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Open Access

Peer-reviewed

Research Article

Mental health and cultural and linguistic diversity as challenges in school? An interview study on the implications for students and teachers

  • Sanna Higgen ,

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Writing – original draft, Writing – review & editing

    s.higgen@uke.de

    Affiliation Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    ⨯
  • Mike Mösko

    Roles Conceptualization, Methodology, Project administration, Resources, Supervision, Validation, Writing – review & editing

    Affiliations Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, Department of Applied Human Sciences, Magdeburg-Stendal University of Applied Sciences, Stendal, Germany

    ⨯

Mental health and cultural and linguistic diversity as challenges in school? An interview study on the implications for students and teachers

  • Sanna Higgen, 
  • Mike Mösko
PLOS
x

Abstract

Mental health and cultural and linguistic diversity in classrooms are part of students’ lives. Both factors can lower the achievements of students and classrooms and pose a challenge for teachers. Yet, little is known about the effects on other areas of school life besides achievements. Also, the consequences for classmates and teachers as well as possible resources are mostly disregarded. Semi-structured interviews were held to investigate the diverse effects of mental health issues and cultural and linguistic diversity on students, classmates and teachers. In total 20 interviews were conducted, seven with teachers, seven with external professionals and six with students. Recordings were transcribed and analysed using qualitative text analysis. Results show that especially externalizing symptoms of mental health issues are a burden to classmates and teachers. Teachers face time management problems and emotional stress. Linguistic diversity constitutes a serious challenge at school for students, classmates and teachers. Yet, cultural and linguistic diversity also imports several resources like fostering openness and integration. Future research should expand this research to older children and investigate the specific needs of teachers.

Citation: Higgen S, Mösko M (2020) Mental health and cultural and linguistic diversity as challenges in school? An interview study on the implications for students and teachers. PLoS ONE 15(7): e0236160. https://doi.org/10.1371/journal.pone.0236160

Editor: Vasileios Stavropoulos, Victoria University, AUSTRALIA

Received: January 24, 2020; Accepted: June 30, 2020; Published: July 20, 2020

Copyright: © 2020 Higgen, Mösko. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The author was supported by the Hans-Böckler-Foundation through a doctoral scholarship. https://www.boeckler.de/index.htm. There was no additional funding for this project.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Worldwide 13.4% of children suffer from a mental disorder [1]. Around one-third of youth experience some form of disorder during their lifetime [2]. If subthreshold symptoms are considered as well, approximately half of the adolescents across eleven countries meet criteria for threshold and/or subthreshold-depression and/or anxiety [3]. As schools are the place where children spend a great amount of their time, the effects of their mental health problems naturally impact the school environment [4–7]. Another factor that shapes this environment is the cultural and linguistic diversity of students [8–11]. The number of international migrants is continuing to increase in recent years [12, 13]. 13.9% of these are below the age of 20 [13]. In Germany, around 10.7% of all students are foreign students that cannot be included in regular classrooms [14]. When looking at the migration background the numbers are even higher [15]. Mental health problems as well as cultural and linguistic diversity both contribute to students’ diversity and impact the school experiences of the children themselves, the classmates as well as the teachers.

Mental health

Psychological stress and mental health disorders can negatively affect the achievements in school, the educational career [4, 5, 16] and the cognitive abilities of the affected children [17]. Studies on Canadian and American children show that this in turn, can lead to grade repetition [17] and leaving school prematurely, raising the risk of unemployment and illiteracy [18]. Furthermore, mental health problems are associated with lower health-related quality of life [19], difficulties in relationships to peers and teachers [6], an increased likelihood of being victimised or bullied by peers [7, 20, 21] and peer rejection [22, 23].

In addition to these negative impacts of mental health problems, classmates of distressed students are affected as well. Student misbehaviour can deteriorate the classroom environment [24] which is related to students' life satisfaction according to a German study [25]. Some research shows that including a disruptive pupil into the school-cohort lowers the academic achievements of their classmates [26–28]. In a US sample emotionally disabled children decreased the reading and maths grades of their peers by over 10 percent of a standard deviation [27]. Besides, teachers spend a great amount of time on disciplining disruptive students [29] which diminishes learning time for the rest of the class.

