Understanding

Mental Health in Schools

Dr. Stan KutcherSun Life Financial Chair in Adolescent Mental Health

November 19, 2008

What is Mental Health??

Mental health refers to the maintenance of successful mental activity.

This includes maintaining productive daily activities and maintaining fulfilling relationships with others.

It also includes maintaining the abilities to adapt to change and to cope with stresses.

Thinking

When the brain is not working properly,

one or more of its 6 functions will be disrupted

Perception

Emotion Signaling

Behavior

Physical

When these symptoms significantly disrupt a person’s life, and meet internationally agreed upon

diagnostic criteriawe say that the person has a

mental disorder

or a mental illness.

The causes of mental illness are

COMPLICATED!!

Genetics Environment

+ +

Neuro –development

Some mental illnesses begin

during childhood and persist into adolescence.

These include:

• Attention Deficit Hyperactivity Disorder (ADHD)

• Autism Spectrum Disorders (ASD)• Generalized Anxiety Disorder (GAD

BUT… many illnesses begin during adolescence.

The illnesses that most often begin during adolescence include:

• Major Depression (MD)• Schizophrenia• Bipolar Disorder (BD)• Panic disorder• Social Anxiety Disorder• Eating Disorders• Obsessive Compulsive Disorder• Addictions

• Contrary to myth, most teenagers pass through the adolescent years without severe and prolonged difficulties

• About 15 percent of teens will experience significant mental health problems during adolescence

• Mental illnesses are the most prevalent medical disorders that onset in adolescence

• The Prevalence of Major Depressive Disorder increases from 1% to 8% post puberty!

Adolescence: normal development and a period of risk for mental disorders

Table: World: DALYs in 2000 attributable to selected causes by age

Adapted from: World Health Organization (2003). Caring for children and adolescents with

mental disorders. Setting WHO directions. Page 3, Figure 1. World: DALYs in 2000 attributable

to selected causes, by age and sex.

Ages 0-9 Ages 10-19

Neuro-psychiatric conditions

(including self-inflicted injuries)

12 29

Malignant Neoplasms

3 5

Cardiovascular Diseases

2 4

Child and Adolescent Health Comparative Burden of Illness for Mental Illness

Disorder 6 Month Prevalence (%) Age = 9-17

Anxiety Disorder 13.0

Mood Disorder 6.2

Disruptive Behavioral Disorders 10.3

Substance Use Disorders 2.0

Any Disorder 20.9

Child and Adolescent Mental Disorders

WHO Health Report, 2001

Mental Health Care for Young People at Usual Risk* for Mental Disorder

FamilyCommunityInstitutions

NGOs

Specialist CAMHC

General Health Care

Severe and Persistent Disorder

Moderate Disorder

Mild Disorder/Demoralization

Prevent Disorder or Impairment orAddress Distress

Facilitate Development

1. Part of the basic human rights framework for children and youth

2. Integral component of enhancing learning through the promotion of mental health, the identification of and accommodation to mental disorders in the learning environment and facilitating the development and application of a mental health friendly learning environment

Human Rights-Based Education & Mental Health

Why should we address mental health in schools?

Difficulties in learning

Difficulties

in performance

Behavioural difficulties School failure

More truancy

More dropouts

Schools can be a great location for mental health promotion, early identification and intervention,

combating stigma associated with mental illness and possibly interventions and ongoing care

• Mental disorders severely impact learning

• Schools are the ideal place to address the linkage between mental disorder and learning

• Education for all requires attention to mental health as a learning enabler

Address Mental Health Needs to Improve Learning and Educational Outcomes

Schools as a Vehicle for Stigma Reduction: A Method for Addressing Social Exclusion

• Stigma against the mentally ill recognized as one of the greatest barriers to social justice, appropriate health care and development of civic society

• Stigma pervades entire social structure

• School based anti-stigma activities may reach all social elements – parents and communities

• Bottom up – top down

• Student education + normalization of mental health problems (anti-stigma)

• Teacher training – knowledge and basic counseling skills

• Community inputs into curriculum – dialectic process - knowledge against stigma

• Proactive mental health in the learning environment

• Self and Peer identification and help seeking behaviour

School Curriculum Development and Application as Mental Health Promotion

Schools as Vehicles for Mental Health Support for Teachers

• Mental health needs of teachers may be substantial and may negatively impact student success

• Issues similar to those faced by students are also faced by teachers

• “On-site” mental health models can also provide teacher support – more effective teacher, more effective teaching, more effective learner

Schools as Vehicles for the Provision of Mental Health Care – on site or facilitated

• Role of school in delivery of basic physical health care well known – various models applied

• Integration of mental health care delivery (including case identification/followup) into existing care delivery frameworks (may require health human resource training or program modifications)

What is needed to create mental health integration in schools?? - Surprisingly little

• Policies and plan that recognize integration of mental health into educational institutions across a variety of domains – to enhance learning outcomes

• Mental health curriculum (building promotion and addressing stigma thru scientific knowledge)

• Teacher training – knowledge and understanding

• Location appropriate infrastructures and supports (gatekeepers, student services expertise, community links, etc.

