Introduction

Ontario Certified Teachers (OCTs) support students’ mental health. The responsibility exists in the profession’s ethics and lives in its practices. It resides in the intentions of individual practitioners and in the collective duties of a multi-disciplinary team of professionals. It entails knowing how to recognize and address signs of mental illness, understanding where to turn for help, and working to avoid stigmatization while promoting wellness. The stigmas, ideas, pre-conceived notions, and understanding of mental health differs across families and cultures.

For the purposes of this advisory, the College has adopted the Public Health Agency of Canada’s definition of positive mental health as “the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face.” Mental health encapsulates one’s ability to manage thoughts, feelings and behaviour, making it possible to set and achieve goals, create and keep relationships, adapt to and cope with stress and sadness, and feel happiness.

Mental illness is more than feeling stressed or unwell. It is “a disturbance of brain function characterized by difficulties in thinking, mood, behaviour, perception, physical functioning and/or signaling mechanisms (or some combination thereof) [that] help us decide what to do day by day. They are diagnosed using internationally recognized criteria that lead to significant impairments in day-to-day living (work, home, social)”.¹

This advisory aims to help OCTs enhance their professional knowledge and practice with respect to understanding how to support students’ mental health.

Teachers’ instructional roles enable them to observe students closely. They are often the first to see changes in student behaviour. In the scope of their practice as an OCT, educators cannot diagnose ailments or propose treatment. Educators can, through awareness, understanding, experience and initiative, keep learning environments functional, inclusive, safe and welcoming to enable learning to occur and students to excel.

This advisory will help you to use your professional judgment to identify and avoid potential risks.

Realities

The World Health Organization says that mental health disorders will be the world’s leading cause of disability by 2030.² One in five Canadians – and one in five students – experience a mental health illness or concern in any given year.³ “Seventy per cent of mental health problems have their onset during childhood or adolescence.”⁴ “An estimated 1.2 million children and youth are affected by mental illness, yet less than 20 per cent receive appropriate treatment”.⁵ Further, “suicide accounts for 24 per cent of all deaths among 15-24-year-olds in Canada” and is the second leading cause of death among teens.⁶ Nearly one-quarter (23.4 per cent) of First Nations youth reported psychological distress scores which suggested that they were likely to have a moderate to severe mental disorder.⁷ The lifetime prevalence of suicide ideation and attempts among First Nations youth was 16 per cent and 10.3 per cent respectively.⁸

The spectrum of mental illness covers students from all backgrounds and across all grades. Many live with illness. Awareness, sensitivity and guidance are vital to helping students learn, grow and adapt regardless of obstacle or need.

Optimal mental health enables good learning. That said, everyone, at some point in life, experiences challenges involving self-esteem, interpersonal relationships, confidence, mood and concentration. These concerns may be temporary or lasting, but they should never go unrecognized.

Early recognition and intervention is critical for mental health issues for students of all ages. Many illnesses develop and peak in the intermediate/secondary grades. Thus it is important that teachers be able to identify children at risk.⁹

Ontario students rate their mental health lower than their physical health – with nine per cent indicating fair or poor physical health versus 19 per cent expressing fair or poor mental health.¹⁰ Students themselves recognize the growing need for assistance. In “A Turning Point for Education: The Student Platform”¹¹, the Ontario Student Trustees’ Association  - l’Association des élèves conseillers et conseillères de l’Ontario (OSTA-AECO) identified student well-being, 21^st century learning, and equitable access to opportunities as three pillars of a strong education system. OSTA-AECO’s survey data said that students wanted to talk to someone about a mental health problem but did not know who to approach. Further, OSTA-AECO said that student access to supports for well-being varied significantly across the province and they recommended mandatory suicide intervention training for guidance counsellors.

The Role of Ontario Certified Teachers

College members are a recognized support in the service of students’ mental health. By understanding the characteristics of mental health, OCTs can help to identify students at risk, seek help, support them on the path to care, and create a learning environment that supports recovery and wellness.

