Many students in upper secondary school, usually 16–18-year-olds, struggle with their mental health and wellbeing. Schools are one of the most important places where mental health support is offered to young people. Many teachers outside of formal mental health or pastoral care roles will also be aware of students who are struggling with their mental health and may be involved in supporting them. This guide will outline some important information that all upper secondary student teachers should know about mental health, particularly if they are not formally tasked with or trained in wellbeing support. This will include how mental health challenges typically present in upper secondary aged students, some common issues that impact wellbeing for young people, and how teachers can support students within their roles.

The spectrum of mental health and wellbeing

The discourse around young people and their mental health often includes the word ‘challenges’ silently, suggesting only a narrow reference to those young people who are experiencing distress or a period of mental ill health. It is important to remember that mental health and wellness is a spectrum, ranging from significant ill health to a state of wellness. The World Health Organisation defines good mental health not only as the absence of mental health challenges, but the presence of a state of holistic wellbeing and the ability to respond flexibly to challenges[1]. Students with good mental health and wellness will have access to sufficient supports and strategies, both within themselves and in their communities, to cope with the stress and emotional challenges they experience without being overwhelmed.

The most common mental health challenges for young people in upper secondary school are anxiety and depressive disorders[2]. New Zealand data demonstrates that more young people are struggling with depressive symptoms than in the past, and many will also experience suicidal thoughts, self-harm, and suicidal behaviour[3]. This pattern is also seen in other countries. Other mental health challenges like disordered eating, psychosis, and substance use disorders are less common but serious, and often start in during these years[4]. It is important to note that some students are more vulnerable to developing major mental health challenges, including Rainbow young people, those of minority ethnicities, and those with disabilities or neurodivergence.

Every student’s emotional wellbeing will exist somewhere on the spectrum from a consistent state of mental and emotional wellness to a major mental health challenge, and most students in upper secondary school will be somewhere in the middle of this spectrum. However, research from countries like New Zealand shows that right now, fewer young people than ever rate their mental health and wellbeing as ‘good’³. This means many students who do not have diagnosable mental health challenges may still not be in a state of good mental wellbeing and could benefit from additional support. Intervening early and supporting students before they develop a major mental health challenge is essential, and teachers can be an important source of support for students beginning to experience challenges to their mental health and wellbeing.

Causes of poor mental health and wellbeing

It is very common for students in upper secondary school to experience declines in their mental health and wellbeing. The exact causes will vary for each individual student, but some common themes have been found in research around the world. One common issue for students of this age is significant stress. This includes academic stress; stress associated with transitioning from school into university, courses, or the workforce; stress from extra-curricular activities; pressure they feel externally and internally; and the strain of juggling work with studying. Many students report significant stress and pressure – even those who teachers may not classify as high-achieving students.

Relationships also often impact mental health and wellbeing for students of this age. Social relationships are highly important for 16-18-year-olds, but navigating them can be extremely complex. This can include relationships with peers and friends, where experiences of bullying or exclusion can negatively impact mental health. Others will be entering romantic relationships and experiencing break-ups. Many students will also be affected by family dynamics, including their relationships with their parents, siblings, and extended family. Strong social relationships and inclusion can greatly benefit student mental health and wellness.

Within this context of stress and complex social dynamics, students are also trying to navigate their own identities. Many will experience challenges to their self-esteem or struggle with their body image. It is very important that teachers to understand the immense pressure students are under, the lack of support many of them feel, and how quickly multiple stressors can mount up and overwhelm students.

What might teachers notice?

It can be challenging for outside observers to identify when a student is struggling in a busy classroom environment, but identifying mental health or wellbeing decline early is important because the earlier support is offered, the more likely the positive impact on the young person. The early stage of wellbeing decline, before formal supports are needed, is also when teachers can have great impact.

One common sign to look out for is behaviour change. This could include noticing a student’s behaviour has changed inside and outside of the classroom. Teachers might observe increased sleepiness, irritability, arguments with peers, disruptive behaviour in class, or difficulty paying attention. Teachers might also notice changes to academic performance, such as declining grades or changes to homework or classwork completion. Research consistently demonstrates that declines in mental health impact school performance[5], so a sudden change in academic performance or attendance should raise questions about student wellbeing.

There can be many reasons why a student’s behaviour and academic output changes, and it is not always indicative of mental health and wellbeing challenges. However, this can provide an opportunity to speak to students about their wellbeing broadly, to ask whether anything has changed in their life or is affecting them at school, and to determine whether they might benefit from any additional support.

