Public school teachers’ perceptions about mental health

Amanda Gonçalves Simões Soares Gustavo Estanislau Elisa Brietzke Fernando Lefèvre Rodrigo Affonseca Bressan About the authors

Abstracts

OBJECTIVE

To examine public school teachers’ perceptions about general health and mental health, and the way in which they obtained this information.

METHODS

Qualitative research was conducted with 31 primary and secondary school teachers at a state school in the municipality of Sao Paulo, SP, Southeastern Brazil, in 2010. The teachers responded to a questionnaire containing open-ended questions about mental health and general health. The following aspects were evaluated: Teachers’ understanding of the terms “health and “mental health,” the relevance of the need for information on the subject, the method preferred for obtaining information, their experience with different media regarding such matters, and perceptions about the extent to which this available information is sufficient to support their practice. The data were processed using the Qualiquantisoft software and analyzed according to the Discourse of the Collective Subject technique.

RESULTS

From the teachers’ perspective, general health is defined as the proper physiological functioning of the body and mental health is related to the balance between mind and body, as a requirement for happiness. Most of the teachers (80.6%) showed great interest in acquiring knowledge about mental health and receiving educational materials on the subject. For these teachers, the lack of information creates insecurity and complicates the management of everyday situations involving mental disorders. For 61.3% of the teachers, television is the medium that provides the most information on the topic.

CONCLUSIONS

The data indicate that there is little information available on mental health for teachers, showing that strategies need to be developed to promote mental health in schools.

Faculty; Mental Health; Self-Assessment; Perception; Health Knowledge, Attitudes, Practice; Qualitative Research


INTRODUCTION

Mental disorders are highly prevalent in childhood.5Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry. 2005 Jun;62(6):593-602. DOI:10.1001/archpsyc.62.6.593 In Brazil, one of the key studies in this area evaluated individuals aged 7-14 years living in the Southeast region and found that 12.7% of the children enrolled in schools had some mental disorder requiring specialized care.3Fleitlich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry. 2004;43(6):727-34. DOI:10.1097/01.chi.0000120021.14101.ca Young people affected by mental illness have worse school performance, a low standard of social interaction, problems with the law, higher school dropout and teenage pregnancy rates.1Breslau J, Lane M, Sampson N, Kessler RC. Mental disorders and subsequent educational attainment in a US national sample. J Psychiatr Res. 2008;42(9):708-16. DOI:10.1016/j.jpsychires.2008.01.016,6Lee S, Tsang A, Breslau J. An epidemiological study of mental disorders and failure of educational attainment in developed and developing countries. Br J Psychiatry. 2009;194(5):411-7.3.,1212 Vigod SN, Dennis CL, Kurdyak PA, Cairney J, Guttmann A, Taylor VH. Fertility rate trends among adolescent girls with major mental illness: a population-based study. Pediatrics. 2014;133(3):e585-91. DOI:10.1542/peds.2013-1761

From a neurodevelopmental perspective, interventions focusing on mental health in schools could prevent the manifestation or reduce the intensity of mental illnesses, preventing problems in the family, academic, and social spheres. Recent systematic reviews have described the effectiveness of various types of preventive interventions in schools for depression, anxiety, and substance abuse, among other disorders.1010 Opler M, Sodhi D, Zaveri D, Madhusoodanan S. Primary psychiatric prevention in children and adolescents. Ann Clin Psychiatry. 2010;22(4):220-34.,1313 Yifeng W, Kutcher S. International School Mental Health: global approaches, global challenges, and global opportunities. Child Adolesc Psychiatric Clin N Am. 2012;21(1):11-27 DOI:10.1016/j.chc.2011.09.005

Globally, health programs targeted at schools evolved in three distinct moments:1313 Yifeng W, Kutcher S. International School Mental Health: global approaches, global challenges, and global opportunities. Child Adolesc Psychiatric Clin N Am. 2012;21(1):11-27 DOI:10.1016/j.chc.2011.09.005

  • Moment 1: focus on physical health. Actions: Immunization campaigns, tracking of specific illnesses, such as vision problems, and the prevention of communicable diseases.

  • Moment 2: psychosocial focus. Actions: Campaigns to prevent drug usage, teenage pregnancy, and initiatives to promote a safe and healthy environment in schools.

  • Moment 3: focus on mental health. Actions: Campaigns promoting mental health, preventive interventions in healthy individuals or those at risk, and early identification and intervention for ill individuals.

