Mental health disorders in our K-12 schools affect many of our youth and directly impact classroom learning and social interactions, both of which are critical to the success of students.
Mental disorders among children is a critical public health issue because of their early onset, frequency, and impact on schools, families, and the community at large.
Much national attention has been given to children’s mental health often through high profile suicides and school shootings, which has placed a focus on “crisis response” rather than a systematic approach to helping our nations’ children with their mental health needs.
In this first of a three-part series, we will examine the nature and scope of mental health challenges facing our youth today.
Defining Mental Health
Positive mental health in childhood is characterized by the achievement of development and emotional milestones, healthy social development, and effective coping skills, such that mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities (Perou, R., et. al. 2013). On the other hand, mental health disorders are described as “serious deviations from expected cognitive, social and emotional development and are described in detail by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition or the International Classification of Diseases (ICD).
The incident rate of mental health concerns in American youth within a given year is estimated to be between 13-20 percent of children living in the United States (National Research Council, 2009). This equates to about 10 million students who need professional help in the K-12 public schools nationwide (National Center for Education Statistics, 2014). For a typical classroom, this would equate to roughly 5 children as having a diagnosable mental health disorder. Stated another way, a typical school of 500 students could have up to 100 students with mental health needs.
Mood disorders such as depression, anxiety, and bipolar disorder are the most common mental health diagnoses among children and adolescents (Pfuntner A, Wier LM, Stocks C., 2013), although the most prevalent parent-reported disorder is attention-deficit hyperactivity disorder (Perou, R., et. al. 2013). Of great concern is the suicide rate among our young people, which can result from the interaction of mood disorders and other factors, and is the second leading cause of death among children aged 12-17 years (CDC, 2011).
These disorders can also be associated with substance use, criminal behavior, and other risk-taking behaviors (Copeland, W.E., et. al., 2007). Often times, these children will have more than one type of disorder, with an estimated 40 percent of children who have one mental disorder possessing at least one additional disorder (Kessler, R.C., et. al., 2012). Students with behavioral disorders are 3 times more likely to be arrested before leaving school. Finally, children with mental disorders are more likely to have continued issues into adulthood with serious implications on society with decreased productivity, increased substance abuse, increase chance of injury and substantial costs to society as a whole (CDC, 2011).
How Mental Health Can Impact an Education
It’s a fact that youth with emotional and behavioral disorders have the worst graduation rate of all students with disabilities. It was reported that nationally, only 40 percent of students with emotional, behavioral, and mental health disorders graduate from high school, compared to the national average of 76 percent (US Dept of Ed, 2011). Over 50 percent of students with emotional and behavioral disabilities ages 14 and older, drop out of high school, which is the highest drop-out rate of any disability group.
What are the most common mental disorders seen in our nations’ schools? In early childhood, a variety of disorders can emerge and can be identified for supports such as depression and other mood disorders, anxiety disorders, attention-deficit disorder, behavioral disorders and obsessive-compulsive disorder. Later in adolescence, while the childhood disorders may continue to manifest, we might see other disorders emerge such as eating disorders, schizophrenia, conduct disorders, personality disorders, and substance abuse/addiction.
For students, these mental health challenges can lead to difficulty following instructions, concentrating, problem-solving, staying engaged and motivated, and exhibiting self-control. Unfortunately, far too many teachers incorrectly attribute these behaviors to simple noncompliance or poor parenting. Some students suffer from such paralyzing anxiety that they are immobilized by fear, thus avoiding school completely. Others have trouble regulating emotions and maintaining friendships, which can lead to isolation.
These mental health disorders often manifest in ways that are distracting and stressful to classmates and teachers. However, most individuals with mental health problems are not violent, and extreme violence is very rare. In this regard, mental illness in our students can impact the performance, achievement, and well-being in school for all students.
Are We Ready to Tackle This Issue in Our Schools?
Unfortunately, most schools and communities currently provide an inadequate system of mental health services, as 70 percent of adolescents with mental health needs do not receive the care they need (Chandra, A., & Minkovitz, C. S. (2006). With a paucity of mental health providers, existing services often are not accessible and health insurance coverage is inadequate or nonexistent.
Poor access and stigma result in the majority of students who need mental health services not receiving proper treatment (Knopf, Park, & Mulye, 2008). While mental health in schools is widely discussed, there are divergent policies, practice, research and training paradigms which impact results. Additionally, schools are faced with a myriad commercial programs to address students’ mental health and SEL competencies, many of which lack a research evidence base (Knoff, H. 2017).
