Adolescents are a susceptible age group in any society. Their mental health impacts their personal and academic life. Policies that shape adolescents’ lives are crucial to the future growth of a country. According to a 2017 report by intergovernmental public health agency the World Health Organization, 50% of mental health problems occur before the age of 14. This is critical because this accounts for 13% of the worldwide illness burden. Experts estimate that 16–18% of Bangladesh’s children and teenagers suffer from mental illnesses. An overwhelming number of these cases go unnoticed and untreated for long periods of time.
Research by psychiatrists Gustavo Turecki and David Brent reveals that school students are struggling to succeed academically and socially. Disengagement from school, limited social-emotional competencies and mental health difficulties represent a few explanations for this. Some innovative school-centric practices from around the world have promoted good mental health. These are basically social and emotional sensitising programmes. Notable among these are the ‘Collaborative for Academic, Social, and Emotional Learning’ in the US, ‘KidsMatter’ in Australia and ‘Social and Emotional Aspects of Learning’ in the UK.
These country-wide programmes have also been shown to improve academic achievement. Adoption of these innovative approaches has suggested that schools can address mental health through reforming behavioural policies, curriculum design and support systems for students, staff and parents. Given their good results, there are lessons for Bangladesh to learn. Unfortunately, Bangladesh has a severe lack of research on the topic of mental health and school preparedness, for which policy recommendations are hard to pose.
Bangladesh has a severe lack of research on the topic of mental health and school preparedness, for which policy recommendations are hard to pose.
Mental health literacy gap
To address the research gap, the authors conducted an in-depth independent study via a series of consultations with relevant stakeholders. This article focuses on the study findings: the role of schools and teachers, in Bangladesh’s policy context, in addressing mental health issues among adolescents. The study explored the challenges that affect grassroots-level teachers/schools in handling cases of mental health. It targeted all major quarters of Bangladesh’s education system:
- Bangladesh’s two main linguistic schools: Bengali and English mediums;
- The two early stages of schooling: primary and secondary levels;
- Bangladesh’s three major areal-density divides: urban, rural and the autonomous hilly areas;
- Bangladesh’s two main formats of schools: secular and faith-based Islamic schools known as Madrasas.
The findings of the study that have implications for Bangladesh’s policymakers fall into three areas: 1) the state of mental health interventions based on adolescents’ perceptions, 2) the state of mental health interventions in schools and 3) impediments to mental health interventions. These essentially reflect individual, institutional and government findings. The covid-19 pandemic of 2020 has had a cross-cutting impact on all three areas, particularly on adolescents.
Mental health interventions based on adolescents’ perceptions
According to joint research in 2016 by US educational psychology experts Diana Joyce-Beaulieu and Carmelo Callueng, adolescent psychological issues are becoming a major public health concern worldwide. This also represents a safety and security issue. Hence, policymakers need to pay heed to this complex matter.
Adolescents in Bangladesh struggle with mental health problems for an array of reasons. These can include neglect, abuse, domestic violence, harassment and scholastic pressure. Mental health issues often lead to suicidal thoughts. The study by the authors shows that Bangladesh’s top three contributors to suicidal thoughts among adolescents are bullying, negative parenting and despair.
Noteworthy anecdotal quotes by different teachers in the grassroots study are as follows:
- ‘When a harassed student is unable to express their issue or doesn’t find anyone who listens, they withdraw into their own world to suicide.’
- ‘In most of the cases they need attention from their parents. They just harm themselves to get care from their families and friends. But there are students who can’t share their insecurities even with their close ones. This leads to suicide attempts.’
- ‘Students are now [during covid-19 pandemic] in mental turmoil. They can’t go out like adults. This harms their mental health.’
- ‘Students are often the targets of bullying, eve teasing, harassment and assault on their route to and from school. During this time, they are unable to seek assistance.’
The findings show that the covid-19 pandemic of 2020 enhanced mental health distress among Bangladeshi students. This had already been hypothesised by many policy research experts.
Mental health interventions in schools
To understand the policy implications of mental health education, it is important to understand some of its fundamentals. Mental health literacy is a subset of health education. It comprises four key elements: 1) maintain good mental health, 2) comprehend mental illnesses, 3) reduce mental disorder-related stigma and 4) increase help-seeking. A mental health literacy curriculum in elementary school is an effective tool to enhance mental health literacy. In Canada and some East African countries, a school-based approach has substantially enhanced mental health understanding and help-seeking behaviour.