Ontario’s Ministry of Education says that “a positive school climate and a safe learning and teaching environment are essential if students are to succeed in school."¹² The Education Act¹³requires principals to consider mitigating factors when making disciplinary decisions or taking action.

Professional standards

The College’s Ethical Standards for the Teaching Profession¹⁴ and the Standards of Practice for the Teaching Profession¹⁵provide a moral and practical framework for this advice. Developed by College members and members of the public, the standards guide and inform the judgment and practice of Ontario’s certified teachers. When educators support students’ mental health, they demonstrate the ethical standards of care, trust, respect and integrity. They express their commitment to students’ mental health and learning through positive influence, professional judgment and empathy in practice.

Professional responsibilities

The responsibility of OCTs to support students’ mental health stems not only from the profession’s ethical and practice standards but from statutes, regulations, school board and employer policies, professional workplace standards and common law. OCTs also receive information from the Ministry of Education, education faculties, College-accredited Additional Qualification courses and programs, federations, and professional associations. The College specifically references students’ mental health as an area of focus in its Accreditation Resource Guide¹⁶ for Ontario’s faculties of education working with teacher candidates.

While educators are frequently in a position to observe, they should not attempt to diagnose mental health problems. However, they can promote positive mental health, destigmatize conditions, and help to identify and report students at risk.

Legal and Disciplinary Considerations

Legal rights, liabilities and requirements involve a number of competing legal principles set out in a variety of provincial and federal statutes as well as in common law. These principles address issues such as age of consent, right to privacy, duty of confidentiality, duty to accommodate, workplace safety, duty to report¹⁷ suspected child abuse and professional obligations.

Several acts provide guidance on matters affecting mental health concerns. These include but may not be limited to: the Education Act¹⁸, the Human Rights Code¹⁹, the Municipal Freedom of Information and Protection of Privacy Act²⁰, the Youth Criminal Justice Act²¹, and the Occupational Health and Safety Act²². Ontario’s Health Care Consent Act²³ says that students can consent to their own care if they are capable of making decisions, understand the information and are able to appreciate the consequences. With some exceptions, everyone is presumed capable. Under the Personal Health Information Protection Act²⁴, “capable” youth can also decide if information about them can be shared. If a student is deemed incapable, the law requires a substitute decision maker be appointed, typically a parent²⁵, guardian or the Children’s Aid Society. Teachers should consult administrators if they are unsure of their legal obligations. OCTs in leadership positions are wise to consult with their employers’ legal advisors when legal issues arise.

Diagnosed mental health illness may also amount to an exceptionality where they affect behaviour, communication or intellectual ability. As such, board Identification, Placement, and Review Committees and school Individual Education Plans for students may come into play.

OCTs are reminded of their duty of confidentiality and to be careful in sharing information of a sensitive nature about students. Students need to be able to trust that teachers and administrators have their best interests at heart.

Characteristics of some mental health conditions

The impact of mental illness on student learning, emotional health, behaviours and relationships manifests in ways beyond struggling to meet learning expectations. Students may abuse substances. They may drop out of school. They may struggle to make and keep friends or to develop appropriate relationships with adults.

Children and youth, however, often demonstrate different moods, thoughts and behaviours as part of normal childhood development. OCTs should pay particular attention to intense behaviours that persist over long periods, are inappropriate for the student’s age, or that appear to interfere with their lives. Excessive or unusual moods might indicate a mental health issue that requires consultation and intervention.

“One might think about children’s mental health as on a continuum ranging from developmentally normal, through problems that may be addressed in the everyday life of the classroom and the school, to problems that require expert assessment and intensive clinical interventions.”²⁶

Signs for possible concern may include:

• significant drops in school marks
• changes to sleeping or eating habits
• avoiding friends and family
• frequent, angry outbursts
• drinking a lot and/or using drugs
• not doing things they usually like to do
• worrying constantly
• frequent mood swings
• obsession or lack of concern about weight/appearance
• lacking energy or motivation
• feeling down
• risky behaviour.²⁷

Behaviours such as cutting, scratching or burning oneself, atypical comments made to peers or in school assignments, and appearing emotionally absent are other possible signs.

