Mental health literacy and help-giving responses of Irish primary school teachers

Abstract

Teachers can play a crucial role in identifying and responding to children’s mental health difficulties. This study explored teachers’ mental health literacy (MHL) and their help-giving responses, a topic which is relatively unexplored, particularly at primary school level. Primary teachers (N = 356) responded to a questionnaire that followed the presentation of each of three vignettes: a non-clinical, control, vignette and two clinical vignettes. One of the clinical vignettes described a child with generalised anxiety disorder and another described a child with depression. Mixed-methods questioning was used to assess teachers’ ability to recognise internalising disorders and their help-giving responses. Most participants were able to recognise a child experiencing an internalising disorder, with 84% accurately identifying anxiety and 71% accurately identifying depression. Multiple regression analyses showed that being female and having more exposure to mental illness were significantly associated with greater concern for affected children. Greater concern and confidence in one’s ability to help students in need were significantly associated with teachers’ intention to offer support. More years of teaching experience was associated with less help-giving intentions. MHL training for teachers is recommended so as to improve their ability to identify and respond to children’s mental health difficulties in a timely manner.

Keywords:

• mental health literacy
• teachers
• primary schools
• internalising disorder
• anxiety
• depression

Introduction

Worldwide, the prevalence of mental health problems in childhood and adolescence is rising, with half of all lifetime cases of mental health disorders starting before the age of 14 years (Kessler et al. 2005; WHO 2016). It is feared that the Covid-19 pandemic may already be exacerbating mental health difficulties further for children and young people (Burke and Dempsey 2020; Pierce et al. 2020; Power et al. 2020; Bray et al. 2020). However, these difficulties often go undetected, and thus, untreated, for years (Kessler et al. 2005). Without intervention, there is an increased likelihood that associated symptoms will persist throughout childhood and progress into adolescence (Bittner et al. 2007) and early adulthood (Cannon et al. 2013). There are multiple reasons for this treatment gap, but the fact that many young people with mental health difficulties delay or do not seek help (Cannon et al. 2013; Ford et al. 2005) is a clear contributing factor. For younger children affected it may be that they rely on the adults in their lives to recognise a mental health concern and take appropriate action (Headley and Campbell 2011). At primary school level, the classroom teacher is considered a well-placed professional to fulfil this role (Meldrum, Venn, and Kutcher 2009). However, international research with teachers of primary school-aged children on their ability to recognise a developing mental health disorder and effectively support affected children is limited.

Internalising disorders

Internalising disorders such as anxiety and depressive disorders are becoming a rising concern in primary schools internationally (Sadler et al. 2018) and in Ireland (McElvaney, Judge, and Gordon 2017). Cannon et al. (2013), for example, found that the most frequently experienced disorders across the lifetime of young people in Ireland are anxiety and mood disorders, including depression. Approximately 1 in 8 children had experienced an anxiety disorder and 1 in 7 had experienced a depressive disorder by the age of 13 years. These findings suggest that the majority of these young people are experiencing difficulties during their time in primary school education. Furthermore, Growing up in Ireland, the national longitudinal study of children in Ireland, has shown that approximately 12.5% of 5-year-olds and 15% of 9-year-olds are showing concerning levels of socio-emotional functioning (Murray et al. 2019; Williams et al. 2011).

In response, Irish government departments advocate for mental health promotion at primary level and effective early intervention (Department of Education and Skills, Health Service Executive, and Department of Health 2015; Government of Ireland 2006). Teachers are expected to address children’s mental health needs, however, little training has been provided to prepare them for this (McElvaney, Judge, and Gordon 2017). Meldrum, Venn, and Kutcher (2009) highlight the vital importance of equipping teachers with the training and knowledge needed to recognise mental health issues amongst children, and the skills to intervene appropriately to support them when they struggle to seek help themselves.

Teachers’ mental health literacy and help-giving responses

‘Mental health literacy’ (MHL) is a relatively new, but increasingly studied, construct with multiple definitions being identified in the research (Spiker and Hammer 2019). The original definition offered by Jorm and colleagues (1997) refers to ‘knowledge and beliefs about mental disorders which aid their recognition, management or prevention’ (Jorm et al. 1997, 182). Jorm (2000) further outlines how MHL consists of several inter-related components including the ability to recognise specific disorders and knowledge and beliefs about self-help, professional help and seeking informational support. More recently, the ability to offer and provide mental health first aid skills to someone presenting with a mental health problem has been added (Jorm 2012).

