Neglect of Mental Health in Schools: A Serious Issue

The neglect of mental health in schools is a clear and present danger.

Yet, the preventive measures are not enough.

There are three apparent reasons behind this issue:

1. First, there is an obvious lack of awareness about mental health problems in schools. According to the National Survey on Drug Use and Health, 60% of people who have a mental health concern or mental illness don’t receive any form of treatment for their condition.

Cases of depression in children are often dismissed as mood swings, and signs of agitation and anger are shrugged off by labeling them as ‘teen rage’ or ‘just a phase.’

2. Secondly, mental illness carries a social stigma. Believe it or not, parents are afraid of seeking help from a licensed mental health counselor fearing their child will be labeled ‘crazy.’

3. Lastly, some schools don’t have the resources, infrastructure or the training needed to proactively detect and help students who run the risk of developing a serious mental health issue.

Here are some alarming statistics on the state of mental health in schools across America:

  • National Alliance on Mental Illness (NAMI) reports that one in every five children in the age group 13 to 18 suffers from a mental health condition. The same is true for every one in seven children, aged 2 to 8.
  • NAMI also reports mental health issues to be one of the leading causes of students dropping out of school. Almost 37% of students with a mental health condition, of age 14 and older, drop out of school—the highest dropout rate of any disability group!
  • As per another report by the Centers for Disease Control and Prevention (CDC), 6.8% of children in the 3–17 age group in the US were diagnosed with Attention-deficit/hyperactivity disorder (ADHD). About 3% of them were found to be suffering from anxiety, while another 2.1% were diagnosed with depression.

History of Mental Health Issues in Schools

School employees, children, and parents have all been affected by the growing epidemic of mental health illness in schools.

Children and teachers have paid for with their lives, while parents have watched in sheer agony and horror as gun violence and self-harm became a frequent occurrence.

Here are some major incidents in schools across the US that can be attributed to mental health issues.
Florida
Parkland, Florida (2018)

Nikolas Cruz lost his father at the age of 6 and had trouble in school while growing up. He was diagnosed as ‘developmentally delayed’ in 2002 and then with anger issues and ADHD in 2013. After being institutionalized for two years in 2014, he moved to Marjory Stoneman Douglas High School in 2016. Allegedly, he tried to harm himself twice, but an investigation by Florida Department of Children and Families closed the case by stating “he had a very low risk of self-harm but suffered from depression, ADHD, and autism.”

After his mother’s death in November 2017, there were several reports and complaints about Nikolas buying firearms. In Feb 2018, he opened fire in the school, killing 14 students and 3 staff members.
Montgomery
Montgomery, Ohio (2008)

Jessica Logan was a cyberbullying victim at school. She was allegedly abused by her classmates over a photo that she had shared with her boyfriend, who had forwarded it to hundreds of other high school students.

This had started a line of abuse, and she became seriously depressed. This ended in Jessica Logan committing suicide in her closet in July 2008. After her parents’ relentless efforts to sue the state and school, House Bill 116 – also called the Jessica Logan Act – was signed by the Ohio state governor in 2012.

The act added harassment, intimidation, and cyberbullying into the existing anti-bullying law, and it also requires school districts to create prevention and protection policies against bullying.
San diego
San Diego, California (2001)

Andy Williams, 15, reportedly injured 13 people and killed 2 in a mass shooting in San Diego, CA, in 2001. Upon his parents’ divorce, Andy moved to California with his father. There, he was a victim of constant bullying and abuse.

The events of his parents’ divorce and continuous bullying soon led him to depression and drug abuse, to the extent of him being suicidal.  Even though he tried to talk to a school counselor about it, he was sent away. His mentions of him planning to “pull a Columbine” to his friends were also never reported to the administration.

Finally, he ended up opening fire on March 5, 2001 killing two and injuring many.
Mental health in schools - Columbine High School
Columbine, Colorado (1999)

Eric Harris and Dylan Klebold walked into their school in Columbine with four guns and thirty homemade bombs. Before committing suicide, they had killed a teacher and 12 of their fellow students and wounded 24 others.
Mental health professionals who helped the FBI in their investigation found out that Klebold was clearly a victim of depression and showed suicidal tendencies and that  Harris had exhibited psychopathic tendencies.