Bangladesh also has its own set of approaches. In this regard, Bangladeshi schools use a variety of methods. The study by the authors found that some schools have set their own internal policies on how teachers can support students in relation to issues of mental health. These policies are mostly teacher-centric. However, such support systems are found mainly in urban private schools. This unfortunately means that the majority of Bangladeshi schools do not have any set policies to deal with mental health issues.
Some salient tools that Bangladeshi private schools with their own mental policies use are as follows:
- Teachers must not use corporal punishment, and need to be aware of students’ emotions.
- Teachers must not use any abusive language or discuss hurtful topics with students.
- Teachers must not harass any student for bad performance.
- Teachers are encouraged to arrange extra classes for students’ betterment.
- Teachers must not ask students any personal questions.
In some Bangladeshi schools, teachers and students had an informal arrangement to deal with stress and anxiety.
The study found that, in some Bangladeshi schools, teachers and students had an informal arrangement to deal with stress and anxiety. For example, many schools in the country use home visits, in-person conversations, open classroom discussions and awareness campaigns. These non-formalised approaches contribute to bettering the mental health of students.
School-level policies play a big role in adolescents’ mental health. Almost all participants in our study felt that there should be formal policies and procedures in place to help students.
In Bangladesh, the challenges of setting formal school-level mental health policies have a geographic nature. As the study showed, it is easier to inculcate mental health education in urban schools. Meanwhile, it is extremely difficult to do the same in rural schools. The main challenge in rural schools is that teachers do not have basic awareness on mental health issues. As such, there is a big mental health literacy gap among school stakeholders.
Impediments to mental health interventions
According to our research, in Bangladesh the main barriers to addressing mental health issues are stigma and resource limitations. Structural social and historical factors contribute to these barriers. In short, as of now, stakeholders don’t take mental health issues seriously!
Bangladesh’s latest education policy, which was formulated in 2010, was meant to address the challenges of the 21st century. However, it focused largely on skills development to prepare students for the Fourth Industrial Revolution. Unfortunately, it did not have any detailed guidance on ways to tackle mental health issues. Nowhere does it mention practices or curricula vis-à-vis mental health. This gives the majority of schools an excuse to ignore this very serious issue.
Schools feel that government authorities should deal with mental health issues. Using this rationale, they are unwilling to pour resources into mental health. Government policies can help facilitate the taking of some baby-steps at school level:
- Arrange workshops or training programmes for teachers on mental health issues;
- Introduce across-the-board counselling services, including for teachers, at schools;
- Introduce counselling services from primary level;
- Introduce school-level collaboration among stakeholders, including like parents, extended family, community members and teachers, to sensitise on mental health issues.
Zooming out, Bangladeshi education policymakers should integrate mental health education with mainstream education. This has to be done by the education ministry at central level. The policy framework needs to clearly stipulate the implementation hierarchy, from the top government level to schools to local stakeholders. And teachers have to be central in this framework!
The issue of mental health may seem neglected and stigmatised but at its core it’s an economic issue. Bangladesh’s economy balances in a tight fiscal space. Not addressing mental health will have a negative impact on the economy. The issue has a very favourable cost–benefit ratio because it frees up significant resources that will otherwise go into overall health and well-being.
International best practices show that school-centric mental health literacy programmes are high-impact tools to address mental health issues. The same will be the case in Bangladesh. For this, a government policy framework is essential. This could entail a holistic school-centric mental health strategy to guide the entire school system to support students. Such a common framework will be possible only through incorporating mental health education into different policies, including Bangladesh’s education policy. This means that the existing education policy of 2010 would need reform.
Designing an effective school-centric programme
Policymakers must take note of another core point in designing school-centric mental health policy: catch them early. In other words, early intervention avoids future consequences. Intervention in pre-primary schools will improve socio-emotional coping and academic performance. In other words, it will have long-term nationwide benefits on mental health and overall wellness.
Policymakers must take note of a core point in designing school-centric mental health policy: catch them early.
In the authors’ mental health literacy study, three grassroots to national-level interventions can be identified. These can prove to be quick wins for Bangladesh. They are:
- Focus on designing programmes to educate school personnel on the early indications of emotional distress among students. This needs to start from pre-school level. Research needs to be conducted to find evidence-based preventative measures.
- Develop an evaluation tool for ‘behaviour management.’ This would regularly monitor interactions between students and staff. This is essential for a healthy social atmosphere in schools. At-risk children will benefit the most out of this.
- Bangladesh has a mental health policy. Apt implementation of this at the local level is needed. More importantly, integration of mental health literacy with education policies is necessary. Any directive to implement mental health literacy at school level has to come from the top, meaning the Ministry of Education.
Photo ©️ Mahmud Hossain Opu