Czech schools are learning to concentrate not just on education but also on students’ well-being. From Page Not Found.
When I was in elementary school, I saw the school psychologist for a grand total of one afternoon, for a consultation about my future career plans. Nobody ever came to “have a chat” with us – not even when one of our classmates died in a car accident. The office of the school psychologist, where kids in American movies go to talk about how their parents are arguing at home, was just a dream. Now we are in a different place. In order for that to happen, however, the situation had to get quite dramatic.
Before the school year has even begun, a one-hour bus ride from Prague brings me to Zruc nad Sazavou. Preparatory works at the local elementary school are in full swing – the school is getting painted, aired out, tidied up. The kids have yet to come to the classrooms but the consulting office, which is where I’m heading, is open all year round. Psychological problems do not take summer vacations.
The relatively large room has several office desks, as well as a couch, a beanbag, and two armchairs. I sit in one of the armchairs. I’m imagining an average elementary school from the survey of the National Institute of Mental Health (NIMH), which says four out of 10 students exhibit the signs of moderate to severe depression. It’s a good thing they have the armchairs. In the Czech school system, there is one such armchair for 2,400 children.
Mental Health Care 196 Days a Year
Among psychiatric outpatients under 20 years of age, the largest group is in the age bracket of 11 to 15 years. Magdalena Lukasova, head of the Working Group for Research in Child and Adolescent Mental Health, part of a research program at NIMH, says they most often come across disorders of mental development (e.g. specific development disorders of school skills, autism), as well as disorders of behavior and emotions (ADHD, eating disorders, anxiety and depression disorders, etc.). Also common are cases in the category of neurotic‚ stress-related, and somatic disorders (anxieties, phobias, PTSD etc.), intellectual disabilities, and depression.
There is no single cause that would explain the growing prevalence of mental health issues among children and young adults. According to Lukasova, it is a combination of a number of factors, including the family environment (conflicts in the family, divorces, how supportive parents are towards their children and how much interest they have in them), the impact of technologies and social networks, academic pressures (and more broadly pressures and expectations that young people are exposed to), romantic troubles, substance abuse, as well as the overall social climate.
But there is a general lack of psychologists and psychiatrists dedicated to kids. The waiting time for appointments in the educational-psychological consultation office for children is several months, in some places up to a year. Adolescence, however, is a critical period of life, crucial for the protection of mental health, and early intervention and prevention are key. Moreover, the early identification of at-risk children, and providing support for them, are objectively the most effective and least costly forms of help.
A system of mental health care focusing on prevention and early help can be created through the cooperation of experts from different fields, says Lukasova. Simply put, the critical situation can be solved if all relevant actors are involved, starting with the children themselves, continuing with the schools and the school psychologists, educational care centers, and all the way up to social and healthcare services.
Such a system would gradually unburden the overloaded specialized psychological and psychiatric services. “But we need to make sure we’re only supporting those programs and services that have proven effectiveness. Otherwise, we’re risking the waste of financial and especially human capital,” emphasizes Lukasova.
Is there a better place for broad-basedinterventions aimed at improving the mental health of children and adolescents? A place where kids and young adults would come every day, Monday to Friday – 196 days a year? In the area of mental health, the school is vital. And some schools are already making an effort to reduce the number of depressive students by adopting a more active, more empathetic, and more caring role.
Green Zruc nad Sazavou
The consultation office at the Zruc elementary school feels calm. This first impression is confirmed by Hana Mekotova, social worker and head of the Zruc Mental Health Team for Children and Young People, sitting across the table from me.
“Kids come here to hide from the noise during the big recess, to eat, to talk. Often the ones who come are the ones who are not feeling that great in the classroom. They try us out, they pop in a couple of times, and then they say they’d like to talk as well,” says the expert, who has been involved in the project from the very beginning.
All the care is provided to them in one place. Nobody has to travel here, make complicated appointments, throw the problem around like a hot potato. The team works not only with the children and their parents, but also educates and supports the teaching staff in the area of mental health.
The wallpaper in the room has a pattern of green leaves. On the floor there are green beanbags. The color green is said to have a relaxing, healing, and balancing effect on the human mind. It harmonizes the body and the soul. At least until the bell rings at the end of recess.
The team at the Zruc elementary school was established in 2021 by the then principal Ivana Stara, special educator Klara Simackova Laurencikova [now the government’s human rights commissioner], and the Czech Professional Society for Inclusive Education (COSIV).