Harris was described as “nice” by some kids, but his personal website revealed his dissatisfaction and hatred towards others.

What Causes Mental Health Issues in Schoolchildren?

mental health in children
Unlike physiological disorders and illnesses, mental health disorders don’t come with a specific set of causes. The best way to understand the causal factors behind mental health disorders is through the biopsychosocial model.

According to this model, it is the interaction of several factors that make an individual susceptible to mental illness.
The key factors are:

  • Biological factors such as genetic makeup, biological processes, and heredity.
  • Psychological factors such as one’s personality, emotional disturbances, and stress.
  • Social factors such as early loss of a parent, bullying, lack of social support, health education, and social care.

Biological Factors
Biological factors include head trauma, change in levels of neurotransmitters in the brain, brain damage due to infection or intoxication, and physiological or hormonal changes that happen during puberty and menstruation.

Vitamin and mineral deficiencies also adversely affect the mental health of an individual.

Biological Factors (2)
Certain personality types can be prone to a particular mental health concern or mental illness. For example, neurotic personality aka neuroticism is often linked with depression and borderline personality can lead to suicidal behavior and self-harm.
Emotional disturbances caused due to an abnormal parent-child relationship can also result in mental illness. Unhealthy parental behavior such as not expressing love and affection, drawing an unrealistic comparison with siblings or being overprotective can cause emotional stress in children.

Lack of interpersonal connection in schools is a key reason for psychological and emotional stress. Children who find it hard to make friends or take part in group activities are prone to psychological stress.

Other psychological factors which may cause mental ailments can be a result of physical, emotional, or sexual abuse, or guilty feelings about masturbation – especially in families with strict religious beliefs.

Biological Factors (1)
Various social factors can make an individual vulnerable to mental health concerns and mental illness.
Examples of social factors are:

  • Financial instability
  • Unhealthy parental behaviors like alcoholism, gambling, or extramarital affairs
  • Discrimination based on race or gender
  • Political turmoils
  • Peer pressure
  • Failure in relationship
  • Fear of abandonment

Case Studies

final 700 x 682 amy

Amy – a 10-year-old in her 5th grade – was bullied in her school due to her socioeconomic background. Her friends shunned her from group activities and called her names like savage, bum, and gritter. The bullying and teasing had driven her away from all social activities, and she soon fell into depression. These incidents gave rise to several failed suicide attempts.

 

final 700 x 682 james

James was the shortest boy in his class. While all the other boys and girls started to tower over him, he still remained 5’2” tall in 8th grade. The girls treated him as a younger brother, while the boys made fun of his short stature.  The constant comparison that he put himself through and the self-blame for not having grown taller had driven him into depression. James began to skip classes and made excuses to avoid going to school. He became lonely and shut himself out from the world.

 

final 700 x 682 sarah

Sarah – a 13-year-old 7th grader – was an outgoing and friendly girl who always tried to make new friends. At home, she was the opposite, often trying to stay away from her alcoholic father and a mother whose affairs did not seem to end. The lack of love and care at home turned into a deep craving for attention in school. She would go to extreme lengths to keep her friends interested in her. She would not express her emotions to others, in the fear of losing them, and turned to engage in self-harm to get attention.

 

final 700 x 682 ryan

Ryan was known as the “hulk” in his school. The high schooler was infamous for his extremely violent and aggressive behavior that spared neither his classmates nor the teachers. He hung out with his ‘gang,’ people who showed similar behavior and were the reason for all the mishaps in the school. The principal had decided to send Ryan to the school counselor. The counselor concluded that Ryan’s personality type was unfit for the school. Hence, he was expelled from school.

 

 Why Is Mental Health Important in Schools?

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Before we go on to highlight the importance of creating an awareness about mental health in schools, let’s first establish the meaning of ‘mental health.’

While people may believe that mental health is just the absence of a mental condition or disease, it is not true! The ability to cope and deal with stress in various adverse life situations is also an essential part of mental health.

Here are 6 reasons why it is important to make people aware of mental health in schools.

