Language and mental health stigma #antibullyingweek

Do you ever challenge people for using language that propagates mental health stigma? Or do you often use it yourself without thinking about it, because no-one has ever challenged you?

I’m talking about words like “crazy, nuts, pyscho, nutjob, bonkers, schizo” etc etc. I have to hold my hand up and say I have been guilty of using such terms in the past and probably still do use some of the words on occasion when I don’t catch myself, because some of these words are so common and we don’t really relate them to any effect on mental health stigma, but as this study suggest such language creates negative attitudes towards mental illness and then may reduce liklihood of people seeking help if they need it.

So this week for Anti-Bullying week I am asking you to think about the language you use and if you are a teacher in a classroom, do think about challenging your students to think about the language they use and the effects it can have. Whether the words are used perjoratively or not, I think it is worth being mindful of the potential effects of the words on bystanders.  That isn’t to say I want to see any of these words banned  (I secretly rather like the adjective “bonkers” when used affectionately!) but to encourage a critical and reflective approach to the power of language.

Just to highlight how tricky this can be some might argue this post is a classic example of:

“Political correctness gorn mad!”

 

But unpicking that statement is in itself a challenge of language. What do we mean by “gone mad”? Is that statement stigmatising to people with mental health issues? Is ‘political correctness’ such a bad thing?.

I don’t have the answers but what I am asking you to do is to be mindful of the langauge you use even if you think it doesn’t matter it probably does, and if you are a PSHE teacher to think seriously about increasing your lessons on mental health education to support young people to support themselves and each other.

 

P.S As an aside for those of you that don’t know- I have written a book for children explaining aspects of serious mental illness (psychosis). It’s called Pretend Friends and it’s out in February.  So expect many more posts on mental health in coming months. But don’t worry I am not moving away from my core work of relationships and sex education, after all healthy relationships helps healthy minds (and vice versa)!

 

 

 

It’s time to talk about gendered harassment

 

“Stop acting like a girl”, “You look like a fag”, “You are such a slut”, “Genderbender”

 

Taunts like these can often be heard in schools across the land, where homophobic, transphobic, bi-phobic, sexist and sexual commentary is often seen as the norm. At the core of each of these comments is a common root: Gendered Harrassment.

What is gendered harassment?

“Gendered harassment is defined as any behaviour, verbal, physical, or psychological, that polices the boundaries of traditional heterosexual gender norms and includes (hetero)sexual harassment, homophobic harassment, and harassment for gender non-conformity.” (Meyer, 2008)

In other words where gendered stereotypes prevail about what males and females should traditionally look and act like then gendered harassment will exist.  Anyone and everyone will be affected by gendered harassment , it is a way of society policing and enforcing its idea of “normal”.

Schools are starting to understand they need to address homophobia, thanks to high profile media campaigns, support and training, which is great but they still lack understanding about how to address sexual, sexist or transphobic bullying, where such behaviours are sometimes perceived as normal “gendered banter” from children and young people.

By reframing the discussion in terms of gendered harassment, this recognises that gender is at the core of all of these different types of bullying and harassment, then schools can get to the crux of the issue and start to address three distinct problematic issues in schools ‘for the price of one‘!

Obviously care will need to be taken not to lose specific nuanced issues within each type of bullying/harrassment.  However by considering these things under the umbrella of  gendered harassment, it gives opportunity to collectively challenge the common issues. This will save time and energy for schools and can transform school environments for male, female, lesbian, gay, bisexual, transgender, and straight students. i.e. such approaches will benefit absolutely everyone (What’s not to like!?).

So it’s Anti-Bullying Week and this week I do hope schools and young people will start to consider critically thinking about approaches to gendered harrassment rather than just sticking up a few “Some people are gay, get over it!” posters and thinking that this is sufficient. It really really isn’t.

For more help with understanding gendered harrassment in your school please contact me alice.hoyle@rsehub.org.uk or visit The RSE Hub

 

 

BREAKING NEWS: Guidance does NOT say sex at 13 is okay.

The Education Select Committee met yesterday and appeared to get a little bit fixated on the Brook Sexual Behaviours traffic light tool. As a result subsequent reporting in the Telegraph the BBC, The Daily Mail, Metro and the Mirror are all now completely miscontruing the excellent Brook Sexual Behaviours Traffic lights tool as a form of teaching guidance for SRE (it’s not guidance for teaching sex ed, it’s a safeguarding tool).

