Children, stress and everyday life
● Protecting children from stress could affect their ability to function in their everyday life
Can you tell us about the training programme?
Kutcher: What we are doing is bringing to Malta an educational mental health intervention that has been studied and applied in many countries around the world. It is highly effective for not only students, but also teachers, as it focuses on understanding mental health and mental health literacy.
Camilleri: Mental health literacy would include things like not using ‘anxiety’ or ‘depression’ to describe everything. For example, it is normal to experience stress before an exam; otherwise, it would not be a challenge. It is important not to bubble wrap kids, as people tend to work best when under pressure. A moderate level of stress, for instance, motivates students to pick up a book and study.
Does the programme’s title reflect the situation in Malta?
Saliba: The idea is that we should not over protect our children, because this will impair their growth and development. One of the topics we discussed is how to distinguish mental distress from mental disorder. A certain level of stress can be helpful, challenging you to overcome obstacles and reach your full potential. Bubble wrapping children disrupts this sort of development.
How can one distinguish between good stress and that which is toxic?
Saliba: Stress is harmful when it leads to functional impairment; in other words, when it begins to interfere with daily activities. This could include somatic symptoms, changes in appetite, altered sleep patterns, as well as interpersonal issues.
Camilleri: Protecting children from stress impairs their ability to cope with everyday life, which is full of different stresses. If stress is prolonged, then it may develop into a mental disorder. Still, we should remember not use labels. For example, we should not say ‘This child has ADHD; we need to sort him out.’ It would be more helpful to say ‘This child struggles to sit still in class. Is there anyone who can help us with this?’
Is labelling entrenched in our education system and, if so, what does the training programme aim to do about it?
Kutcher: Labels are for soup cans; diagnoses are for people. It is important to diagnose people with mental disorders, but it is also important not to misdiagnose those who are not suffering from any disorder. This programme tries to teach teachers, parents and students to use the right words to describe what they see and not to jump to conclusions.
Has there been a rise in young people claiming to have a mental disorder or suffering from extreme stress? If so, why do you think this is?
Saliba: We know that most mental disorders usually develop before the age of 25. The aim of this course is to identify them early. There are a number of reasons why stress has increased over time, such exams, applying for university, relationships, breakups and childhood trauma. This can affect a child’s academic performance and relationships as well.
Kutcher: The prevalence of mental disorders has not changed over the past 40 years. What has changed in the last decade is the increase of self-reporting/self-identifying. As people start learning more about mental illness, they start questioning whether they also have one and seek help.
We also have a big problem with young people interpreting normal, acute stress as ‘abnormal’. If they feel unhappy, they assume they have depression; if they feel nervous, it means they suffer from anxiety. So they seek help for normal feelings, and this causes huge problems as it leads them to believe they are unwell. It also increases the demand for health services, which are already limited, to the detriment of patients in genuine need of treatment. The poor and disadvantaged are hit the hardest by this.
Camilleri: Self-reported studies show that 25% of young people are depressed, but the reality is they do not meet the full criteria for depression. They might be feeling sad and low, but this is not clinical depression. So we need to be aware of the language we use. We also touch upon the notion of stigma in mental health illnesses.
How is teaching of mental health literacy helping to decrease stigma?
Kutcher: One of the things that people are learning about is how to use a curriculum resource in schools and how to teach that resource. As part of that, young people and teachers are being taught to understand stigma and are being given the tools to decrease such stigma. The result, as evident from research carried out in other countries, is that the stigma surrounding mental health decreases and remains low. That is very positive. Once these adolescents grow up, they continue to carry this sense of understanding and, over time, we will see decreases in stigma. Teachers are extremely important people; they have an important place in the social hierarchy. Once they themselves become less stigmatised, we will see an impact on a wider level.
Do you believe that the education system is at fault when it comes to this inability to cope with stress?
Camilleri: I think that rather than a fault, we are all trying to improve our knowledge of mental health. The more we know, the more we can help and be effective. This is something cultural, and probably even international, where we assume that a child is anxious or depressed, which is probably not the case. I believe it is down to the language we use. Everything is connected.
Saliba: We should acknowledge that this training programme is also tied with the Ministry for Education. Taking on this curriculum is a very positive step forward.
What do you hope this conference will achieve?
Saliba: We hope that this mental health guide will be implemented as part of the school curriculum. We hope that students can better appreciate mental health and mental health disorders, reducing stigma.
Kutcher: The health and education sectors should work together more often. I feel that it is wonderful that the minister for education has direct knowledge of the issue and has expressed a great interest in it. That kind of dedication increases the chances of success.
Dr Stan Kutcher, Emma Saliba and Dr Nigel Camilleri