For school programs focused on mental health to be satisfactorily developed in the country, it is necessary to evaluate Brazilian teachers’ and students’ understanding of mental health and the way in which they obtain information on this topic. Therefore, understanding these individuals’ daily lives, needs, behaviors, and social expectations, will enable us to develop effective actions in the process of knowledge construction.9Moraes AF. Informação estratégica para as ações de intervenção social na saúde. Cienc Saude Coletiva. 2008;13(Suppl 2):2041-8. DOI:10.1590/S1413-81232008000900008

In Hong Kong, a study was conducted on educator perceptions about general health.2Chan CMS, Kitzmann KM. Exploratory factor analysis: health perceptions of Chinese early childhood educators in Hong Kong. Health Promot Int. 2010;25(4):412-24. DOI:10.1093/heapro/daq031 For the sample studied, physical health was related to physical functioning and mental health with the ability to think clearly and coherently. Furthermore, psychosocial health referred to the ability to relate to others.

An evaluative study of attitudes toward mental health problems in the classroom showed that the teachers lacked knowledge of handling such situations, as they received little training.1111 Pavri S, Monda-Amaya L. Loneliness and students with learning disabilities in inclusive classrooms: self-perceptions, coping strategies and preferred interventions. Learn Disabil Res Pract. 2000;15(1):22-33. DOI:10.1207/SLDRP1501_3 However, trained teachers can improve their students’ health conditions by guiding parents and helping children acquire healthy habits.4Hearn LA, Miller MR, Campbell-Pope R. Review of evidence to guide primary health care policy and practice to prevent childhood obesity. Med J Aust. 2008;188;8Supll:87-91.

This study aimed to analyze public school teachers’ perceptions about mental health, and the way in which they obtained this information.

METHODS

A qualitative study was conducted in a public school in Sao Paulo, SP, in Southeastern Brazil. The study is a part of Projeto Cuca Legal,a a Universidade Federal de São Paulo. Projeto Cuca Legal. São Paulo; [s.d.][cited 2014 Oct 20]. Available from: http://www.cucalegal.net.br which seeks to train teachers to promote mental health in schools.

The teacher training was conducted in eight meetings, through informative lectures, case studies, and discussions.

The sample studied comprised 45 primary education teachers – cycle II – and secondary education teachers in the morning, afternoon, and night shifts. The inclusion criteria consisted of attending the Collective Pedagogical Work Hour (CPWH)b b CPWH: A meeting or any collective activity, usually weekly, between teachers and coordinators in order to discuss strategies for implementing consistent educational projects or team development. The CPWH usually happens within the school unit and lasts around 2h, which are designated as working hours. and a classroom workload of at least 12 hours per week. Teachers with a weekly workload of less than 12h or those who did not participate in the CPWH were excluded from the study.

A self-administered questionnaire including ten essay questions was used, with open- and close-ended questions, to document knowledge and concern about mental health and the way in which information about mental health reached the teachers (Table 1). This evaluation occurred two months after the psychoeducational activities of Projeto Cuca Legala a Universidade Federal de São Paulo. Projeto Cuca Legal. São Paulo; [s.d.][cited 2014 Oct 20]. Available from: http://www.cucalegal.net.br were concluded.

Table
Summary of the teachers’ responses to the questions on the questionnaire administered, based on the Discourse of the Collective Subject (DCS) method. (N = 31)

The data analysis employed the Discourse of the Collective Subject (DCS)7Lefèvre F, Lefèvre AMC. Os novos instrumentos no contexto da pesquisa qualitativa. In: Lefèvre F, Lefèvre AMC, Teixeira JJV, organizadores. O discurso do sujeito coletivo: uma nova abordagem metodológica em pesquisa qualitativa. Caxias do Sul: EDUCS; 2000. technique, developed for research on social opinion, seeking to determine the design of a given community from individually collected reports, in a qualitative and quantitative manner. DCS favors a recovery of the thoughts, values, and beliefs individually internalized via discourse.8Lefèvre F, Lefèvre AMC. Depoimentos e discursos: uma proposta de análise em pesquisa social. Brasília (DF): Liber Livro; 2005; p12 The Qualiquantisoft software was used to process the statements.8Lefèvre F, Lefèvre AMC. Depoimentos e discursos: uma proposta de análise em pesquisa social. Brasília (DF): Liber Livro; 2005; p12

Analysis of the statements involves selecting the key expressions from each statement, identifying the central ideas of each key expression, and creating the DCS.8Lefèvre F, Lefèvre AMC. Depoimentos e discursos: uma proposta de análise em pesquisa social. Brasília (DF): Liber Livro; 2005; p12 Key expressions are the passages that best answer the questions. Central ideas describe the meaning present in each statement in a synthesized and precise manner, i.e., the respondents intended meaning. The combination of similar key expressions and central ideas in a “discourse synthesis” comprises the DSC.7Lefèvre F, Lefèvre AMC. Os novos instrumentos no contexto da pesquisa qualitativa. In: Lefèvre F, Lefèvre AMC, Teixeira JJV, organizadores. O discurso do sujeito coletivo: uma nova abordagem metodológica em pesquisa qualitativa. Caxias do Sul: EDUCS; 2000.

