Life Skills and Adolescent Mental Health

Front matter

ROME GER OCUS

Fotos fe! Skills _ Adolescent Mental

Health Can Kids Be Taught to Master Life?

Contents

Preface vii

Introduction vii

The case of Sweden viii

Introduction

In the middle of August 2020, when the 636,000 Norwegian primary school pupils returned from their generous two-month summer holiday, something had ostensibly changed. The Norwegian Directorate for Education and Training had, as a part of its subject renewal policy decided that three transverse themes should now be taught through previously established subjects such as Norwegian, mathematics and gymnastics.' These three themes — health and life skills, sustainable development and democracy and citizenship — were highlighted to reflect current key societal issues that present-day youth would inevitably and necessarily face during their lifetime. However, of the three themes, I will limit myself to, and predominately examine, the objectives and unfolding and potential consequences/pitfalls of health and life skills (or, as it is more literally translated and is occasionally referred to by myself, “life mastery”) in this book.

The main question I try to answer is: Why are health and life skills being introduced in public schools at this time? The least sensational reply might highlight that the school curriculum is just being updated to be of relevance to the societal changes and challenges of the 21st century. That is certainly a conceivable answer. However, an important motivation behind the examination in this book is the conviction that these changes in schools are also an expression of a deeper, and potentially troublesome, transformation in how we have come to think about individuals’ wellbeing and mental health. Without giving too much away, behind the subject renewal policy is the idea that the upcoming generation needs guidance in how to live their lives and take responsible choices for their own health, and that it is up to the public schools to provide them with this. This may lead to the following questions: Has education not always provided youth with both knowledge and a basic set of skills such as reading, writing and calculating that prepares them for their life as grown-ups? Why is there suddenly an urge to highlight and address life skills as something explicit in itself?

International readers, unaccustomed to the public debate and concerns in Norway, might perhaps ask themselves whether something particularly viii Preface worrisome is going on in this far-off, northern yet oil- and gas-blessed country that calls for this seemingly dramatic step. Yet the answer, I believe, is “no”. The current changes in Norwegian public schools are an expression of a broader apprehension that is set to inevitably arise, or has already taken place, in most countries globally — although not necessarily always operationalised through the teaching of health and life skills. The tendency I am referring to is an outspoken concern for adolescents’ mental health. A possible solution to this uneasiness is to use psychoeducation and teach children healthy coping strategies for handling stress and pressure in a way that prevents them turning into anxiety, depression, self-harm or eating disorders. Moreover, a potential place to do that is in public schools, since these are institutions where almost all children and adolescents will spend a large share of their day throughout their formative years. Norway may well be one of the first countries that explicitly introduces health and life skills as a subject for all pupils — although indirectly through the established body of teaching. However, in many Western countries, as I will show henceforth, there are examples of a similar tendency in the last couple of years. All of these programs, globally, are faced with some of the same dilemmas presented in this book. My aim — and hope — is that my critical examination of the introduction of health and life skills in Norwegian schools can also serve as a useful scrutinisation of the potential pitfalls elsewhere, whether similar life skills programs have already been introduced or governments or professionals are seriously considering them. I also hope that it serves not only as an examination of life skills in schools but also of wider questions about the role of education and ultimately how much responsibility one could reasonably ask young people to take for their own mental health.

The case of Sweden

One does not have to go far from Norway’s borders to find a similar line of thought. In fact, in the winter of 2022, several organisations, including UNICEF, Save the Children and Bris, came together in Sweden to make a public call for mental health education to be made compulsory in schools. Their request that the Swedish National Agency for Education put mental health on the curriculum is fascinatingly similar to the calls made by organisations in Norway years prior to this. The following is a transcript of an entire news story from Radio Sweden.

