1 Towards an effective educational work in preventing youth mental distress: theoretical premises and possible directions
Educational work in the area of mental health can be regarded as a challenge (Palmieri & Gambacorti-Passerini, 2019): this contribution aims to deepen this statement by proposing a number of trajectories of reflection.
Behind the phenomenon that we call mental distress (and similar terms) there is a multifaceted story embedded in Western culture over a very long period of time (ibidem; Foucault, 2011): a story that highlights a range of different understandings on the part of various disciplines and professional specialisms.
The term mental health is, indeed, very recent: before the 1970s, the focus was only on pathological problems. One all-encompassing term much used until the twentieth century was madness which reflects the fact that the attention of medical professionals — that is, those most involved — was focused on the functioning of mental disease.
In Italy, the concept of mental health has recently been strongly linked with the work of Basaglia (1982), who opened up the possibility of re-thinking the concept of madness. Basaglia hypothesized a fundamental connection between each person’s mental condition and her existential story (her used here for brevity), her educational, family and social experiences. Which suggests that, in order to reach an all-round understanding of mental health, we need a collaborative approach between several disciplines: at least those of psychiatry, pedagogy, psychology and philosophy. Basaglia’s work led to new ways of organizing psychiatric services and treatments, established by Law 180/1978, known as Basaglia’s Law. The real revolution, though, consisted in turning the focus of psychiatry from the pathological aspects of madness, to a concern for mental health, increasingly oriented to exploring the existential links between life and mental health. In this approach, every person has mental health, which can be more, or less, robust, exactly as for physical health: so both health and illness, physical and mental, must be thought of as aspects of everyone’s daily experience, intimately linked with each individual’s existential conditions (Garista & Zannini, 2020).
Scientific research has developed this trajectory, highlighting components that can prevent a mental disease or facilitate it. These are the factors known as social determinants (Marmot, Friel, Bell, Houweling, & Taylor, 2008; WHO, 2015); for example having a house, a job, and a net of relationships are fundamental criteria for mental well-being (Kitchen, Williams & Chowhan, 2012; Hergenrather, Zeglin, McGuire-Kuletz, & Rhodes, 2015; Webber, Reidy, Ansari, Stevens, & Morris, 2016).
So, by referring to social determinants, it is possible to begin considering — although the educational gaze is very recent in the mental health area — the richness of an educational contribution encompassing the dimensions of living, working, creating and maintaining a relational net. It is, thus, a serious professional challenge, being involved in an area where a wide range of professionals has been present for a very long time.
The World Health Organization and the European Union (WHO, 2001; UE, 2014), too, have followed Basaglia, stressing the importance of mental health, widening the concept and aiming to enlarge the field of psychiatry without abandoning its specificity. Psychiatry remains focused on the biological dimensions of mental distress, but thinking of the wider idea of mental health encourages us to concentrate on the social, psychological, existential dimensions that are present in every experience of mental health or illness. Above all, this direction considers every patient’s life story as a fundamental aspect in preventing, maintaining or taking care of his/her mental health (Saraceno, 1995).
Of course, mental health is fundamentally important at every stage of life, but some transitional moments require particular attention in the prevention of disease and the promotion of positive mental health. In western culture, one of these moments is adolescence (Ogden & Amlund Hagen, 2014), especially its second phase (16–24), where young people are moving toward adulthood.
Adolescence is a complex process, in which everyone faces challenges around growth and transformation, and seeking their identity (Erikson, 1956): the transition into adulthood (Barone, 2015).
From an educational point of view, Barone suggests adolescence as a complex system of changes (2009, p. 93), moving between the dimensions of the body, space, thinking and time, and, education can be thought of as the central point linking these dimensions. It can be a material field of experience, allowing an improvement, a re-elaboration and a transformation of the individual’s personal experience (Barone, 2009).
In this sense, an educational effort in this direction can be pivotal in preventing distress (Garista & Zannini, 2005) and in promoting a sense of existential well-being that allows young people to make the most of their time as an adolescent and “living the limit” of adolescence (Barone, 2005, p. 17), creating and maintaining their mental health.
Along these lines, the synergistic collaboration between the disciplines of psychiatry, pedagogy, philosophy and psychology (Carozza, 2010; Gambacorti-Passerini, 2016) can be fundamentally important in promoting young people’s mental well-being. Massa (Barone, Orsenigo & Palmieri, 2002), in discussing the fundamental nature of the contribution of education to mental health, emphasized that we must consider the entire existential and educational story of every subject as the scenario in which a possible mental disease can appear.