  • Correlation between mental health and success: Having good mental health development can help a child to succeed in school and in life. Research shows that children who receive socio-emotional support and mental health guidance in schools and from outside often perform better in academics.
  • Easier to monitor at school: Benefits of mental health services in schools are immense as children spend almost 6 hours a day at school. Therefore, they are more likely to seek services available there. This makes schools the ideal place to offer prevention and intervention services.
  • Guarantees student safety: Proper mental health services ensure children’s safety in schools. Mental health services include socio-emotional learning – ensuring mental wellness and resilience – and making positive connections with other students and adults. This plays an important role in making the children feel safe and empowered to report safety concerns.
  • Equips schools in handling a crisis: In the aftermath of a crisis, mental health services in schools will be essential to identify children who need help and engage in crisis intervention or trauma counseling if required.
  • Reduces risky behavior in children: Addressing mental health in schools also involves reducing risky behavior in children, which include smoking, consuming alcohol, illicit drug use, self-harm, and risky sexual behavior. Whole-school approaches like the Gatehouse project have shown significant results in reducing self-harm and other problematic behaviors in schools.
  • Helps student-athletes cope with pressure: Although physical activity can improve mental health, it has been observed that high school students engaged in sports are more vulnerable to mental health concerns and mental illness, possibly because they are always under pressure to perform. The stress from high expectations and criticism can lead to depression or anxiety, which can affect their performance.

What Are the Roles of School-Based Personnel in Providing Mental Health for Schools?

Community-Based Mental Health Providers: They provide health services such as group, community, and family counseling in addition to crisis intervention and case management such as referrals to community resources.

School Counselor:  They address academic achievement, personal/social development, and career development of students. They assist in developing school guidance curriculum, individual student planning, and responsive services such as counseling, consultation, referrals, peer support, information and support systems.

School Nurse: They provide health services, health education, healthy environment, nutritional services, physical education/activity, counseling, parent/community involvement, and staff wellness.

School Psychologist: They consult with teachers, parents, and administrators to find effective solutions to learning and behavioral problems. They also evaluate students for special educational interventions. They provide counseling, crisis intervention for children at risk and engage in research and planning to improve mental health in schools.

School Social Worker: They assess home, school, personal, and community factors that may affect a student’s ability to learn. They provide counseling, case management, and crisis intervention. They also consult with teachers, administrators, and other school staff regarding social/emotional needs of students and coordinate with family, school and community resources on behalf of students.

How Can Schools Detect Mental Health Issues in Children?

Now that we have established the need for mental health in schools, there is a bigger question that’s still unanswered.

How to identify the signs of mental illness in children?

The table given below summarizes the signs to look for across age-groups.

PRIMARY SCHOOL STUDENTS MIDDLE SCHOOL STUDENTS HIGH SCHOOL STUDENTS
Behavior problems in preschool or daycare Excessive fear and worries Destructive behavior and damaging property
Hyperactivity in comparison to other students Extreme hyperactivity Withdrawal from family and friends
Trouble with sleeping/Persistent nightmares Sudden decrease in school performance Writing or constant mention of harming oneself
Excessive fear, worry, or crying Loss of interest in friends and recreational activities Use or abuse of substances
Extreme disobedience or aggression Loss of appetite Engaging in risky behavior such as speeding in car/bike, unprotected sexual interactions, or vandalism
Excessive temper tantrums Sudden increase in weight or showing extreme concern about weight gain Signs of Depression: Student is often agitated and hostile. S/he has unexplained headaches or stomach aches, extreme sensitivity to criticism and difficulty in concentration. S/he shows fatigue and lack of energy, lack of interest and pleasure in daily activities, significant weight loss or gain, insomnia or excessive sleeping, feelings of worthlessness, or excessive guilt, and recurrent thoughts of death or suicide.
Frequent stomach aches or headaches with no physical explanation Visible prolonged sadness Signs of suicidal ideation: Student displays lack of personal care, tardiness, defiant behavior, or giving away prized positions. S/he has a previous history of suicide attempt, alcohol/drugs use or experimentation, frequent mention of taking one’s own life or has encountered recent stressful life events
Signs of depression: sadness, carelessness,over-apologetic self-blaming, feeling unimportant and lonely Substance use or abuse
Signs of Suicidal Intention: reckless behavior, disobedience, extreme guilt, expression of hopelessness Signs of Depression: sadness, carelessness, being over-apologetic, blaming oneself for everything, feeling unimportant and lonely
Signs of suicidal ideations: reckless behavior, disobedience, extreme guilt, expression of hopelessness

Warning Signs Applicable for All Age Groups

Certain common signs can help identify mental health concerns or mental illness among children of all age groups.

