Mary's Story

Nothing to be ashamed of

Mary used to be among the top students in her class. Changes began when she entered form 3 last summer. Her parents were very concerned about her behaviour. She became suspicious and always claimed that she heard voices talking to her even when no one was present. Sometimes she was just depressed for no particular reason, and had very low self-esteem. The family had no clue of what was happening with her until a psychiatrist diagnosed her conditions as early symptoms of schizophrenia.

The illness affected Mary's performance in school as well. Academically, her grades dropped drastically due to the loss of interest in her studies. She became withdrawn and did not socialise with her friends. While her teachers and classmates had noticed something unusual about her, her parents hesitated to inform the school about their daughter's problems for fear that she might not be accepted by the school or her classmates.

To control her symptoms, Mary had to take anti-psychotic medications. But symptoms of the illness together with her reaction to medications made it difficult for her to concentrate in class. Mary's parents then realised that she would not be able to learn effectively in the long run, if she was not given appropriate support. They decided to discuss Mary's condition with the principal.

In coping with her problems, the school adopted certain accommodation measures, both in classroom practices and academic arrangements. For example, knowing that Mary might take leave because of her conditions or the need to receive medical treatment, they did not require her full attendance at school. To help her prioritise her tasks, the teachers devised a tailor-made study plan for her and provided her close guidance.

The cooperation between her parents and the school went well. They met regularly to monitor Mary's progress and brainstormed different approaches to help her manage her studies, and her relationships with other students. With the help and understanding of the teachers and students, Mary's academic performance began to improve and so did her relationships with her classmates.

Mental Illness

Mental illnesses may impact on the way a person thinks, behaves, and interacts with other people. The term mental illness actually encompasses numerous psychiatric disorders. The more common types include:

• Anxiety disorders
• Eating disorders
• Mood disorders (including depression)
• Schizophrenia

Signs of illness or reactions to medication may include tiredness, poor concentration, sudden change in weight, memory loss and erratic school attendance.

Special Considerations

Many people suffering from mental illnesses may not look ill while others may appear to be confused, agitated or withdrawn. Mental illnesses require treatment. Today, most people who have mental illnesses, including the more debilitating ones such as schizophrenia, can be treated effectively.

If there are students with mental illnesses in your class, the following may be beneficial:

• Be aware of students who display signs of becoming unwell and monitor how they are coping with school
• Allow adequate time and privacy for discussion with the student, so that he or she does not become anxious about unfinished conversations
• Listen and be attentive while the student speaks
• Encourage the student to seek assistance through counselling
• Avoid stigmatisation
• Avoid disclosing the illness of the student without his/her consent

How can I make my class inclusive for students with mental illnesses?

To assist students with mental illnesses to learn and to enjoy school life, some adjustments are necessary. Some students may need certain special adjustments in teaching methods whilst others may require special accommodations in performance assessment. Examples of such adjustments are:

• Make available reading lists and handouts earlier in the term, this will assist students who sometimes may have to be absent due to their impairment
• Where appropriate, make special arrangements for examinations such as allowing the student extra time
• Disseminate correct information about mental illnesses in class

Illness-specific Adaptations

Schools and teachers are reminded to consult the attending physicians of the student before adopting any of the following adjustments, as the symptoms and manifestations of mental illnesses vary from case to case. Readers are also reminded that the following adaptations could not substitute for medical treatment, and the student at risk should be referred to medical experts for proper treatment.

Anxiety Disorder

Anxiety disorders are illnesses that fill one's life with overwhelming anxiety and fear. Each type of anxiety disorder has its own distinct features, but they have the common theme of excessive and irrational fear and dread. The more commonly known anxiety disorders are panic disorder, obsessive-compulsive disorder, generalized anxiety disorder and phobias.

Just like adults, students can become anxious as well. Stressful life events, such as starting school, moving, or the loss of a parent, may trigger the onset of an anxiety disorder. Some common problems faced by students with anxiety disorders are:

• Physical symptoms resulting from the student's anxiety problems, such as headaches, stomach aches, palpitation, nausea and diarrhoea
• Behavioural problems manifesting from the student's anxiety problems, such as restlessness, irritability, avoidance, defiance and (in younger children) crying and tantrums
• Irrational phobia of examinations or other specific objects

Examples of adjustment:

• Recognise that the fear is real and do not dismiss the student's fear as trivial
• Avoid forcing the student to overcome his/her fear by trying to belittle the fear and do not cater to fears by avoiding something deliberately
• Where the student's attending doctor agrees, encourage the student to use coping and relaxation strategies such as visualization (e.g. imagine floating on a cloud or lying on a beach) and deep breathing

Eating Disorder

The term eating disorder generally refers to any destructive or self-defeating pattern of eating behaviour. Typically, students with eating disorders are preoccupied with food, weight and their personal body image. Anorexia nervosa and bulimia nervosa are among the more commonly known eating disorders.