It is a Europe-wide phenomenon that young people are facing difficult conditions in their transition to adulthood. European youth is nowadays facing multiple challenges: global and local socio-economic problems are making it difficult, for example, to find a job, to have a family, and, in the traditional sense, to become adult (Xie, Sen & Foster, 2014). Moreover, there are other aspects of the contemporary lives of young people that are mental health risk factors of increasing severity. The first example is the increase in school dropout rates, and the concomitant growth of the number of NEETs (Not (engaged) in Education, Employment or Training). Secondly, there is a range of issues of inequality, around migration, class and gender (West, 2016). Furthermore, the recent experience of Covid-19 has created particularly difficult conditions for young people, changing both their usual experiences and their chances of continuing their educational and employment projects. All of these factors — including, especially, their educational experiences, affect the mental health and wellbeing of young people, who risk growing up learning to feel bad (Palmieri, 2012; Bruzzone, 2020).
The competences of educational professionals around these issues are, therefore, important, and they need to become sufficiently aware of, and appropriately trained in, the contribution that education can make in looking after the mental health of their students (Fadda, 1997; Whitley, Smith & Vaillancourt, 2012; Malti & Noam, 2009), including preventive measures.
In every context of intervention, the actions of educational professionals can prevent youth mental disease and promote well-being: being aware of, and trained in these matters can be a strong starting point from which to plan and implement primary and secondary educational action (Rossetti, 2009) to protect mental health. In schools, for example, teachers can take into consideration their students’ mental health when making all their didactic choices (Guerra, Rajan & Roberts, 2019; White & LaBelle, 2019; Mazzer & Rickwood, 2014).
In local educational services for youth outside school, too, the actions of educational professionals are pivotal in thematizing various aspects of the educational path and the life-story of every young person. On this, Galanti (2007) stresses the importance of thinking about the link between mental disease and every subject’s educational path and their cultural and social milieu. A reflective contribution from pedagogy about these links can help in deepening teachers’ understanding of the mental distress increasingly prevalent today and in planning specific educational interventions which turn the social, cultural, economic factors of distress into potential educational opportunities.
Of course, these aspects can also be thematized in specific mental health services and projects in which educational professional participate (Malti & Noam, 2009).
Highlighting the role and importance that pedagogy and educational activities can offer in taking care of youth mental health, specific research can be undertaken in exploring the perceptions of educational professionals and their lived experiences around these themes, as we will now present.
2 Thinking at a research project: methodological aspects for a phenomenological inquiry
2.1 Research question and objectives
The principal research question of the research project we are presenting is: What can be the meanings of the activities of educational professionals in promoting young people’s (16–24) well-being and preventing their mental distress? According to what we wrote in the first paragraph, with the expression mental distress in the present research we refer not only specifically to pathological problems but mostly on existential efforts that can strain young people’s mental health.
Particular attention has been devoted to exploring the meanings generated by professionals working with young people and their ways of thinking about mental health. The specific objectives have been articulated as follows:
Exploring the ideas, representations and meanings that educational professionals attribute to such concepts as mental health and mental distress, highlighting their thinking about good practice in working for mental health (promoting mental health, preventing disease, taking into account those experiences of their students that might cause distress).
Investigating which strategies for action, formal and informal, are adopted by educational professionals for the prevention of mental distress and the promotion of well-being in the young people they are working with.
Highlighting good practice, or critical aspects of educational interventions, in the primary prevention of mental distress, with specific reference to those contexts where ad hoc actions have already been conducted.
The principal aim of the project is to underpin and develop awareness of the importance of the contribution that educational professionals can make in anticipating and understanding the signals of mental distress in young people.
2.2 Methodological aspects
The design of the project includes qualitative research (Denzin & Lincoln, 2011), which aims to explore the complex contents of a human phenomenon (Mortari, 2007), where different elements are in constant interaction (Bateson, 1997).
Knowledge of such a context is the result of a complicated process, in which it is not possible to find a representation of truth as something isomorphic to reality, because such an epistemological model cannot understand human phenomena, including educational activities.
The focus of most research in the human sciences is located in the lifeworld (Dahlberg, Dahlberg & Nyström, 2008), highlighting the epistemological levels of criticality to be faced. An epistemological model is needed in order to observe and explore the lifeworld, one that can encompass all its complex and ever-changing elements.
Lincoln and Guba’s proposal (1985), defined as naturalistic, moves in this direction: it implies that we conduct research in the context where the phenomenon to be studied takes place. The model thus foresees that the researcher must stay in the context, observing and understanding the focus of the inquiry as it unfolds.