MHL and informed help-giving responses are a crucial component of the Gateway Provider Model (GPM) (Stiffman et al. 2000). This model highlights how ‘gateway providers’, including teachers, are vital in supporting young people with mental health difficulties, as they could be the first individual to identify a problem and provide or recommend supports. These can range from applying simple psychological tools and techniques in class to scaffold children with milder problems, to recognising when a child has more significant symptoms and needs referral for professional intervention. The idea that the improvement of teachers’ MHL may lead to improvements in help-giving responses and referral to appropriate mental health services is consistent with the GPM (Stiffman, Pescosolido, and Cabassa 2004).

In addition to the early identification and management of psychological issues in selected students, teachers who are informed about, and sensitised to, children’s mental health needs are in a unique position to be able to promote positive messages about mental health and well-being to all students. This can be integrated informally in the classroom or involve teaching an evidence-based social emotional curriculum, and can serve to improve children’s own mental health literacy (e.g. Ojio et al. 2019). However, understanding the mental health literacy of teachers is key to considering the usefulness of implementing such practices (Reinke et al. 2011).

Research directly assessing teachers’ perceptions of mental health issues in the classroom is limited (e.g. Splett et al. 2019; Whitley, Smith, and Vaillancourt 2013). Studies in the UK (Rothì, Leavey, and Best 2008), Australia (Graham et al. 2011) and the US (Reinke et al. 2011), for example, have highlighted teachers’ lack of confidence, experience, information and training as barriers to identifying and addressing mental health issues. For example, only 4% of early childhood and elementary school teachers in Reinke et al. (2011) ‘strongly agreed’ with the statement ‘I feel that I have the level of knowledge required to meet the mental health needs of the children with whom I work’. A further 24% of teachers ‘agreed’, leaving the majority neutral or disagreeing. More research is needed to explore teachers’ confidence in supporting primary school children who are experiencing mental health difficulties. Albert Bandura defined ‘perceived self-efficacy’ as individuals’ beliefs about their capabilities to produce behaviours necessary to specific performance attainments (Bandura 1977, 1986). Consistent with self-efficacy theory, teachers’ beliefs about children’s mental health and their beliefs about their own capacity to help could potentially influence the extent to which they offer support (Graham et al. 2011).

The need to assess teachers’ knowledge and recognition of symptoms of internalising disorders may be especially pressing. Despite their prevalence, these disorders are often under-detected. The more obvious, overt, symptoms associated with externalising conditions, such as acting out and disrupting class, can lead to the ‘squeaky wheel phenomenon’ where those with more noticeable issues are more likely to receive support and services (Bradshaw, Buckley, and Ialongo 2008). Recent research by Splett et al. (2019), for example, noted how teachers of primary school-aged children perceived externalising symptoms to be more serious and more concerning than internalising symptoms. Furthermore, their level of concern was associated with help-giving in the form of referral to mental health professionals.

Research exploring the development of teachers’ MHL suggests that improvements can be made in terms of increasing teachers’ knowledge of mental health disorders and their confidence in helping students with mental health difficulties (e.g. Bird 2020; Jorm et al. 2010). A variety of training programmes have been developed that involve awareness campaigns, educational videos, lectures, group discussions, and web conferences (for a review see Yamaguchi et al. 2020). These initiatives all invariably aim to elevate teachers’ knowledge of child and adolescent mental health conditions and confidence in their help-giving skills, while reducing stigmatising attitudes and responses towards affected students. While their evaluations look promising, Yamaguchi and colleagues (2020) have cautioned that more high-quality research is needed before their effectiveness can be ascertained. Furthermore, a greater emphasis needs to be placed on teachers’ actual help-giving, in order to assess the intention-behaviour gap.