In the Kutna Hora district, similar to virtually any other Czech region, there is a lack of services – especially those in the area of mental health. When the social worker Mekotova returned home after years spent abroad, she was taken aback by the state of Czech education and the frequent lack of support services. Apart from her, the teams working within the Children’s Mental Health program always also include a nurse, a special educator, a psychologist, and a child psychiatrist. One such team works at the Zruc elementary school, another one at the Kamenna Stezka elementary school in Kutna Hora. By 2027, the Ministry of Education says such teams should expand to the rest of the country.
Apart from providing mental health care to children, the teams also support the parents and teachers of children with mental health issues, difficult behavior, special needs, and those from socio-economically disadvantaged backgrounds.
Respecting Trauma
As part of a two-year pilot project, funded by EEA and Norway Grants, team workers were trained by the Norwegian Ostbytunet Center for Treatment and Professional Development in Child Psychiatry in the neurosequential model of therapeutics, developed by the American psychiatrist Bruce D. Perry. This therapeutic approach is based on respecting trauma, and it is unique in the context of Czech education.
“Simply put, we look at the development of the child through the experience which has formed its current state, behavior, emotions, and perception. When a child goes through a complicated situation, whether it’s physical or psychological abuse or the divorce of its parents, we can see how this experience gets translated in the child’s behavior. With this knowledge, we can start the therapeutic process,” explains social worker Milos Brezina from the Kutna Hora team.
Rather than have “problematic” students labeled as such throughout their elementary school years, teams try to understand them – and use that understanding to help them. “When a child isn’t getting good grades and is disruptive in class, we try to view that child through the lens of experience. Let us have a look at why the child is expressing itself in this way, what can be done about it – and what I, as the educator, can do in order for the situation not to escalate,” adds Mekotova.
Punishment – You’re being disruptive, leave the classroom! – will typically make the situation even worse. According to experts, much more effective than comments in the student’s record are calm and consistent reactions from the teachers. Talking to the child in a calm manner, asking them what they need, what is burdening them. Using this approach, you sometimes realize that the child sees aggressive behavior at home, perceiving it as a standard. Instead of “What are you doing?”, we should be asking “What happened to you?”
The two teams work out of the consultation offices, but they’re also mobile. Each team has the use of a car to visit other schools in the district. The services they provide are free of charge, and they cooperate closely with pedagogical-psychological consultation offices and other professional organizations.
The specific situation influences who travels where. The design of mental health care is tailor-made for the particular child. “It is based on expertise – who knows what, who’s better at this or that. For example, we have a special educator here, and the team in Kutna Hora can also work with her,” Mekotova explains, saying it is common to use the capacities of the other team. “We are quite inter-connected. Sometimes, we consult more serious cases with the other team. We try to advise one another, to be in it together,” she adds.
For example, they can drive to Uhlirske Janovice to visit Kamil Slavicek and his son Vitek, now 16 years old, who has atypical autism. Thanks to the mental health team, the family no longer have to travel back and forth.
“What we like best is that it all takes place at the school. Before, we had to travel. In school they told us what the problem was, we then went to see the psychologist, who told us what the solution could be, and with that we went back to school, where sometimes they told us that it wouldn’t work,” describes the father, adding that as his son matures, he needs fewer and fewer professional services. These days, they’re mostly guided towards more self-reliance.
He cannot state with precision how positive the team’s impact was on Vitek, but he appreciates the cooperation between teachers and other professionals. What they used to consider Vitek’s bad manners is now viewed as a phenomenon linked to his autism. These days, they can identify and even prevent such behavior. Naturally, this, too, is a long-distance run, which is not without its obstacles.
One such example is the intermediate period before the educators familiarize themselves with the new approaches, no longer just following instructions without taking context into consideration. “My son is really into science, he has an interest in everything, even anatomy. Because teachers had autism training with the team, his biology teacher asked whether she can show the class images with the internal organs – apparently, autists don’t like that. Naturally, he said no straight away. He got stuck and no longer wants to see anything of the sort, even though he never used to have this problem,” Slavicek says.
The teams don’t only work with the kids, but also with their parents – sometimes primarily with the parents. According to Brezina, the therapeutic process is thus a process of cooperation: “We have a lot of cases where we have very few, sometimes almost no contacts with the child, but a lot of work with the parents.” They, too, need support. In his opinion, this was not always the case. “In the past, everybody had to cope with this on their own. And nobody saw that as a parent, they were creating a traumatizing environment.”
Leveling the Playing Field
For kids like Vitek, who need a somewhat “different” approach, the team, working in cooperation with teachers, tries to find a tailor-made plan. Anti-stress aids, in the form of different relaxation toys, can also be helpful. As Mekotova emphasizes, however, not even these commonplace items are common in the Czech education system.