Out of the initially selected 45 teachers, 12 missed the interview, one refused to participate, and another stopped working at the school. Thus, 31 teachers participated in the study [21 (67.0%) female, 10 (32.2%) male].

This study was submitted and approved in 2011 by the Research Ethics Committee at the Escola Paulista de Medicina, Universidade Federal do Estado de São Paulo (Protocol 0658/11). All participants signed a free and informed consent form.

ANALYSIS OF RESULTS AND DISCUSSION

Impressions of “Health” and “Mental Health”

The following data have been analyzed based on the teachers’ responses to the questionnaires administered (Table 1).

According to the results of the DCS analysis, for 58.1% of the teachers, health is related to “physical, mental, and spiritual well-being existing together. It is being well disposed and healthy in every way, which leads a citizen to have self-confidence. It is when you are well both existentially and metaphysically, in the most intimate and profound part of the human being. Being healthy involves the full harmony of one’s physical and mental metabolism, as it’s possible to be healthy in every way”. As for mental health, 41.9% of the teachers defined mental health as follows: “the ability to be free of disorders that cause an emotional imbalance. It’s the mind functioning within the standards established by medicine for this area, i.e., the balance of brain functions, the nervous system, and nervous impulses. Thus, the mind and body work in harmony so that there are no negative feelings and we can overcome difficulties, without using alchohol and drugs to overcome problems”. The percentage of teachers who associated mental health specifically with mental illnesses was 6.4%.

Access to Mental Health information in the media

When asked about encountering mental health information via mass media, 80.6% of the teachers reported never having heard a debate or radio program that addressed the topic; 71.0% had never researched or read anything related to mental health on the Internet; 67.7% had never received printed information about mental health; 61.3% had never read articles on mental health in magazines or newspapers; and 38.7% had never watched videos or television programs that addressed mental health issues.

The percentage of teachers who had access to information through a Health Center was 6.4%. Within the school environment, the topic is considered to be infrequently addressed.

Perceptions about need for Mental Health programs in schools

The study investigated the importance of developing communication strategies to support teachers in their daily life. A large majority (80.6%) of the teachers said the following: “the informative material helps because usually information is superficial and it can clarify what is myth and what has been scientifically proven. It would be another way of orienting ourselves, since we have little knowledge about it, and very often we do not know which course of action to follow because we feel insecure. We need to receive conceptual information about the subject in order to stay updated and know the way in which to deal with it in our daily lives. Sometimes, we seek professional help because we lack information. Information through any media is important; the more information is available, the greater is the understanding of the illness. The informative material should be easy to read and comprehend. Furthermore, the written information should serve as a research source”.

The percentage of teachers identifying lectures and discussions with a medical specialist, printed materials, and online materials as the most interesting strategies is 54.8, 25.8, and 22.6, respectively.

It was found that, for the teachers, mental health is linked to the balance between mind and body, as a requirement for happiness. Few teachers described mental health as mental illness. No discriminatory rationales appeared in the teachers’ statements, but there were reports of insecurity in decision making when dealing with students having mental disorders. The teachers attributed this insecurity to a lack of information about mental health and demonstrated interest in acquiring knowledge on the subject, as they believe this may be useful in their daily interactions with students. Furthermore, developing information strategies was considered important in the learning process, as the teachers consider them as a way to consolidate knowledge.

The results of this study corroborate the data published in two studies that assessed teachers’ perceptions about mental health. Pavri & Monda-Amaya1111 Pavri S, Monda-Amaya L. Loneliness and students with learning disabilities in inclusive classrooms: self-perceptions, coping strategies and preferred interventions. Learn Disabil Res Pract. 2000;15(1):22-33. DOI:10.1207/SLDRP1501_3 show that due to lack of training, teachers do not know how to deal with problems involving mental health in schools. Fisherc c Fisher EJP. Perceptions of mental illness and learning disorders in public schools: a review of services, perception, and popular culture [master’s thesis]. North Carolina: University School of Arts and Sciences; 2011. reveals that the teachers interviewed did not negatively perceive students with mental health problems and recognized the importance of psychoeducational programs offered at school. The present study is a pioneering study in Brazil on this topic.

Among the various types of media, TV was the main source of information about mental health, due to greater number of programs related to the subject, when compared with other media. During the data collection period, schizophrenia received more attention on TV due to a soap opera that had a character with the illness. The information in the soap opera began to serve as a source of knowledge for the teachers. In addition to schizophrenia, other topics about mental disorders are also portrayed in miniseries and other programs that promote debates on TV, but they were not mentioned by the teachers. However, the teachers reported that the information obtained via the media is inadequate, superficial, or sensational.