While interventions to improve MHL may benefit teachers generally, further research is also needed to investigate individual characteristics of teachers that can influence their MHL or help-giving responses. For example, previous studies among the general population have shown that Irish females were significantly more likely than males to recognise a mental health disorder (e.g. Byrne, Swords, and Nixon 2015; Lawlor et al. 2008; Headley and Campbell 2011). More recent, international, studies corroborate with these results, reporting that females have higher MHL than males (Hadjimina and Furnham 2017; Cotton et al. 2006) and women teaching in a university in Australia have higher MHL than their male colleagues (Gulliver et al. 2019). Loades and Mastroyannopoulou (2010) reported how primary school teachers’ years of teaching experience and previous exposure to mental illness contributed to the variance in an overall statistically significant binary regression model of variables contributing to the recognition of mental health problems among students. However, neither teaching experience nor exposure to mental health difficulties made unique statistically significant contributions. Developing a research-informed knowledge base by which to identify groups of teachers who might particularly benefit from MHL educational programmes could inform related intervention planning.

The present study

This study aims to explore Irish primary school teachers’ MHL and help-giving responses with regard to hypothetical children presented with clinical and non-clinical levels of mental health difficulties. The aspects of MHL investigated are the ability to (i) recognise that a child has symptoms of an internalising condition and (ii) express greater concern for the clinical vignette characters when compared with the non-clinical vignette character. The clinical conditions presented are anxiety and depression, as these internalising disorders are a particular concern in Irish primary schools (Cannon et al. 2013; McElvaney, Judge, and Gordon 2017), and internationally (Werner-Seidler et al. 2017; Merry et al. 2012). Based on the research findings and literature outlined above, the present study sets out to answer the following questions:

1. Can primary school teachers identify a child with clinical levels of anxiety or depression from a description of their symptoms?

2. Do they express greater concern for children with internalising disorders compared to children with situational stress?

3. What individual characteristics are associated with these aspects of teachers’ MHL?

4. What types of help-giving responses do teachers offer children experiencing mental health difficulties?

5. Can intention to help a student in need be predicted by teachers’ gender, teaching experience, prior exposure to mental illness, MHL and confidence?

It was hypothesised that the majority of teachers would be able to recognise symptoms of childhood anxiety and depression and show concern and sensitivity to the severity of the clinical conditions. It was also hypothesised that increased concern would be associated with an increased likelihood to provide support to a child experiencing difficulties. Types of help-giving responses and the role of individual characteristics in MHL and help-giving would be explored.

Materials and methods

Participants

In this cross-sectional study, participants were recruited by emailing a random sample of approximately 2000 primary schools across the Republic of Ireland. School email addresses were accessed through data available on individual schools provided by Department of Education and Skills website (education.ie/en/find-a-school). Some participants were recruited through contacts the researcher (a qualified primary school teacher) had with four school principals. The number of teachers recruited through each method is unknown due to the anonymity of the data. Only qualified teachers were invited to participate.

A total of 356 primary school teachers participated in the study. Of those, 296 were females (83.1%), 58 were males (16.3%) and two participants preferred not to report on this (0.6%). The results below include all 356 participants; however, when analysing sex as a variable, the two participants who chose not to disclose their gender were excluded from these statistical tests. The gender breakdown was representative of Irish primary school teachers as a whole (86.9% female, 13.1% male; Eurostat 2016). Participants consisted of principals (including teaching principals) (19.7%), vice principals (3.1%), mainstream classroom teachers (54.5%) and special education teachers (SET) (24.7%). SET teachers included those working in a mainstream setting, teaching in an autistic unit, or in a special school. As teachers on career breaks may have still received staff emails (and could possibly be teaching abroad) a note was put on the questionnaire which stated that responses must be related to their time teaching in Ireland. Overall, participants’ teaching experience ranged from one to 45 years, with an average of 14 years (M = 14.1, SD = 5.7).

