PRESCHOOL EDUCATORS’ VIEWS ON SUPPORTING CHILDREN WITH MENTAL HEALTH ISSUES IN EARLY CHILDHOOD EDUCATION

Schools are considered the ideal place to provide mental health services. International literature highlights the importance of early detection of mental health problems and the implementation of preventive interventions in school context. The present study aims to explore preschool teachers’ views regarding the involvement of the school in the prevention and treatment of students' mental health problems in preschool education and the ways in which the school can assist in supporting students. The sample of the research consisted of 115 preschool teachers. The method of data collection was a questionnaire. The results of the research showed that the majority of teachers believe that the school should be involved in the prevention and treatment of children's mental health problems. In addition, they defined the characteristics of mental health in preschool children. Simultaneously, they argue that enhancing a child's self-confidence, developing positive interpersonal relationships between teachers and students and collaborative relationships with parents are the main ways in which the school can support students with mental health problems. Research findings could be utilized in designing mental health promotion interventions.


Introduction
The school environment is an important area for promoting children's mental health. Simultaneously, the relevant literature emphasizes the importance of teachers' active role in promoting mental health (Elias & Weissberg, 2000). Mental health is defined as a state of emotional and social well-being in which the individuals are aware of their potential, can cope and manage the normal stresses of life, can work productively and efficiently, i Correspondence: email enikolaou@aegean.gr and are able to contribute to the community (WHO, 2004). Mental health is directly related to health and quality of life.
According to World Health Organization, mental health promotion is a broader concept than the prevention of mental disorders. Within the context of mental health promotion, the factors and processes that protect mental health and reduce risk factors are strengthened. Mental health promotion often refers to "positive mental health rather than poor mental health". Positive mental health is the desired result of mental health promotion interventions. Promoting mental health is related to quality of life rather than the absence of mental illness and the emphasis on deficits (WHO, 2001).
The World Health Organization (WHO, 2004) defines mental health promotion as the actions, conditions and environment that support mental health and allow individuals to adopt and maintain a lifestyle characterized by health. It includes actions that increase the chances of mental health experiences. In addition, the World Health Organization considers fundamental actions that facilitate the development of an environment that respects their rights at the socio-economic, political, and cultural level. Prevention is related to disease prevention while promotion is related to improving health and well-being. The World Health Organization links prevention to the reduction of mental disorders and relapse. It also focuses on high-risk groups in order to prevent the occurrence of mental disorders.

Literature Review
According to Reinke, Stormont, Herman, Puri, & Goel (2011), the vast majority of teachers argued that the school should be involved in addressing students' mental health problems. Teachers maintained that it is the school's responsibility to support students' mental health needs and that teachers could play a significant role. However, they feel that they do not have the necessary knowledge and skills to support children with mental health issues. In addition, the majority of teachers asserted that the implementation of socio-emotional learning programs is more in line with the role of school psychologists. Moon, Williford, & Mendenhall (2017) contended that teachers and principals are willing to enhance the school's capacity to meet the mental health needs of students. A key mechanism for achieving the above goal is the knowledge, awareness and ability to meet the mental health needs of children. The majority responded that they desire to be trained in understanding the concept of mental health, behavioural management as well as social skills. Mental health literacy training is a key tool in promoting students' mental health and consequently their educational achievements. Teacher training is related to the prevention of externalizing and internalizing problems through the timely detection and referral of students.
In the research of Cefai & Askell-Williams (2017), teachers argued that the involvement of school community in promoting children's mental health and well-being is essential. They were in favour of a holistic approach which includes the development of skills, inclusion, the development of cooperative relationships with parents and the development of positive relationships with students. In addition, Ekornes (2015) asserted that teachers acknowledge their crucial role in identifying students' mental health problems and making referrals in mental health services. They also highlighted the need for inter-professional collaboration. Holt (2019) argued that teachers consider the promotion of students' mental health and the creation of a positive climate in the classroom as an important dimension of their role. They stressed the importance of forming positive interpersonal relationships between teachers and students. Moreover, they highlighted the importance of their own mental health in order to be able to properly perform their role, the importance of their ability to manage their emotions and the need to be positive role models. They also referred to their contribution to cultivating students' interpersonal skills and to creating an environment where students receive respect and acceptance.
Danby & Hamilton (2016) explored how teachers perceive the concept of mental health. Their descriptions included social functioning and the absence of mental illness. They also mentioned the ability of expressing emotions, the ability of coping with life's difficulties and positive self-esteem. Moreover, they argued that the school should provide a safe and supportive environment and they stressed the need to collaborate parents and mental health professionals to ensure early intervention. In addition, they mentioned the empowerment of parents through the organization of seminars in order to raise awareness of the needs of their children.
Nikolaou, Moustakas & Markogiannakis (2017) explored teachers' perceptions regarding supporting children with depression in school context. They argued that supporting children, a positive interpersonal relationship with these children, a positive climate in the classroom, cooperation with parents and mental health professionals are considered effective strategies for addressing the mental health issues of children with depression. Moreover, they contended that the implementation of socio-emotional programs by teachers in cooperation with mental health professionals, as well as the implementation of mental health prevention programs aiming at all children by mental health specialists are effective strategies. In addition, the collaboration between school and family is vital to addressing the needs of students (Stamatis & Nikolaou, 2016). Finally, teachers' role in mental health promotion is highlighted and is vital to students' adaptation to school Stamatis & Nikolaou, 2020).