Students with eating disorders face common problems such as:

• Severe disturbances in eating behaviour
• Refusal to maintain a normal body weight according to age and height
• Feeling of distress or low self-esteem
• Extreme concern about body shape or weight
• Physical health complications, including heart conditions, dental problems and stomach problems

Examples of adjustment:

• Look out for behavioural cues before a situation escalates out of control
• Refrain from making comments to the student about appearance
• Avoid, where practicable, exposing the student to activities that may unnecessarily draw attention to his/her weight
• Encourage a supportive classroom environment and help the student set realistic goals
• Help the student build up his/her self-esteem and guide the student to pay more attention to issues other than his/her own physique

Mood Disorder (including depression)

Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of exhilaration. While many people go through sad or elated moods from time to time, people with mood disorders suffer from such severe or prolonged mood states that disrupt their daily lives. Among the general mood disorders are major depressive disorder, bipolar disorder, and dysthymia. Depression is one of the more commonly known mood disorders.

Students with mood disorders face common problems such as:

• Overwhelming feelings of sadness or grief
• Anger and irritability
• Symptoms of extreme excitement such as elated emotion, wild behaviour, overblown self-confidence, compulsive spending and recklessness
• Reclusive
• Loss of interest in taking part in activities
• Difficulty in concentrating and making decisions
• Loss of energy
• Unreasonable sense of guilt and despair
• Loss of incentive or hope
• Sleep disturbances
• Thoughts of death, suicide or harm to others

Examples of adjustment:

• Identify and refer students at risk to appropriate experts such as counsellors for help
• Develop support strategies such as building a support network to assist the student in need
• Find out what motivates the student and how he/she can learn best
• Teach the student problem solving techniques, e.g. generating different solutions for the problems he/she is facing
• Encourage the student to use positive self-talk (for example, it's OK when there are mistakes) and problem solving techniques when confronted with difficulties
• Stay alert and seek help from appropriate person(s) if the student displays signs of having suicidal tendencies or ideas of inflicting harm on others.

Schizophrenia

According to the World Health Report published by the World Health Organization, schizophrenia is characterized by fundamental distortions in thinking and perception, and by inappropriate emotions. The disturbance involves the most basic functions that give the normal person a feeling of individuality, uniqueness and self-direction. The behaviour of patients of schizophrenia may be seriously disturbed during some phases of the disorder, leading to adverse social consequences. Hallucination ("voices") and strong belief in ideas that are false and without any basis in reality (delusions) are key features of this disorder.

Students with schizophrenia face typical problems such as:

• Distorted perceptions of reality
• Hallucinations and illusions
• Delusions
• Confused thinking, lack of initiative and disorganized behaviour
• Difficulties in expressing emotions
• Problems in making or maintaining a relationship with friends

Examples of adjustment:

• Referr students at risk to proper medical care
• Use alternative means of communication, e.g. writing, if the student can better organize his/her thoughts
• Direct the student's mind to other interests and help him/her recognize that he/she does not need to wait for incoming voices
• Learn about signs and symptoms of the illness and its treatment, and learn to recognise the warning signs of relapse; do not mistake the negative signs of the illness as laziness
• Discuss with the student, the parents and the attending doctors the best ways to encourage the student to take medicines
• Record and report episodes of relapse to the student's parents and/or the attending doctors
• Avoid patronizing or being critical to the student when the student experiences a difficult time

DDO and the Code of Practice on Education

The Disability Discrimination Ordinance (DDO), effective since 1996, protects persons with a disability from discrimination, harassment and vilification on the ground of their disability.

The Ordinance makes particular references to the field of education to ensure that persons with a disability have equal opportunities in education. It requires educational establishments NOT to discriminate against students with a disability and to make reasonable accommodations to address their special needs. Such accommodations may include adjustments in teaching, communication, and assessment methods. The DDO also prohibits harassment in educational establishments, including harassment of students with a disability by other students. The law binds the government, educational establishments and their employees, and in the case of harassment and vilification, even the students.

The Code of Practice on Education under the DDO was issued in July 2001 by the Equal Opportunities Commission (EOC) to provide guidance on the legal requirements under the DDO in the field of education. It serves to assist educational establishments in developing policies and procedures that prevent and eliminate disability discrimination, and educators in making provisions for students with disabilities. It covers a wide range of practical guiding principles on matters such as admission, providing access, curriculum design and assessment.

The Code is an aid for providers and recipients of educational services. It helps the providers to better understand what constitute non-discriminatory good practices in education, and the recipients to understand their rights and obligations.