Site Based Mental Health Responsibility

Gatekeepers

Educators

Students

Site Based Mental Health Responsibility

Gatekeepers

Educators

Students

Mental Health Care Providers

Site Based Mental Health Responsibility

Gatekeepers

Educators

Students

Mental Health Care Providers

Administration

Curriculum

Site Based Mental Health Responsibility

Gatekeepers

Educators

Students

Mental Health Care Providers

Administration

CurriculumParents

Keys to Success

• Promotion

• Prevention

• Early identification

• Early intervention

• Ongoing collaborative care

What does this mean?

• Work from the school out, not from outside the school in

• Collaborative cross-sectoral frameworks and action: Policy and Practice

• Build evidence driven programs based on local population characteristics and needs

• Evaluate, evaluate, evaluate - modify

Sun Life Financial Chair in Adolescent Mental Health Model

Chair Team

Youth Advisory Group

Educator Advisory

Board

Chair Advisory

Board

Projects

1. Student Services Staff Training• Understanding Adolescent Depression Suicide Training

Program for Educators• Data collected

2. CDHA School Health Staff Centre Training• Understanding Adolescent Depression Suicide Training

Program for Health Professionals

3. Gatekeeper Model• Temporary – Millwood• Under Development with Dept. of Education

What is the Chair doing to address youth mental health in schools

4. Health Promoting Schools• Invited to integrate mental health into the health promoting

school health policy

5. Curriculum & Teacher Training• Teacher Training program – CMHA - piloted in Canada• MSVU teacher training courses

6. Educator Advisory Board• Dept of Ed, Dept of Health, HPP, NSTU, Guidance counselors

& principals• Youth Advisory Group

What is the Chair doing to address youth mental health in schools

7. Jr. High Chats• Public talks with schools with CHOICES

8. Transitions• Data from high school – university• Next project – Jr. high to high school transition

9. Needs assessment of school mental health needs• Directed by IWK• How do we work collaboratively with schools?

What is the Chair doing to address youth mental health in schools

Next Steps…

• What are the barriers to integrating mental health in schools?

• How do we meet the needs of educators?• How do we develop a framework for action?

• Action • Response to educators needs• Timely cohesive and collaborative approach• Develop a framework for action and policy

Sun Life Financial ChairIn Adolescent Mental Health

For more information visit

WWW.TEENMENTALHEALTH.ORG

Symptoms can include

Sleep problemsExtreme emotional highs and lows

Thinking difficulties or problems

focusing attention

Mental illness can occur when the brain (or part of the brain) is not working well

or is working in the wrong way.

What do we know about the

causes of mental illness?

The symptoms of mental illness are a result of abnormal brain functioning.

Mental illness is a brain disorder.

Mental illness is rarely if ever caused by stress alone

What do we know about the

causes of mental illness?

It is not the consequence of poor parenting or bad behavior.

It is not the result of personal weakness or deficits in personality.

It is not the manifestation of malevolent spiritual intent.

Only in exceptional cases is it caused by nutritional factors.

It is not caused by poverty.

WHO Health Report, 2001

Disorder % Total

Unipolar Depression 16.4

Alcohol Use Disorder 5.5

Schizophrenia 4.9

Iron-Deficiency Anemia 4.9

Bipolar Disorder 4.7

Leading causes of years of life lived with a disability: Ages 15-44

Disorder 1 Year Prevalence (%) Age = 18-54

Any Anxiety Disorder 16.4

Any Mood Disorder 7.1

Any Major Depressive Disorders 5.3

Bipolar Disorder 1.1

Schizophrenia 1.3

Any Disorder 21

Epidemiology of Mental Disorders

WHO Health Report, 2001

How Extensive Should Specialty Child and Adolescent Mental Health Services Be?

• What best meets population mental health care needs – the development of needs based mental health care or the development of specialty mental health services

• Traditional models have focused too strongly on access to specialty mental health services and not enough on access to needs based mental health care

Age of Onset of Selected Psychiatric Disorders – example: Alberta, Canada

• Mental health education and stigma reduction

• Mental health promotion (from safe schools to pro-social learning), case identification

• Mental health care delivery (onsite/facilitated)

• In the school and in the community – Promotion, Prevention, Care

What is the Opportunity of Schools in Addressing C/A Mental Health Needs

Schools as a Vehicle for Stigma Reduction: A Method for Addressing Social Exclusion

• Stigma is…

– Social Stigma– Professional Stigma– Personal Stigma

Canadian Medical Association Report on Stigma Survey of 1,002 Canadian adults conducted by Ipsos-Reid

• Findings:

– One in 10 thinks that people with mental illness could "just snap out of it if they wanted"

– One in four Canadians is afraid of being around someone who suffers from serious mental illness.

– Only half of those surveyed would tell friends or co-workers that a family member was suffering from mental illness.

– Only 16 per cent said they would marry someone who suffered from mental illness, and 42 per cent said they would no longer socialize with a friend diagnosed with a mental illness. By contrast, 72 per cent would openly discuss cancer and 68 per cent would talk about diabetes in the family.

– Half of Canadians think alcoholism and drug addiction are not mental illnesses.

– One in nine people think depression is not a mental illness, and one in two think it is not a serious condition.