Supporting students in secondary school

Informal support from teachers in schools: Teachers play an extremely important role in supporting students with their mental health and wellbeing. Teachers spend a lot of time interacting directly with students, and supportive relationships with teachers are associated with student wellbeing[6]. It is important to understand that many students will experience brief, minor changes to their mental health and wellbeing, and not every student who is experiencing a challenge with this will need formal support – they may just want a trusted person to talk to, short-term support managing stress or workloads, or some help developing skills. Teachers with whom students already have trusting relationships can be highly beneficial here.

Deciding whether students will benefit from formal support, or whether they just need some informal connection with a teacher, can be complex. It is important that individual teachers do not feel they need to make this decision alone, and know who they can talk to if they need to discuss a student’s needs.

Suggested action: Establish who to talk to about student wellbeing at your school. Establishing this pathway proactively means that, if a student raises mental health concerns with you, you already know who can help clarify whether the student should be referred for formal support.

Formal support in schools: Different school systems, both within and across countries, will have different supports and programmes available to support student wellbeing. For example, in New Zealand many schools have registered nurses and school counsellors available. Understanding the supports available to students within a school is very important, so that student can be quickly referred for support where appropriate.

For students experiencing more significant mental health challenges, it is well documented that many struggle to engage with the mental health system, even when support services like school counselling are available to them[7]. Teachers, as trusted adults who know students well, can play an important role in bridging the gap to support. While teachers may not be involved directly in offering support through school mental health programmes, they can help students access this support, and increase their comfort in doing so, by pointing students towards resources if they ask for them, and facilitating and supporting them to access these services, such as by introducing them to the school counsellor.

Suggested action: Familiarise yourself with your school’s resources for supporting student wellbeing, and the processes for accessing these. This could include identifying the person within the school responsible for wellbeing, reviewing the process for contacting them if you are concerned about a student, and reviewing how students can seek help independently if they would like to. A good starting point is familiarising yourself with the school’s process for what teachers should do if they notice a student is struggling or seems vulnerable. If your school does not already have a formal process in place for this situation, some helpful questions to ask could be:

• Will the school support me speaking to a student directly if I am worried about them?
• Does the school expect me to wait for them to approach me?
• Who should I tell if I’m worried about a student?
• What kind of documentation, if any, is needed?
• Who can I refer a student to if they tell me they want to speak to someone?
• If they only want to speak to me, can I get support from other staff to do that safely?
• What is the school’s process for informing families if we are worried about a student?

Schools will often vary in their policies, and it is a good idea for teachers to make sure they are familiar with the expectations in their own school. If the school does not have specific policies, or they have not been recently updated, a review can be worthwhile. In New Zealand, the Ministry of Education has produced a mental health guideline for schools[8] which could guide this process. Research has also been done to develop guidelines on how teachers and schools can respond to different kinds of distress including self-harm[9] and suicide[10]. The World Health Organization also offers training on supporting students experiencing emotional distress which, while developed in Western Europe, has relevant learnings for teachers in other regions[11]. While it may not be possible for every teacher in upper secondary school to familiarise themselves with all guidelines, reviewing them with faculty and senior leadership is worthwhile for ensuring that students experience a consistent, reliable, evidence-based approach across the school.

Support outside of school: Just as different school systems have different supports within schools for student wellbeing, they will also have different processes for referring students to support outside of school. Typically, support should be available outside of school for students experiencing mental health difficulties that the school mental health team cannot manage, or who would prefer to receive support outside of school. 

It is a good idea for teachers to become familiar with the system in their local area. Some organisations, such as Youthline in New Zealand, will accept referrals directly from students without needing to speak to their primary care physician or a school counsellor. Others, like Child and Adolescent Mental Health Services in the community, may require a referral from a professional like a general practitioner or a school counsellor. While teachers will likely not be responsible for making these referrals, having some knowledge of the services available can help when speaking with students who are interested in finding further support outside of school.

Suggested action: Ask the staff member at your school responsible for student wellbeing who students are referred to if they are struggling with their mental health and need support outside of school.

What is not a teacher’s responsibility? Mental health and wellbeing is complex, and all students have unique needs and worldviews. Teachers may interact with students they believe could benefit from additional support, but who are not yet ready for or interested in this. It is not a teacher’s responsibility to force students to seek help, but rather to inform others in the school if they are concerned about a student, and involve them in the decision-making process. Teachers should not hold this worry and concern alone.

What to do when schools do not have processes in place for mental health support. Schools are essential to a functional mental health response. 16-18-year-olds are among the most vulnerable in our society to experiencing mental health challenges, and evidence consistently demonstrates that schools can be one of the most effective sites of intervention and support[12]. Any school that does not have processes in place for mental health support should immediately consider what they could put in place, including consulting young people in the school about what they need, and learning what is and is not available in the local community.