A central question in qualitative research is the choice of the methodology: an attentive evaluation must be undertaken to define the best method to answer the research question (Richard & Morse, 2007).
The principal question in the present research was how best to grasp the meaning of educational practices relevant to the fostering of well-being and the prevention of mental distress in young people. It is for this reason that the phenomenological-hermeneutic method (Van Manen, 1990) was chosen. It is based on the hermeneutical direction (Gadamer, 1983) of phenomenology (Husserl, 1987) and thus provides an interesting path for the collection of useful material, oriented as it is to the interpretation of the phenomenon to be studied and of how meanings around it are developed.
Phenomenology is focused on describing the essence of the basic structure of experience (Merriam, 2009, p. 25), defined as the meaning-giving actions of lived experience; here, phenomena means “phenomena of experience” (Dahlberg, Dahlberg & Nyström, 2008, p. 32). In this sense, “the object of phenomenological research is focused on participants’ experiences about the phenomenon to be studied, on their ways of giving it meaning, in an inter-subjective dimension” (Artoni & Tarozzi, 2010, p. 16). The concept of “meaning-giving” is central to our knowing and grasping reality: the phenomenological approach tries to grasp the essence of acts of meaning-giving because it is the only way in which humans access the world (Van Manen, 1990, p. 9).
The researcher, therefore, assumes a fundamental role in this approach to research, because the phenomenon is also given significance by her gaze (Artoni & Tarozzi, 2010, p. 16; Ghirotto, 2016).
Starting from Husserl, phenomenological philosophy developed along different trajectories and perspectives. Tarozzi and Mortari (2010) indicate four principal modes of phenomenological approach: descriptive (Amedeo Giorgi), hermeneutical (Max Van Manen), transcendental (Clark Moustakas) and phenomenographic (Ferente Marton).
Choosing an hermenutical direction implies the recognition of an important role for interpretation in building knowledge about the person’s lived experience. As Artoni and Tarozzi say, the phenomenological approach is “centred on the interpretive dimension that considers the researcher as a mediator for participants’ meaning of their lived experience” (Artoni & Tarozzi, 2010, p. 14). Sità describes hermeneutical specificity thus: “In the hermeneutical approach, there is a specificity of interpreting, grounded on the consideration that all knowledge is inevitably interpretive and that the richness of every subject’s world depends on the dialogical space in which it is shared and re-interpreted” (Sità, 2012, pp. 22–23).
In this framework, the material collected in the field, for example, participants’ words, can be considered as a collaborative construction by the researcher(s) and the participants, because the interpretation of experience can be created through sharing and dialogue.
Therefore collecting the words of educational professionals about the role of their practice in promoting mental health in young people can allow us to illustrate the research question by means of dialogical and reflective moments in which their significance is explored.
In line with the phenomenological hermeneutical method referred to above, the design of the present project centres on a case study strategy (Yin, 1994; 2006), because the research question requires a deepened understanding of the studied phenomenon, with particular regard to the context in which it happens.
There are various definitions of the case study strategy, but there is broad agreement on some of its constitutive characteristics, in particular: the phenomenon being studied must be linked to a complex situation and observed in its real context (Bassey, 1999) and the principal aim of the case study must be a deep understanding of that peculiar phenomenon, in that peculiar defined and circumscribed context (Merriam, 2009, p. 41).
2.3 Contexts, participants and research instruments
Based on the research question, three cases were selected for study, all in educational contexts in Milan but different from each other in terms of their users, their mission and their location. The research question has thus been explored in different contexts, considering their similarities and their differences.
The selected contexts are:
A high school;
A social cooperative with a specific educational mission;
An agency offering career counselling and training.
The choice of research instruments for the collection of material was made in the light of Van Manen’s (1990) insistence that to reach and, subsequently, to give meaning to other people’s experience it is necessary to borrow it, collecting material speaking of it.
The principal research instrument we used is the interview (Sità, 2012), conducted in a semi-structured way, in order to collect representations, perceptions and narratives (Tedlock, 2011) directly from participants.
The following professionals were involved as participants in semi-structured interviews, between March and July 2018:
3 teachers from the high school;
4 educators from the social cooperative;
5 teacher-trainers from the agency.
The interviews were focused on the representations and the meanings that participants connect with the concept of mental health, on their awareness of the potential importance of their activities in promoting well-being and on the educational practices they used in their workplace in order to prevent mental problems in their young people.
Participants were asked to sign an informed consent for the audio-recording of the dialogue, so that interviews could then be transcribed verbatim.
