Children’s mental health: shifting the dial away from treatment towards prevention and early intervention

It’s not every day you get everything you worked for, but in June 2022 the Victorian Government announced a $200 million investment to roll out the Mental Health in Primary Schools Program (MHiPS) to every government and low-fee non-government primary school in the state.

It’s a new model of school mental health support that trains experienced teachers to become Mental Health and Wellbeing Coordinators in primary schools.

Paediatrician Professor Frank Oberklaid, an internationally recognised authority and advocate for children’s health, designed the Program as co-group leader of Child Health Policy, Equity and Translation at the Murdoch Children’s Research Institute in Victoria.

“We can’t say it’s going to fix everything or prevent every mental health issue,” Oberklaid told Cosmos.

“This is a capacity building exercise in increasing the confidence and expertise of the teachers and the coordinators themselves, but also in increasing the capacity of schools to be able to address mental health issues.”

Early intervention is key

Oberklaid has always had a clinical interest in children with developmental and behavioural problems – the interface between paediatrics and mental health.

Over the years, his career has moved from looking after individual children towards trying to understand why children would need to seek treatment with him in the first place.

“Many of the patients we see, as they’re sitting in our office, I think to myself: ‘boy, I wish I could have seen this child two or three years earlier when signs of struggling were just starting to appear,’” says Oberklaid.

“By the time they get to me, or by the time they get to a psychologist or psychiatrist, often they’ve had signs that things aren’t going well that have been there for a while and the problems are really entrenched, more complex, and harder to treat.

“The research is pretty clear around children that so many of the problems we see are either totally preventable, or if we intervene early, we can sort of head them off at the pass.”

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Read more: Mental health issues the most common long-term health condition in Australia.

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Oberklaid was co-chair of the development of the National Children’s Mental Health and Wellbeing Strategy for the Australian Government; a ten year roadmap for how government should invest in child mental health. The Strategy identifies four main themes: parents, school, community-based services, and research and evaluation.

Oberklaid says that schools are an ideal place to target children’s mental health because almost every child goes to school and teachers, who are trained observers, are watching kids for six hours a day, five days a week.

“So, they’re in an ideal position to both build resilience but also to detect problems early, because one of the things that I’ve always been interested in is shifting the dial away from treatment towards prevention and early intervention,” he says.

As a result, Oberklaid conceived of a new model, the MHiPS, which was co-designed with the schools, teachers, principals, and unions.

Oberklaid and his colleagues at the Centre for Community Child Health at MCRI developed a training program in conjunction with the Graduate School of Education at Melbourne University to train Mental Health and Wellbeing Coordinators.

Oberklaid says that it isn’t a clinical role, they don’t treat children, but they do have three important functions within the school environment.

“First, to work with a classroom teacher to help the classroom teacher identify emerging signs that things aren’t going so well.”

“Secondly, to work to develop a whole school approach to mental health, rather than mental illness, and building resilience and professional development strategic for classroom teachers.

“And thirdly, to be a liaison between the school and community agencies. So, for those children that have more complex issues, that need more complex assessment or treatment, they are the liaison so schools are able to make informed referrals to people in the community,” he adds.

They first tested the Program’s feasibility in a study in 10 schools, which expanded to formal evaluation in 26 schools and then 100 schools, and will now been extended to 1800 schools over 2023-26.

Reducing the stigma children’s mental health

Oberklaid says parents may also feel stigma around acknowledging their child might have a mental health challenge, and teachers can feel that same stigma when raising these issues with parents.

To help enable these conversations between parents, teachers, and health professionals, they introduced a new tool – called the Children’s Wellbeing Continuum – at the end of 2022.

The Continuum has four anchor points that range from “Good” through to “Coping”, “Struggling”, and “Overwhelmed”, that help create a shared language around children’s mental health.

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Read more: Breaking the stigma of mental health in culturally and linguistically diverse communities.

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“We know that most kids, as they go through life, they’re going to have some hiccups from time to time. There’ll be losses, there’ll be transitions, that we really hope they’ll cope with,” Oberklaid explains.

“Some kids aren’t going to cope; they’re going to start to struggle for one reason or another.

“What we want parents and teachers and other professionals to do is to identify those children as soon as they start to struggle and build scaffolding around them, build coping strategies around them, to get them back to coping,” he says.

The idea is to try to prevent children from becoming so overwhelmed that they need tertiary mental health care, and the language opens up space for more informed conversations to enable this.

In November, Professor Frank Oberklaid was the Victorian state recipient of the 2023 Senior Australian of the Year Award. He is now a nominee for the national Award, which will be presented in Canberra on Wednesday 25 January.

You can watch it at 7:30pm (AEDT) on ABC and iView.