IPN July 2022

Back to School? Don’t Forget about Mental Health

Written by Allison Dunne BPharm MSc MA. IUHPE accredited health promotion practitioner

At this time of year you may see several articles about how you, as a pharmacy team, can help families preparing to go “back to school”. Common topics include the use of vitamin supplements, prevention of head lice and preparation for in the inevitable cold and flu symptoms. Indeed, these are all important factors for physical health. But what about mental health and wellbeing? This article will consider the mental health impact of the return to school and how pharmacy teams can support families during this exciting, but often challenging, time of year.

When we think about mental health we should consider both the positive and negative aspects. Positive mental health, sometimes called mental wellbeing, includes factors such as happiness, life satisfaction and quality of life. Positive mental health can be protective against some mental health conditions and is important for child development (Department of Children and Youth Affairs, 2014). Young children who have positive relationships with their parents, and teenagers who have supportive peer groups, tend to experience good mental wellbeing (Nolan & Smyth, 2021). The quality of relationships with teachers has also been shown to be important for good mental health, especially among adolescents (Nolan & Smyth, 2021).

Mental health conditions such as depression and anxiety affect a significant number of children. A recent report notes that 16% of 13 year olds in Ireland are at risk from depression (Department of Children, Equality, Disability, Integration and Youth, 2021) while over 11,700 young people accessed HSE Child and Adolescent Mental Health Services in 2021 (Pollak, 2022). Parents who are concerned that their child has a mental health condition should speak to the pharmacist about whether referral to the GP is appropriate.

Going back to school can trigger feelings of worry and anxiety in some children. In the pharmacy you may meet several parents of children who are concerned about their children experiencing stress during this period. Understanding the causes of common worries can help you to support parents and children during this time. Some of the more common concerns are discussed here.

Exam Stress

Worries about exams and school performance are normal (Duvall & Roddy, 2021). While a small amount of stress around exams is common, if the levels of stress are affecting sleep and daily tasks it is time to encourage parents to take action. Schools can offer support to students who are worried about exams. If additional help is needed the GP is the first port of call for children who are experiencing high levels of anxiety. In a small number of cases children can be diagnosed with anxiety disorders requiring medical intervention or counselling.

Bullying

The Irish government framework for the health of children and young people is called Better Outcomes, Brighter Futures (Department of Children and Youth Affairs, 2014). The framework identifies bullying as a common concern for school children. The most recent progress report, using data from 2018 noted that 31% of 11-17 year olds have been bullied in school, with 13% stating that they have acted as a bully (Department of Children, Equality, Disability, Integration and Youth, 2022). Worries about bullying may lead to increased stress in the lead up to return to school. Parents can support their children with regular conversations about school worries and encourage reporting of bullying to the school. Each school should have an anti-bullying policy. Parents can access these (often available online) and should speak to school staff about any concerns.

Sleep

Reduced sleep has been linked to poor concentration and learning during school hours (Hayes & Bainton, 2020). Over the summer holiday it is normal for sleep patterns to be different to during the school term. Bedtimes may be later with the long summer evenings, and a morning lie-in may become a regular occurrence. As the end of the school holiday approaches, bedtimes can be gradually adjusted to match the school routine. Pharmacy staff can remind parents of the importance of good sleep hygiene in the preparation for the return to school. This will make the first few days of term easier

to cope with and start the school year with good sleep habits. Primary school children should sleep for between 9 and 12 hours per night, with teenagers aiming for between 8 to 10 hours (Great Ormond Street Hospital, 2020). Some sleep hygiene tips from Great Ormond Street children’s hospital are;

• Reduce caffeine intake; watch out for caffeine in fizzy drinks as well as tea and coffee.

• Timing of meals; a large meal just before bedtime can disturb sleep. Aim for the main meal to be earlier in the day and give a small snack or warm drink before bedtime.

• Physical activity; sports or a walk in the fresh air during the daytime can help with sleep at night. Avoid vigorous activity just before bedtime.

• Technology; bright lights from mobile phones, televisions or other electronic devices can keep the brain alert. Keep the hours before bedtime device-free. Try a book or relaxing music at bedtime instead of an electronic device.

• Routine; going to bed and waking at the same time every day (even at weekends) can help with good sleep (Great Ormond Street Hospital, 2020).

Social media

While social media can be a good way for young people to keep in touch with friends, parents may find that children are spending long periods of time online during the holidays. As a return to school date gets closer, the pharmacy team can remind parents to try to gradually reduce screen time to make the transition back to school easier. Late night screen time should be minimised to support good sleep.

Support groups for children and parents

The pharmacy team have an important role in understanding the role of health services and support groups, to enable staff to direct parents and young people to access these services. The HSE provides an up-to-date list of supports for school aged children at https://www2.hse.ie/wellbeing/mentalhealth/supports-for-young-people.html Some of the supports are listed here:

Childline provides free listening services to children and young people up to the age of 18. The Childline helpline is open 24 hours every day and can be accessed by Online chat at www.childline.ie, Freephone 1800 666 666 or by texting the word “Talk” to 50101

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Jigsaw is a national centre for youth mental health. They use early intervention to support the mental health of young people aged 12 to 25 years of age. Jigsaw has 13 centres across Ireland. They offer a place that young people can visit for free with confidential support from trained mental health professionals. They can also be accessed online at www.jigsaw.ie

BeLonG To youth services is the national organisation supporting lesbian, gay, bisexual, transgender, and intersex (LGBTI+) young people between 14 and 23 years in Ireland. Services include support groups for young people and parents. The services are confidential, free-of-charge and welcoming to all young people. www.belongto.org

In summary, the end of the summer holidays can bring mixed emotions for children and their parents. The pharmacy team are ideally placed to support families during this period and to signpost to local services where appropriate.

Action points for continuing professional development

After reading this article you could:

• Discover more about local and national supports for young people and parents. Find out where your nearest branch of Jigsaw is.

• Think about your local schools. Is there an anti-bullying policy on the school website? Does the school offer a wellbeing programme?

• Read more about child mental health and wellbeing using the references below.

References

Department of Children, Equality, Disability, Integration and Youth (2022). An indicator set for Brighter Outcomes, Better Futures. 2021 update.

Department of Children, Equality, Disability, Integration and Youth (2021). Growing Up in Ireland. Social-Emotional and Behavioural Outcomes in Early Adolescence.

Department of Children and Youth Affairs (2014). Better Outcomes, Brighter Futures.

Duvall, A., & Roddy, C. (2021). Managing anxiety in school settings : creating a survival toolkit for students. London ;: Routledge, Taylor & Francis Group.

Great Ormond Street Hospital. (2020). Sleep hygiene in children and young people: information for families. Retrieved on 18th May 2022 from https://media.gosh.nhs.uk/ documents/Sleep_hygiene_F1851_FINAL_ Jun20.pdf

Hayes, B., & Bainton, J. (2020). The impact of reduced sleep on school related outcomes for typically developing children aged 11–19: A systematic review. School psychology international, 41(6), 569-594. doi:10.1177/0143034320961130

Nolan, A., & Smyth, E. (2021). Risk and protective factors for mental health and wellbeing in childhood and adolescence. Economic and Social Research Institute. Research series number 120.

Pollak, S. (2022). More than 11,700 children and teenagers accessed mental health services last year. Retrieved on 19th May 2022 from https:// www.irishtimes.com/news/health/more-than- 11-700-children-and-teenagers-accessed-mentalhealth-services-last-year-1.4779390.

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