Children should learn about mental health in schools just like they learn about physical health, that’s according to 16 organizations who work with children’s wellbeing and health in Sweden. Karin Schulz from the organization Mind: “We see several warning signs. Many children say they are mentally unwell and they turn to the health service more than ever before because of mental illness. And the

Preface ix prescription of anti-depressants are increasing a lot”, she says. “So that is why we think it is important to think preventatively to equip children and young people with knowledge and tools so that they can understand themselves and their surroundings better”, she says. The organizations including UNICEF, Save the Children and Bris want to make mental health education compulsory for all students in primary as well as secondary school. In an op-ed piece in the daily Dagens Nyheter, they claim every other 15 year old today is suffering from mental health problems, which is twice as many in the beginning of the 1980s. They say that the results from the research are clear: young people that learn about mental health feel better. They learn how to take care of their mental health. As well as where they can turn for help if they need it. The organizations refer to Finland, New Zealand and some states in the US where mental health already is on the curriculum and say it is time for Sweden to put it there too. But it is up to the national agency for education to decide whether to make it a subject in its own right or integrate it into the current PE-classes, says Karin Schulz from Mind. “We don’t say exactly how this should be done, but we think it is vital knowledge that all children have the right to”, she says. In addition to the classes to teach children about mental health the organization also wants to include it in the regular health checks that children undergo at school.”

What is both intriguing and potentially worrisome is that this line of thinking is almost identical to that of Norway a few years earlier. The parallel basic assumption appears to be that there are perturbing signs of a mental health epidemic among younger people in our country. Therefore, something must be done. That “something” is prevention in schools by giving children more knowledge and tools so that they can “understand themselves and their surroundings better”. To support this, there is the disputable claim that research allegedly shows that young people who learn about mental health feel and fare better. The only uncertainty is connected to how this should be rolled out in schools in practice. For instance, whether it should be an independent subject in its own right or integrated into the current PE classes.

An optimistic interpretation would be that these calls for education in life skills and mental health in both Norwegian and Swedish schools are similar only because the problem of youths’ declining mental health is alike in most countries; the necessity of teaching children life skills and educating them about mental health in public schools appears to have gained momentum in several countries worldwide. Yet, a more sceptical view — to which I will subscribe in fair shares in this book — is that organisations and governments around the world are, by default, drawn to the simplest and most readily available “package” and individual “solution” to societal problems that does not require institutional changes.

x Preface Look to Finland

If we move even further east to Finland, which Schulz advised Swedish educators to do, what do we find there? Initially, it is worth stating that Finland’s educational system is frequently ranked as the best in the world. Often the practice of delaying the start of education to age seven, fewer mandatory standardised tests, a low amount of homework and the unique prestige teachers hold are mentioned. However, a recent report in The Lancet Child & Adolescent Health journal pointed to a perhaps overlooked component: Social and health care for students provided by the schools themselves. After the introduction of legislation in 2014, it became a requirement that school staff paid attention to their students’ wellbeing and welfare. Teachers were also encouraged to take any concerns about their students — if they were given permission — to one or all members of the schools health and welfare team. This was also backed up by a seven-day time limit for appointments after a concern was raised, and just one day if the situation was judged as critical. Moreover, the school nurse routinely meets all pupils individually each year, and a doctor on specific years. Furthermore, health education is also introduced as a special subject for students from the 7th grade onwards. Typically, focus points will be bullying, diet, prevention of illness, good health and safety and mental health — the latter allegedly given extended attention to keep it from being stigmatised.

Now, this sounds almost too good to be true. Yet current development in Finland is not without its alarms for the future either. In the aforementioned report, Silja Kosola, who has worked as a Helsinki-based school doctor for 8 years, acknowledges the benefits of her home country’s health and welfare system for children but is also open about her concerns for the direction they are currently taking, mentioning both the dangers of over-screening and medicalisation.* For instance, the juxtaposition of school nurses being routinely advised to screen for depression among 15-year-olds using the Beck Depression Inventory and their inevitably finding more teenagers with mild to moderate symptoms. A consequence of this might be that the child psychiatric services are over-stretched; and that those with more resourceful parents get help over those with less privileged backgrounds but often more severe problems. In the interview, Kosola therefore also ponders on whether such broad-scale assessments and interventions form the most beneficial approach, or whether the resources could ideally be used better if they were deployed more selectively. Whether the investment in social and mental health will be successful remains to be seen. Finland has had some success in reducing externalised symptoms in recent decades, not least suicide, yet internalised symptoms, such as depression, anxiety, stress and self-esteem issues, have increased in later years — particularly among girls — a pattern all too familiar for most Western countries.*