A collation of the miseleading headlines is as follows:

Teachers told: sex at 13 ‘is normal part of growing up’

Sex ‘normal at 13′ suggestion raises concerns

Sex between 13-year-olds is NORMAL, says controversial ‘traffic light tool’ sent to schools to teach about relationships (N.B this one is complete rubbish- the tool has never been sent into schools to teach about relationhships)

School kids having sex at 13 is ‘normal’ says controversial advice given by charity

Campaigners claim schools are teaching pupils that 13 is a normal age for sex

I am really cross and disappointed about this. Some of the (totally rubbish and written in a hurry churnalism) articles imply that the Traffic Light tool is the same as the non-statutory supplementary guidance for SRE (produced because the current statutory guidance from DfE was produced in 2000 and is now out dated). Brook have written an excellent response statement to the article here which clarifies things further and Ally Fogg at the Guardian has written an excellent piece on this issue here.  I also wanted to add a post from my perspective of a practitioner of Sex Education, because when I’m teaching SRE in schools, I also automatically have an additional responsibility for child protection.

TO CLARIFY (if I was an Education Editor of a widely read national newspaper my refuting headline would be!) :

SEX EDUCATION TEACHERS ARE NOT BEING TOLD (BY ANY GUIDANCE DOCUMENT OR ANYONE ELSE) TO SAY SEX AT 13 IS OKAY! 

The traffic light tool actually a safeguarding tool for practitioners (not necessarily SRE teachers but maybe youth workers, teachers, pastoral leads, child protection officers etc.) to assist in identifying whether a sexual behaviour is ‘normal’ for an age group or a ’cause for concern’. The age ranges are 0-5, 5-9, 9-13 and 13-17 deliberately because there are overlaps.  It has not been reported (because that destroys the anti-sex ed narrative) that in the 9-13 age range a red behaviour (ie. one that is a serious safeguarding concern) is:

• sexual activity e.g. oral sex or intercourse

And in the 13-17 age range one of the green behaviours (ie. one that is not usually a cause for concern unless there are other factors going on) is:

• sexual activity including hugging, kissing, holding hands

Obviously the tool is an aid to professional judgement but does not replace it.  We know there maybe 13 year olds having their ‘first snogs or fumbles’, and usually this is in line with normal development. However a disclosure of a sexually active 13 year old (ie. having penetrative sex) would, in most settings, trigger a referral to the child protection lead and probably further support/intervention being put into place to support the young person. We have mandatory reporting for under 13’s because under 13’s are not able to legally consent to sex but for 13-15year olds the law is not intended to prosecute mutually agreed teenage sexual activity between two young people of a similar age, unless it involves abuse or exploitation.  Therefore the tool is entirely reasonable (and not “illegal” at all as suggested by Sarah Carter from the Family Education Trust).

Yes, we all know that sex under the age of 16 is illegal, but we also know that almost 1/3 of our young people are having sex under the age of 16 (remember that most of these will be ~15, and most people have lost their virginity by 19. So erm it’s a no brainer that the teen years are vital for high quality accurate age appropriate sex education! D’uh!). Talking about this statistic doesn’t mean any practitioner of sex ed is encouraging or condoning underage sex (I regularly use it as a social norming approach- when I ask my classes what percetage of teens have sex under the age of 16 they all respond with “90-100%” and are suprised to find out it is far lower!). Teachers of sex education are not on some kind of crusade to encourage underage sex (urgh at the thought!) but we recognise our duty is to support young people and meet their needs, where they are at, and signpost where to get further help and support.

Yes, the Brook Traffic Light Tool does also mention in the 13-17 age range:

• consenting oral and/or penetrative sex with others of the same or opposite gender who are of similar age and developmental ability

which the media has seized upon.  But as a professional interpreting this in practice, I would be looking very closely at the 9-13 behaviours and the 13-17 behaviours and in my experience if a sexually active 13 year old presented to me, then often they are not in consensual situations, or have chaotic home lives, and therefore more support and intervention is needed to support that young person. (Particularly if there needs to be a (potentially criminal) investigation into the often older partner).