Talking about mental health

Talking to students: Many adults can feel nervous about talking to teenagers about their mental health and wellbeing. This is a natural response, and it is completely normal to feel worried when talking about mental health. Being prepared in advance by becoming familiar with school policies and guidelines can help alleviate some of this worry. There are also some broad principles that can be helpful to bear in mind:

1. Relationship building.  The dynamic that teachers establish with their students will inform how comfortable they feel talking about their wellbeing. In research, students say they often prefer to talk to teachers who are trusted, and who have shown they understand and respect them[13]. The relationship teachers build with their students is the most important way to show students that they are there for them, they care, and they want to help.
2. Being direct is powerful. Direct communication is a helpful way to make sure both teacher and student are on the same page. When teachers are worried about something specific, it is important to be specific about what is being asked. For example, if a student is withdrawing in class, it can be helpful to directly ask the student about this, whether they are okay, and offer to help them access any supports they might need.
3. Transparency is key. It is important not to make promises to students that cannot be kept. This is particularly important when it comes to confidentiality. Teachers should never promise to keep information regarding student safety, including thoughts of suicide, confidential. Promises like this are not fair to teachers or safe for students. In research, young people consistently say they value honesty more than promises of confidentiality that may get broken[14]. It is important to be honest with students about what will, and will not, be kept confidential.
4. Teamwork is essential. No single teacher can be responsible for supporting students’ wellness. Forming a network is important, and it is essential that teachers know who to go to within the school for advice about supporting a student. Often schools will have established guidelines for supporting students struggling with major mental health challenges, including those missing school regularly or who are at risk of suicide. While students might be reluctant to involve others, it is essential if the student’s safety may be at risk. Teachers also need support from others within the school in order to protect their own wellbeing.

Suggested action: Ask the school leadership if there are policies in place for how to speak to students about their mental health and wellbeing and, if not, suggest adopting a policy to reduce teacher anxiety about this.

Talking to families: Most schools will have policies around informing families about students’ mental health, particularly if a student is at risk of harm. This can often be a very challenging experience for teachers as students can be very resistant to informing their families. It is important to know that there are many reasons why students can be reluctant to talk to their families about their mental health. Different families will have different levels of awareness of mental health, different cultural expectations, and different experiences with mental health stigma. Some students may be experiencing complex family dynamics that are directly impacting their mental health. Students can often predict how their families will react better than teachers can, and it is important to listen to their concerns rather than dismissing them.

Transparency is an important principle here. Promising confidentiality when a family may need to be informed can cause a lot of frustration and lost trust, so it is best to be honest and direct about involving families. When it is necessary to inform a student’s family, it is important to discuss this with the school’s leadership and pastoral care team, who should lead this decision making. These conversations can be very challenging, and the burden to make these decisions should not rest with a teacher who has not been appropriately supported by the school to make these decisions.

One way to advocate for a student who is having a difficult time involving their family is to give them some opportunities for exercising agency during the process. This could include choices about which staff members they would like to be present, which member(s) of the family they would like to be informed, and whether they would prefer this happen in person or over the phone.

Suggested action: Clarify with the staff member responsible for student wellbeing or pastoral care what the processes are for informing families about student wellbeing, and who is responsible for this.

Talking with external mental health providers: Sometimes an external mental health provider may be in touch with teachers about options such as modified learning plans or students having time off school for their wellbeing. There may be tension between the recommendations providers make and the teacher’s goal to keep students learning, or the realities of working in a busy classroom. Many external providers may be able to discuss adapting their recommendations, or the school’s mental health and pastoral care team may be able to support with this. One of the strongest predictors of poor educational outcomes for students is their mental health, and supporting the student to improve their wellbeing will ultimately be the best way to promote their long-term educational attainment. A student who maintains a good relationship with the school during a period of struggle is much more likely to feel comfortable returning to school when they are able.

Key learnings

• Every student with whom teachers interact will be somewhere on the spectrum from good emotional wellbeing to a period of major mental ill health. Unfortunately, more students than ever in upper secondary school are experiencing less than optimal mental health and symptoms of anxiety and depression, and suicidal thoughts and behaviour are increasingly common. This can be related to the enormous stress and pressure that 16-18-year-olds face, the challenges they experience in social relationships, and the process of navigating themselves and their identity in a complex and changing world.
• Teachers can be some of the most trusted adults in student’s lives, and students may often disclose to them if they are struggling with their mental health. Teachers also have a lot of face time with students and may be some of the first adults to notice if a student’s behaviour changes or they begin experiencing emotional distress.
• Proactivity is key for safely supporting students. Knowing the school’s processes and policies around mental health in advance ensures teachers can be ready to support students in the moment, rather than worrying about what they can do or what the school offers. This allows teachers time to ask clarifying questions about processes they don’t understand, or challenge if they think school policies could be revised to be in line with national guidelines.
• For teachers wondering how best to support their students, relationship building and transparency are essential. Students are more likely to seek support from teachers they know and trust, and teachers can play an essential role in helping students access resources and seek help within and outside of school. Informing students about the limits of what you can offer and policies on confidentiality gives them agency in the help-seeking process.
• Finding your own support is important for teachers. You may have to make tough decisions about approaching students, supporting students to talk to their family or school counsellors, or managing behaviour in class. You should not feel alone in these decisions.

