mental health

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
22nd 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)
 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).
 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).

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

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

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

7. Social wellbeing
 access to services
 self-respect and dignity
 clean and free environment
 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
 displacement
 poverty
 poor housing conditions
 conflicts within family and community
 social exclusion and isolation

12. What reduces community
mental health and
wellbeing?
 injustice and discrimination
 urbanization
 communicable diseases
 work stress
 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 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
 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
 do not take treatment as prescribed
 mess up family/home affairs
 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
 misuse psychoactive substance
 show hostility
 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
 50% of the patients experienced disharmony with their families
 1/3rd of the patients were considered a burden to the family
 Only 1/4th of the patients received better family care
 1/3rd 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
Interventions
Social
Medical (treatments)
Strengthening resilience and support
Individual
Family
Community
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
 Ayurvedic, siddha and sinhala medicine
 Astrological consultation – palm/ horoscope
reading
 Healing rituals – bodhi pujas, exorcism
 Practical advice based on dhamma – pirith
chanting, medication
 Healing at temples, churches and mosques

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

26. Recommendations for developing
community-based mental health
services
Principles:
 Bottom-up approach:- ‘home-grown’
 Involve local community organizations (e.g.
schools, temples, churches, mosques, etc. )
 Culturally and socially acceptable/sensitive
 Include marginalized groups
 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
 Child neglect, ill-treatment and poor care
 Malnutrition
 Traumatic experiences – loss of family members,
displacement, detention, physical injuries
 Substance abuse
 Sexual abuse and child prostitution
 Child trafficking and labour
 Domestic violence

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

29. Mental health problems
of children (1)
May present as:
 emotional problems such as phobias,
excessive anxiety, depression, irrational fears
 Unusual behaviour / conduct such as
aggressiveness, timidity
 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
 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)

31. Mental health problems
of children (3)
 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)

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
 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
 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)
 Providing a safe context for children to
talk
 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)
 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
 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

37. Prevention of mental
health problems (2)
 Educating parents and community
members on risk and protective
factors of mental health
 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 remain accessible and
responsive to their needs?
 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
 Fostering partnerships between school
and community agencies, service
providers etc.
 Strengthening community support
networks

40. Factors that enhance
resilience among children
 Positive role models
 Positive self-esteem
 Supportive relationships with teachers
and friends
 A sense of hope and purpose
 Belief in one’s self
 Strong social skills
 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 peers from various communities and social
classes
 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.)
 Maintain a sense of self-worth as well as respect for others
 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)

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

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