Mental Health in Schools

1. Dr. Alan Brown, Chief Department of Psychiatry (HHS and JBMH) Medical Director Child and Adolescent Psychiatric Inpatient Services (HHS) Mental Health in Schools

2. Overview 1) Mental Health – Definition 2) Mental Illness – Inseparable from physical illness 3) Prevalence Rates 4) Most Common – Anxiety, Depression, ADHD 5) Resilience 6) Treatment Resources

3. Mental Health Exists on a Continuum

4. Mental Disorder/Illness Mental Health Problem Mental Distress No Distress, Problem or Disorder The Inter-Relationship of Mental Health States

5. 1 in 5 students will experience a mental health problem…. ONE in FIVE Every School…..Every Classroom

6. Mental Health is…. The ability to think, feel and act in ways that help us cope with life’s ups and downs, make good decisions and have meaningful relationships Balancing all parts of life is important to maintaining positive mental health and well-being

7. What are Mental Health Problems? Emotional, behavioural and brain-related disturbances that interfere with development, personal relationships, and functioning Disturbances that are severe and persistent enough to cause significant symptoms, distress, and impairment in one or more areas of daily life are termed mental health disorders/mental illness

8. Mental Health Problems include a Range of Difficulties Mental Health problems are characterized by many different signs and symptoms and present in various forms Some mental health problems manifest outwardly (externalizing) Students appear aggressive, impulsive, non-compliant Some mental health problems manifest inwardly (internalizing) Students appear withdrawn, lonely, anxious, depressed

9. Mental Illness is…. A medical condition that impacts functioning over a period of time Not result of a personal failure or weakness, but is caused by a social, psychological, genetic, physical, chemical or biological disturbance (often in combination)

10. What’s the Difference? Physiological differences in people who struggle with a mental health disorder Brain differences Driven by genetic, epigenetic effect (hereditability components to these disorders) Underlying genetic structure can be changed by environmental impacts suppressing or expressing genes Similar to other disorders i.e. diabetes

11. Mental Health Disorders are Physical Disorders Research (genetic, imaging, immunological) all show that mental health disorders are inflammatory disorders (redness, swelling, increased fluid secretion and diminished function in the brain) Not a choice or character flaw

12. The Good News Proven strategies and supports Psychosocial (talk therapy) and pharmacological (medications) treatments are most common, and are often used together While many mental disorders are chronic, we can help with coping Early identification and intervention improves prognosis

13. But Most Do Not Receive the Help They Need Up to 80% of children and youth who experience a mental health problem will not receive treatment Major barriers include: Lack of, difficulty accessing, or long waitlists for local services Stigma Misidentification or lack of identification of symptoms

14. Facts and Figures Causes – multiply determined (biological, life experiences, individual factors, early trauma) Onset – In 70% of cases, the onset of problems begins before age 18; with 50% of cases starting before age 14 Co morbidity – If have one disorder, other problems are also likely (75% have more than one mental health problem) Impact – disturbances to academic and social well-being, isolation, despair, anger; heightened risk of suicide Stage 1 versus stage 4 treatment: minimizing secondary impacts (reduce academic impact, social impact, identify formation in adolescence, sense of self)

15. Safe and Inclusive SchoolsHDSB Mental Health and Addiction Strategy Launched September 2013 Developed based on Resource Mapping and Needs Assessment Data Mental Health is the presence of physical, emotional, intellectual and social well-being. Our Mission: The Halton District School Board is committed to the mental health and well-being of every student. The Halton District School Board will inspire and support learning; create safe, health inclusive and engaging environments, provide opportunities for challenge and choice; and prepare students for success.

16. When Should I Be Concerned? Notice changes in behaviour See behaviour that are not age-appropriate Behaviours continue over a period of time Then: seek assistance from school supports (Teacher, Administration, SERT, PSSP)

17. Signs… Emotional/Behavioural Signs Academic Signs Communication/Social Skills Signs

18. Prevalence of Mental Disorders in Young People: Who is in your Classroom? Population Prevalence • Depression (4-6%) • Psychosis (0.5 – 1.0%) • Anxiety Disorders (6-10%) • ADHD (2-4%) • Anorexia Nervosa (0.1 -0.2 %) • Total (15-20%) • SUICIDE: 4-5/100,000 • ASD (1-4%) • Substance Abuse (10%) Translation to the “average” Classroom • Depression (1-2) • Psychosis (rare) • Anxiety Disorders (1-3) • ADHD (1) • Anorexia Nervosa (rare) • Total (3-5) • SUICIDE: 4-5/100,000 • ASD (1) • Substance Abuse (2-3)