Preface Xi Something is rotten in the state of Denmark

If we move further south to Denmark, the government decided in 2018 to form a National Stress Panel, given the background of a worrying increase in selfreported levels of stress among Danish youth throughout the 2010s. One year later, this commission presented twelve actions meant to reverse this negative trend.” Their third specific plan of action was to prepare children and adolescents to master life better, and their suggestion was that life skills should be established as a recurrent theme in Danish public schools, modelled on the recently decided changes in Norway. This proposed plan of action was welcomed by the leader of the students’ organisation, Sarah Gruszow Bærentzen, but simultaneously dismissed by the leader of the teacher’s union, Anders Bondo Christensen, and the minister of Education, Merete Riisager from the Liberal Alliance — whose main reaction was that it was not a school’s mandate to solve societal problems.* In a previous interview, Riisager also argued that the main problem was not a culture of achievement in education based on tests, presentations and grades but a culture of perfection, which transcends life in school and hangs over youths’ heads in all walks of life.” Not only that, Riisager appears to interpret suggestions like teaching life skills in schools as an expression of disclaiming liability by her generation of adults. That this ultimately hurts the children, who themselves are forced to behave as adults, is the underlying message. Despite Riisager’s initial success in rejecting the incorporation of life skills in schools in Denmark, the debate of what to do about the growing discontent, stress and mental health complaints among Danish youth continues with increased intensity. For instance, the Danish Socialist Party have youth discontent as their top political priority. However, their remedy is directed more at relieving the pressure in the education system, a more practical curriculum and the presence of more adults in classes and schools. !° It is also worth mentioning that despite there not being a national curriculum in health and life skills, Danish municipalities are still recommended to follow the philosophy of early intervention and implement established programs, such as PALS (“Positive behaviour, supportive learning environment and interaction in school”) and ABC (“Act Belong Commit”) in schools. Many municipalities have done just that." Meanwhile, the worry about young people’s declining mental health appears to increase each year in Denmark, as reflected during the Danish Election in 2022, when this issue became one of the major topics in the debates prior to the election of a new government.

Back in the UK

In the UK, “Personal, social and emotional development” has become one of three prime areas within the Early Years Foundation Stage, a statutory framework introduced in the British government’s Childcare Act in 2006. Self-regulation, managing the self, building relationships and understanding xii Preface your feelings are some of the key components here. Ideally, the typical student should “show an understanding of their own feelings and those of others, and begin to regulate their behaviour accordingly”."? Back in 2008, Kathryn Ecclestone and Dennis Hayes published their seminal book The Dangerous Rise of Therapeutic Education that aimed to explain why Western society has seemingly come to regard today’s youth as less psychologically resilient than their predecessors. As an illustration, they began their book with a memorable quote from a history teacher in London: “[y]ou know something has changed when young people want to know more about themselves than about the world”. The English education system had in recent decades, according to Ecclestone and Hayes, been permeated by psycho-emotional practices, programs and rhetoric, which suggested that the primary trait of education was no longer that of knowledge but rather of safety and personal development. In the reprint of their book from 2019 the new preface is entitled *The continuing dangerous rise of therapeutic education”, which suggests that the trends they noted in the early 21st century have only increased since.'* State support for psychological, social and emotional learning is immense across most political parties. For example, the Labour government’s Social and Emotional Aspects of Learning (2003—2010) was heavily influenced by positive psychology, person-centred counselling and cognitive behavioural therapy (CBT), and the Liberal Democrat/Conservative coalition that the following year replaced “emotional wellbeing” with “character” and “resilience” — perhaps more in line with their ideological values but still in line with the same thinking. Currently popular interventions in primary schools, such as mindfulness, have seen the Welfare Trust spending £6.4 million to explore the benefits of mindfulness classes in schools. Notwithstanding, young people’s mental health problems appear only to worsen in the UK. One in six children aged between 5 and 16 was believed to have a mental health problem in 2021, whereas that number was one in nine four years prior to that.'> It should be mentioned that, of course, the Covid-19 pandemic (as in most countries) is believed to be partly responsible for this negative trend due to increased isolation and loneliness among young people, the negative consequences of which might be reversed as society gradually re-opens.