The majority of teachers has had students with mental health problems in their classes [7, 30] which shows that it is a prevalent issue in school. Yet, many teachers feel isolated [31], incompetent in supporting these children [30, 32] and lack professional training in dealing with mental health issues [7]. The mental health needs of their students pose a burden on the teachers [33]. A qualitative study with teachers from Australia investigated the teachers’ perspective on externalising and internalising problems in high school students. The teachers identified children with externalising symptoms as being more disruptive which can impact the entire classroom [34] and cause teachers’ stress [34, 35]. Also, troublesome students can deteriorate the teachers' perception of the classroom environment [36, 37].

Cultural and linguistic diversity

Another important factor that affects the classroom environment is the cultural and linguistic background of students. A Germany study found that migration background is associated with lower achievements in students [8]. Language deficiencies form a barrier to higher education, which are largely determined by the language spoken at home [8]. An international meta-analysis conducted by van Ewijk and Sleegers [9] concluded that a higher share of students from one ethnic minority affects pupils' achievements of the same minority. If students are used to a more traditional classroom environment they might not participate as much in an intercultural classroom [38]. Besides, in a Belgium sample non-native students were at a higher risk of being victimised, especially in schools where they constituted a minority [39].

In some cases, cultural and linguistic diversity leads to decreased achievements of the entire classroom [8, 40, 41]. However, this effect is controversial and was attributed to socio-economic status in other studies [8, 42–44]. Goldsmith [10] and Moody [45] detected that with increasing ethnic heterogeneity at schools in the United States, levels of interethnic conflict and friendship segregation were augmented. A side effect of ethnic heterogeneity in Flemish schools was an increase in a feeling of futility, which lead to a rise in school misconduct by native students [46]. Migrant children, however, seemed to be unaffected by the ethnic composition of students at least when looking at misconduct [46]. A review by Gray-Little and Hafdahl [47] found that with increasing consonance of a racial group in a school setting the self-esteem of that particular group amplifies accordingly.

The cultural and linguistic background of students can even alter the teaching style. By adapting their lessons to the language deficiencies of students, teachers can inadvertently be responsible for lower achievements in a classroom [8]. Besides, differing perceptions of race by teachers can lead to negative expectations of minority students and impact on the students’ achievements as was shown in studies from the United States [48, 49]. Teachers face the challenge of having to recognise differences between students while avoiding assimilation or essentialism [50, 51]. They are required to possess a range of teaching styles to meet the variety of needs of their students [52–54]. Flores and Smith [11] suggest that teachers need diversity preparation to be able to create an equitable learning environment. They need to go through the difficult process of reflecting their own feelings, their own race, and attitudes about race to provide children with an education that is free from prejudice [52, 55, 56]. To be able to teach diverse classes effectively teachers need to develop intercultural competence and simultaneously foster this competence in students [52, 57, 58]. Intercultural competence is the capability of changing the cultural perspective and adapting to cultural differences [59, 60]. It is the competence to encounter other cultures positively [51] and to interpret oneself in varying cultural ways [60]. For teachers, intercultural competence refers to the ability to think and act in interculturally appropriate ways in the context of the school and classrooms [61, 62]. Intercultural competence in teachers can be increased through training cultural self-reflection and awareness [63, 64].

Most investigations on cultural and linguistic diverse classrooms have focused on the negative impacts on students and teachers. However, as literature from the United States from other contexts than school depicts, multiculturalism can have positive impacts like increasing a firm's performance [65, 66] or enriching the education of college [67] and medical students [68]. In the school context, Stanat, Schwippert [8] found, that the share of students with migration background positively influences the aspiration for higher education in students. Besides, a greater diversity of a high school student's environment in the United States was associated with more comfort with classmates from different ethnic or racial groups [69].

The literature identifies some effects of mental health and cultural and linguistic diversity on students and teachers. Yet, most research has focused on the academic performance of students neglecting personal consequences for students and teachers or interactions between the varying parties. Besides, there is only little information on the possible resources found in culturally and linguistically diverse classrooms. Therefore, semi-structured interviews with teachers, students, and external professionals were conducted to investigate their perspective on the effects of mental health and cultural and linguistic diversity in school.