Materials

The majority of the literature to date that investigates MHL uses brief written vignettes (Leighton 2010). Findings suggest that responses to vignettes are congruous to those in real-life situations and reduce social desirability bias when compared with direct questioning (Leighton 2010). This study was composed of three vignettes (see Appendix). Two clinical vignettes described a child with symptoms of generalised anxiety disorder (GAD) (Headley and Campbell 2011) and a child with clinical depression (Kelly et al. 2011), respectively. A third non-clinical control vignette described a child experiencing situational stress (Loades and Mastroyannopoulou 2010). Vignettes were counter-balanced to reduce gender bias so that half of participants read vignettes describing a ‘boy in their class’ and the other half of participants read about ‘a girl in their class’ (Swami 2012; Tredinnick and Fowers 1997).

The vignettes were adapted slightly to portray primary school-aged children (i.e. the originals described adolescents) and to ensure they adhere to Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for internalising childhood disorders (American Psychiatric Association 2013). For example, a sentence about suicidal ideation was removed from the vignette describing a child showing symptoms of depression. Research shows suicidal ideation is not as common in depressed children of primary school-going age. These small changes were then reviewed and validated by nine clinical psychologists. Suggested amendments were made and the resulting vignettes and related questions were piloted with six participants to ensure appropriate interpretation and understanding.

The initial questions which followed each vignette were from the original Friend in Need Questionnaire developed by Burns and Rapee (2006) and adapted to suit a sample of primary school teachers by referring to a child in their class as opposed to a friend. These questions included an open-ended assessment of teachers’ abilities to recognise the condition that the vignette character presented with (‘What, if anything, do you think is the matter … ?), and a measure of their concern (‘If [vignette child name] was a child in your class, how worried would you be about his/her overall emotional well-being?’). Responses to the first question were coded, while responses to the second were on a four-point scale ranging from (1) I would not be at all worried about his/her emotional well-being to (4) I would be extremely worried about his/her emotional well-being, so that higher scores indicated greater concern.

Further questions were derived from other studies on MHL (Kelly et al. 2011; Headley and Campbell 2011; Loades and Mastroyannopoulou 2010). Teachers’ helping response towards a student with an internalising condition was assessed by way of the question, ‘If you were [vignette child name]’s teacher, how likely would you be to help him/her with this problem’. Teachers then chose from a five-point scale ranging from (1) very unlikely to (5) very likely, so that higher scores reflected greater intention to help. They were also asked to describe a specific help-giving response option for each vignette character. Teachers’ confidence to help was assessed by way of the question, ‘How confident would you be in offering help with (vignette character’s) problem?’. Teachers then chose from a five-point scale ranging from (1) I would not try to help, I would probably make things worse to (5) I would be very confident that I could help so that higher scores indicated greater confidence in the ability to help. Teachers were also asked to report on the adequacy of the training they have received on how to help a child with a mental health disorder.

Finally, teachers responded to a nine-item scale that measured their exposure to, and experience with, mental illness (Tsang et al. 2006). Items included ‘I have had a mental illness’, ‘I have lived with someone with a mental illness’, ‘I have seen realistic portrayals of mental illnesses in newspapers, films or TV programmes’. Participant scores ranged from 0 to 9 with higher scores indicating a more previous exposure.

Procedure

Ethical approval was obtained for the study through the School of Psychology Research Ethics Committee in Trinity College Dublin. Public primary school principals were contacted by the researcher via email, inviting qualified primary school teachers to respond to a questionnaire regarding the mental health of primary school children. The email asked principals to share a link to the online questionnaire with their teaching staff. The corresponding author had contact details for four principals and the contact info for other principals were obtained through the website www.education.ie, where a list of all schools in Ireland contact details is available to the public. Teachers accessed the information on the study through the link provided and were invited to respond to the online questionnaire, which took approximately 20–30 min to complete.

Analyses

Data from an online survey tool were imported to IBM SPSS Statistics 24.0 for statistical analyses. To address the study aims, descriptive and frequencies analyses were performed along with ANOVA and regression. For all statistical analyses, the .05 alpha level was used for statistical significance.

Results

Teachers’ recognition of students’ internalising disorders

Following each vignette, participants were asked what, if anything, they thought was wrong with the child described. Teachers’ recognition of each child’s problem was coded and descriptive analyses were conducted. For the GAD vignette, just 3.9% stated that the child had an ‘anxiety disorder’. A further 84.3% mentioned ‘anxiety’ in some form in their response, though it cannot be discerned if they were referring to sub-clinical or clinical levels of distress. The remaining 11.8% did not identify the child with GAD as experiencing anxiety. For the depression vignette, 71.3% correctly identified the description of clinical depression by responding with the words depression/depressed/depressive in their answer. Two participants (0.6%) specified the child as having a depressive/mood disorder or clinical depression. The remaining 28.7% did not perceive the depressed child as being so.

