Therapy enters school: psychologists go to schools to address the explosion of mental health problems

There are 30 students between 13 and 14 years old sitting at their desks during tutoring time.

The arrangement of the tables has changed, it no longer follows the traditional pattern of sitting in rows facing the blackboard area.

Now, they are placed in a U shape, everyone can see each other's faces.

An educational psychologist asks them in a workshop what they do when they have anxiety.

None of them are surprised, some murmur in low voices, others raise their hands and a few comment on their response out loud.

“I lie on the bed and do nothing,” says one girl.

Another, who comes out on the board, writes “crying and being overwhelmed.”

After the covid pandemic and the rise of unrest among young people, in 2022 the WHO recommended that all countries offer better mental health care through community services present in “everyday life”, such as schools.

In the last year, different projects have emerged in Spain to bring the figures of clinical and educational psychologists to centers to help alleviate the saturation of primary care and its inability to address the discomfort of minors, and at the same time, teach teachers to manage these vital crises.

“It is not something that we have invented, other countries around us such as the United Kingdom or Denmark have been doing it for years,” explains Celso Arango, director of the Institute of Psychiatry and Mental Health at the Gregorio Marañón Hospital, about a new program with which they have brought clinical psychologists, psychiatrists and nurses to 57 public and subsidized schools and institutes in the Community of Madrid to provide

on-site

care to students with mental health problems.

“The WHO recommendation implied bringing attention to the place where people are, which in the case of minors are schools;

“We copy and adapt how other countries have done,” says Arango.

With funding from two foundations (Alicia Koplowitz and Nemesio Díez), six teams have been hired (made up of child psychiatrists, clinical psychologists and nurses) who work from educational centers with computers connected remotely to the hospital, so that they have the children's medical history, provide individual and group therapies, and prescribe pharmacological treatment if necessary.

In the most serious cases - the increase has been recorded above all in suicide attempts, eating disorders (where the proportion of boys has increased, going from a ratio of 9 girls for every boy, to 7 for every 3), and anxiety or depression disorders as a result of bullying―, students are referred to the mental health center in the area with a preferential appointment.

Intervention at the center is given in less serious cases with the idea of ​​avoiding new referrals.

“There is an overflow, mental health centers have problems coordinating with schools, and they have waiting lists of up to three months for cases that are not very serious,” explains Celso Arango.

In Spain, there are six clinical psychologists per 100,000 inhabitants in the public network, three times less than the European average.

According to data from a 2022 Anar Foundation study, only 44% of minors between 13 and 17 years old who contacted them in the last three years due to suicidal ideation or suicide attempts received psychological care, either within the system publicly or privately.

Of the 628 suicide attempts recorded in 2006 in the population between 10 and 24 years old, this number rose to 2,092 in 2020, more than triple, according to data from the Ministry of Health.

Of them, 1,511 were girls.

Meanwhile, hospitalizations due to self-harm – considered in many cases the preamble to suicide – have almost quadrupled in recent decades: from 1,270 in 2000 to 4,048 in 2020. In 2020, suicide was the second cause of death among young people aged 15 to 29 (300) behind tumors (330).

Until that year, such a high number of children under 15 years of age had never been reached (14 took their lives, seven boys and seven girls).

“The objective of our program is to improve attention to the mental health needs of minors in their school environment and to this end we also train teachers and counselors in identifying warning signs and in managing situations,” says Arango. , which regrets that, unlike other countries, in Spain mental health is not part of the teachers' curriculum.

The identification of which students present alarm symptoms is done by the teachers, and once they have the authorization of the parents, they begin the therapy.

In parallel, they are collecting and analyzing data with the London School of Economics to prepare a cost-efficiency study.

"We want to show if with this program we reduce the incidence of mental disorders, admissions to psychiatric wards, the prescription of drugs, the number of times that parents stop going to work to take care of their children... to know if it costs money or represents savings.”

Private initiative is also moving in this direction.

An example is the project that the International University of La Rioja (UNIR) has brought to 20 charter and private schools in the Community of Madrid through its Emooti emotional well-being clinic, specialized in child and adolescent care.

"We are facing a change in model, now we go where they ⌊the minors⌋ spend more hours... socialization problems among peers can end up becoming mental health problems," explains Hilario Blasco, medical director of the center and previously head of research in mental health in childhood and adolescence at the Puerta de Hierro University Hospital in Madrid.

This Family Support Service (SAF) consists of individual sessions carried out by health psychologists in the centers themselves, and training plans for teachers and families.

The majority of cases in which they have already intervened are eating disorders, self-harm, addictions to technologies (social networks, porn or video games) and bullying situations between peers.

In an investigation led by Blasco at Puerta de Hierro, they found that if a 14 or 15-year-old adolescent begins to self-harm, immediate intervention is necessary, and if this is not done, the probability of a suicide attempt in a short time increases. they shoot

“We are measuring the impact of our interventions to be able to offer a personalized and anonymous mapping for each of the classrooms, a comparison between the start and the end of the course,” says Blasco.