Methods

Ethics

Ethics approval was obtained from the ethics committee of the chamber of psychotherapists Hamburg on September 7th 2018 (application no. 04/2018-PTK.HH). The agency for school and vocational education approved of the study on October 11th 2018. At the beginning of each interview, participants received oral and written information about the purpose of the study and a description of the ethical rules used for research including confidentiality, informed consent, information and voluntary participation [70]. Compliance with the data privacy laws according to the §27 HmbDSG on the treatment of personal data for the purpose of scientific research was assured. All participants gave written informed consent for the interviews to be recorded, the recordings to be transcribed and the results of the study to be published anonymously. Parental permission was obtained for all children that participated in these interviews.

Researcher characteristics

The first author conducted and analysed all interviews. SH is a female master’s in psychology and a doctoral researcher (exemplary research areas: resilience, primary school, prevention). She was a first-time interviewer but received training in conducting interviews and qualitative data analysis from the research group.

Recruitment

Participants were selected based on a purposive sampling approach [71]. The recruitment of the primary school teachers aimed at maximum variation in respect to age, years of work experience and location of the school. Schools were chosen from three different locations: One is located in a small rural town with around 40% of students that have a migration background. The other two are in a large city. One is situated in a high-income suburb where only 5% of students have a migration background. The other one is in a low-income suburb where over 70% of students have a migration background. Seven teachers were recruited, three from the small town and four from the bigger city, two from each school. All had experience with culturally and linguistic diverse classes and mental health issues in students. The schools were contacted via mail or personal contact. Teachers that might be interested in participating in the interview were recommended by their colleagues or the head of school. The teachers were reached via telephone or mail. No teacher refused to participate in the interview.

Students were recruited through contacts made with the interviewed teachers. Students were supposed to have experience with mental health issues in classmates and diverse classrooms. Besides, they should variate in gender and age. No student refused to participate in the interview.

In addition, external professionals that work in areas related to mental health and cultural and linguistic diversity were interviewed. They were recruited as a key informant sample based on their experience. The research team discussed the choice of externals and agreed on the professions that should be interviewed. An online search was conducted to identify one special needs educator and the two psychologists. The other externals were recruited through contacts with experts and word-of-mouth. Interview partners were contacted via email. Two contacted externals did not agree to give an interview because of limited time resources or legal issues. Two did not reply to the emails they were sent.

Data collection

Interviews were held between September and November 2018. They were based on a semi-structured guideline [72] and carried out at the participants' homes, their workplace, or school. Interviews were always conducted in a private one-on-one setting. Only one interview was conducted simultaneously with an external and a teacher because the external had invited the teacher without advanced notice to the interviewer. The interviews were digitally audio recorded. They lasted on average M = 32:46 (range = 22:19–50:13) minutes with teachers, M = 31:41 (range = 17:48–50:13) minutes with externals and M = 22:21 (range = 12:52–26:49) minutes with students.

Guideline

The content of the interviews focused on experience with mental health issues in children and cultural and linguistic diverse classrooms. The guidelines were pilot tested with one teacher. No changes were made to the guidelines following the pilot testing. The first part of the interviews with teachers and externals contained questions on mental health issues in children. They were asked how it might be expressed in school, what influences this expression can have on the class and the classmates and what challenges thereby arise for teachers. The second part of the interviews focused on cultural and linguistic diverse classrooms. Teachers and externals were asked what kind of challenges exist for the students and teachers and what resources can be found.

The guidelines for students were developed and discussed with the research team. They were piloted with one child. Subsequently, a few more specific questions were added to the guidelines. Students were asked what they do when they feel unwell, how their friends and teachers could help them, whether they noticed when a friend is feeling unwell and what they themselves or the teachers could do to help them.

Protection of data privacy

In order to protect the participants' data privacy, informed consent was separated from the recorded data. All names and identifying information were replaced by labels and numbers during the transcription process.

Transcription

Members of the research team transcribed the interviews verbatim. All transcripts were checked for accuracy by the main author. Transcripts were not returned to participants for correction.