Logistic regression was performed to ascertain the effects of teacher gender, years of teaching experience, and previous exposure to mental illness on teachers’ ability to correctly identify a student as having symptoms of GAD or depression. Only previous exposure was found to significantly predict teachers’ recognition of depression (β = .123, p < .05) so that more exposure was associated with a greater likelihood of correctly identifying this clinical condition (Table 1).

Table 1. Descriptive details for, and correlations between, key variables.

	M (SD)	Achieved range	Gender (ref ‘female’)	Years of teaching experience	Exposure to mental illness	Ability to identify GAD	Ability to identify depression	Concern for child	Confidence	Help
Gender (ref ‘female’)	16.3% male	83.1% female	1	−0.034	−0.053	.026	.072	.137**	−0.075	−0.009
Years of experience	14.09 (10.71)	1–45 years	−0.059	1	−0.078	.008	−.006	−0.055	0.190**	−0.059
Exposure	6.26 (2.25)	1–9	−0.064	−0.078	1	.071	.123*	0.100*	0.068	0.079
Identify GAD	11.8% incorrect	88.2% correct	.026	.008	.071	1	.038	.072	−.023	−.020
Identify depression	28.7% incorrect	71.3% correct	.072	−.006	.123*	.038	1	.214**	−.057	−.029
Concern	3.77 (0.35)	2–4	0.137**	−0.055	0.100*	.072	.214**	1	−0.074	0.159**
Confidence	3.64 (0.82)	2–5	−0.078	0.190**	0.068	−.023	−.057	−0.074	1	0.348**
Help	4.47 (0.73)	1–5	−0.009	−0.059	0.079	−.020	−.029	0.159**	0.348**	1

**p < .01.

*p < .05.

Teachers’ concern for students with and without internalised disorders

Teachers responded to the question, ‘If [vignette child name] was a child in your class, how worried would you be about his/her overall emotional well-being?’ on a four-point scale ranging from (1) I would not be at all worried about his/her emotional well-being to (4) I would be extremely worried about his/her emotional well-being. Higher scores indicated greater concern.

A repeated measures ANOVA with a Greenhouse–Geisser correction determined that the average degree of concern differed significantly between vignettes (F (1.805, 640.931) = 1287.91, p < .000, n² = .861). Post hoc tests indicated that teachers’ were significantly less concerned for the ‘non-clinical’ vignette character (M = 2.05, SD=.036) compared with both the child with GAD (M = 3.75, SD = 0.24) and the child with depression (M = 3.78, SD = 0.25). There was no significant difference in the amount of concern reported for the two clinical vignettes.

A multiple regression model was next performed to investigate which individual characteristics of teachers (i.e. gender, years of teaching experience, and level of exposure to mental health conditions) were associated with greater concern for a child with an internalising condition. Responses to the question assessing concern for GAD and depression were combined and averaged to create a new variable indicating concern expressed for children with internalised disorders (Cronbach’s alpha .708). Scores ranged from 1 to 4 with higher scores reflecting greater concern. The mean score was 3.76 (SD = 0.347) indicating that teachers generally showed high levels of concern.

All relevant assumptions were met. Collinearity results were within accepted limits and residual and scatterplots indicated that criteria for normality, linearity and homoscedasticity were satisfied (Hair et al. 1998).

This model was statistically significant, R² = .032, F(3, 350) = 3.861, p =  .01. Gender (β = .137) and exposure to mental illness (β = .113) were significant in the model so that women and teachers with greater exposure expressed greater concern (Table 2).

Table 2. Coefficients table of predictors of teachers’ concern in multiple regression model.