  1. Constant feeling of anxiousness
  2. Frequent tantrums or intensely irritable
  3. Loss of interest in hobbies or previously-enjoyed activities; withdrawal from friends and family
  4. The person is usually lethargic
  5. Engaging in risky and destructive behavior
  6. Harming self or others

Signs that tell us that a person is being bullied:

  • Making excuses to skip school
  • Skipping meals or binge eating
  • Frequent nightmares
  • Feeling helpless or having a decreased self-esteem
  • Self-destructive behaviors
  • Sudden loss of friends or avoidance of social situations
  • Declining grades and loss of interest in school work

Signs that tell us that a person is bullying others:

  • Being friends with bullies
  • Increasingly aggressive
  • Constant blaming others for their problems
  • Not taking responsibility for their actions
  • Competitive and worried about their reputation and popularity

Signs that tell us that a person is suicidal:

  • Talking about wanting to die or to kill oneself
  • Looking for a way to kill oneself
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or being in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Feeling anxious, agitated, or reckless
  • Sleeping too little or too much
  • Withdrawing or feeling isolated
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

Signs that tell us that a person is suffering from anxiety disorder:

  • Feelings of apprehension or dread
  • Watching for signs of danger
  • Anticipating the worst
  • Trouble in concentrating
  • Feeling tense and jumpy
  • Irritability and feeling like your mind’s gone blank

Considering the wide variety of behavioral issues that need to be tracked across thousands of students, schools that don’t have a system in place to manage mental health issues among their students will really fall short in addressing their challenges.

 Framework to Manage Mental Health in Schools

The National Center on Safe Supportive Learning Environments suggests that a mental health program should provide services in schools at three levels:

  1. Universal: Promoting mental health among all students
  2. Selective Services: Targeted at a small group of students who show risk for similar mental health concerns
  3. Indicated Services: Intervention targeted at individual students who exhibit serious signs of a mental health illness

Biological Factors
The goal of universal mental health programs is to help children and youth of all ages – with or without disabilities or mental challenges – to be mentally healthy and to teach them about taking care of their mental health. Whole-school programs can also help in the early detection of mental health problems.

So, how do universal programs help in increasing mental health awareness?

Universal programs encourage these practices at schools:

  • Assessment of every student’s mental health: Schools should make sure that each and every student is evaluated and checked for signs or symptoms of a mental problem.
  • Collaboration with Parents and Teachers: Getting everyone on board is an important part of promoting mental health at schools. Feedback should be solicited from all stakeholders on what can be done to improve students’ mental health.
  • Enrollment in Prevention and Promotion Programs: Schools should enroll in prevention and promotion programs designed to improve the condition of mental health in schools.

Here are two holistic systems based on which schools can provide positive mental health:

  • School Health And Performance Evaluation system (SHAPE) helps schools in keeping the mental health assessments of the students up to date. It also helps schools find suitable screening tools and interventions for every mental health condition.
  • Positive Behavior Interventions and Support (PBIS) helps schools build systems capacity for implementing a multi-tiered approach to social, emotional, and behavioral issues. The PBIS works toward improving social, emotional, and academic outcomes for all students, including students with disabilities and students from underrepresented groups.

Different Intervention Strategies

As a first step, schools can consider implementing a universal intervention program that provides resources and tools to proactively create a positive environment and also create an awareness about the importance of mental health in schools.  Here are some examples of universal intervention programs that schools can easily implement.