Methodology
The present sample research aims to explore the views of preschool teachers regarding their role in the prevention and treatment of mental health problems. Expanding knowledge on this topic can contribute to early diagnosis of children's difficulties, to mental health promotion as well as prevention.
This research attempts to fill gaps in existing knowledge and provide information for the adoption of new practices in an issue that is associated with children's well-being and their adaptation to school environment. The sample of the research was consisted of 115 preschool teachers. Data were collected by a questionnaire based on previous research. In relation to the educational level of the teachers of the sample, 74.8% were university graduates, while 25.2% were holders of a postgraduate degree, master or doctorate. Regarding the studies of teachers in special education (S.E.), the largest percentage of the sample 56.1% (f = 64) was without studies in S.E., 29.8% (f = 34) of the participants had attended a seminar or training in S.E., 11.4% (f = 13) held a master's degree and only 2.6% (f = 3) were graduates of a Department of Special Education. One teacher did not answer this question (f = 1).
Specifically, 29.6% (f = 34) had 1-5 years of service, 26.1% (f = 30) of teachers had 13-18 years of service, 25.2% (f = 29) had 6-12 years, 5.2% (f = 6) ranged from 19 to 25 years and the same percentage (5.2%) had from 31 years of service and over. 4.3% (f = 5) of the sample had 26 to 30 years of service. In relation to the previous service of teachers in special education, 86.1% (f = 99) of teachers in the sample did not have any relevant service. Cumulatively, 10.4% of the sample had 1 to 4 years of service (f = 12).

Results
The data in Table 1   The absence of mental health disorder is the dimension that most characterizes the mentally healthy child of preschool age according to the answers of the teachers.   Table 3 shows that the majority of teachers (82,6%) believe that the school is important to participate in the prevention of students' mental health problems. According to Table 4, the vast majority of teachers, 82.6% (cumulative percentage of teacher responses placed in the categories "to a very great extent" and "to a great extent") argue that the school should be involved in addressing mental health problems of the students.  Table 5 shows that 41.7% of the sample believes that supporting students with mental health problems is included in the role of teacher "to a great extent", 14.8% believe that it is included in the role of teacher "to a very great extent", while 39,1 % of the sample has a neutral view.  Table 6 shows that the teachers of the sample believe that enhancing students' selfconfidence is an important part of the role of teachers in supporting students with mental health issues (M = 4.70, S.D = 0.533). The above dimension gathered the highest average compared to the other dimensions studied. This is followed by the development  The above results indicate that teachers are willing to contribute to the prevention of mental health disorders, to mental health promotion in general as well as to providing support to children with mental health issues. These findings align with relevant literature (Reinke et al., 2011. Moon et al., 2017. Teacher support is regarded as a significant protective factor for promoting students' psychological resilience (Nikolaou et al., 2021). In addition, the definition of mental health is associated mainly with the absence of mental health disorder and social functioning as indicated by the means of their responses in relation to the characteristics of mentally healthy children. The way they perceive mental health is consistent with Danby & Hamilton (2016) research's findings. Moreover, the fact that they related mental health with the absence of mental health disorder conveys a pathology-oriented definition which was also found in previous research (Graham et al., 2011). Teachers' perceptions regarding supporting children with mental health issues are crucial as they are key stakeholders in mental health promotion. Their active participation is linked to the effectiveness of school mental health promotion programs (Rowling, 2008). Further research could explore the research questions of the present study employing a larger sample or by conducting interviews.

Conclusions
The educators of the present study argue that Attention Deficit Hyperactivity Disorder and Anxiety Disorders are the most common disorders in preschool education. There follows the developmental delay of children. Selective mutism and depression are less common than the mental health issues mentioned above. In relation to the characteristics that define the mentally healthy child in preschool education, it was found that the absence of mental disorder, the ability to form interpersonal relationships with classmates and sociability are the dimensions that are most attributed to the mentally healthy child. In addition, the vast majority of teachers considered that school's involvement in the prevention and treatment of mental health problems is important. In addition, supporting students with mental health problems is largely part of the role of the teacher according to the research findings. In particular, teachers expressed the view that strengthening students' self-confidence, developing interpersonal relationships between teachers and students are part of the role of teachers to support students with mental health problems. Simultaneously, the detection of students 'mental health problems and the implementation of programs in the classroom for students' behaviour problems in collaboration with experts was considered crucial.