One of the limitations of this study is the use of structured instruments, which potentially limit the extent of the respondents’ answers. However, such type of instrument was selected because it facilitates data standardization. The information obtained from the teachers may not apply to other social or cultural contexts. In addition, data collection was performed after the intervention program,a a Universidade Federal de São Paulo. Projeto Cuca Legal. São Paulo; [s.d.][cited 2014 Oct 20]. Available from: http://www.cucalegal.net.br which may have skewed the results. However, this study was the first to investigate public school teachers’ perceptions about mental health with a robust methodology.

The meanings attributed to mental health by the teachers indicate interest in obtaining knowledge on the subject of mental health, since this can be useful in working with students. The data obtained suggest that, in the educator’s view, little information on mental health is available for teachers, and therefore, there is a great need to develop educational strategies about mental health in schools.

REFERENCES

  • 1
    Breslau J, Lane M, Sampson N, Kessler RC. Mental disorders and subsequent educational attainment in a US national sample. J Psychiatr Res. 2008;42(9):708-16. DOI:10.1016/j.jpsychires.2008.01.016
  • 2
    Chan CMS, Kitzmann KM. Exploratory factor analysis: health perceptions of Chinese early childhood educators in Hong Kong. Health Promot Int. 2010;25(4):412-24. DOI:10.1093/heapro/daq031
  • 3
    Fleitlich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry. 2004;43(6):727-34. DOI:10.1097/01.chi.0000120021.14101.ca
  • 4
    Hearn LA, Miller MR, Campbell-Pope R. Review of evidence to guide primary health care policy and practice to prevent childhood obesity. Med J Aust. 2008;188;8Supll:87-91.
  • 5
    Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry 2005 Jun;62(6):593-602. DOI:10.1001/archpsyc.62.6.593
  • 6
    Lee S, Tsang A, Breslau J. An epidemiological study of mental disorders and failure of educational attainment in developed and developing countries. Br J Psychiatry. 2009;194(5):411-7.3.
  • 7
    Lefèvre F, Lefèvre AMC. Os novos instrumentos no contexto da pesquisa qualitativa. In: Lefèvre F, Lefèvre AMC, Teixeira JJV, organizadores. O discurso do sujeito coletivo: uma nova abordagem metodológica em pesquisa qualitativa. Caxias do Sul: EDUCS; 2000.
  • 8
    Lefèvre F, Lefèvre AMC. Depoimentos e discursos: uma proposta de análise em pesquisa social. Brasília (DF): Liber Livro; 2005; p12
  • 9
    Moraes AF. Informação estratégica para as ações de intervenção social na saúde. Cienc Saude Coletiva. 2008;13(Suppl 2):2041-8. DOI:10.1590/S1413-81232008000900008
  • 10
    Opler M, Sodhi D, Zaveri D, Madhusoodanan S. Primary psychiatric prevention in children and adolescents. Ann Clin Psychiatry. 2010;22(4):220-34.
  • 11
    Pavri S, Monda-Amaya L. Loneliness and students with learning disabilities in inclusive classrooms: self-perceptions, coping strategies and preferred interventions. Learn Disabil Res Pract. 2000;15(1):22-33. DOI:10.1207/SLDRP1501_3
  • 12
    Vigod SN, Dennis CL, Kurdyak PA, Cairney J, Guttmann A, Taylor VH. Fertility rate trends among adolescent girls with major mental illness: a population-based study. Pediatrics. 2014;133(3):e585-91. DOI:10.1542/peds.2013-1761
  • 13
    Yifeng W, Kutcher S. International School Mental Health: global approaches, global challenges, and global opportunities. Child Adolesc Psychiatric Clin N Am. 2012;21(1):11-27 DOI:10.1016/j.chc.2011.09.005

  • a
    Universidade Federal de São Paulo. Projeto Cuca Legal. São Paulo; [s.d.][cited 2014 Oct 20]. Available from: http://www.cucalegal.net.br
  • b
    CPWH: A meeting or any collective activity, usually weekly, between teachers and coordinators in order to discuss strategies for implementing consistent educational projects or team development. The CPWH usually happens within the school unit and lasts around 2h, which are designated as working hours.
  • c
    Fisher EJP. Perceptions of mental illness and learning disorders in public schools: a review of services, perception, and popular culture [master’s thesis]. North Carolina: University School of Arts and Sciences; 2011.
  • Based on the masters’ dissertation of Soares AGS, titled: “Mapeamento da produção de sentidos atribuídos à Saúde Mental e avaliação da percepção sobre o Programa Psicoeducacional ‘Projeto Cuca Legal’ entre Professores e alunos,” presented to the Postgraduate Program at the Escola Paulista de Medicina, Universidade Federal de São Paulo, in 2011.

History

  • Received
    17 Dec 2012
  • Accepted
    1 June 2014
  • Publication
    Dec 2014
Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br