with severe emotional disturbance, post traumatic states, eating disorders, deafness, autism, family issues) Making referrals to relevant specialists (e.g. children with severe emotional disturbance, post traumatic states, eating disorders, deafness, autism, family issues) Enabling children to develop appropriate life-skills, self-esteem and resilience Enabling children to develop appropriate life-skills, self-esteem and resilience

36 Prevention of mental health problems (1) Acquiring professional skills in understanding child development and mental health Acquiring professional skills in understanding child development and mental health Creating a supportive school environment that is conducive to learning and developing life skills Creating a supportive school environment that is conducive to learning and developing life skills Providing mental health education, knowledge, attitudes and behaviours to all children Providing mental health education, knowledge, attitudes and behaviours to all children

37 Prevention of mental health problems (2) Educating parents and community members on risk and protective factors of mental health Educating parents and community members on risk and protective factors of mental health Identifying factors that place children at risk and reinforcing protective factors Identifying factors that place children at risk and reinforcing protective factors

38 Challenges for teachers How can we provide a safe and supportive environment in which all students can maximize their learning? How can we provide a safe and supportive environment in which all students can maximize their learning? How can we remain accessible and responsive to their needs? How can we remain accessible and responsive to their needs? How can we assist our students to develop their ability to cope with challenges and stress? How can we assist our students to develop their ability to cope with challenges and stress?

39 Providing supportive context for children Liaising with families, parents and care-givers e.g. home visits Liaising with families, parents and care-givers e.g. home visits Fostering partnerships between school and community agencies, service providers etc. Fostering partnerships between school and community agencies, service providers etc. Strengthening community support networks Strengthening community support networks

40 Factors that enhance resilience among children Positive role models Positive role models Positive self-esteem Positive self-esteem Supportive relationships with teachers and friends Supportive relationships with teachers and friends A sense of hope and purpose A sense of hope and purpose Belief in one’s self Belief in one’s self Strong social skills Strong social skills Good peer relationships Good peer relationships

41 What are Life-Skills? Skills that enable people to: Live in harmony with parents, teachers and others in authority Live in harmony with parents, teachers and others in authority Live in harmony with peers from various communities and social classes Live in harmony with peers from various communities and social classes Make socially & culturally appropriate relationships Make socially & culturally appropriate relationships Make decisions that are in keeping with social and cultural norms (ethical values, expectations of kith and kin, worldviews, etc.) Make decisions that are in keeping with social and cultural norms (ethical values, expectations of kith and kin, worldviews, etc.) Maintain a sense of self-worth as well as respect for others Maintain a sense of self-worth as well as respect for others Deal with adversity in socially acceptable and culturally appropriate ways Deal with adversity in socially acceptable and culturally appropriate ways

42 Specific Life-Skills Specific skills would depend on social and cultural context in which the person lives – so would vary and the specifics of the skills required would change as society changes and / or person moves (e.g. migrates) Specific skills would depend on social and cultural context in which the person lives – so would vary and the specifics of the skills required would change as society changes and / or person moves (e.g. migrates)

43 Western and Non-Western Understandings of Life Skills WesternNon-western Decision-making and problem solving analyzing information and experiences objectively and making decisions based on facts analyzing information and experiences objectively and making decisions based on facts adherence to cultural norms and seeking guidance from elders and spiritual influences adherence to cultural norms and seeking guidance from elders and spiritual influences Communication ability to express views and opinions directly ability to express views and opinions directly indirect expression of views, respecting views of other people, and dependence on family indirect expression of views, respecting views of other people, and dependence on family Independence Depend on oneself primarily and maximize self-confidence Depend on oneself primarily and maximize self-confidence respecting opinions of others and more accepting of dependence on others respecting opinions of others and more accepting of dependence on others

44 Western and Non-Western Understandings of Life Skills WesternNon-western Coping with emotions Recognizing emotions, controlling emotions and expressing emotions in acceptable ways Recognizing emotions, controlling emotions and expressing emotions in acceptable ways wide cultural variation in expression of emotions and need to control emotions wide cultural variation in expression of emotions and need to control emotions Coping with stress Understanding causes of stress and controlling stress Understanding causes of stress and controlling stress cultures vary a great deal in ways of dealing with stress – some prefer acceptance of control cultures vary a great deal in ways of dealing with stress – some prefer acceptance of control


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