“If the mindset is that the child is scolded for playing with something and not paying attention, we try to reframe that towards the idea that the child can pay attention even if it is playing. As a matter of fact, that play itself can help it concentrate,” she explains..
In the case of children with anxieties, there is negotiation with the teachers as to whether the student might be excused from oral examinations at the blackboard, or whether they could take their written exam outside of the classroom. “In some more serious cases, when children don’t even make it to school, we’re even asking that they be able to only come in for a couple of hours at first, then gradually increase that number,” says Brezina, adding that the objective is to make the child stronger so that it can eventually return to a regular regime.
“This is quite complicated, though, because support tends to drop off and we need to keep reminding people that it’s not okay yet. Take a child that is not doing well, but is laughing in school. It’s doing okay now, somebody might say, but that doesn’t necessarily have to be the case. And because there’s confidentiality between us, we cannot describe what has happened to the child, or how it’s doing,” Mekotova adds.
Do other kids not complain that the system is unfair?
Brezina says it’s important to realize school isn’t fair. “Everybody comes here from a different environment. Some children have stimulating parents – by the time they enter school, they can already read and do basic math. Other kids, however, experience little interest shown in them. In school they can feel threatened, because they are not accustomed to pretty things. If you put two such kids next to one another, they can’t write a test in the same way, even if they are of similar intellect. On the contrary, we are leveling the playing field, making the system fairer.”
No More Ambulances or Police at School
As part of a 15-million-crown [590,000-euro] grant, the project had fixed indicators it had to comply with during the two-year pilot phase. Partly, these were quantitative milestones – certain numbers of lectures, conferences, and clients. Feedback was also collected.
The education and research organization Schola Empirica conducted a study of the well-being of 339 primary and secondary school students in Kutna Hora in November–December 2023. The report, seen by Page Not Found, states that “compared with students from other schools, students from Kutna Hora have higher well-being in seven areas and lower well-being in no areas. Generally speaking, however, the differences in the mean values of well-being between schools in Kutna Hora and elsewhere were small (as expected).”
It is too early for any major conclusions, but it seems that mental health care in the Kutna Hora district is on the right track.
Parents, too, are happy with the services of the Mental Health Team. They include Jana Buricova, whose 11-year-old son Jan has ADHD with autistic traits. The cooperation, going on for three years, has been very successful, with every problem getting solved immediately. Jan has become calmer and less aggressive.
“He trusts the professionals, he likes seeing them. He feels good in the calming room – that’s what he calls it,” adds Buricova.
The work of the team at the Zruc school has also delivered other interesting results. Ambulances no longer arrive here when a pupil has a panic attack, nor do police have to come and deal with difficult behavior. This is still common practice in a lot of other schools.
“We have talked to police officers who were surprised by how long it had been since they were called out here,” says Mekotova with a smile. “What is going on? We have taken care of things. An island of support.”
The work of the mobile teams in the Kutna Hora district is also positively assessed by external experts. For example, the theory of multidisciplinarity which underpins their work is much appreciated by the therapist and director of mental health NGO Nevypust dusi, Barbora Psenicova.
“We believe that if people with different skills and competences meet in a timely and targeted fashion, they can jointly help a child or a young person – with much lower costs for society, much faster, and in a much more coordinated fashion. The clients often understand what is going on around them, they have their key worker who accompanies them. Such a team can work in a much more targeted manner with the needs of the child, as well as of the entire system, such as family or school,” Psenicova told Page Not Found.
In her opinion, the demand is there, especially when it comes to the basic reason this service exists: People find it hard to orientate themselves in the support system. If they decide to share their problems, they don’t want to move with their issues through 10 different services, unguided.
She says that early team intervention can eliminate the expressions of psychological troubles and disorders. At the same time, it can support children’s better qualities, and work with the safe environment around them.
Bureaucracy and Mindset Impose Limits
After the successful pilot period, the Mental Health Team managed to obtain funds from some municipalities in the Kutna Hora district and an educational foundation.
“They are contributing funds, making sure we continue to provide our services. That means there is demand in the region for what we do,” Mekotova says.
Now it’s time to turn the Kutna Hora program into a system-wide service. The process, however, is taking a lot of time and involves a significant administrative burden.
“We meet many of obstacles when it comes to, for example, the interpretation of legislation. Not even those who create these obstacles fully understand them. We can also see this in other areas – it takes a very long time for something new to get implemented here. We can compare our situation with that in the UK, where similar teams were first established more or less in the same time as over here. In the UK, they now have some 400 teams, whereas we still only have the two,” Brezina says.