Prevention programs

In another line of work less focused on therapy and more focused on prevention, the General Council of Psychology of Spain began the research project Evidence-Based Psychology in Educational Contexts (PsiCE) last year with the collaboration of eight autonomies. (Andalusia, Aragon, Asturias, Castilla La-Mancha, La Rioja, Madrid, Murcia and Valencia) to test a protocol designed to prevent emotional problems in the educational environment and analyze its effectiveness.

In a total of 45 primary and secondary schools, experimental groups of students have been created who have participated in 10 sessions led by educational psychologists in which they have discussed how emotions influence behavior, what types of traps there are in thinking, or how to deal with avoidant behaviors, among others.

Nearly 9,000 students between 12 and 17 years old have followed the program.

“We are measuring aspects such as the emotional state of the kids and what relationship it has with academic performance,” explains Pilar Calvo, member of the psychology council and coordinator of the study.

“We calculated the effects of the group intervention at 6, 12 and 18 months, and now we are in the phase of preparing the results report,” she says.

In the previous questionnaire, they identified that 12% reported emotional and behavioral problems, 15% reported symptoms of serious anxiety, 26% reported symptoms of moderate intensity depression (6% were serious), and 4.9% claimed to have tried take your own life at some point.

The objective is to demonstrate the benefits of incorporating the figure of the educational psychologist in the centers with the creation of specific positions for this position, since currently the positions for the guidance department - which, in practice, allocate 90% of their time to evaluate students with learning difficulties and develop personalized study plans - in addition to psychologists, pedagogues or graduates in other areas who have a master's degree in teacher training, so the counselor is not always a psychologist.

“The models that are based on the intervention of the clinical psychologist in the centers have limitations: they come only to do therapy, but they do not imbibe the dynamics of the center, and that is essential to be able to influence the socialization and interaction between the kids” , points out Pilar Calvo.

"What we are looking for with this project is to extract scientific evidence of which programs work with ordinary school groups, that are operational for all students, and we have already conveyed to the Ministry of Education our request for the authorization of this new specialty of the educational psychologist who would work side by side with the rest of the center's professionals," indicates José Antonio Luengo, dean of the Official College of Psychology of Madrid and author of the book

Adolescent pain

(Plataforma Editorial).

We jump into practice.

A group of teachers from the Maestro Rodrigo de Aranjuez public preschool, primary and secondary school attend one of the four training sessions designed for them within the PsiCE program in the Community of Madrid.

—At the end of class, one of my students approached me.

He verbalized to me his discomfort and his desire to hurt himself.

At that moment I didn't know what to do, I felt afraid, I got very nervous and I thought: Should I shut up?

Do I notify his family?

At what level of your mind is that intention?

Is it going to be something immediate?

“We are not prepared for this,” says Fernando, one of the tutors of an ESO group.

—He has chosen you as his reference adult.

This is very important.

Even if it is the management team that activates the protocol, you have to ask your student again how he is, you can't forget or look the other way—, answers Gema García, the educational psychologist.

In addition to resolving their doubts, it teaches them techniques to correct without damaging their self-esteem, to know how to react to a grievance.

“First you have to become aware of your emotion, so as not to explode, and never take it personally,” he tells them.

Assess their successes, and always call them by their name.

One of the teachers, Sandra Ruiz, asks for a guide to understand at what age children begin to feel empathy because "sometimes they insult other classmates repeatedly and I need to understand if they are aware of the damage they cause."

Another teacher, Paloma Ruiz, says that in recent years they have received a lot of training in digitalization, when the most important thing is emotions: “We need it urgently.”

“If you don't connect with them, the content will never arrive,” says Vanesa Olivares, another of the teachers.

For Raquel Yévenes, from the general subdirectorate of Educational Inspection of the Community of Madrid and coordinator of PsiCE, this project is important because the teacher has become the “first agent” who knows the emotional situation of the minor.

“The concept of a neighborhood no longer exists, there are many only children, where do children socialize now?” she asks herself.

“At school,” she explains.

Along with her, the director of Maestro Rodrigo, Julia González, says that the centers are living beings where relationships are woven, and the teachers are, many times, the reference adult that minors may not find anywhere else.

“With the pandemic our way of accessing students changed, the view is from another place;

"We were connected during confinement, they saw our houses, they met our dogs... now we are aware that there is a situation that we can improve."

The director, Julia González, enters the classroom where 30 second-year ESO kids receive one of the emotional education workshops.

One of the boys, who barely speaks during the entire session, has the hood of his sweatshirt up.

“This course has come new,” she whispers.

“It is not a challenge to the teacher, he does not want to confront the system.

He wears the hood because he needs it.”

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