Archive for August 2017

Addressing the Rising Mental Health Crisis in Public Schools

More than 50 million students are enrolled in public schools across the United States. Of those, one in five meet the criteria for a mental health condition. About 70-80% of these students won’t receive any kind of treatment or therapy. Because children and adolescents spend most of their time at school, teachers, administrators, school nurses, and other staff are often in a unique position to be the first to identify any problems or issues in a child’s life. Here are some ways for public schools to better address this rising mental health crisis.

Mental Health Screening in Public Schools

Most schools do not have any type of mental health screening in place for students. The National Association on Mental Illness supports mental health screenings for several reasons. Half or more of chronic mental health issues begin at or before age 14. Early identification and treatment can help prevent more serious problems down the road.

Just as screenings are done for a variety of physical health problems, mental health screenings in public schools could greatly benefit vulnerable students. Conducting mental health screenings in schools allows teachers to recognize the warning signs of various mental health issues, allowing for earlier identification and quicker connections to the treatment resources students might need.

The Role of Public School Nurses in Mental Health

While school nurses are usually the most likely to catch any mental health issues early on, many schools only have one on-staff nurse, and many of these nurses only work part-time. It is not uncommon for entire school districts to share one nurse, meaning that one nurse may see hundreds or even thousands of students (depending upon the size of the district). This makes it more unlikely that a school nurse would be able to spot symptoms of mental health issues, as the nurse may not be available or have enough time with each student to address their needs.

According to the American Association of Pediatrics, schools function as the mental health system for approximately 80% of students. For this reason, school nurses play a critical role in identifying problems so they can be treated as soon as possible. Unfortunately, school nurses typically receive little to no training in mental health.

While nurses aren’t expected to be psychologists or therapists, they should be aware of emotional, physical, and behavioral warning signs for common mental health problems. Awareness and recognition of problems as soon as they arise could prevent a suicide.

Integrated Mental Health Strategy in Public Schools

Researchers suggest the best way to help students with mental health issues may be to have teachers, counselors, administrators, and school nurses work together to spot and handle mental health issues. Saddling this responsibility on one teacher or administrator is not likely to be effective because they typically do not have the necessary training or time. On average, school counselors see around 500 students. School nurses may see even more students, especially if they are the only nurse for an entire district. Teachers also see a significant amount of students, ranging from 20-30 in elementary schools to hundreds of students in middle schools and high schools where students change classes and teachers throughout the day.

Integrating mental health care and strategies in public schools can help all staff who encounter students. They will likely be better able to recognize mental health problems and provide early intervention as well as prevention for many issues, including thoughts of suicide, drug and alcohol use, and relationship abuse. To recognize these potential problems, some degree of training in mental health will likely be necessary.

Some signs that a student may be experiencing a mental health condition include:

  • Sudden changes in a student’s mood or behavior
  • Frequent mood swings
  • Behavioral problems such as aggression, temper tantrums, or lashing out in school
  • Poor academic performance
  • Poor hygiene
  • Frequent absences
  • No longer participating in extracurricular activities
  • Isolation from peers
  • Difficulty paying attention in class
  • Excessive worrying or anxiety
  • Hyperactivity
  • Difficulty relating to others
  • Somatic complaints (stomachaches, headaches) with no clear physiological cause

Providing Mental Health Services in Public Schools

According to the 2016 Children’s Mental Health Report, young people with access to mental health treatment and services in school are 10 times more likely to seek help for mental health and substance abuse concerns than those who do not have such programs available. Many schools are choosing to address the rising mental health crisis in the public-school system by hiring a professional psychotherapist, counselor, or psychologist on staff. Other schools have therapists come in from community mental health centers to see students who are struggling with mental health issues beyond the guidance counselor’s scope of expertise.

Congresswoman Grace Napolitano is currently working on implementing the Mental Health in Schools Act, which would provide $200 million in funding through competitive grants of $1 million each to 200 public schools across the country. This funding would help them provide on-site licensed mental health professionals in public schools. Napolitano has been executing these programs since 2001 in 14 public schools in her congressional district. This approach has proven successful and will be expanded nationwide through the funding provided by the Substance Abuse and Mental Health Services Administration.

School Refusal in children

School refusal describes the disorder of a child who refuses to go to school on a regular basis or has problems staying in school.

Children with school refusal may complain of physical symptoms shortly before it is time to leave for school or repeatedly ask to visit the school nurse. If the child is allowed to stay home, the symptoms quickly disappear, only to reappear the next morning. In some cases a child may refuse to leave the house.

Common physical symptoms include headaches, stomachaches, nausea, or diarrhea. But tantrums, inflexibility, separation anxiety, avoidance, and defiance may show up, too.

Starting school, moving, and other stressful life events may trigger the onset of school refusal. Other reasons include the child’s fear that something will happen to a parent after he is in school, fear that she won’t do well in school, or fear of another student.

Often a symptom of a deeper problem, anxiety-based school refusal affects 2 to 5 percent of school-age children. It commonly takes place between the ages of five and six and between ten and eleven, and at times of transition, such as entering middle and high school.

Children who suffer from school refusal tend to have average or above-average intelligence. But they may develop serious educational or social problems if their fears and anxiety keep them away from school and friends for any length of time.

What can parents do?

  • Expose children to the school in small degree, increasing exposing slowing over time. Eventual this will help them realize there is nothing to fear and that nothing bad will happen.
  • Talk with your child about feelings and fears, which helps reduce them.
  • Meet with the school counselor for extra support and direction.
  • Arrange an informal meeting with your child’s teacher away from the classroom.

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Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and/or hand washing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.