Coherently with the research method, the interviews were analysed following the model proposed by Van Manen (1990). Specifically, we followed the holistic approach (ibidem), in order to grasp the global meaning emerging from every interview, and the selective approach (ibidem), focused on highlighting the meaning arising from every answer.
The plan for the analytical process also included “peer debriefing” (Mortari, 2007, p. 71), which is a discussion between different researchers, focused on what emerges from the analysis.
3 Discussing results: What can ‘educational work to prevent mental disease’ mean?
The principal areas emerging from the analytical process were:
The meanings of the concept of mental health.
The meanings of young people’s mental health.
The meanings attributed to the educational work intended to help promote well-being, and the roles and competences of the educational professionals involved.
In this dissertation, we are going to concentrate the discussion of the results of the third area, in order to deepen our understanding of the meaning of educational work.1
The collected words of the participants offer very rich material with which to attempt to grasp the meaning of educational work as a way of promoting mental well-being.
Our analysis of the material focused on the meanings to be attributed to the educational work itself and to the educational professionals’ roles and competences.
We present below the suggestions that emerged from the material under these headings.
Firstly, we will explore the ideas, representations and meanings of educational work.
Three principal ways of giving meaning to educational work can be found in the words of the participants.
Firstly, educational work is intended to mean something that refers to a relational effort, a sort of being with, staying with youngsters.
The presence of the professional is signified here by such words as listening, being a confidant, not judging, getting worried by youngster’s troubles:
The educational professional works on relationships, trying to give self-esteem to teens, helping them in their difficulties, not judging them. (I 6).
Not judging young people…this is a fundamental aspect of educational work, together with listening to them (I 4).
This nucleus of meaning represents the idea of educational work in which the presence of the educational professional offers a relational opportunity to accompany youngsters:
It’s important to let young people know that you are there […] I’m here and I’m interested in you (I 1).
This is the representation that emerges most frequently in the collected material, and, as we see below, it creates some difficulties in thematizing the roles and competences we need to explore.
Secondly, two participants offer a particular vision of educational work in this area, grounded in the methodology they have adopted, Life Skills Training, which informs their work in the classroom. Their words indicate that the Life Skills Training model orientates their work and provides the basis on which they can help young people maintain their mental health.
We use the Life Skills Training model and I really believe in it. We work on daily life competences, generally adolescents have these abilities but they don’t know it, they don’t train them and they don’t use them when they have problems (I 2).
Our work is to make the Life Skills as a concrete experience for teens (I 1).
This meaning for educational work indicates that it is tied to a precise and defined model by means of which the educational activity can be created. This can be a good starting point, but it must be accompanied by an effort to think about educational work in a wider way: if not, professionals risk being stuck with one particular methodology, not considering other ways of creating experiences in which they can involve their young students.
Thirdly, a few participants presented another nucleus of meaning for educational work: as the capacity and the opportunity to create experiences where teens are involved and, by doing things, can create their own mental well-being.
It’s fundamental that educational professionals are able to offer meaningful experiences, together with teens (I 7).
Educators project and live experiences in the present time with youngsters, thinking of the future but also considering the past (I 3).
This nucleus allows us to highlight the experiential component that characterises educational work (Dewey, 2014) and that can thematise it not only as a relational effort but also in its fundamentally important material components (Ferrante, 2016).
Having established these three areas of meaning, we can now focus on the meanings that participants expressed about the educational roles and the competences relevant to the care of young people’s mental well-being.
Participants thematised educational work as a relational one, and nominated competences linked with relational tasks:
Everything that regards relationship…this is the principal instrument for educational professionals in my opinion (I 3).
Being always able to listen to, to open a dialogue, welcoming teens…these are educational professionals’ competences (I 9).
When asked to refer to particular competences relevant to the care of mental health, they often say they have no such competence in this area, and that when there are specific problems they ask for the intervention of an external expert to work with the teens:
If I perceive that a student has some troubles, maybe I go close to him and I ask ‘What is wrong?’, or maybe I organize a meeting with his parents… This, I think… We act like this… Then, for specific preventive actions we refer to experts’ interventions (I 5).
External experts proposed projects of peer education, gambling, activities focused on well-being (I 8).
It seems, therefore, that the relational competences they are thinking of, around educational work as relational, are not enough to characterize their work as an opportunity to take care of their young students’ mental health: the chance to intervene through practices based on being with, creating relationships with young people is not related to specific educational competences around mental health (Atkins & Rodger, 2016; Long, Albright, McMillan, Shockley, & Price, 2018).