In schools, we must embrace a two-dimensional approach to promoting mental health in all children through evidence-based programs for all students as well as providing explicit interventions and wrap-around collaborative services for those children with mental illness. In this regard, schools must go beyond the belief that mental health in schools is only about treating disorders with therapy and counseling.
Recently, there has been an increased emphasis on social-emotional learning (SEL) competencies and social skills and the link to mental health status (CASEL, 2016). For many children, the intersection of mental illness and weak SEL competencies can result in serious difficulties at home and school with peer relationships (Schieve LA, Boulet SL, Kogan MD, et al., 2011).
From a broader prospective, students without diagnosable disorders but exhibit generalized psycho-social issues are even more prevalent and are at risk for functional issues as an adult. With such staggering numbers and an apparent increase of children dealing with mental disorders, it’s clear that schools must be a primary source of early identification and primary supportive interventions via school mental health professionals such as School Psychologists, Counselors and Social Workers.
Steps to Addressing Mental Health in Schools
Comprehensive mental health in schools aspires to do the following as outlined by Adelman and Taylor (2011).
One often overlooked aspect of this problem for schools is the need for gathering data on students’ mental health and SEL competencies. Appropriate assessment and identification methods are key factors in helping inform mental health supports for students who need Tier 2 or Tier 3 services.
Given that many schools already engage in schoolwide screening for academic problems, the infrastructure may be in place to integrate mental health concerns (Rossen & Cowen, 2015). When schools engage in robust multi-tiered system of supports (MTSS) process and gather the types of data indicative of mental health concerns such as attendance, internalizing/externalizing symptoms, behavior referrals, bullying, social-emotional competencies and social skills, schools are able to generate a robust “whole child” picture that can aide in early identification and appropriate avenues for intervention.
One major roadblock to these efforts is that most schools and districts do not have a powerful and flexible data system with which to enter and analyze these multiple measures student data. Typical data systems focus on high-level dashboards and other highly aggregated data and are unable to focus on each students’ individual data patterns that elucidate specific needs particularly with these non-academic data.
In our next installment, we will examine in detail the etiology and nature of the most common types of mental illness seen in our schools. In our last post, we will describe what steps we can take to address mental illness as a broader community.
National Research Council and Institute of Medicine. Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press; 2009.
CDC. Web-Based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA; 2011. Available at http://www.cdc.gov/injury/wisqars/index.html.
Pfuntner A, Wier LM, Stocks C. Most frequent conditions in U.S. hospitals, 2010 Rockville, MD: Agency for Healthcare Research and Quality; 2013. January Contract No.: HCUP Statistical Brief #148.
Health Care Cost Institute. Children’s health care spending report: 2007–2010. Washington, DC: Health Care Cost Institute; 2012.
Schieve LA, Boulet SL, Kogan MD, et al. Parenting aggravation and autism spectrum disorders: 2007 National Survey of Children’s Health. Disabil Health J 2011;4:143–52.
Copeland WE, Miller-Johnson S, Keeler G, Angold A, Costello EJ. Childhood psychiatric disorders and young adult crime: a prospective, population-based study. Am J Psychiatry 2007;164:1668–75.
Kessler RC, Avenevoli S, McLaughlin KA, et al. Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychol Med 2012;42:1997–2010.
U.S. Department of Education, Twenty-third annual report to Congress on the implementation of the Individuals with Disabilities Education Act, Washington, D.C., 2001.
Project Achieve. Knoff, H., 2017. www.projectachieve.org
Mental Health in Scools: Engaging Learner, Preventing Problems, and Improving Schools. Adelman, H., Taylor, L. (2011). Corwin Press. New York.
National Center for Education Statistics. (2014). Fast facts. Washington, DC: Author. http://nces.ed.gov/fastfacts/display.asp?id=372
Rossen, E., Cowen, K. Improving Mental Health in Schools. 2015. Phi Delta Kappan Volume 43, Issue 4: Learning & Mental Health.
Knopf, D., Park, M.J., & Mulye, T.P. (2008). The mental health of adolescents: A national profile, 2008. San Francisco, CA: University of California, San Francisco, National Adolescent Health Information Center
Chandra, A., & Minkovitz, C. S. (2006). Stigma starts early: Gender differences in teen willingness to use mental health services. Journal of Adolescent Health 38, 754e.1-754e8.
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