Disorders may include: anxiety disorders (phobias, social anxiety, separation anxiety/panic), obsessive-compulsive disorders, attention-deficit/hyperactivity disorders (ADHD presenting as predominantly inattentive and/or hyperactive/impulsive); mood disorders (depression, childhood bipolar disorder), and eating disorders (anorexia, bulimia, binge-eating).

What you can do:

• be aware of traumatic events in a student’s life or in the community, which can trigger change
• be cognizant of how you talk with students and parents/guardians. Model language that avoids stigmatizing mental illnesses. For example, a student living with bipolar disorder versus ‘He’s bipolar.’
• notice whether your students have friends, how many, who they are (are they age-appropriate?) and how long they’ve had them
• observe whether they are functioning well in school and managing their work; describe the behaviours you see (difficulty sitting still or taking direction)
• be aware of possible barriers to students getting effective help
• consult with your principal or vice-principal about your concerns
• consult with experts such as school board psychologists and social workers, where available
• keep good records and always document.

Supporting Students’ Mental Health: Advice to Members

The measure of mental wellness is being productive in daily activities, nurturing relationships, adapting to change, and coping with stresses. Ontario Certified Teachers embrace a professional ethical responsibility to educate students in safe, caring, accepting, inclusive and equitable environments and which honour their mental wellness, dignity, culture, language and heritage. Accordingly, OCTs understand and follow government and employer policies, procedures, protocols and expectations.

Create a supportive learning environment

Positive classroom environments promote good mental health, help to prevent problems or reoccurrences, and reduce the effects of mental health issues on students’ ability to learn. Do the culture and structures within your learning environments promote students’ mental health? Can students and staff talk about mental illness openly in terms that do not promote stigma?

Is there a School Support Team with information and strategies to support identified students or a school-based support plan that involves parents, family doctors, social workers, psychologists or others? Furthermore, are there opportunities for professional development on mental health?

Learn to recognize behaviours of concern

Social inclusion, freedom from discrimination, and violence and access to economic resources are key determinants of mental health. Learn to recognize the characteristics of mental illness in students and take action. Are there chronic health problems, a family history of illness or disorder, or family conflict or intergenerational trauma? Has a family doctor been consulted? When is it appropriate to inform your school’s health and wellness team and school administrators about your concerns? Do you know the factors associated with higher risk of mental health difficulties? Can you determine what constitutes a crisis (abuse, self-harm, suicide attempts, threats to others)?

Intervene appropriately

Approach students with potential mental health concerns with sensitivity, empathy and understanding. Use positive, accepting language and offer positive options. Acknowledge anger, but don’t accept abusive, offensive language, and don’t argue. Ask if there’s someone they usually get support from who you can call on their behalf. If students are at risk of harm, act immediately according to your employer’s policies and protocols. Always maintain professional boundaries when providing support.

As required, inform and involve colleagues, parents, and other para-professionals. Other regulated professionals who may be essential in the care and delivery of programs and services may include audiologists, speech-language pathologists, occupational therapists, physiotherapists, psychologists, psychological associates, and social workers. Whenever possible, collaborate with other partners such as elders, knowledge keepers, Indigenous organizations or members of a faith community.

Be sensitive

Recognize and appreciate that there may be community, religious and cultural differences that affect student and parent choices regarding mental health illnesses and treatment. Validate their feelings and hear their concerns. Speak simply and succinctly. If necessary, repeat things. Avoid language that creates stigma. Allow students time to process information and to respond. Let them know you’re listening. Most importantly, demonstrate patience, calm and a willingness to help. In some cases, it may be helpful to suggest practices such as yoga, journaling, prayer, cultural ceremonies, volunteering, exercising or connecting with nature to help students manage stress.

Act professionally

Always maintain a professional relationship with students and recognize that each situation is different. Respect students’ personal space when addressing concerns about behaviour. Ensure that they understand what you can and cannot do in your role. With respect to communicating electronically online and via social media, act online as you would as a professional in person.²⁸ Observe, listen, inform and involve others, but do not counsel unless this is your role and you have the appropriate training. As well, do not disclose confidential information.

