World Health Organization (WHO) claims about 20% of children and adolescents will contract an emotional and/or behavioral disorder during their life time1, 2. They can have a drastic impact on the academics and social life of these children, depriving them from achieving their full potential.3 Teachers play an important role in the life of children and adolescents as a group who has the unique opportunity to spend a considerable amount of time with them observing their behaviour, academic performance and social interactions during the most wakeful hours of the day. Especially in rural settings of developing countries, teachers play a significant role in the community as they usually have a fair awareness of the students’ family backgrounds and are capable of advising the family in various issues including health related problems4. Therefore, it is of paramount importance that the teachers have high mental health literacy (MHL).
MHL is defined as knowledge and beliefs about mental disorders that aid their recognition, management and prevention5. Deficiency in MHL of the public can hinder the evidence based mental health care6. Research conducted worldwide have revealed that there are inadequacies in MHL of teachers4, 7, 8. In a Brazilian study on public school teachers’ perceptions about mental health, 80.6% have showed great interest in acquiring knowledge; yet the lack of reliable sources of education created lack of confidence in managing everyday situations involving mental health problems9. The same study revealed that the television was the source that provides information in the case of 61.3% of the teachers9. The clinician authors of current study come across many children who face adversities in the hands of the teachers due to poor MHL of those teachers.
Studies have shown that the improvement of MHL of the teachers is helpful in early detection of students suffering from mental disorders and aids early referral to professional care10, 11. School based programs such as Canadian mental health and high school curriculum guide (The Guide) and the African version of the Guide significantly improved knowledge, decreased stigma and enhanced help-seeking efficacy among teachers12,13,14,15. In a Tanzanian study more than 200 students with potential mental health issues were identified and referred for professional care following a training program to improve MHL12.
Sri Lankan data shows the prevalence of child and adolescent mental health problems is a considerable health issue in the country. In a national survey, 18.9% of the adolescents aged 13-18 years showed some abnormality in emotional and behavioral parameters16. Out of them 15.5% and 12.4% were severely affected in educational functioning and peer relationships respectively. In central SL, 13.8% of school children aged 7-11 years showed emotional and behavioral problems17.
The concept of MHL is not much familiar in Sri Lankan context. The stigma in relation to mental health is high in the country18. This probably contributes to poor conceptualization of MHL in general. There are a few published studies on MHL of various stakeholders in mental health19, 20. However, there are no published studies in SL on evaluation of MHL of teachers. Teachers learn some child psychology principles briefly at the teacher training schools. There are diploma level courses in early childhood and primary education which include social and personality psychology as sub-courses at the only government run open university21. A few non-governmental organizations (NGOs) and individual mental health professionals conduct haphazard training programs for teachers on request of individual schools. There are no regular island wide hands on skills training programs for teachers on emotional and behavioural disorders among children and adolescents.
The clinician authors come across school children and adolescents with mental health problems whose teachers have either failed to detect the problem or managed it adversely, over decades, on a regular basis. That further deteriorates the condition leading to unfortunate circumstances like poor school performance and worsening of the emotional /behavioural problems such as school refusal, withdrawal and irritability. In order to change this on going adversity, a teacher-training program to improve MHL on emotional and behavioural disorders of childhood and adolescents was developed and delivered. The training was named sisu sitha noridawa (SSN) meaning, “not hurting the feelings of the student” in Sinhala, the main language in SL. The phrase was coined based on the famous Sinhala poem guru sitha noridawa which means, “Not hurting the feelings of the teachers” in order to catch the attention of a wider audience of teachers for the training. The effectiveness of the intervention (the training) was evaluated statistically.