A Mental Health Screening Project in Istanbul, Turkey

By Baysal, Serpil Ugur; Ozmen, Banu et al. | Journal of School Health, October 2004 | Go to article overview

A Mental Health Screening Project in Istanbul, Turkey


Baysal, Serpil Ugur, Ozmen, Banu, Parman, Talat, Sahip, Yusuf, Bulut, Aysen, Gokcay, Gulbin, Journal of School Health


In Turkey, 12 million students and 500,000 teachers in 60,000 elementary schools comprise approximately 20% of the population. School-aged youth cannot benefit from regular primary health care services as do children under age five. The Turkish Ministry of Education, Department of Health, organizes all school health services including mental health. Approximately, 1.5 million students are screened for health annually in primary schools by the Ministry, and less than 1% report mental health problems. (1) There are three types of social security services in Turkey where 20% of the population has no health insurance. Problems detected at school are expected to be solved at the institution, but collaboration and coordination are not well developed. Teachers are expected to recognize and report students with learning and behavioral problems. At schools with a guidance counselor available, counselors are responsible for taking care of the child. Counselors send students to Guidance Education Centers if needed. For further evaluation and therapy, patients also can be referred to public or university hospitals where child psychiatrists are available.

PROJECT SETTING

Method

The screening project was conducted at an elementary school in a semi-urban area of Istanbul, where students of immigrant families come from the east and southeast Anatolian region of Turkey with a low socioeconomic level. During 2000-2002, in collaboration with related institutions and school management, secondary class students (n = 424) received regular physical and mental health check ups. The service was provided by a team which included a pediatrician, family health specialist, public health specialist, child psychiatrist, dentist, nurse, teachers, and volunteers. Teachers, students, and parents received education programs that addressed topics regarding physical and mental health, communication, and health protection. Children who required further evaluation or treatment were referred to a local university or public hospital. Students were examined individually. Parents consented to the evaluation and were present during the physical and mental health examinations.

An inventory for mental health status was developed and administered to each student. The inventory included 15 items on learning abilities, evaluation of behavior, relationships, interests, and school success and failure. Based on inventory results and comments from teachers and parents during the physical examination, 103 students with potential mental health problems were evaluated. The psychiatrist and family physician examined children in a specifically designed room with their parents present. Psychological tests (personality tests) were administered to 48 children at the University Hospital.

PROJECT RESULTS

Main health problems of the 424 students related to oral and dental health, followed by acute diseases, chronic problems, mental health, and vision problems. Of 103 students evaluated, nine reported no psychological problems. The remaining 94 students were evaluated in four groups.

Group 1 (n = 30) reported both learning and behavioral adaptation difficulties. Whether the behavioral problems cause school failure or vice versa remains open to discussion. School failure and lack of social adaptation can occur simultaneously and are related. Group 2 (n = 21) reported learning difficulties associated with school failure. Major problems that required psychiatric consultation were school failure and attention deficit.

Group 3 (n = 13) reported behavioral and adaptation problems including lack of adaptation to the environment, problems with peers or problems toward authority, inability to cope with classes and school, being extremely introverted, or causing discipline problems. Achievement in classes was normal, and this aspect was not considered a problem by their teachers.

Group 4 (n = 30) reported other problems including primary nocturnal enuresis, stuttering, and sleep disorders. …

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