One nucleus of meaning characterizing educational roles and competences is strongly linked to the reported model of Life Skills Training: participants who nominate it link their competence to the use of this particular method:
In this sense, using Life Skills Training model, the educator can be a sort of facilitator of the emerging of thinking and emotions. The educator must also be able to create a net of professionals and services to accompany teens (I 2).
The competences related to Life Skills Training are important for educators…an efficient communication first of all (I 1).
We also notice, in some professionals, the idea that educational competences can be thematized as the capacity to create experiences by means of which the young people involved can be helped to learn how to take care of their own mental well-being:
Educational professionals must be able to create experiences to promote well-being (while) being very careful in the projecting of the experience itself, in order to understand that a certain kind of experience can contribute to (the) experiment functioning or un-functioning feelings (I 3).
Proposing experiences that can have an educational impact on social and cross-competences, that in schools are not really stressed (I 10).
Obviously, this orientation is directly linked to the understanding of educational work as grounded in projecting and creating an experience, both in order to create well-being and to prevent distress.
One important observation, finally, relates to school-teachers: some professionals emphasised the difficulty the school has with the educational components of the teacher’s role, that is, those that go beyond his/her didactic tasks. It is a difficulty that circumscribes the school’s ability to develop specific interventions aimed at preventing mental ill-health in their young people.
Schools have a great difficulty…teachers are not trained in working in an educational way…we are more used in offering information and notions to students (I 9).
I often ask myself What is our role as teachers of a high school? […] In which way we have to educate students?… educating is a very tricky term for school…even if considering an action to promote students’ well-being (I 10).
Here the collected material exemplifies the difficulty many educational professionals have with being able and willing to intervene and offer support when young people are in distress, as reported also by the scientific literature (Mazzer & Rickwood, 2015).
It seems that educators — including schoolteachers — do not regard their daily educational activities as relevant to the promotion of their students’ mental health. Consequently, they prefer to call in external experts to deal with these issues (Gambacorti-Passerini, Palmieri & Zannini, 2019).
The general impression gained is the absence of the skills needed to work educationally on the promotion of mental health in their students, or the prevention of distress.
Therefore, if we wish distress (and its prevention) to be an object of educational interest (Palmieri, 2012), we must consider how best to offer training for educational professionals in this direction.
The first step, perhaps, would be to help them ascribe meanings to their everyday practices (Bruzzone, 2012), in order to thematize them and to link them to educational theory, to reduce their tendency to relate educational practice only to good sense or to the routine repetition of what seems to be good.
In training of this sort, professionals working in education learn how to question daily educational events, how to ask the most useful questions (Gambacorti-Passerini in Palmieri & Gambacorti-Passerini, 2019, p. 96) in trying to understand what is happening. Such competences necessarily include the awareness that our educational questions are always framed in a particular epistemological and theoretical perspective, which by definition offers only a partial point of view of the educational phenomenon, of its understanding and of the possible ways of acting (Denzin & Lincoln, 2011, pp. 12–14).
This is related to the development of an epistemological responsibility (Caronia, 2011) that is fundamentally important for the professional working in education because it highlights the importance of being aware of the theoretical perspective in which our practice is built.
It seems important, given the research material quoted above, that — if educational work is to be regarded as including the opportunity to promote the mental well-being of young people — we encourage educational professionals to give meaning to their practices and to the thinking that sustains them, explicit and implicit. In this way, they can be trained in a reflective practice (Mortari, 2009) that can help them to signify their daily activities and to make the conceptual links with the relevant epistemological framework.
Furthermore, we can argue that an educational competence with respect to maintain mental well-being in youngsters is to be built not so much through specific knowledge aimed at dealing with peculiar manifestations and symptoms of distress — these can be other professionals’ tasks — but more through the development of a pedagogical outlook on the experience of distress (Gambacorti-Passerini, 2020). Giving meaning to educational practices, in this direction, can be linked to the competence in identifying formative ways to accompany young people in thinking and re-thinking their life project in order to maintain mental well-being or to face a moment of mental distress.
Reflecting on the collected material, we can reiterate that the meaning of the practices of educational professionals and their knowledge in promoting mental well-being is to establish care actions aimed at youngsters’ development of existential possibilities. In this sense, it is a question of maintaining a professional focus on promoting a vision of mental distress that is relocated to the existential sphere as one of the possibilities of being, as we wrote in the first paragraph. Through reflective work and critical thinking, it can be possible to illuminate the educational skills that professionals can put in place to transform the daily and routine actions related to living into possible educational scenarios, starting from which to create further and unprecedented existential possibilities for youngsters.
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A specific reflection about the other points emerging from the analysis can be found in Gambacorti-Passerini, 2019.↩︎