(As an aside, I have actually never had consensual penetrative sexual activity disclosed to me in 13 year olds, but once had to refer on two horrific cases of 13 year olds who had been gang raped, one of whom thought it was some kind of ‘rite of passage’ and and minimised it as ‘normal thing’ to happen in her peers which absolutely broke my heart. This is also why I am so angry about this misreporting- the Brook Traffic LightsTool is invaluable in suppporting professionals to protect young people so how dare they twist it like this, to score political points!?)

Like most practitioners I would use the SRE guidance documents (both statutory and non-statutory) and my school policy to ensure my teaching was in line with all of these.  If I had a disclosure or something happened that concerned me in a lesson (likely discussion of an amber or red behaviour) –  then I would refer it to my child protection lead in the school who would also be hopefully using the traffic light tool to determine the level of intervention needed.  I am clear on this, many teachers of PSHE are clear on this, but some aren’t, and they won’t be helped by misguided and innacurate reporting on it from the press.

It’s such a shame that such inaccurate reporting about sex education works to damage the reputation of this really important subject and may make some teachers reluctant or fearful about teaching it.  I just hope the Education Select Committee who are currently hearing evidence about PSHE will be able to see through this poor sensationalist reporting (and selective presentation of evidence and innacurate statements about “legality” from the Family Education Trust to the committee) to understand that the difference between guidance documents supporting the teaching of SRE, and guidance documents supporting the safeguarding of children and young people. Ultimately the the safety and healthy sexual development of young people depends on us getting this right. So maybe just maybe the reporters could try and get this right too?

 

 

 

 

The pill, mental health and evidence base versus lived experience. Yes it’s a feminist issue.

So @DrAliceRoberts wrote this article about her experiences of the Pill and mental health in the Guardian, and @cbpolis  did a response on her blog and twitter exploded into a giant debate about evidence based medicine and rather unfairly people told Dr Alice off for writing the article due to her position as a public engagement officer for science. Erm – well given the fantastic discussion she has stimulated I think she is doing a wonderful job!!!

I got very cross about these discussions so here is my contribution based on my experiences as a scientist turned social scientist with a passionate interest in sexual health education and supporting young people and adults to make the best contraceptive choices available to them and that those decisions are informed by facts not opinion.  For information my masters degree was in Evidence based practice (in education) and challenging homophobia (and I looked at gender for a lot of it as well). So I like to think I have a reasonable understanding of evidence based practice and sexual and mental health.

So the following is based on me pretending I know what I am talking about, but before I also get yelled at on twitter by the EBM evangelicals- or picked apart for selective evidence, this is a blog post and not an RCT (randomised control trial for those not in the know) so pretty much these need to be taken as musings and not evidence of anything other than THIS STUFF IS VERY IMPORTANT TO THINK AND TALK ABOUT. 

So here are my points:

1) All science occurs under patriachal capitalist conditions. We like to think science is objective but it simply can never be due to these forces. We can try, but the fact of the matter is pharmaceutical companies have vested interests in favourable research, female research and researchers are much more likely to be marginalised (and no I don’t think “double blind peer review” is enough to ensure female led research has an equal footing to male led research).  Female voices and experiences are continually erased throughout history and in life and this is also true in science.

2) The evidence for and against the pill possibly causing mental health issues is still very mixed, however much people are firing evidence one way or the other to “prove their point”. The only conclusion I think that can be made is “we don’t know enough yet but it’s worth investigating further.” 

The very clever @Unity_MoT (luff him) has been pointing out the following.

@bengoldacre On the other side of the coin, been looking at the evidence base and it’s far from robust. @DrAliceRoberts @cbpolis @dhaerinck

— Unity (@Unity_MoT) July 23, 2014

@bengoldacre There are enough anecdotal reports of mood disturbance to warrant proper investigation. @DrAliceRoberts @cbpolis @dhaerinck

— Unity (@Unity_MoT) July 23, 2014

@bengoldacre RCOG citing three small RCTs, most recent from 1994, not adequate evidence of no effect. @DrAliceRoberts @cbpolis @dhaerinck

— Unity (@Unity_MoT) July 23, 2014

@AliceHoylePSHE Yes, but there are added complications here in terms of empirical evidence. What we may have here is a subgroup of women…

 

@AliceHoylePSHE …whose reaction to pill is opposite to that of much larger sub group of women for whom pill acts to stabilise mood. — Unity (@Unity_MoT) July 23, 2014