Life skills around the world

My earlier suggestion that there are suspicious similarities across borders in the line of thought that life skills and mental health should be taught in schools may have a reasonable explanation. Life skills has been on the agendas of global and influential organisations like the World Health Organization (WHO), which are defined as more or less universal, for the past decades. As far back as 1977, the WHO highlighted the necessity of promoting health as a positive concept and resource for everyday life. This was later agreed in the Ottawa Charter for Health Promotion in 1986. Following up on this, the WHO

Preface xiii issued the seminal report “Life Skills Education for Children and Adolescents in Schools” in 1994. In the opening paragraphs, readers around the world can read the following:

Promoting Psychosocial Competence: Psychosocial competence is a person’s ability to deal effectively with the demands and challenges of everyday life. It is a person’s ability to maintain a state of mental well-being and to demonstrate this in adaptive and positive behaviour while interacting with others, his/her culture and environment. Psychosocial competence has an important role to play in the promotion of health in its broadest sense; in terms of physical, mental and social well-being. In particular, where health problems are related to behaviour, and where the behaviour is related to an inability to deal effectively with stresses and pressures in life, the enhancement of psychosocial competence could make an important contribution. This is especially important for health promotion at a time when behaviour is more and more implicated as the source of health problems. The most direct interventions for the promotion of psychosocial competence are those which enhance the person’s coping resources, and personal and social competencies. In school-based programmes for children and adolescents, this can be done by the teaching of life skills in a supportive learning environment. !6

Here we find the whole idea of life skills in schools spelled out. Human behaviour is depicted as the major source of health problems, and now more than ever. However, although it may sound fairly straightforward, what is this notion really an expression of? One interpretation could simply lead to the perception that research has demonstrated that individual behaviour, or rather bad behaviour, is the single most important explanatory factor and predictor for health problems. Well, yes, but what does this really imply beyond the merely obvious? One implicit idea underlying this conception might be that, in the middle of the 1990s, most people in most Western countries no longer suffered from some of the social ills that previous generations did before them. Therefore, objectively, they could be held more accountable for their behaviour, either good or bad, than has traditionally been the case. Another possible interpretation, however, rejects this notion that all men are equal, and stresses that each individual’s capability for displaying health-promoting behaviour and making sound and healthy choices for themself is still very much a result of where in the social pecking order you find yourself; whether you come from a family with plenty sociocultural resources, etc. In fact, if this latter explanation holds some truth to it, claiming that behaviour is the major source of health problems might actually help to disclose this fact, leaving the impression that those who succeed prosper because they have earned it. Notwithstanding, in fact, the whole game is “rigged” and life chances are extremely unfair in terms of where one starts in life.

xiv Preface

Nonetheless, the WHO went on to list the following areas of life skills as vital across cultures: Decision-making and problem-solving, creative thinking, critical thinking, communication and interpersonal skills, self-awareness and empathy, assertiveness and equanimity, resilience and coping with emotions and coping with stress.'’ Perhaps also influenced by the positive psychology movement in recent years, life skills education is therefore frequently seen as supporting positive youth development, and something that prevents both delinquent behaviour and mental health problems:

life skills education, have found [sic] to be an effective psychosocial intervention strategy for promoting positive social and mental health of adolescents, which plays an important role in all aspects such as strengthening coping strategies and developing self-confidence and emotional intelligence."

In addition, it appears that life skills training is also understood to be increasingly important, perhaps as the upcoming generation’s worry that the burden of societal challenges — and at the same time, the huge amount of stimuli and information they are exposed to on a daily basis in their digital lives — grows larger every day. According to the WHO, to date, life skills have often been taken for granted but are becoming more and more of a necessity:

[T]here is growing recognition that with changes in many cultures and lifestyles, many young people are not sufficiently equipped with life skills to help them deal with the increased demands and stresses they experience. They seem to lack the support required to acquire and reinforce life skills. It may be that traditional mechanisms for passing on life skills (e.g. family and cultural factors) are no longer adequate considering the influences that shape young people’s development. These include media influence and the effects of growing up in situations of cultural and ethnic diversity. Also the rapid rate of social change, witnessed in many countries, makes the lives of young people, their expectations, values, and opportunities very different from that of their parents.'°

It appears that life skills are frequently perceived as the answer to the difficulty of being a young person that struggles or suffers from mental health issues at the beginning of the 21st century. More or less systematic attempts at life skills education can, in addition to the countries already mentioned, be found in Holland, Germany, Greece, Canada, the US, Mexico, Brazil, South Africa, Hong Kong, Pakistan, Nepal and India. Life skills also recurrently appear in worldwide development programmes that aim to empower young people, and girls in particular. However, they may produce contradictory outcomes when it comes to gender oppression. For instance, in Rajasthan, India, the life skills programme seeks to teach girls about bodily integrity but may, at the same time, accidently re-inscribe the caste norms.”