Data analysis

Transcripts were analysed according to the qualitative text analysis by Kuckartz [73] using Maxqda Analytics Pro 2010. In qualitative text analysis by Kuckartz [73] a structure is formed by formulating main categories or extracting these from the transcripts in a first coding process. The research team discusses the main categories and identifies subcategories. Subsequently, all interviews are coded again using the developed category system.

Deductive categories were formed based on the interview guideline. During the first coding process, other main categories emerged. Two members of the research team coded five interviews separately. They compared their deduced codes and discussed questions that arose during coding.

Codes could be anything between a few words or an entire paragraph. All codes were described in code memos and linked with a supporting quote. All transcripts were coded once. Then the entire material was coded again using the established code system. The final codes were discussed with the research team to identify appropriate labels.

Results

Sample

The sample consists of seven female primary school teachers, six children, and seven external professionals with specific knowledge on the matter. The teachers were on average M = 47.86 (range = 33–71) years old and had M = 17.57 (range = 2–42) years of teaching experience. One teacher was born in Russia and one in Brazil. The others were all German. Students were either seven (n = 3) or ten (n = 3) years old and were in first or fifth grade. In each grade two girls and one boy were interviewed. Externals were M = 50.86 (range = 35–69) years old with M = 20 (range = 5–43) years of work experience. There were two special needs educators (male and female), two psychologists (male and female), one paediatrician (female), one worker from the German Child Protection Agency (female), and one social space manager (female).

Coding

Regarding the question of the effects of mental health problems in students the main category “mental health problems” splits into the sub-codes "individuals", "classmates", "teachers" and "resources". Each sub-code consists of multiple subcategories (Table 1). Concerning the questions of the effects of cultural and linguistic diversity the main category "cultural and linguistic diversity" divides into the same sub-codes, namely "individuals", "classmates", "teachers" and "resources". These sub-codes also consist of multiple subcategories (Table 2).

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Table 1. Effects of mental health problems in children.

https://doi.org/10.1371/journal.pone.0236160.t001

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Table 2. Effects of the cultural and linguistic diversity of students.

https://doi.org/10.1371/journal.pone.0236160.t002

Teachers and externals expressed similar views on the effects of mental health and cultural and linguistic diversity on students and teachers. Every subcategory was mentioned by both sides. However, teachers and externals occasionally mentioned different examples. In those cases where there are differences between both groups, they will be pointed out in the results. Students' comments mostly serve as an enrichment of the data.

Mental health

Individuals.

When looking at mental health problems of individuals in school, the most dominant issue in the interviews was the damaging effect of externalising behaviour. This behaviour causes students to disrupt lessons and act out against teachers. Many suffer from restlessness. The interviewed teachers also mentioned it causes problems during the break time when students have more freedom. Students and teachers named many instances, where children acted with aggression towards classmates and against themselves.

Mental health problems can also manifest themselves in withdrawal. Withdrawal implies no participation in school and little talking. Teachers, as well as externals, have even experienced children that dissociate or show selective mutism. These students do not interrupt the school lesson.

Yet, according to teachers and externals, both externalizing and internalising behaviour can cause social problems because children have difficulties finding friends. Especially conflict communication was named as challenging for a lot of them as they exhibit low frustration tolerance.

Besides these forms of expressing their problems, some students show inappropriate behaviour. One teacher mentioned a very problematic student who would steal things from classmates and teachers or imitate death by asphyxiation. Other teachers had students that showed infant-like behaviour or motoric difficulties. One student and two externals talked about children that would show or talk about sexual behaviour. Finally, the German Child Protection Agency worker had witnessed self-harming.

Mental health problems often go hand in hand with a feeling of excessive demand by everything that is asked of the children. The children feel stressed and sad. The exerted pressure on these children can make it impossible for them to focus on school requirements.

Consequently, mental health problems can lead to a deteriorated school performance. Many students have difficulties concentrating because their mind is full of other issues. According to two externals, some children show disinterest in school and even resort to avoidance of school, if the situation becomes too unbearable.

Mental health problems sometimes manifest in somatic symptoms. As the child clinician pointed out many children see a doctor for physical problems, which are frequently not recognised as symptoms of mental health problems in the first instance.