 

@AliceHoylePSHE So you have two subgroups the larger of which masks the evidence for the smaller. That’s a sod to spot unless you know… — Unity (@Unity_MoT) July 23, 2014

@AliceHoylePSHE …exactly what you’re looking for and design your study specifically to control for masking effects. — Unity (@Unity_MoT) July 23, 2014

 

 

3) So erm How dare people erase the lived experience of women like this!? The sheer volume of women on twitter talking about their mental health experiences as a result of hormonal contraception should be raising red flags somewhere. How can this be dismissed because the “evidence” (such as it is) says there is no effect!? How about listening to women? That especially goes to clinicians. In my job I have worked with clinicians who are far to willing to prescribe LARC’s (long acting reversible contraceptives) without bothering to take the time to ensure this is an informed choice by the young person. To the extent I know of a young lesbian woman with an implant in (despite not having sex with men) because the Dr wasn’t listening too her and she was too embarrased to come out to them, and inexperienced to know that the implant might not be the best choice for her to sort her painful periods given she DOESN’T HAVE SEX WITH MEN AND IS NOT AT RISK OF TEENAGE PREGNANCY. I’ve seen clinicians first hand dismissing women who are drawing a link between their mental health and the pill as “its not due to that” and deciding there must be something else going on, so prescribing anti-depressants. Big Pharma must be rubbing their hands with glee. 

 

4) I’m sharing my lived experience here in solidarity with Dr Alice Roberts but at same time it is probably bit TMI for my work blog post (sorry!) Certain pills made me feel mental and as soon as I came off them I felt so much better. However I have had times in my life where I was fine on a particular pill and then when I went back to it years later I didn’t react well to it.  So based on my sample size of 1 I think the pill may effect mood but it doesn’t always and there may well be other factors at play, but for me the mood lift in the days after coming off the pill is too much to be a coincidence. Interestingly my husband considers my mood on hormonal contraception to be much more regular, than off the pill where it is admittedly at times variable :D but a regular low mood is not as much fun as a rollercoaster ending in a dip of weepy cathartic PMT. :D 

5) So in conclusion where does this furore leave those of us who talk about contraception for a living? I don’t see there is any problem in talking about one of the possible side effects of the pill may be low mood and explaining that the evidence for this effects is mixed, lots of women will be fine, other women may not feel great on it,  so it is down to the individual to try out the contraception that works best for them and their life and with the side effects they feel they can live with. 

As an aside a sexual health colleague of mine is trying to get clinicians to explain the side effects of the implant, such as erratic bleeding for a few months after insertion to women. This is because studies have shown that women who have the implant for more than 8 weeks are more likely to keep it once the bleeding has settled down, but those who weren’t expecting these side effeects can’t cope and want to get it taken out early but then face battles with health professionals reluctant to remove it. He thinks some work done around explaining the side effects and supporting women to get through the early days whilst their body settles into the new method would mean less women taking it out, and less costs to the NHS.   Reasonable I think.

What I’m trying to say is some expectation management about side effects in the early days can help women find a method to best suit them but the key is give women the facts and support them to make their own choices. Don’t disregard our voices because our experience doesn’t fit with the evidence narrative.

Informed choice innit. 

Rant over. 

 

 

 

 

SRE- It’s my right.

Today the Sex Education Forum have launched their It’s my right campaign.  Including a letter in the guardian with a signature from yours truly.

Being a big fan of human rights just wanted to set out that the World Health Organisation specifies the right to information as well as education in their list of sexual rights.

They also “Recommend the provision of scientifically accurate and comprehensive sexuality education programmes within and outside of schools that include information on contraceptive use and acquisition” in their guidance and reccommendations on Ensuring human rights in the provision of contraceptive information and services.(WHO, 2014)

Plus the UN convention on the rights of the child features Article 28 which outlines the right of the child to an education. In 2010, a report the UN Special Rapporteur on the right to education, explicitly stated that this includes the right to a ‘sexual education’ and set out a number of standards, outlining the right to a ‘comprehensive sexual education’ within the context international human rights law) including: “There is no valid excuse for not providing people with the comprehensive sexual education that they need in order to lead a dignified and healthy life.” amongst other gems. The whole document is well worth a read.

So yes SRE is a human rights issue, and yes SRE it’s my right, it’s my daughters rights, its all our rights.