Preface XV

The universalised approach to skills in life is also frequently depicted as a kind of competency, where health is frequently depicted as a literacy on the same line as reading and writing:

The underlying cause of the problem of confusion for many people is a low level of health literacy. Literacy skills in general are the strongest predictor of an individual’s health status, more so than their income, age, education level or employment status.!

It is worth highlighting how having “health literacy” in many states globally is upheld as a personal responsibility and key to being an accountable citizen. Thankfully, it is still acknowledged that some groups may be disadvantaged and have difficulties in managing this demand. Yet the rhetoric then often narrows down to how governmental authorities should make sure that they equip these disadvantaged people with the necessary skills so that they can also become healthy citizens:

Above all, health literacy should be, and needs to be, an active part of a person’s citizenship and it is a key component of social inclusion. We should all take it upon ourselves to ensure we are as health literate as we possibly can be and make use of the courses and opportunities that are on offer. However, governments and other authorities have a critical role to play too — particularly for disadvantaged groups. At a time when most countries are investing in a number of initiatives for senior citizens, such as enhancing their computer skills, they also need to make sure that people are equally equipped to make healthy choices in supermarkets, restaurants, or when talking with their physicians. This will help safeguard the health of citizens into the future.”

However, it seems that the notion of health literacy started with research on the connection between low literacy skills (with regard to reading and writing) and poor health among medical patients.” Gradually this finding appears to evolve and lead to talk about “health literacy” as a competency in itself; rather than just an expression of patients with low levels of education and wealth who also have poorer health than peers from more privileged backgrounds.” Just as governments in the past — and in some cases in the present — around the world have had the prevention of illiteracy as one of their major goals, decision and policy makers around the world now need to react to their respective national concerns for their youth’s mental health literacy and life competence.

Unsurprisingly, commercial companies that offer to follow up on this for governments and educational bodies regularly appear. These companies make convincing claims, quoting both science and bodies like the WHO. Just listen to how a typical representative of the education company Positive Action xvi Preface convincingly maintains their argument in ‘Why Should We Be Teaching Life Skills in Schools in 2022?:

The internet is a wildly useful innovation. Information has become faster, better and easier to attain — more so every year. Discover why kids and young adults need real-life skills empowerment now more than ever.

However, because the information accessed via the internet is unfiltered, this has opened up a complex information age with a wide range of stimuli. It can get young people into an emotional mess.

Not to mention the misinformation, cyberbullying, and other negative consequences affecting kids in the modern age — it’s hard to cope.

That’s why kids and young adults need real-life skills empowerment, now more than ever. . .

All-encompassing skills like these can’t be left to learn in the home setting alone — especially since kids often spend more time in school.

Imagine young people graduating from school with excellent scores but not knowing the first thing about coping with reality. What if they couldn’t communicate effectively? Or couldn’t handle money issues and were always in debt?

It’s both alarming and all-too-common. That’s why parents and teachers alike should play an active role in preparing kids for the future.

Where the school is concerned, that means doing more than merely teaching algebra and biology. While no one can downplay the importance of good academics, it’s just not enough without the necessary life skills... . Setting Young People up for Success: Young people are brimming with untapped potential. And they need dedicated skills that empower them to bring out the best in themselves. . . . It’s a proven philosophy. Get in touch with Positive Action today for the curriculum and kits, training, and more. Positive Action will help you achieve the best outcomes — well rounded, empowered, and educated young people.”

As is often said, something must be done — but not something too original (or costly)! So why not teach life skills in schools? Expressing hesitation is rapidly seen as somewhat passe, as the enthusiasts depict life skills as a new landmark discovery that is set to become a necessity. For example, Dan Domenech, the executive director of the US national School Superintendents Association, has said “[w]e are finally beginning to recognize that school is more than just teaching the kidsreading, writing and arithmetic.””°