Beware of over-care or over-stepping boundaries. For example, be aware that some students can misconstrue help as intimacy. Consult your principal or vice-principal frequently.

Professionals also practise self-care. Recognize your stressors and know the resources that are available to you.

A self-reflective framework to support students’ mental health

Reflect

Ask yourself:

1. What do I know about mental health and mental illness?
2. What are my personal thoughts and biases?
3. Do I use language that is respectful and non-stigmatizing?
4. Am I part of a school-wide approach to promote mental health? Is there an underlying philosophy of respect? Are expectations clear? Are routines predictable?
5. What is my support network? Who can I talk with about my concerns at my school?
6. Do I know what professional development I need to support students’ mental health and where to access it?
7. Do I know what my employer’s policy is with respect to getting help?
8. Do I know the school’s mental health lead and/or mental health counselor and how to contact them?
9. Who else on staff has information that can be shared?
10. Do I model a positive outlook, understanding and acceptance of others’ feelings, self-regulation of my emotions, and constructive conflict resolution?
11. Do my students enjoy learning and take an interest in school activities?

Detect

Ask yourself:

1. Am I aware of the early signs of possible mental health concerns, mental illness or substance abuse?
2. Is there an identifiable continuum of care for students?
3. Does the student have/need an Individual Education Plan or safety plan (including such things as triggers, warning signs, coping strategies, support network, crisis plan and resources)?
4. Are students self-injuring, at risk of suicide, or at risk of harming others?

Intervene and Support

Ask yourself:

1. Have I created an environment in which students feel safe, valued, engaged and purposeful?
2. What does this student need to succeed?
3. Are students engaged in their own diagnosis and treatment/care?
4. Do I help to remove the stigmas around mental health and make it easy for students to approach me or acquire the information they need?
5. Have I created a positive learning environment that encourages caring, respect, and acceptance and recognizes religious and cultural differences?
6. Do I look for opportunities to promote mental health within the curriculum?
7. How can I develop and implement instructional practices that better serve the learning needs of students with mental health issues?
8. In providing support, am I mindful of the need to maintain professional boundaries?
9. How do I support students who feel ashamed or stigmatized?
10. Do I know what to do and who to contact if a student discloses suicidal actions or thoughts?

Report

Ask yourself:

1. Have I informed my students about the school’s confidentiality policies and my duty to report?
2. Do I know who to report to and what to report?
3. Do I know who to report to in an emergency (threats of violence or suicide)?
4. Do I collaborate with parents, medical professionals and other community members as needed?
5. Do I keep my communication with parents and students professional, culturally appropriate and open?

The daily actions of teachers and their positive relationships with their students actively promote the mental health of students.²⁹ It’s important that OCTs role model for others by maintaining their own wellness.

Your personal knowledge is valuable, but never as powerful as when it’s combined with the knowledge of your professional peers. Your commitment to learning about and addressing mental health issues is the best way to support students.

Apply your professional judgment. If you are unsure whether an action is appropriate and you have a concern, report to your supervisor.

Consider consulting the following agencies for additional information:

• Aboriginal Health Access Centres https://www.allianceon.org/aboriginal-health-access-centres 
• Centre for Addiction and Mental Health [CAMH] http://www.camh.ca/
• Children’s Mental Health Ontario [CMHO] https://www.cmho.org/
• Canadian Mental Health Association [CMHA] https://cmha.ca/
• Ontario Mental Health Association  [CMHA-Ontario] http://ontario.cmha.ca/
• Mental Health Commission of Canada https://www.mentalhealthcommission.ca/English
• Sick Kids’ Hospital, Centre for Brain and Mental Health http://www.sickkids.ca/Brain-Mental-Health/index.html
• Children’s Hospital of Eastern Ontario [CHEO] http://www.cheo.on.ca/en/cheomentalhealth
• School Mental Health – ASSIST https://smh-assist.ca/
• EdCan Network https://www.edcan.ca/
• EDU http://www.edu.gov.on.ca/eng/parents/mentalhealth.html
• Teenmentalhealth.org http://teenmentalhealth.org/