Psychiatric specialist Gabriel Ellul has told The Malta Independent on Sunday that he and other psychiatrists are observing an increasing number of secondary school students seeking professional help - one of the many factors behind this, according to him, is the pressure being placed onto students as a result of the continuous assessments they have as part of the new O-Level/SEC assessment model.

Dr. Ellul confirmed that several such students are seeking professional support in order to cope with their mental health struggles - a number of which are prescribed medication for their anxiety, stress, or any other condition.

"I have many people who seek my help and the help from colleagues of mine because of anxiety issues and also because of issues related to focus and attention," he said.

According to him, the most common problems psychiatrists encounter are children and adolescents who are having problems managing their emotions, understanding their needs, achieving a school-life balance, as well as in how their family dynamic is able to offer them support or not. These issues - apart from the struggle to find a balance between their personal life and school - are leading them to experience stress.

While it's difficult to pinpoint this new assessment model as a central reason to this increase, he has come across several cases where young people were stressed out and anxious about their O-Level assessments, specifically because these assessments are being held throughout the academic year.

The O-Level overhaul was announced in October 2019 and introduced during the scholastic year beginning in 2020. Through the new system, the classic O-Level examinations at the end of Form 5 are no longer responsible for 100% of the subject grades - part of the new assessment format includes continuous assessment throughout secondary school.

July 2025 will be the first time that secondary school students will receive their SEC results which are not fully derived from the April-May examinations post-Form 5. These assessments were initially announced to comprise 40% of the total grade per subject, however, this was later revisited.

In July this summer, TVM News reported that exams will make up 70% of these results while the remaining 30% will come through the continuous assessments conducted by students' educators.

In July 2023, Education Minister Clifton Grima had stated that he was "definitely not" satisfied with that year's observed O-Level results; the obtained grade performance of this student cohort witnessed four out of ten students fail their exams, as per Times of Malta. These SEC results saw 20% of students receive a "U" grade (marked as unclassified), 11% obtain failing grades between 6-8, and just under 7% being absent from their exams.

Grima had said he wanted every child sitting for exams to have "the necessary tools to achieve results."

Commenting on this education reform, Ellul said that as a policy, it can have very good results if implemented properly, though he also remarked that the present format places a lot of emphasis on grades and is having an effect on youngsters and young adults.

"It makes people feel as if they are valued according to the grades they receive," Ellul stated. "Although it might not be the message which the curriculum wants to show, it is the message received by many students, and that causes a lot of anxiety and stress."

He said he had clients who detailed how their teachers set a very high bar from the start of the academic year, applying heavy pressure within days of summer's end. Ellul said that in such cases, students felt as if their assessments were commencing immediately and that it was absolutely imperative that they don't fail - comparisons were drawn to these situations being perceived like life-or-death situations.

"If the idea behind this new policy was to allay anxiety through a more comprehensive assessment, which I think is very reasonable, in actual fact, the message at the grassroots may be 'you're being tested throughout the year'," Ellul said.

He also questioned whether this is causing some sort of Hawthorne Effect - a psychological phenomenon explaining that human beings alter their behaviour once they are being observed - in these secondary school children, since "they can't let their guard down because they feel as if they are being observed continuously". While saying this sensation may hold school children more accountable, which is not an issue in itself, Ellul questioned if there have been studies done on how this may impact children in an educational setting.

The psychiatrist also remarked that most of the difficulties he encounters are related to poor strength of character, i.e., the ability for a person to have integrity in who they are and what values they represent. He said that today's children are being moulded in a manner that is resulting in them growing suggestible to their surroundings, including social media; the latter medium was observed to cause its young users to absorb the culture of giving online followers the false impression that they are perfect persons.

He also labelled social media as "one of the factors which are mostly to blame" for what is happening presently, specifically marking out the rise in depression and anxiety. He explained that part of this is due to social media's isolated nature of consumption as people think they are relating to others.

Ellul described how constant technological access is resulting in many children to disrupt the structure of their days and nights, allowing them to access the online world and contact people during very late hours. He also added that in some cases, he has observed this online presence to expose children to predators and cyberbullying.

In his eyes, this common characteristic is being greatly affected in secondary students by the message being broadcasted through the present O-Level assessment model that "you need to be perfect or the best you can [be]."

"That's what's at stake here - people feel that unless they perform, then they are nothing," Ellul stated.

He added that it is possible the new assessment model leads to a change in culture and mentality; however, having just been introduced, this has so far been a culture shock to all persons involved - mainly educators and students.

Ellul believes that the country has "a pervasive problem" with its heavy focus on grades that has gone on for a long time. He believes it would be worthwhile if some of the focus on O-Levels and comprehensively assessing children on their academic progress was shifted towards a greater focus on life skills.

"We have to reevaluate what school is about," he said. "We are very focused on grades and making sure the curriculum has been followed through. I see realities where people leave with a good understanding of algebra, but they don't know how to work in a relationship, for example."

Ellul listed skills to include interpersonal skills, emotional awareness, social skills, how to work with AI and social media, as well as how to avoid encountering predators online and cyberstalking.

"These are the skills we need to teach our children because unfortunately, the reality out there is that we see people going into casualty, emergency department daily with overdoses, self-harm, etc." Ellul remarked. "I'm speaking about people ages 10+ - even eight years old, I've had a case."

The psychiatrist also observed that getting a top grade in a particular subject does not mean much unless that student wishes to continue down that academic path, though learning skills on communicating properly with other people are life lessons.

Ellul observed that there has been an increase in the number of young people who seek professional help, though he explained that this is due to a wide variety of factors; this increase is being observed within the private sector and the public service through the rising number of referrals to the Child and Young Peoples Unit at St Luke's Hospital. Besides these personal educational pressures, other main factors to these increasing numbers are the improving stigma behind treating mental health (including awareness visible on social media) or because another relative, such as a parent, has first accessed support themselves.

Social media awareness is helping people learn the signs to having conditions such as ADHD and, in some cases, is helping people to discover that they may have the condition themselves and get treatment. School staff are responsible for identifying such cases in school children, he commented.

According to Ellul, treating these conditions with medication has been revelatory for adults who experienced the majority of their lives with these conditions, unknowingly. He said that through the offered medication, he has had clients thanking him as they have become better enabled to keep focus and stay attentive, control their emotions, manage their time, and communicate in their personal relationships.

This experience was described similarly to having a "spiritual revelation" given the bearing it has had on how these people see the world and interact with it.