	Unstandardised coefficients		Standardised coefficients	t	Sig.
	B	Std. error	Β
Gender (ref ‘female’)	0.128	0.049	0.137	2.590	0.010*
Years of teaching experience	−0.001	0.002	−0.036	−0.683	0.495
Previous exposure	0.018	0.008	0.113	2.134	0.034*

Dependent variable: teachers’ concern.

**p < .01.

*p < .05.

Help-giving responses offered by teachers

An overwhelming majority, 95.6%, of teachers believed they did not have adequate training to support children with mental difficulties. No significant sex differences (χ²(1, N = 354) = 1.580, p = .21) were noted in male and female teachers’ responses in this respect.

Teachers were asked to explain what steps they would take to help the child in each vignette. Their stated help-giving responses were coded and categorised into either ‘External’, ‘Internal’, or ‘Unsure’. External help-giving responses (GAD: 45.5%, Depression: 54.5%) included school referral of child to a professional or advising parents to seek professional help for the child (e.g. Referral to GP/NEPS/CAMHS/TUSLA* psychologist/nurse/therapist). Internal help-giving responses (GAD: 53.1%, Depression: 42.7%) included types of help-giving where the intervention remained inside of the school, for example asking for advice from more senior staff member in school, discussing the issue with the child and/or a parent, asking a special education teacher in the school to withdraw the child for small group support. Some teachers also stated that they would begin to implement classroom strategies such as ‘mindfulness’ or ‘reward charts’ or possibly a wellbeing programme such as ‘Weaving Wellbeing’ or ‘Friends for Life’. If both types of help-giving responses were listed, responses were coded as ‘External’. If participants responded ‘unsure’ or ‘don’t know’, their response was coded as ‘Unsure’ (GAD: 1.4%, Depression: 2.8%). No significant sex differences between internal and external responses were found for the child described with GAD (χ²(1, N) = 350) = 1.210, p) = .27) or depression (χ²(1, N) = 345)) = .917, p) = .34).

Factors associated with teachers’ help-giving

Teachers’ helping response towards a student with an internalising condition was assessed by way of the question, ‘If you were [vignette child name]’s teacher, how likely would you be to help him/her with this problem'. Response options were on a five-point scale ranging from ‘very unlikely’ to ‘very likely’, so that higher scores reflected greater intention to help. The mean help score for GAD was 4.60 (SD = 1.02) while the mean help score for depression was 4.34 (SD = 0.419) indicating that teachers generally showed a high level of intent to help the two clinical vignette characters. When these two scores were combined and averaged to create a new variable reflecting likelihood to help a child with an internalising disorder (Cronbach’s alpha .681), the overall mean score was 4.47 (SD = 731).

A multiple regression model was performed with Likelihood to Help as the dependent variable. The predictor variables were teachers’ gender, years of teaching experience, level of exposure to mental health issues, concern for the vignette characters with internalising conditions, and confidence in the ability to help. All relevant assumptions were met (Hair et al. 1998).

This model was statistically significant, R² = .170, F(5, 348) = 14.231, p < .001. Years of teaching experience (β = −.120), concern (β = .180), and confidence (β = .379) were significant in the model. While concern and confidence were associated with greater willingness to help, more years of teaching experience were associated with less willingness to help. Teachers’ confidence in their ability to help was the strongest predictor of their likelihood to help (Table 3).

Table 3. Coefficients table of predictors of teachers’ likelihood to help in multiple regression model.

	Unstandardised coefficients		Standardised coefficients	t	Sig.
	B	Std. error	β
Gender (ref ‘female’)	−0.059	0.098	0.030	−0.600	0.549
Years of teaching experience	−0.008	0.003	−0.120	−2.388	0.017*
Previous exposure	0.009	0.016	0.028	0.558	0.577
Concern	0.380	0.105	0.180	3.618	0.000*
Confidence	0.339	0.045	0.397	7.552	0.000*

Dependent variable: likelihood to help.

**p < .01.

*p < .05.