19. Why Talk About It? Between 15%-25% of children/youth report at least one mental health problem or illness Suicide is the 2nd leading cause of death among Canadian adolescents Untreated youth mental health problems become adult mental health problems, 70% of adults with mental health issues reported problems started in childhood School difficulties may be a sign of emerging or unrecognized mental illness; these can impact a youth’s ability to be successful at school

20. What is an Anxiety Disorder? Feelings of excessive stress, fear, worry or nervousness over a prolonged period of time during situations where this response is not justified Interferes with daily activities and relationships Signs may include: school or task avoidance, worrying, frequent crying, isolation, easily frustrated, shyness, aggression, perfectionist behaviours

21. Types of Anxiety Disorders Generalized (over worry) Social (fear of negative judgement of others) Performance (pressure of situations) Anticipatory (too nervous before changes or transitions) Panic Attacks (provoked and unprovoked) Obsessive Compulsive Disorders

22. Normal Anxiety versus Anxiety Disorder ANXIETY BEHAVIOUR THOUGHTS PHYSICAL FEELINGS Anxiety is a normal emotion, it exists to help us survive, keep safe and perform better… It is time limited!

23. What is Depression? Normal to have feelings of sadness and disappointment Not simply having “the blues” A mood disorder causing a disruption in the way a person feels and experiences emotion and impacts daily functioning Clinical depression: low mood persists for at least 2 weeks and is accompanied by changes in physical, emotional and cognitive state

24. DEPRESSION IS A FLAW IN CHEMISTRY NOT CHARACTER

25. What Anxiety/Depression can look like at School Academic: poor concentration, forgetful, declining motivation, incomplete/late work, declining grades Emotional/Behavioural withdrawn, negative self talk, harmful coping styles, struggling with peers, teacher and family relationships, avoiding tests, school refusal, Day/Night reversal, nothing makes them happy

26. Attention Deficit/Hyperactivity Disorder Attentional: Difficulty focusing Sitting quietly, off task Hyperactive/Impulsive: Poor social behaviour and can impact peer relationships Impulsivity Taking turns may be challenging Completing tasks or attending to details

27. Dual Diagnosis Two or more diagnosed disorders ASD, MID, DD: May or may not have mental illness symptoms presenting as part of ASD diagnosis e.g. ASD and OCD, anxiety (social, performance, anticipatory, panic attacks) Students with ASD may have significant psychiatric challenges that can be treated to help these students function

28. Other Bi-Polar Mood Disorders 4% Schizophrenia 1% Schizo-Affective Disorder 0.5% Psychosis 1-2% Reactive-Attachment Disorder vs. Attachment Disorders Post Traumatic Stress Disorders

29. Factors Associated with Effective Mental Health Promotion (Resilience) Programs that focus on applying physical social emotional learning skills in daily life Using interactive classroom instruction with frequent opportunities to practice Culture of respectful supportive relationship among students, school staff, and families Multi-year, multi-component approaches Whole school, community-involved approaches Support physical fitness development Greenberg et al., 2003 Stewart-Brown, 2006

30. What Do All Child/Youth Students Need? A warm welcome A smile A connection to a caring adult, every day A chance to learn A safe place to risk Someone who notices when something is wrong Someone who reaches out when they notice Someone who listens, and tries to find help for them Someone who believes in them, and instils hope

31. Caring Adults… Know their children students Notice changes Listen attentively Don’t promise to keep secrets Reframe negative thinking and find ways to build hope Use humour Nurture strength as a lever to hope Know where to get help when problems are too big to manage alone

32. Caring Classrooms Build Skills We can be proactive by teaching students social emotional learning skills so they are prepared for life’s challenges Research suggests that social emotional skill building helps students both emotionally AND academically Five core skill areas have been identified: Self Awareness Social Awareness Self-Regulation Relationships Decision-making

33. Relationships are Key Empathy Positive Regard Respect Genuineness Specificity of Response Concrete

35. New release from the Ministry of Education – An Educator’s Guide to Promoting Students’ Mental Health and Well-Being

36. Resources School teachers, counsellors, social workers, CYC’s, administration Primary physicians and paediatricians ROCK – behavioural difficulties Woodview – behavioural difficulties Nelson Youth Centre – social skills Hospital Outpatient Services, Clinical Day treatment Services (HHS, JBMH) Emergency Department CAPIS (Child/Adolescent Psychiatric Inpatient Services) ADAPT (Alcohol and Drug Assessment Prevention and Treatment Services) Halton Support Services – Autism and Developmental Delay CAS (Children’s Aid Society) Websites e.g. CAMH, moodgym.com Private therapists/psychologist Bibliotherapy