Classmates.

The peers of children with mental health issues show varying reactions, which form three categories. In some cases, the behaviour of distressed children causes others in the classroom to devaluate this child. Even little aberrances can call the attention of students and bring them to focus on these. Experts pointed out that the peers might stigmatise this child for example as "the clown". One psychologist mentioned that some mental disorders like obsessive-compulsive disorders or tic disorders can disrupt and irritate the entire class. Aggressive or aberrant behaviour can even lead to exclusion or bullying. Some externals stated that teachers might have a hard time explaining differential behaviour or treatment to the other children in the classroom.

Sometimes distressed children instigate classmates to participate in disrupting the lesson. One student talked about having been incited into bullying a teacher with another student. If peers suffer from a similar mental health problem, they often do not want one child to gather all the attention of the teachers and students. The reaction of the classroom can in turn influence the subsequent behaviour of the distressed child.

When a child is aggressive, it can be a serious burden to the classmates and the entire classroom atmosphere. Some children explained that there were times when they were afraid of going to school. Students also complained about disruptions during lessons that would keep them from concentrating. Teachers, as well as students, observed lower achievements for the entire classroom if one student demands a lot of attention.

Teachers

The integration of students with mental health issues in the classroom can be a personal burden for teachers. Sometimes it inflicts psychological or emotional stress on the teachers which requires the establishment of boundaries. Many teachers talk about feeling left alone. Additional appointments with parents or social workers increase the burden. This can even lead to burn-out. The externals report that between teachers, parents and experts the responsibilities are not clearly distributed. This can cause stress and blame. Externals criticised that teachers lack the training for handling mental health problems which leads to insecurities.

For the teachers, a significant problem is time management. As many of them explained they are torn between sticking to the curriculum and trying to discipline the students. Especially when, at the beginning of each lesson, they must deal with conflicts that happened during break-time. This minimises learning time for the entire class.

Another challenge that teachers, as well as externals, recognise is caring for all students simultaneously as distressed children can demand a lot of attention. Sometimes teachers try taming one aggressive child while at the same time observing the rest of the classroom. This can make teachers feel like they do not do justice to every student. Besides, teachers are required to train the students' social competencies and integrate every student into the classroom. A few teachers also mentioned situations where they had to protect the class from one aggressive student.

Dealing with mental health issues in students, calls for important skills in teachers. They need to be able to reflect on their own behaviour, possibly even with a supervisor. Some students need differential treatment which requires teachers to be able to interpret and classify behaviour correctly. Externals especially mentioned the need for teachers to be patient.

Including students with mental health issues into the classroom makes collaborating with the parents or caregivers even more important. This implies additional work for the teachers through house calls and meetings. Some teachers reported situations where parents hindered cooperation when they did not recognise their child's problems. One external raised the concern that there is a lack of transparency between teachers and parents.

Resources.

Despite all those the negative effects, mental health issues in children can also lead to support from their classmates. The interviewed students showed distinct skills in recognising other's emotions. They explained that they would generally try to help their friends and classmates when they were sad by distracting them or mediating in conflicts. The students displayed an understanding for the behaviour of distressed children even when they were aggressive or loud. These assertions were supported by the teachers.

Externals, students and teachers explained that some students simply accept differences between people. They do not judge others and understand the children's behaviour in relation to their experiences. Others focus on their personal goals without letting themselves be distracted by classmates.

Cultural and linguistic diversity

Individuals.

For refugee children or children with a migration background, the biggest barrier in school clearly seems to be the deficit in the native language. The lack of language skills leads to learning difficulties and makes it hard for them to concentrate or participate in regular lessons. Besides, conflicts with peers often arise from misunderstandings and the inability to solve a conflict with words. One psychologist that works extensively with children with migration background explained that language deficiencies can lead to low self-esteem which in turn can cause psychological distress or mental health disorders.

Closely related to this issue are insecurities concerning their social affiliation. They might neither feel home in the country their parents were born in nor in the country they live in now. Especially children that just arrived in a new country, do not yet have friends that they can rely on and identify with. Teachers observed that children from the same country will often stick together and demarcate from the rest. This is true for immigrated children as well as for children born in the host country.