Here’s hoping the government will finally listen and set these rights into legislation.

 

 

Joining up the dots….

• Self Esteem
• Healthy Relationships
• Health including sexual health and mental health
• Increased Confidence, Assertiveness skills
• Independence and abilities to seek help when needed
• Knowledge and understanding of the human body
• Knowledge and understanding of relationships, sex, sexuality, sexual health, pregnancy and pregnancy choices, contraception, STI’s, abortion, consent, power, gender, sex in the media, ethics etc etc.
• Contribute to reducing teenage pregnancy rates
• Contribute to reducing STI transmission rates
• Contribute to reducing sexual crime rates
• Spiritual, Moral, Social and Cultural development (SMSC)
• Anti-bullying (including Transphobia, Homophobia, Biphobia, sexists and sexual bullying)
• Gendered Harrassment and Violence Against Women and Girls (VAWG)
• Sexual harrassment, assault and rape
• Domestic violence and violence in teen relationships
• Sexualisation
• Child Sexual Exploitation (CSE)
• Tackling gang violence
• FGM
• Equality
• Inclusion
• Wellbeing

What is the one thing that joins these dots together? *subtle hint- it’s my favourite subject!*

This list was off the top of my head in 5 minutes I am sure there are many more things that high quality Sex and Relationships Education can contribute too (tweet me or comment below and I will add to list).   I find it so frustrating that these links are not always made by policy makers.   High quality SRE can contribute to prevention efforts of many of the negatives on that list and significantly boost the positives.

A gentle reminder that pretty much everyone on this planet has sex at some point in their lives and the vast majority of us are here because our parents had sex. Sex is central in society yet hidden, tabboo and maligned. Which means sex education is also. Seems daft when you think sex and sex education impacts on so much.

How can we help the policy makers join up the dots and see that significant investment in High Quality SRE is crucial as it contributes to so many vital areas of current concern? Without such investment, many of the agendas in this list will not suceed.

 

 

Love is all you need. Video resources for schools

Collecting some video resources useful for classrooms when exploring understandings of sexual orientation and homophobia and bullying. Will add to this post as I find more but here are my current faves which I find incredibly moving and powerful :

Also primary schools have you seen this new resource from Stonewall?

Creating safe spaces in Sex Education- separate or mixed gender groups?

***This is a rough post that will be edited as some of the ideas are discussed on twitter and in the comments***

A large part of a Sex Ed teacher’s job is creating safe spaces, a space where discussion can flow freely, where participants are all aware this is a mutally supportive learning environment and no-one will make fun of anyone in the group for asking a “silly question*”.

I think considering your groupings is very important, how do you create a safe space so that the more gregarious members don’t dominate at the expense of the shyer? Also should you offer separate sex groupings to allow conversations more personal to each group to flow? (eg. periods and vaginal discharge versus wet dreams and smegma)

In my experience sex education is best taught using a combination of separate and mixed sex groupings. You can get incredible discussions in single sex groups where finally young women feel able to openly discuss female sexuality without fear, and young men without the opposite sex present (apart from my presence if I couldn’t get a male teacher to lead the session!) suddenly stop acting with bravado and like they know it all and ask questions that have genuinely been worrying them.

Likewise bring those groups back together and getting the perspective of the opposite sex can be very powerful indeed.  I would always argue that both groups need to cover the same material. I do not like the idea of boys getting the wet dream talk while girls get the period talk. All young people need to know information about both sexes.

Offering single sex groupings in sex ed can also serve to reassure parents about participation in sex education particularly in primary schools or from religious communities. Students maybe less likely to be withdrawn in this case.

However, single sex groupings may not meet trans or gender non-conforming students needs, as a safe space cannot be created if you are forced to join a group where you don’t feel you belong and are denied entry to the other group.  This is something that needs to be thought carefully about, as a result I have come up with some thoughts about creating safer spaces that would still hopefully enable free flowing discussion for all. I’d love to hear your thoughts! Please add in comments below.

a) Firstly as their teacher you know your group better than anyone- use your professional knowledge about the groupings to decide which will be most appropriate to your group. If single sex groupings won’t work for your class don’t do them.

