By Jane Meredith Adams – EdSource

Sweeping national reforms in children’s mental health care have yet to materialize in the wake of the Newtown, Conn., school shootings, but a group of high-profile educators and policy analysts in California is mapping a plan to transform student mental health services in the state.

Tens of thousands of students with emotional disorders, including clinical depression, chronic anxiety and post-traumatic stress, sit in California classrooms each year, posing a widespread challenge to teachers’ and administrators’ efforts to improve academic outcomes.

Yet resources for student mental health care vary from woefully inadequate to model programs, with the majority of schools unable to provide enough services to meet demand, advocates say. The mandate of the Student Mental Health Policy Workgroup, convened in 2012 by Superintendent of Public Instruction Tom Torlakson, is to assess the mental health needs of students and gather evidence to support its policy recommendations to the superintendent and the state Legislature.

Now, the 35-member, all-volunteer group is hoping that its first recommendation will gain traction this summer. Recognizing that student mental health care won’t improve unless school personnel understand the issue, the group is calling for including training in student mental health disorders and how they manifest at school among requirements for teacher and administrator credentialing.The group hasn’t yet presented its proposal to the California Commission on Teacher Credentialing, which is reviewing other proposed reforms in teacher preparation programs.

“We feel this is a crying need in California credentialing programs,” said David Kopperud, education programs consultant with the state Department of Education and chair of the Student Mental Health Policy Workgroup. “This is something school administrators and teachers run into frequently – depression, eating disorders, and other mental health issues – and yet they are not trained to handle situations like these.”

Kopperud cited a recent incident in which a school coach, who was frustrated that a student was emaciated, stood over her at lunchtime to make sure she ate. The student, who suffers from the eating disorder anorexia nervosa, then threw up her lunch in the bathroom. The coach had her suspended, said Kopperud.

“He had never heard of anorexia nervosa,” said Kopperud, who also serves as chair of the State School Attendance Review Board, which makes recommendations about attendance-related services. “He thought she was being defiant.”

While school shootings, including the December killing of 26 people at Sandy Hook Elementary School in Connecticut and the 1999 killing of 13 people at Columbine High School in Colorado, prompt widespread public concern about student mental illness and violence, “the vast majority of people who are violent do not suffer from mental illnesses,” states the American Psychiatric Association.

For the Student Mental Health Policy Workgroup and other groups in the state, student mental health is about violence prevention in the broadest sense. Their recommendations include efforts to improve school climate – the degree of rapport among students, staff, teachers and administrators – because teachers who are connected to students, and vice versa, are more likely to talk about bullying and other issues before they escalate, they say.

Nationally, one in five adolescents experience significant symptoms of emotional distress and nearly one in 10 are emotionally impaired, according to the National Adolescent Health Information Center at UC San Francisco. In California, 35,201 hospitalizations for mental health issues were reported in 2011 for children ages 5 to 19. One in three California students in seventh, ninth and eleventh grades reported feeling so sad and hopeless for most days over two weeks or more that they stopped doing some usual activities, according to the 2008-2010 statewide California Healthy Kids Survey, developed for the state Department of Education by WestEd, an education nonprofit. The survey asked students to self-report “depression-related” feelings, and did not report clinical diagnoses (see graphic of state data).

Yet fewer than half of all students with mental health disorders are likely to receive any sort of treatment, according to the U.S. Department of Health and Human Services.

“The children’s mental health system is as fragile as the at-risk youth it is intended to serve,” said Julia Graham Lear, a founder of the George Washington University Center for Health and Health Care in Schools.

Untreated symptoms

In the schools, the need for services is evident, said Susan Kitchell, a high school nurse in the San Francisco Unified School District.

“We see it all – clinical depression, panic disorder, eating disorders in both sexes, hallucinating that is auditory or visual, post-traumatic stress,” said Kitchell. “Our biggest issue is capacity. We have 2,100 kids in our school and one full-time nurse, one full-time mental health counselor, two half-time counselors, and interns.”

“The issues most frequently coming through my door are depression and anxiety, because the pressure to achieve is very high,” said Stephanie Haluck, a school psychologist in the Campbell Union High School District. “Students take classes before and after school, plus extracurricular activities – the marching band is very big at my school. They get really overwhelmed.”

In the 2012-13 school year, Haluck ate lunch regularly with a student who had been hospitalized with an eating disorder, helped a student who was re-entering school after being hospitalized for attempted suicide, and provided grief counseling to students, faculty and parents after a student committed suicide.

But in many schools, psychologists like Haluck aren’t available, and the burden falls on teachers, said Rusty Selix, executive director of the Mental Health Association in California and a member of the Student Mental Health Policy Workgroup. “The teachers are the victims – they don’t know exactly what the problems are, but they quit teaching because of the difficulty of working with these kids.”

He added, “There ought to be a system where teachers can tell someone, a counselor or a principal, so the kids can get care – and we know that the care should be available on campus.”

Serena Clayton, executive director of the California School Health Centers Association and a workgroup member.  noted that the group can only recommend improvements to the student mental health system, not legislate or fund them. What’s needed, she said, is strong support from Torlakson and others.

If the group is going to be successful in changing teacher and administrator credentialing to include student mental health awareness, “Torlakson is going to have to be a vocal advocate and bring other advocates on board,” said Clayton.

Kathy Rabun, a vice president of the California State PTA  who also participates in the mental health work group,  is hoping to draw attention to the work already happening in some schools and districts. “I hope student mental health becomes a complete movement,” she said.


This article was originally posted to EdSource

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