One teacher mentioned that in her experience some children have more difficult preconditions. Especially in wealthy neighbourhoods, immigrated children are constantly confronted with having less equipment than the other children have. Another teacher reported that some refugee children have no schooling experience.

Finally, in some children, you can see the strain caused by the experiences they have made in their home country or during their flight. If children experienced traumatic situations it can lead to difficulties in concentrating and in some cases even result in posttraumatic stress disorder. One external explained that some children from troubled countries might not have learned how to solve conflicts without violence.

Classmates.

The negative reactions of classmates to children with different cultural or linguistic backgrounds pertain to four categories. If a child acts very different from what children are used to it can lead to incomprehension and misunderstandings. Different eating or behavioural habits can be hard to understand for some children if they are used to other customs.

In the worst cases, this incomprehension can cause exclusion of certain students. Some classmates use peculiarities to distance themselves from other children or bully them. Teachers, as well as the special needs educators, recount instances of bullying that go in both directions against children with migration background as well as against children born in the host country. One teacher was especially concerned by children with migration background receiving special treatment. This assigns them an outsider position that they often don't want.

Occasionally differences build a barrier between children. The topic that was mentioned most by teachers, as well as externals, was religion. Diverging public holidays or values concerning relationships can cause conflicts and insults.

Some teachers recognised that in cultural and linguistic diverse classrooms students have to meet a few challenging expectations. They are expected to be patient when a teacher explains something multiple times. Besides, students should be considerate when children do not understand the teacher or receive special treatment. Finally, children are often required to work independently when the teachers focus their attention on single students. All this can be especially challenging for troubled children.

Teachers.

When teachers face a cultural and linguistic diverse classroom, they find themselves confronted with new challenges. Teachers need to obtain intercultural competence to deal with cultural and religious differences. They must self-reflect on their own normality which might differ from the one of the students or the parents just like concepts of school and mental health.

Teachers need to adjust their teaching style when they are confronted with a diverse classroom. The interviewed teachers considered the provision of appropriate learning material as one of the biggest challenges. They are expected to follow the curriculum while simultaneously teaching a new language to some students. Teachers and externals both perceive empathy and patience as crucial skills to strengthen every individual student.

Another challenge that teachers deal with is working with the parents of migrant students. Often there is a language barrier, which requires a certain amount of planning before a meeting can take place. Moreover, upbringing in other countries can differ from their own idea, especially when it comes to gender roles. A few teachers and externals stated that cultural or religious conflicts between children do not originate from the students themselves but are attributable to some parents who promote prejudices.

Resources.

Despite these challenges, all interview partners were able to identify multiple resources of cultural and linguistic diverse classes. Often the first reaction when it came to diversity was that the origin is irrelevant for the children. Especially young children easily find a way to connect and do not care where someone is from. Teachers explained that during lessons the background is not important.

The teachers highlighted the openness of their students. Through close contact with diverse cultures, children learn to interact with different people and find commonalities. The teachers see this as a possibility to dismantle prejudices. In the interviews, the children appeared very comprehending of deviant behaviour or differential treatment because of cultural differences.

Teachers and externals consider multicultural classrooms a great enrichment because students can contribute first-hand insights on languages, religion, food, or public holidays from other countries. One teacher explained that thereby children learn that differences between cultures are often negligible.

In this context, the teachers stated the commitment and integration of the parents as another resource. When parents participate in the preparation of celebrations this collaboration can help to reduce stereotypes.

In addition, the school can be a resource for the children that arrive new to the country. Meeting and studying with peers can facilitate the establishment of relationships and enable them to find friends.

Children, teachers and externals all stressed the helpfulness of students. The social space manager explained that for most students their initial reaction to a child in need seems to be helping rather than bullying them. One teacher stated that diverse classrooms help prepare for life because they reflect our society which is becoming more and more colourful.

Discussion

The interviews with teachers, externals and students reveal that mental health issues can be a serious burden not only for the affected student but also for classmates and teachers. Cultural and linguistic diversity poses a challenge if language or religious barriers exist. On the other hand, this diversity bears a variety of resources for students, teachers, and parents.

