How accurate are teachers’ assessments of children’s mental health?

Last updated 15 March 2021
teacher with pupil

Frances Mathews, Tamsin Ford and colleagues have performed a secondary analysis of the 2004 British Child and Adolescent Mental Health Survey, to understand how accurately teacher concern predicts the presence of a mental disorder in school children. They found that teacher concern was only moderately predictive and sensitive, but a lack of teacher concern was highly predictive and specific. Even though teacher concern did identify children with poorer mental health, it did not accurately differentiate between those with a clinically impairing disorder and those with subclinical levels of mental health difficulties.

“Teachers seem to accurately identify children who are mentally healthy, but they can also correctly identify children whose mental health is poorer than average”, explains Ford. “Their concerns, however, identify a broader spectrum of children than those with impairing mental health conditions”. Therefore, teacher concern alone identifies children whose needs do not meet the threshold for CAMHS, as well as those who do. However, if both teacher and parents were concerned, the child was much more likely to have a disorder, suggesting that corroboration of teacher concerns may help to identify those most in need of CAMHS support.

As children spend a great deal of their time within school, checking how a child’s attainment, behaviour and peer relationships compare to others constitutes a vital part of a mental health assessment. “This information can tell you a lot about how a child is functioning”, says Ford. “If a teacher is not concerned, then our data suggest that it is very unlikely that a child has a significant problem”.

The researchers welcome the current emphasis of policy on a closer collaboration between schools and mental health services. However, they explain that this emphasis will only extend to a third of the country in the next few years.  Going forward, we need to understand how best to support teachers and school mental health practitioners such that affected children receive the appropriate level of support that they need. Longitudinal research is also warranted to determine how teacher-identified children with poor mental health fare over time. Ford et al. explain that if these children continue to struggle or even deteriorate, then this might suggest the potential gains of early intervention.

 Referring to

Mathews, F., Newlove-Delgado, T., Finning, K., Boyle, C., Hayes, R., Johnston, P. & Ford, T. (2020), Teachers’ concerns about pupils’ mental health in a cross-sectional survey of a population sample of British school children. Child Adolesc. Ment. Health. doi: 10.111/camh.12390.

See also:

Department of Health and Social Care & Department for Education, 2017. “Transforming children and young people’s mental health provision: A green paper.” Retrieved from: https:// www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-greenpaper

Mental health of children and young people in Great Britain, 2017. Retrieved from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017

Dr Jessica Edwards
Jessica received her MA in Biological Sciences and her DPhil in Neurobehavioural Genetics from the University of Oxford (Magdalen College). After completing her post-doctoral research, she moved into scientific editing and publishing, first working for Spandidos Publications (London, UK) and then moving to Nature Publishing Group. Jessica is now a freelance editor and science writer, and started writing for “The Bridge” in December 2017.

Discussion

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A really interesting article, thank you. I work in the field of child and adolescent mental health in schools and we use an assessment tool that helps schools identify pupils with hidden biases that affect their self-regulation. This alongside a teacher’s knowledge gives an excellent insight into how a pupil is thinking and feeling, because we all know that many pupils will keep issues firmly hidden on their private, ‘back’ stage.

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I am a former special needs teacher.I now work with teens and young adults with SEND for a local authority. I also have a primary aged child recently diagnosed as on the Autism Spectrum, who struggles with attending school due to anxiety. These experiences lead me to question whether the research mentioned included children with special needs? As a teacher I knew my students well and agree that I was well placed to spot mental health difficulties early. However, I worked in a special school and therefore taught classes of 12 students. Teachers in mainstream schools are trying to cater to the needs of 30 children. My experiences with my own child as a parent have taught me a great deal about ‘masking’; children who present as coping well in school, and only let their guard down at home where they feel safe. My child appears as a very different child in school to at home. At home we see suicidal crises , lashing out in anger and fear, hours of meltdowns. In school they see the perfect student ; quiet, studious and bright. I used to think as a teacher I knew a lot about Autism, but caring for a child at home with my child’s difficulties is an intense and steep learning curve . In my work for a local authority, I also see young people who suddenly crash out of school, broken and exhausted, and this often appears to come ‘out of the blue ‘, as they are so able, and seem so ‘normal’ in school. There are enough of these children and young people that we actually have a specialist team to pick them up and get the support in place they probably should have had years ago. Many of the children haven’t accessed education for months, sometimes years as their mental health declines. My child is one of them, and is now supported by the very colleagues I sit alongside in my work. These may seem like a small number but at least 300 children were on their books last year. That’s a small school. The outlook for these children is not good unless they get the right support.

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This is an issue that I find really worrying as a healthcare professional, and a parent. I spent years trying to get a referral for my child, but the GP insisted the school should do it, school insisted referral not needed as daughter appeared fine (very common complaints among SEN parents). Finally, I paid for a private paediatrician and used school emails and reports as evidence, and paediatrician diagnosed straight away, because her presentation was clear. The referral pathways into these services need to allow GP’s and parents to be involved in the assessment process, instead of (unintentionally, I’m sure) discounting their opinions in favor of teachers who have neither expertise in mental health, nor expertise in an individual child.

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