Children's mental health issues

The core question to be answered in the current field of children's mental health has never been "how to quickly screen and identify children with psychological problems", but "how to integrate care for children's mental state into every daily scene in the family, school and society, and avoid alienating 'mental health' into another yardstick for scoring and labeling children."

In my third year as a resident psychological social worker in a public elementary school, I met Xiaoyu, who was in third grade. When the class teacher pulled him into my office, he had three disciplinary tickets in his hand, all of which were for "shaking the chair without any reason and disrupting the order of the class." The parents had already made an appointment with the psychiatrist to get checked for ADHD. I sat with him in the corridor for ten minutes. He picked at the hem of his school uniform and told me that he was counting beats when he rocked the chair. At the thirtieth beat, the sycamore tree downstairs would shake, and then his mother would appear at the school gate to pick him up. His parents had just finished their divorce at that time, and his mother had promised to pick him up every Wednesday. But last month, he suddenly changed the rules and asked him to pick up three outstanding students this week. Oh, it turns out that rocking the chair is not "poor self-control", but the unspoken expectation hidden in his small movements.

The academic and practical circles have been arguing for almost ten years about where to start the work on children's mental health. My old classmate who is the deputy director of the children's department at the Provincial Mental Health Center always talks about it every time we get together. Last year, the number of outpatient visits in their department increased by 32%. There was a 12-year-old girl with scratches all over her wrists when she came in. Her parents said, "She was just pretending, she just didn't want to go to school." So he has been pushing for normalized psychological screening for all school years. He believes that early detection and early intervention are the bottom line, and a late step may be a lifelong regret. But my friends who work in educational sociology are firmly against it, saying that the screening in many schools is too rough now. A set of questions can be filled out in half an hour, and those with low scores are directly called in for a conversation, and parents are even given a "suggested suspension of school" notice. It is only a temporary low mood, but being labeled as "depressive tendency" has pushed the child into a dead end.

Both arguments are valid, and I've swung between them many times myself. I went to a junior high school to give a lecture last week. When the lecture was over, a mother made me cry and said that the school released the psychological evaluation results last week. Her son’s score was only 72. The teacher asked her to take the child to the hospital for evaluation, otherwise it would affect the registration for the high school entrance examination. I looked through the set of assessment questions, and one of them was "Have you ever felt like life was boring recently?" The child chose "Occasionally." What kind of problem do you think this is? He had just broken up with his best friend the day before and hadn't spoken to each other for three days. He was so angry when he filled out the questionnaire that he almost got labeled as a "psychological abnormality" by randomly checking the options. Oh, by the way, don’t think that only urban children have this kind of problem. Last year, I went to a rural primary school in western Guangdong for research. There was a left-behind child. After his grandmother passed away, he locked himself at home for three days without going to school. The village cadre said, "This child is just ignorant and too willful." Later, when we went to his house, we discovered that he hid the cloth tiger that his grandmother had sewn for him under his pillow, and whispered to the tiger every day, but no one wanted to sit down and listen to him.

I have been doing psychological intervention for children for almost eight years, and I can honestly say that in many cases the most useful things are not advanced techniques such as cognitive behavioral therapy and sand tray therapy. There used to be a little girl in fifth grade who lived with her father after her parents divorced. After her stepmother gave birth to her younger brother, she refused to speak. Her parents took her to several hospitals, but to no avail. I spend twenty minutes every Wednesday squatting with her on the edge of the playground, watching the ants carry the bread crumbs. I don’t urge her to talk, and just chat with her, such as, "Look at this ant moving such a big piece, is it going to receive a reward from the queen today?" When I was in the sixth week of squatting, she suddenly gave me half a piece of orange candy and said, "I saw my brother throw away my mother's photo last week, and I picked it up and hid it in the back of my schoolbag." You see, a child's heart is never pried open with professional tools. It's your willingness to squat with him and see the world in his eyes, and he will naturally tell you his secrets.

According to the "China National Mental Health Development Report 2023", the depression detection rate among adolescents aged 14-18 is 17.5%, of which 3% are severe depression. This number is indeed worthy of vigilance, but what is even more worthy of vigilance is our attitude towards this number: Don't panic when you see the data and think about "singling out the children with problems", but forget to ask, where do these emotional problems come from? Is it because you have too much homework and can't sleep until twelve o'clock? Were you bullied at school and no one said anything? Do your parents always keep saying "If you don't pass the key points in the exam, you will be doomed"?

It's a bit funny to say that many parents are now willing to spend tens of thousands of dollars to enroll their children in emotional intelligence classes, concentration training classes, and buy various so-called "mental health picture books", but they are unwilling to take ten minutes a day to put down their mobile phones and chat with their children "Did they encounter anything interesting at school today?" Last time a father complained to me that his son would get annoyed if he couldn't say more than three sentences to him. I asked him what is the first thing you usually say to your child? He said, "Have you finished your homework?" What score did you get on today's exam? ”——You said, it’s strange that your child is willing to talk to you.

In fact, there has never been a standard answer to the question of children’s mental health. Do you think screening is useful? It can indeed save many children who have reached the edge of the cliff. ； Are you saying that screening is useless? The harm of arbitrary labeling is really no less than the problem itself. After all, the key to solving this problem is never in the evaluation form, not in the doctor's diagnosis, but in the hands of everyone who is willing to squat down and look into the child's eyes. If you are willing to listen carefully to the non-nutritious nonsense he speaks, are willing to catch his weird little emotions, and are willing not to use the yardstick of "normal" and "excellent" to block him, this will be more effective than any customized intervention plan.