The interviews focused on German primary schools. Primary school classes in the here included cities have between 17–26 students [74]. The distribution of teacher assistants and pedagogues in these schools depends on the amount of special needs students and of students in total in a school and classroom [75]. In most cases, teachers are only supported by an assistant for a few hours a week [76].

The teacher sample was recruited with maximum variation. Yet, only female primary school teachers participated in the interviews. Though the majority of primary school teachers in Germany are female (89.5%) [77] the experiences of male teachers with challenges at school might differ from the ones of female teachers.

Externals are not referred to as experts as no expert interviews were conducted. Expert interviews focus on the expertise of a person and their specific knowledge on a subject [78]. In this study, externals were included to expand the information received from teachers and provide a different perspective on the issue of interest. Therefore, not every question of the interview guidelines pertained to the externals' specific field of expertise.

As recommended in the literature interviews with children should be focussed, short and target specific situations [79, 80]. This limits the possibility of generalising their statements. Nevertheless, it is important to collect the opinions of children, when researching their environment [79, 81].

Even though the teachers and externals worked in diverse locations with varying lengths of experience, and schools with different socioeconomic backgrounds the challenges and problems of mental health issues and cultural and linguistic diversity they recounted were rather similar. Teachers confirmed the evidence that mental health problem can lead to lower achievements in school [4, 5, 16]. In addition, the previously stated risk of being bullied by peers [20, 21] and the difficulty in relationships [6] were often mentioned. Externalising behaviour, especially aggression towards peers, constituted the most dominant challenge in these interviews. Teachers did not talk about grade repetition or leaving school prematurely due to mental health issues [17, 18]. However, this is most likely because only primary school teachers were interviewed.

Some teachers and students verified that symptoms of mental health in one student could lead to lower achievements in the entire classroom [26–28] because teachers have to focus all their attention on single students and lessons are disrupted. Problematic behaviour of one child can incite other students to join in disrupting the class as had been suggested by O'Brennan, Bradshaw [36]. In addition to these ramifications, teachers, students, and externals in this study also explain that mental health issues in children can lead to fear and a deteriorated classroom atmosphere. However, they were also capable of identifying resources such as support and acceptance of differences.

In the literature, the reason why problematic behaviour is stressful for teachers, authors supposed that this is because teachers constantly have to divert their attention from the classroom and discipline the child [82, 83]. Teachers confirmed that one big source of stress is keeping an eye on every student. As previously stated, teachers often feel left alone [31]. Besides, teachers and externals perceive a need to collaborate with the parents which can be challenging at times [31]. Externals also criticised insufficient professional training of teachers in dealing with children with mental health problems [7] as teachers occasionally need to protect students from themselves or others and always interpret their behaviour in relation to the students' history. In addition, teachers and externals explained that the uncertain distribution of responsibilities, the lack of transparency in collaborating with the parents and the additional appointments further add to their stress.

Concerning the cultural and linguistic background of students, the interviews confirm that native language deficits can lead to learning difficulties and concentration problems [8, 9]. However, those were not the only effects mentioned in this study. Deficits in the native language can also lead to problems in conflict communication and lower self-esteem. Similarly, Gray-Little and Hafdahl [47] had identified lower self-esteem in minority students. This study shows that cultural and linguistic differences impede the finding of friends and social affiliation. As previously stated, migration background can lead to bullying by native students [39]. Yet, teachers explained that bullying appears in both directions.

The teachers and externals did not state any concerns regarding the effect of a cultural and linguistic diverse classroom on students' achievement as was done extensively in previous research [8, 42, 84]. Also, a feeling of futility in the native students and a rise in misconduct [46] were not mentioned. While Goldsmith [10] identified an increase in interethnic conflicts, teachers and externals here did not worry about conflicts but more about ethnic grouping, exclusion and barriers that form between students because of incomprehension and challenges imposed on students. Possibly, the results of this study differ from the literature because the effects were visible when comparing different schools, while the teachers here only referred to one school. Besides, teachers, as well as externals, were eager to look at the source of the conflicts instead of simply blaming it on culture.