  • Create a positive environment at school: Schools should observe areas in and around their campus and assess if the school environment is pleasant and friendly. After the assessment, they should make the necessary changes to keep the school comfortable and inviting for students.
  • Promote social and emotional learning: Guide students to develop critical skills for life. Help children with recognizing and managing emotions, thinking about their feelings and controlling or regulating behavior. The Search Institute’s Developmental Assets and Character Counts! Program are great resources that schools can leverage.
  • Practice mindfulness and yoga: Children experience stress as they face diverse situational challenges every day. Mindfulness, yoga, and relaxation can improve stress-coping abilities and reduce anxiety among students, thereby ensuring a better mental health in schools.
  • Establish motivation initiatives for all students: Initiatives like the ‘student of the week’and/or ‘student of the month’ and Buddy (mentoring) program can motivate students to try harder and also help students develop competence.
  • Develop School‐wide Behavior & Social Skills: PBIS is a social skill development program that aims to promote the emotional well-being of students. Project Achieve: Stop and Think Social Skills Project for Schools is another evidence-based model prevention program that provides early academic and behavioral interventions.

John P Salerno, a Research Training Coordinator at the University of Miami, reviewed several universal intervention programs and concluded that universal intervention programs have shown good results as far as awareness and prevention of mental health problems are concerned. However – apart from prevention measures – schools also need to take proactive measures to identify and help students at risk.
In such cases, selective and indicative interventions are critical.
Biological Factors (3)

  • Assess the Students’ Medical Records: Schools can use a detailed health and medical record to filter high-risk students and students with a prior history of mental illness into a focused intervention schedule.
  • Train Teachers: As students spend more time with teachers in their early age, training teachers in identifying risky and abnormal behaviors in class can be very useful in early intervention for children vulnerable to mental illness.
  • Increase Parent-Teacher Interaction: Including parents in the intervention process can be very effective. It would lead to a better evaluation of students’ mental health.
  • Use Technology to Filter At-Risk Students: Schools should consider using technology to monitor any suspicious or indicative activity online. For example, SysCloud’s cloud-based monitoring service allows schools to monitor students who are at risk of self-harm or violent behavior by monitoring online content such as emails, documents, and chats.
  • Encourage Sports and Arts: In recent studies, it has been found that engaging in sports can have a positive impact on improving mental health in schools. According to an article published by BeBrainFit.com, arts in any form such as music, drama, painting, etc., can help in relieving stress. Schools can encourage high-risk students to engage in sports and arts in order to channel their energy, creativity, and concentration into something productive, which can increase their self-esteem and, in turn, improve their mental health.
  • Individual Treatment Using Evidence‐Based Therapeutic Approaches: Identified students can be given individual care and treatment using scientifically-proven treatment methods.
  • Violence Reduction, Anger Management, & Peer Mediation:  Such intervention programs can help students cope with stressful situations in a positive manner and, in turn, reduce violence to a large extent. Winning Against Violent Environments (WAVE) is a mediation program wherein students learn and participate in conflict management techniques and become agents of change by taking skills, such as effective decision-making, communication, and problem-solving into the classroom and to the community.
  • Substance Abuse Prevention: LifeSkills provides students with the skills and knowledge necessary to help them avoid the misuse/abuse of opioids and prescription drugs. This is effective in reducing the risks of alcohol, tobacco, drug abuse, and violence while supporting the social and emotional development of the students.

Use this helpful checklist by ADAMHS to determine programs needed in your school. Click here to download the pdf.

Better Mental Health Can Help Reduce Gun Violence in Schools

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Mass shootings in schools have become frequent in the past few years. According to NBC News, there have been thirteen school shootings in the first five months of 2018.

Even though mental illness is not the sole cause of gun violence, there is a clear relationship between the two factors.
gun violence graph
According to Jessica Henderson Daniel – the President of the American Psychological Association – only a small fraction of violence is committed by those diagnosed with or suffering from mental illness.

Yet, this small percentage cannot be disregarded.

Other factors such as gun availability, criminal behavior, the social network of the perpetrator, and having been a witness to a violent incident also seem to contribute to gun violence.

We cannot disregard the traumatic long-term effects that gun violence has on the survivors of a school shooting incident. While the short-term reactions may be shock, confusion, and fear among the students, its long-term effects may be poor attendance, behavioral changes, and inability to focus on learning.

There are no clear-cut warning signs that can predict gun violence. However, schools can definitely watch out for red flags.