Discussion

The results of the present study indicate that the majority of teachers were able to correctly recognise a cluster of symptoms in a child as either anxiety or depression and are able to distinguish between a child with an internalising disorder and a child experiencing situational stress. These findings align with previous studies of MHL in Ireland and internationally with adolescent and adult populations (e.g. Loades and Mastroyannopoulou 2010; Burns and Rapee 2006; Byrne, Swords, and Nixon 2015). However, the sizeable minority who were unable to identify symptoms in both vignettes as indicative of a clinical disorder (up to 30% in the case of depression) is concerning and warrants attention. As ‘gatekeepers’ in helping children to access the supports they need (Whitley, Smith, and Vaillancourt 2013; Stiffman, Pescosolido, and Cabassa 2004), it is critical that these teachers are aware when their students are experiencing distress (Furnham and Swami 2018).

Previous exposure to mental illness, through such avenues as personal or vicarious experience or training on the topic, predicted teachers’ ability to correctly identify internalising disorders and show greater concern for children with them. Greater concern and confidence in one’s ability to help these children were associated with a greater intention to provide support. Previous research has suggested that symptom recognition and help-giving efficacy (knowing when and where to seek help) are aspects of MHL (e.g. Kutcher, Bagnell, and Wei 2015; Kutcher, Wei, and Coniglio 2016) and that increased MHL leads to increased help-giving responses (Jorm et al. 2010; Whitley, Smith, and Vaillancourt 2013; Wei et al. 2015). This gives justification for the need to provide training to Irish primary teachers to increase knowledge of specific mental health disorders and increase their confidence in supporting children affected by them. Recent efforts to increase teachers’ MHL so as to benefit themselves, their students, and their colleagues have shown promise (e.g. Woloshyn and Savage 2020) and should be considered a compulsory element of teacher training.

Previous studies have demonstrated significant gender differences in MHL (Hadjimina and Furnham 2017; Byrne, Swords, and Nixon 2015; Cotton et al. 2006; Burns and Rapee 2006), and the present study lends some support to this, with being female associated with expressing greater concern. Gender was not found to be a significant predictor of help-giving, however, suggesting that male and female participants were equally likely to support a child in need, once a need is perceived. This is in contrast to some existing research in the field of mental health where help-giving intentions and actions are generally found to be better among female participants (e.g. Davies et al. 2016; Gibbons, Thorsteinsson, and Loi 2015).

A concerning finding in the present study was that teachers with more teaching experience were less likely to help a student in need. It is possible that teachers with more experience also have greater emotional exhaustion (Kokkinos 2007), compassion fatigue and burnout (Rossi et al. 2012; Koenig, Rodger, and Specht 2018; Schwab and Iwanicki 1982). Perhaps these teachers have grown frustrated trying to access mental health services, or perhaps they perceive ‘likelihood’ to help instead as their ‘ability’ to help and negative experiences of trying to help in the past have caused them to believe they are unable to do so effectively. Indeed, correlational analyses in the present study indicated that lower confidence in helping ability was associated with less helping intention. The factors that contribute to self-efficacy of teachers urgently need to be investigated in order to give them the confidence to help young children with internalising disorders. It is also worth noting that this measure looks at teachers’ perceived ‘likelihood to help’ and therefore their self-reported intention to help. It cannot be assumed that participants’ intentions would translate into actual help-giving behaviour when experiencing a similar situation in their own classroom (Ajzen 1991; Yan and Sin 2014).

Research suggests that a child with a mental health disorder who seeks help from a mental health professional is less likely to continue to have mental health problems into adulthood (Jorm 2012; Cannon et al. 2013). However, findings show that when recommending help for a student with an internalising disorder, only around half of the participating teachers proposed professional help. This suggests that many teachers lack knowledge of appropriate help-giving responses for children with internalising disorders. This may be explained by the worrying statistic that over 95% of teachers in this study reported that they do not feel adequately trained to support pupils with mental health difficulties. It is also worth considering whether schools have links to external supports, whether teachers perceive there to be adequate external supports available for referral, and whether students will be responded to in an appropriate and timely manner. This issue is a clear cause for concern and needs to be urgently addressed by the Department of Education and Skills to respond to the increasing mental health issues among primary school children (McElvaney, Judge, and Gordon 2017).

