Understanding Mental Health in Schools

1. Understanding Mental Health in Schools Dr. Stan KutcherSun Life Financial Chair in Adolescent Mental HealthNovember 19, 2008

2. 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.

3. When the brain is not working properly, one or more of its 6 functions will be disrupted Behavior Thinking Perception Physical Emotion Signaling

4. When these symptoms significantly disrupt a person’s life, and meet internationally agreed upon diagnostic criteria we say that the person has a mental disorder or a mental illness.

5. The causes of mental illness areCOMPLICATED!! + + Genetics Environment Neuro – development

6. 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

7. 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

8. Adolescence: normal development and a period of risk for mental disorders • 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!

9. Child and Adolescent Health Comparative Burden of Illness for Mental Illness 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.

10. Child and Adolescent Mental Disorders WHO Health Report, 2001

12. Mental Health Care for Young People at Usual Risk* for Mental Disorder Severe and Persistent Disorder Moderate Disorder Mild Disorder/ Demoralization Prevent Disorder or Impairment or Address Distress Facilitate Development Family Community Institutions NGOs Specialist CAMHC General Health Care

13. Human Rights-Based Education & Mental Health • Part of the basic human rights framework for children and youth • 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

14. Why should we addressmental health in schools? More dropouts Difficulties in performance Difficulties in learning More truancy Behavioural difficulties School failure

15. 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

16. Address Mental Health Needs to Improve Learning and Educational Outcomes • 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

17. 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

18. School Curriculum Development and Application as Mental Health Promotion • 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

19. 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

20. 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)

21. 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.

23. Gatekeepers Educators Site Based Mental Health Responsibility Students

24. Mental Health Care Providers Gatekeepers Educators Site Based Mental Health Responsibility Students

25. Administration Mental Health Care Providers Gatekeepers Educators Site Based Mental Health Responsibility Students Curriculum

26. Administration Mental Health Care Providers Gatekeepers Educators Site Based Mental Health Responsibility Students Curriculum Parents

27. Keys to Success • Promotion • Prevention • Early identification • Early intervention • Ongoing collaborative care

28. 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

29. Sun Life Financial Chair in Adolescent Mental Health Model Chair Team Youth Advisory Group Educator Advisory Board Chair Advisory Board Projects

30. What is the Chair doing to address youth mental health in schools • Student Services Staff Training • Understanding Adolescent Depression Suicide Training Program for Educators • Data collected • CDHA School Health Staff Centre Training • Understanding Adolescent Depression Suicide Training Program for Health Professionals • Gatekeeper Model • Temporary – Millwood • Under Development with Dept. of Education

31. What is the Chair doing to address youth mental health in schools • Health Promoting Schools • Invited to integrate mental health into the health promoting school health policy • Curriculum & Teacher Training • Teacher Training program – CMHA - piloted in Canada • MSVU teacher training courses • Educator Advisory Board • Dept of Ed, Dept of Health, HPP, NSTU, Guidance counselors & principals • Youth Advisory Group

32. What is the Chair doing to address youth mental health in schools • Jr. High Chats • Public talks with schools with CHOICES • Transitions • Data from high school – university • Next project – Jr. high to high school transition • Needs assessment of school mental health needs • Directed by IWK • How do we work collaboratively with schools?

33. 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

34. Sun Life Financial Chair In Adolescent Mental Health For more information visit WWW.TEENMENTALHEALTH.ORG

35. Symptomscan include Thinking difficulties or problems focusing attention Extreme emotional highs and lows Sleep problems

36. Mental illness can occur when the brain (or part of the brain) is notworking well or is working in the wrong way.

37. 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

38. 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. 

39. Leading causes of years of life lived with a disability: Ages 15-44 WHO Health Report, 2001

40. Epidemiology of Mental Disorders WHO Health Report, 2001

41. 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

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

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

44. Schools as a Vehicle for Stigma Reduction: A Method for Addressing Social Exclusion • Stigma is… • Social Stigma • Professional Stigma • Personal Stigma

45. Canadian Medical Association Report on StigmaSurvey 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.