b) Ask the group in advance of separating out the groups that this is your plan. Discuss with the group whether they want this option or would prefer to stay together. Go with the group consensus about what they would prefer, but also ensure you give opportunities for individuals to come to you after the lesson if they prefer to chat about their preferences then if they prefer not to do this as part of the group. If a student does raise concerns about being in a single sex group, ensure you work with that student to identify how best a safe discussion space can be provided for them.  If this can’t be done in single sex groupings then don’t do them. To my mind supporting a trans student in your class to feel safe in your classroom trumps the needs of the rest of the group. It is important to be aware that young trans students are often at the highest risk of self harm and suicide therefore your role is to create a supportive classroom environment to best benefit their mental health as much as you are able.

c) Sometimes there won’t be opportunities to separate out the sexes due to teacher or classroom availability.  You could experiement with having three main discussion groupings- a boy group, a girls group and a mixed group. Discuss the same issue and then feedback and then discuss whether the different groups felt differently about any of it. (This way you could try and make sure the students were in the group they would feel most comfortable in too).

d) You could arrange your seating plan to maximise discussion between participants. You know your students- you know which ones won’t mind discussing things with the opposite sex and which ones might prefer to discuss things with participants of the same sex. Instead of throwing out questions for a whole class response- allow everyone in the class a minute or two to discuss it in their pair or group before feeding back. You circulate so you can have micro supportive discussions based on need. These may or may not be fed back to the whole group.

e) I am really not a fan of schools that enforce boy/girl seating plans etc, and PE in particular is quite problematic (I’d love a PE teachers thoughts on how to manage this inclusively in PE).  I think schools do need to be mindful how they segregate and think carefully about how they can meet the needs of trans students (remember around 1% of the population will be trans so schools may well have trans students). So even just flagging such thoughts up for consideration in your school can help create safer spaces for trans or gender non-conforming youth in your school.

In conclusion whilst not a fan of separating out the sexes arbitarily in most aspects of school life where there is no clear benefit, I can see there are benefits in sex education and I think we can still create safe spaces for all students regardless of their gender, it just needs some careful thinking about how we do this most effectively.

Happy Educating!

P.S I have tried to use sex (meaning sex assigned at birth- girl boy man woman) instead of gender (the gender identity you assume – male, female) in this post in most places. However when writing about sex education and mentioning sex as human biology and not meaning the act- it got a bit confusing and also strange writing “separate sex groups” – because of worries people might misread as “group sex”! So I’m not sure I got it right in places- any thoughts on a solution!?

 

*A top tip about questions having a basic ground rule such as “there are no silly questions- if you have a question you want answering then it is likely others in the group have wondered the same thing.” (I usually add in a caveat about “if you ask a question with the aim of embarrassing me or the class I won’t answer it, and you run the risk of your genuine questions not being taken seriously”. As a result I never have non genuine questions, sometimes ones that make me raise my eyebrows but I can tell they are from a place of genuine befuddlement. :)

Masters announcement

In case you missed me shrieking delightedly about it on twitter yesterday:

I GOT A DISTINCTION FOR MY DISSERTATION!!!!!

The marks still need to go through external examiner and be checked against my other modules so at this stage not sure what my final overall grade will be*.

But after all that struggle to get my head around concepts like hegemony, praxis and paradigm I’m pretty bloody proud of myself right now.

I’m also seriously considering a PhD in challenging gendered harrassment in schools. Ahem I do believe I told you all to stop me if I mentioned such a thing but it seems like a waste to not continue with academic learning now I have my academic dictionary all sorted (note I didn’t even mention academic wankery either!)

 

 

 

* Annoyingly about 80% of my modules are distinction level but I did 30% of the distinction level stuff at a different university so the grade can’t be counted. Which means of the remainder I have about 65% at distinction and rest not so may mean a merit overall which is extremely extremely annoying!

A Masters Dedication to my Dad

I dedicated my masters dissertation to my dad who died 9months before I started the final bit of my masters having encouraged me to start it and championed me all the way through and paid for some of the modules when I was too skint!.

I wanted to also share this dedication publicly because my dad was ace and I turned out pretty okay as a result ;)

 

Dedicated to my dad, John Smith

1935- 2012

 

This masters dissertation is dedicated to the man who taught me there is nothing more important than education and equality. It has been completed in his memory to stand as evidence of everything I have learned and am still learning about the world, equality and understanding.

 

For you Dad.