Endnotes

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[1] World Health Organization (2022). Mental Health Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

[2] Wuthrich, V.M., Jagiello, T. & Azzi, V. (2020). Academic stress in the final years of school: A systematic literature review. Child Psychiatry Human Development, 51, 986–1015. https://doi.org/10.1007/s10578-020-00981-y

[3] Sutcliffe, K., Ball, J., Clark, T. C., et al. (2023). Rapid and unequal decline in adolescent mental health and well-being 2012–2019: Findings from New Zealand cross-sectional surveys.  Australian & New Zealand Journal of Psychiatry, 57(2), 264-282. https://doi.org/10.1177/00048674221138503

[4] Uhlhaas, P. J., Davey, C. G., Mehta, U. M., Shah, J., Torous, J., Allen, N. B., Avenevoli, S., Bella-Awusah, T., Chanen, A., Chen, E. Y. H., Correll, C. U., Do, K. Q., Fisher, H. L., Frangou, S., Hickie, I. B., Keshavan, M. S., Konrad, K., Lee, F. S., Liu, C. H., Luna, B., McGorry, P. D., Meyer-Lindenber, A., Nordentoft, M., Ongur, D…Wood, S. J. (2023). Towards a youth mental health paradigm: a perspective and roadmap. Molecular Psychiatry. DOI: 10.1038/s41380-023-02202-z.

[5] Brännlund, A., Strandh, M., & Nilsson, K. (2017) Mental-health and educational achievement: the link between poor mental-health and upper secondary school completion and grades, Journal of Mental Health, 26(4), 318-325, DOI: 10.1080/09638237.2017.1294739.

[6] Moore, G. F., Cox, R., Evans, R. E., Hallingberg, B., Hawkins, J., Littlecott, H. J., Long, S. J.,  & Murphy, S. (2018). School, peer and family relationships and adolescent substance use, subjective wellbeing and mental health symptoms in Wales: A cross sectional study. Child Indicators Research, 11, 1951-1965. DOI: 10.1007/s12187-017-9524-1

[7] Radez, J., Reardon, T., Creswell, C., Lawrence, P. J., Evdoka-Burton, G., & Waite, P. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child Adolescent Psychiatry, 30, 183–211. DOI: 10.1007/s00787-019-01469-4

[8] Ministry of Education (2022). Mental Health Education Years 1-13: A guide for teachers, leaders, and school boards. https://hpe.tki.org.nz/guidelines-and-policies/mental-health-education/

[9] Meinhardt, I., Cargo, T., Te Maro, B., Bowden, L., Fortune, S., Cuthbert, S., James, S., Cook, R., Papalii, T., Kapa-Kingi, K., Kapa-Kingi, M., Prescott, A., & Hetrick, S. E. (2022). Development of guidelines for school staff on supporting students who self-harm: a Delphi study. BMC Psychiatry, 22(1), 1-14.

[10] Ministry of Education (2019). Preventing and Responding to Suicide: Resource Kit for Schools.  https://assets.education.govt.nz/public/Uploads/MOE-Suicide-Prevention-Publication-Updated-2019.pdf

[11] World Health Organization: Eastern Mediterranean Region (nd). Mental Health in Schools Training Package. WHO EMRO. https://www.emro.who.int/mnh/publications/mental-health-in-schools-training-package.html

[12] Orygen (nd). Evidence Summary: A review of secondary school-based mental health prevention programs. https://www.orygen.org.au/Training/Resources/Depression/Evidence-summary/A-review-of-secondary-school-based-mental-health-p/orygen-schools-evidence-summary-pdf.aspx?ext=

[13] Krane, V., Ness, O., Holter-Sorensen, N., Karlsson, B., & Binder, P-E. (2017). ‘You notice that there is something positive about going to school’: How teacher’s kindness can promote positive teacher-student relationships in upper secondary school. International Journal of Adolescence and Youth, 22(4), 377-389. DOI: 10.1080/02673843.2016.1202843

[14] Stubbing, J., & Gibson, K. (2022). What young people want from clinicians: Youth-informed clinical practice in mental health care. Youth, 2(4), 538-555. DOI: 10.3390/youth2040039