A new understanding of the approach towards mental health care is also taking a lot of time. This is also confirmed by Barbora Psenicova from Nevypust dusi. “We’re talking about a major change in the narrative of how care is provided – we are changing the system from one service focused on one person to a cooperation of several different elements. They cooperate with the child itself, but also with the family and other people from the child’s life. Such a change requires a lot of willingness.”
“At the end of the day, relationships solve everything,” is how Brezina puts it. “That is the basic element of any type of improvement in mental health, in the quality of life. If relationships are good, so is life.”
Fears Remain
“The project has gone through two years as a pilot project and another full year. What have you learned in this time?”
After hearing “a lot of things,” I also learn something more specific.
“We certainly cannot be too happy when it comes to the state of mental health of Czech children. However, I do view positively the fact that the kids are starting to recognize that there is such a thing as mental health. They don’t mind asking for help – it has become a part of their lives,” Brezina comments.
There is definitely hunger for the services, both locally and beyond. The teams are now cooperating with two schools outside the Kutna Hora district, and parents from all around the country are contacting them. “A lady from Jesenik called me, which is a three-hour drive from Kutna Hora, saying she’s unable to find anyone else and she doesn’t mind driving this far,” Brezina says.
A big talking point with the teaching staff has been the lack of mutual support and solidarity. The teachers of older students would often blame those who teach younger kids for their lack of preparedness, instead of being collegiate and looking for a joint solution. A less experienced educator is left to his or her own devices, instead of being supported by a more experienced colleague.
“The change is not happening as fast as we would like it to. There still isn’t 100% trust in this type of support – we’re only building it, and it will still take a lot of time. When doing interventions or talking to parents and teachers, we still hear a lot of fear that they’re doing something wrong,” the head of the Zruc team reflects.
Top-down support is also often missing. The school principal plays a vital role when it comes to the attitude of the students towards mental health support. After all, it’s the principal who decides whether the school even begins discussing this topic.
Can the State Afford It?
The Ministry of Education plans to follow up the work of the Kutna Hora district mental health teams with a systematic introduction of multidisciplinary teams in other regions. According to ministry spokesman Patrik Kubas, the goal is to deploy 30 teams all over the Czech Republic.
This is supposed to take place by 2027, which, however, sounds quite unrealistic, given the proposed budget cuts. But Psenicova sounds optimistic: “I’m hoping that given the current crisis situation in the mental health of children and young people, this should be a priority for us and for the government. Children and young people should be a priority.”
However, money is often lacking. For the time being, the funding of school psychologists is primarily covered from European funds, but this funding will end in 2024. Afterwards, according to the news outlet Seznam Spravy, the program will be placed within the national budget, but the government hasn’t been able to guarantee systematic funding as of now.
For the time being, enthusiastic teachers and psychologists who care about the deteriorating situation in mental health play key roles. How much longer can this situation continue? Has anyone asked them how they feel about it?
“The schools that have their own school psychologists are still in the minority. Personally, I cannot imagine a school where a full-time psychologist wouldn’t come in handy. We need the schools to be aware that the existence of mental health issues among children is a rule, not an exception. So that even individual staff members understand that this is not something they can avoid tackling,” comments 27-year-old Josefina Kodet Kucharova, who has spent a year working as a psychologist at a secondary school in Prague.
She thinks it’s important that the school environment clearly sees mental health as an important concern. Making sure the kids feel all right is something that is taken into account when the school curriculum is crafted. “This may sound banal, but unfortunately, it’s not common everywhere,” she says.
The most common issues children bring to Kodet Kucharova are anxiety and depressive disorders. Students with more serious psychological problems tend to have a broader support network outside the school: “So it’s not just up to us to deal with the issue. In these cases, the school is primarily a place of first contact in the case of a crisis.”
Before she started working as a school psychologist, she taught high-school students about mental health. That’s when she found out she really enjoyed working with teenagers. Thanks to the relatively small age difference, she feels she can empathize with their world. She feels a bit like their older sister.
“What I love about this job is that I can truly change their environment for the better.”
“Of course, it is all very demanding, and it all very much depends on other people also wanting the change – the teachers, the school administration … Maybe the very first thing I remember from school psychology in college is ‘make allies and take care of your relationships,’ and that is certainly the case,” the school psychologist concludes.
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Adela Svadba is a writer for Page Not Found, a Czech weekly magazine dedicated to entertaining, high-quality, innovative journalism,where this article originally appeared. Transitions’ Solutions Journalism program supported the writing of this article with support from the Evens Foundation.
Photos by the author.
Translated by Matus Nemeth.
