‘Teen Substance Use, Mental Health and Body Image: Practical Strategies for Support’  was written by Ian Macdonald, who has 20 years’ experience working with young people in education.

teen drug use

Read this article from Macdonald on his book and transforming PSHE lessons to provide young people with the support they need:

Just over a year ago I started writing ‘Teen substance use, mental health and body image’, with the simple goal of spending my summer down time a bit more productively than the previous year. I had come to realise that my experiences working in education and public health (young people’s substance misuse and mental health) were actually quite valuable and well respected by others – something I still struggle with today! My focus was always to cement the links between mental health and risky behaviours in adolescence, adamant that this should be both rooted in evidence and practice. I had long held the thought that effective PSHE was the real missing link in the prevention agenda, underpinning the support systems which come further down the line. I also had the frustration that we had an education and public health workforce with the potential to impact this, yet communication between the two being separated further by endless policy changes and separating of roles. This gives us the reactive and information heavy approach to PSHE highlighted in chapter 2, which can potentially do more harm than good:

“As a catch-all term we often hear the phrase ‘mental health awareness’. It is a term I have come to struggle with, as for some it can mean everything we want it to – promoting positive mental health and wellbeing, providing the opportunity to practise healthy coping and asking for help when needed, while also identifying when we don’t feel great and how to respond to that. However, it can also mean a very simplistic understanding of ‘mental health’ – just facts about what certain mental health conditions are, without any content aimed at upskilling young people or changing their attitudes towards their own and others’ mental health. It is these latter elements which are most important within mental health education, yet it is those which are often missed for the reasons outlined earlier. I have heard of young people being quite traumatised by being shown a television documentary on mental health in the interests of ‘raising awareness’. This being done in isolation and not as part of a wider programme of health education resulted in it being a distressing experience. In this way, mental health education can be subject to the ‘something is better than nothing’ approach described earlier, and not one which is delivered in a safe and effective way (p.33-34)”

One of the key tools we can introduce to helping young people adopt healthy ways of coping is through the use of social norms, not only in covering alcohol and other drugs where its adoption has been more supported, but also across other healthy behaviours.

“(PSHE) content has been influenced by increasing awareness around the numbers of young people smoking, drinking and coming to harm as a result. Therefore, the approach becomes more about avoiding the negative behaviours and their consequences. Ultimately this creates an approach which is constantly chasing its tail. It also creates an approach which unwittingly normalises the very behaviours we want young people to avoid, as our starting point is always the negative. If we are to create a more effective model of prevention, we need to give more credence to the behaviours we want young people to adopt rather than avoid. The social norm approach seeks to challenge these misperceptions to positively influence future behaviour choices, with PSHE being a key vehicle for the delivery of this. The use of social norms in alcohol and drug education in particular has long been rooted in the notion that young people (and the adults in their lives for that matter) consistently over-estimate the numbers of their peers who are drinking, smoking, taking drugs, and even having sex. This is in part down to that desire to always act older than we are, and doing things which indicate increased maturity. It is also down to how these behaviours are presented in the media – ‘they are all doing it’ – and these behaviours becoming ‘normalised’” (p.60)

With all this mind, I wanted to keep the end of the book focused on the ‘so what’ factor. How can an increased understanding of the evidence and theoretical models help inform how we support and deliver health education to young people in school and similar settings? A big thing here is how we develop a language around mental health by making simple changes:

“So it is here that we can make a clear distinction between when we are experiencing feelings and emotions like anxiety, and when we are suffering from them. This may seem a little petty, but we should consider how this simple shift in thinking and contextualising of mental health in schools can impact on whole school approaches to wellbeing. This helps us normalise rather than medicalise elements of everyday life (Kutcher, 2017). It also opens up the opportunities to discuss and explore those causes and healthy ways of coping, and also to help young people develop a shared language around mental health. Importantly, it supports that proactive approach to promoting positive mental health rather than the reactive one of avoiding poor mental health” (p.110)

The new relationship, sex and health education curriculum requirements give a fantastic opportunity to embed creative and evidence informed approaches to support young people’s health. To do this we need more champions of ‘what works’ in this area, from both the education and health perspectives. With this mind, I have tried to ensure each chapter has both a base in what the guidance and evidence tells us works, as well as some practical ideas on how to implement this with young people. I hope this can inform conversations within education settings on how to best support young people to make healthier choices, and inform how schools can be supported to adopt those approaches in conjunction with local health professionals.

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