In line with previous research [11, 52, 57], the results show that it is crucial for teachers to obtain intercultural competence and the ability for self-reflection to be able to teach cultural and linguistic diverse classrooms successfully. Teaching students of varying language abilities was named as very challenging for teachers. Additionally, this study identified the collaboration with parents of different cultural and linguistic backgrounds as important yet complex.

Resources of cultural and linguistic diversity in school had not been a focal interest in research previously. The interviews did, however, uncover a variety of positive effects of diversity in school. Just as it enriches the education at college [67] it can have the same impact on primary school lessons. Besides, it expands the openness and relationships of students. Especially younger children were deemed as very open towards other cultures. This is in line with previous research that found younger native Dutch adolescents to be more in favour of minorities than older adolescents [85].

Limitations

There are some limitations to this study. No interviews were conducted with children with a migration background. In the classes that were contacted, the language proficiency of the students with a migration or refugee background was not sufficient for an interview. Despite multiple efforts it was not possible to receive parental permission for interviews with students of different cultural and linguistic backgrounds. It would have been interesting to hear their perspective on problems and resources that emerge in cultural and linguistic diverse classrooms. Similarly, no students with mental health issues were interviewed. Due to the protection of data privacy teachers could not disclose information about possible mental health issues in their students. It would be valuable to find out, how children with mental health issues experience their time at school.

The sample size of this study is relatively small. However, despite the great diversity of interviewed teachers and externals there was extensive overlap between their answers so that more interviews would most likely not have produced a lot of new information. Besides, there is evidence that six interviews are sufficient to identify the main themes of a topic [86].

In this sample, the focus was only on primary schools. It is possible that older children perceive other effects of cultural and linguistic diversity or react differently to mental health problems in classmates. Killen and Stangor [87] found that with increasing age adolescents become more interested in social group functioning, issues of social cohesion and society. Therefore, the effects of diversity might be stronger and more adverse in older age groups.

Conclusion and outlook

Semi-structured interviews with teachers, students and externals were conducted on the challenges that arise through mental health issues or cultural and linguistic diversity in classrooms. Mental health problems reduce the academic as well as the social competence of affected children. Besides, the expression of the symptoms can deteriorate the achievements of the classmates and worsen the classroom atmosphere. Teachers are required to develop skills in dealing with the students and spend extra time on solving conflicts and training social competencies.

Cultural and linguistic diversity may lead to learning difficulties and uncertain social affiliation in students. It can form a barrier between classmates and cause bullying and exclusion. Teachers expressed the need for appropriate material for teaching different languages. Yet, cultural and linguistic diversity bears a variety of resources like facilitating integration, openness and enriching the lessons.

Future research should assess the specific needs of teachers when dealing with mental health problems in students to develop adequate interventions and types of support. Furthermore, older children should be questioned to see how mental health and cultural and linguistic diversity operate in higher classes.

The cultural background of the interviewed teachers was not assessed in this study. However, the culture of a teacher can influence the relationship with their students in various ways. Studies from the United States show for example that teachers rate children of a different ethnicity as more negative [88, 89] and have lower expectations for their educational success [90]. Therefore, assessing cultural background and cultural attitudes of teachers might be an appropriate way to control possible confounders in similar studies.

Mental health issues in children inflict a variety of challenges on teachers and students. Like studies on mental health literacy in teachers [91, 92] and on the teachers’ role in dealing with mental health issues in school [30, 34] the results of this study suggest that it would be advisable to include a mental health training into the teacher formation to increase their confidence and ability in dealing with mental health problems in students. Besides, the effects of cultural and linguistic diversity identified here lead to the assumption that teachers could benefit from an intercultural competence training enabling them to encounter the cultural differences of their students positively and act interculturally appropriate [63, 64].

Supporting information

S1 Transcripts. Excerpst of the transcribed interviews with the externals.

https://doi.org/10.1371/journal.pone.0236160.s001

(PDF)

S2 Transcripts. Excerpts of the transcribed interviews with the teachers.

https://doi.org/10.1371/journal.pone.0236160.s002

(PDF)

S3 Transcripts. Excerpts of the transcribed interviews with the students.

https://doi.org/10.1371/journal.pone.0236160.s003

(PDF)

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