A key limitation to the present study is that it does not identify whether participants identified the child in the GAD vignette as having a significant amount of anxiety resulting in a clinical disorder or whether they thought the child was experiencing typical, everyday anxiety. If a participant answered ‘anxiety’ when asked to label what might be the matter with the GAD vignette character it was coded as correct. However, just 3.9% of participants explicitly stated that the child had an ‘anxiety disorder’. There has been much debate in MHL research in how answers of problem recognition should be coded and whether only the technical term for certain disorders used by professionals should be accepted as correct. It could be possible that this study may have overestimated the amount of teachers who recognised the problem as a mental health disorder. Additionally, although participant recruitment attempted to reduce sampling biases by inviting all schools to participate in the study for whom contact details were available, it is possible that teachers with an interest in mental health, and conceivably higher MHL, were more likely to get involved. Our results here may not be representative of teachers as a whole. A final limitation worth noting is that this study’s design was cross-sectional and data were collected at one point in time. As such the observed associations in these analyses presented cannot be construed as causal.

The mental health of students is a growing concern among educators and has recently been exacerbated by the Covid-19 pandemic. Schools are important settings where mental health can be promoted, and difficulties can be identified and dealt with. Given the length of time primary school teachers spend with the children in their class each day, they are in a unique position to recognise children showing symptoms of mental health disorders. This research suggests that Irish primary school-aged children who are experiencing symptoms of a mental health disorder would benefit from the support of a teacher who is adequately and appropriately trained to perceive their situation as concerning and know the correct course of action to take to secure help. Being able to identify and respond to children’s mental health difficulties in a timely manner reduces their distress in the here and now and reduces their need for future intervention later in life. As such, compulsory pre-service teacher training in MHL is recommended, as well as continuous professional development workshops for existing teachers.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Eilís Ní Chorcora

Eilís Ní Chorcora is the Coordinator for Research and Impact for Trinity Access at Trinity College Dublin. Her interests include youth mental health and wellbeing, widening participation and inclusive education.

Lorraine Swords

Lorraine Swords is an Assistant Professor with the School of Psychology and Trinity Research in Childhood Centre at Trinity College Dublin. Her research interests are in peer interactions in the context of physical or mental health conditions in childhood and adolescence, focusing on help-seeking, help-giving and stigmatizing responses.

Notes

* GP: General Practitioner; NEPS: National Educational Psychological Service; CAMHS: Child and Adolescent Mental Health Service; TUSLA: Child and Family Agency.

Appendix

Vignettes

Situational stress vignette

Molly is a 12-year-old, shy young girl who worries a lot about tests and her marks in school. She often cries if she receives a poor mark or if she is criticised. She very much wants to please her teacher and parents, and thus fears making mistakes and feels guilty when she does poorly. She often worries so much about her teachers’ and parents’ expectations that she feels she cannot breathe and will ask to stay home from school. Every time Molly leaves the house she fears that her pet dog may die while she is away even though the dog does not have any illnesses. She also complains of abdominal pain that is present in the morning but not in the evening. Molly missed a significant number of school days during the previous year because of this pain. She also missed out on a number of school trips, as she fears the bus will crash. At night time Molly has difficulty falling asleep and frequently asks her parents for their reassurance.

Anxiety disorder vignette

Maebh is a 10-year old girl who is in 5th class, who lives at home with her mother. Since she joined your class at the beginning of the term, she happily attends school and has never expressed undue concerns. She is sociable, and seems to make friends relatively easily, and was recently happy to go on a school trip involving spending a night away from home. Last week Maebh’s mother broke her wrist and Maebh has mentioned how she is worried about her mother being home alone while Maebh is in school and not being able to complete tasks with one arm in a cast. This morning Maebh was crying and asked if she could call home to check on her mother. Otherwise, she was engaged in class and was seen laughing with her friends at break-time.

Depressive disorder vignette

Niamh is a 12-year-old who has been feeling unusually sad and miserable for the last few weeks. She is tired all the time but yet has trouble sleeping at night. She doesn’t feel like eating and has lost weight. Niamh is a terrific pianist and used to love to practise each day, but for the last few weeks she has stopped practising and says she finds no enjoyment in playing the piano anymore. She can’t keep her mind on her studies and her marks have dropped. She puts off making any decisions and even day-to-day tasks seem too much for her. Niamh feels she will never be happy again.