Here are some examples:

  • Telling someone about a hypothetical shooting plan, either to find a partner in crime or just for attention
  • Showing antisocial traits or engaging in violence
  • Exhibiting lack of remorse

Schools should put in place processes and systems that will aid them to identify such red flags and intervene proactively. The least that schools can do is to screen for weapons on a daily basis.

Installing metal detectors at every entrance of the school might discourage some students to bring weapons to school; however, such measures have been known to detrimentally impact student perceptions of safety.

How to Deal with the Aftereffects of a School Shooting?

Students who witness gun violence can become mentally traumatized. Some students may feel guilty for surviving while their friends died, while others can develop serious trust issues due to anxiety about their safety.

If there is no support system in place, students might feel emotionally and socially isolated.

Mental health professionals on campus, school administrators, counselors, psychologists, nurses, teachers, parents, and other personnel have a role to play in helping students cope with the aftermath.

According to the National Centre for Biotechnology Information (NCBI), school administrators should be trained in using Psychological First Aid for Schools (PFA) after a traumatic event. It helps to stabilize and re-establish the emotional connection between students and those around them.

The Inter-Agency Standing Committee (IASC) has defined the key components of PFA. They include:

  • Protect survivors from further physical or psychological harm
  • Identify and provide support for the most-distressed students
  • Return to school and familiar routines
  • Facilitate communication among families, students, and community agencies
  • Educate those affected about the expectable psychological responses, basic coping tools
  • Ask for people’s concerns and try to address those immediately
  • Refer to locally available support mechanisms or to trained clinicians, as appropriate

Learn, Protect, Connect (LPC) is a simple PFA strategy that schools can implement.

Listen, Protect, Connect (LPC): An Evidence-Informed Model

LPC is a five-step crisis response strategy designed to reduce the initial distress of students immediately after a traumatic incident. It uses parents, teachers, primary care and “neighbor-to-neighbor” providers to give basic psychological support to students.

The five steps are:

1.  Listen
Teachers and school counselors should provide safe spaces where students are encouraged to share their experiences and express their feelings of worry, anxiety, fear, or other concerns about their safety.

2. Protect
School staff should try to make students feel both physically and emotionally safe. They should honestly tell students what is being done to manage the situation and give them a sense of security and protection. This information should be provided in an age-appropriate manner.

3. Connect
Schools should strive to re-establish normal social relationships and connections. Teachers and parents should make students aware of the support systems available to address their emotional needs.

4. Model a Calm and Optimistic Behavior
Adults can model a calm and optimistic behavior by:

  • Maintaining a balanced level of emotions and reactions with students,
  • Engaging students in periodic safety drills to remind them of how to stay safe,
  • Expressing positive thoughts to encourage students to look at the future with hope, and
  • Thinking out loud with students to help them cope with day-to-day challenges.

5. Teach
School counselors, nurses, and social workers should help students understand the normal reactions that may follow a traumatic incident. This will help them get back to their routines easily.
Some of the signs that school staff should look for in determining if a student needs immediate help are:

  • Dead/missing family members, schoolmates or friends
  • Fear for their lives after witnessing the death of another person
  • Being injured in the attack
  • Loss of home, pet, or a relocation
  • Past traumatic experiences or losses
  • Past history of post-traumatic stress disorder (PTSD), anxiety or mood disorders, coupled with any of the above

Conclusion

Schools are grappling with multi-dimensional challenges in providing a safe and holistic learning space for children and young adults. The emotional roller coaster that children and adolescents go through – as they navigate through a competitive world – takes a toll on their mental health.

Unfortunately, incidents of self-harm, cyber-bullying, and violent behavior such as gun violence have almost become a routine affair. The aftereffects of such incidents go beyond the loss of lives and leave a permanent scar in the minds of all the survivors.

Even the First Lady has outlined her mission to promote the well-being of children. Melania Trump’s Be Best initiative is aimed at highlighting major issues faced by children today and encouraging positive social, emotional, and physical habits.

The only way that schools can fight back is to take a proactive approach to manage mental health in their schools. The solution lies in creating a system that includes infrastructure, people, process and technology to help students cope with the challenges and give them the support needed to become productive citizens.

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