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Money
Time
Teachers Don't Care

"It is debateable how teacher mental health
knowledge can best be promoted. For instance,
Mental Health First Aid Teacher Training has
been advocated by Jorm et al., 2010 and, to date,
this training has good outcomes, although it relies
on teachers taking the time out of their busy
schedules to undertake additional training.
Specialist training workshops - delivered by
CAMHS have also proven to be successful;
however, such delivery relies on good CAMHS
school collaboration (Wolpert et al., 2011). The
Carter review of Teacher Education, 2015) does,
however, make the sensible recommendation that
mental health awareness should be an integral
part of teacher training as this will eventually
ensure every teacher’s understanding of this topic. "

"Also, in this time of
austerity and uncertainty, schools do not have
sufficient funds to buy in specialist mental health
services and therefore any investment in this area
may not be sustainable. Furthermore, schools do
not feel they have the skills or expertise to support
or identify children with mental health
difficulties, especially children with less visible
emotional disorders"

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"In public schools today, children with disabilities are far more likely than their classmates to be disciplined, removed from the classroom, suspended, and even expelled."

"A report by UCLA’s Civil Rights Project released earlier this year found that just over 5 percent of elementary-school children with disabilities were suspended during the 2011-12 school year, more than double the overall suspension rate. Among secondary-school students, 18 percent of kids with disabilities were suspended, versus 10 percent overall. Even more striking, a third of all K-12 children with emotional disabilities—such as anxiety or obsessive compulsive disorder—were suspended at least once, according to Daniel Losen, the lead author of the UCLA report."

"And in some cases—typically ones involving uncooperative students with severe behavioral challenges, such as those with autism, and educators who aren’t trained in proper protocol—kids are pinned down or isolated against their will, a practice known as restraint and seclusion. A 2014 Propublica investigation of federal data found that restraint and seclusion was used more than 267,000 times nationwide in the 2012 school year, and that three-quarters of the students restrained—often by being tied up or strapped to a chair with materials such as bungee cords and duct tape—had physical, emotional, or intellectual disabilities."

Effects of uneducated teachers: "Some school officials say these practices are a necessary last resort to protect other students’ and teachers’ safety. Nonetheless, they have resulted in injuries ranging from bloody noses to broken bones—and at least 20 deaths as of 2009, according to a Government Accountability Office report cited by Propublica. Yet as of last year, only about half of states had laws prohibiting schools from using restraint."

"Studies have found that just one suspension makes a kid three times more likely to be involved with juvenile justice in the following year, and more than twice as likely to drop out of school. These outcomes can come with severe and long-term implications given the connections between dropping out and incarceration, and perhaps even, according to a recent study, premature death."

Why?
"Some educators have told me they feel they have no other option when children are misbehaving, regardless of whether their acting out stems from an underlying learning or emotional disability. With strained resources, large classes, and the placement of special-needs children in mainstream classrooms, teachers feel poorly equipped to manage the kids who are especially challenging or uncooperative; some assume that any non-punitive models of school discipline will demand too much money and time. So they fall back on punishment as a reflex."

What should be done:
"The models vary district to district, but what they tend to have in common is an understanding that educators should look beyond a child’s actions to address the root causes of misbehavior, rather than labeling the student as a problem."

Does it Work?/PBIS:
"Salinas, California, high school cut suspensions by 70 percent through “positive behavioral interventions and support,” or PBIS, giving students the kind of acceptance they may have otherwise sought in gangs. In PBIS, which is one of the most studied and validated new discipline models being used in schools, educators are expected to teach kids both appropriate behavior and the consequences for inappropriate behavior, acknowledging when students follow the rules, whether with kudos from a teacher or a reward such as quarterly lunch with the principal."

More Positive Effects
"Broward County School Superintendent Robert Runcie, for example, said his Florida district (which is one of the country’s largest) saw a dramatic drop in student arrests and suspensions after implementing its new disciplinary program. The initiative, he said, focuses on giving students support, including by pairing each student with a caseworker who follows up with the kid over the course of as many as four months after a suspension. More than 90 percent of students didn’t commit a second offense, according to Runcie, who attributed the strides to the district’s move away from punitive discipline. “It’s about changing the culture; it’s about changing beliefs,”

"One Maine school I recently wrote about used a $10,000 grant to implement school-wide collaborative discipline. That’s pennies compared to what it costs annually to incarcerate a young person in the same state: $224,960, according to a Justice Policy Institute report that estimates it costs $8 billion a year to incarcerate young people nationwide."

"Meanwhile, some skeptics of non-punitive discipline argue that schools put safety at risk by eschewing harsh punishment. Yet data from a handful of existing programs suggests that these approaches can actually improve safety. After the Meridian Public School District in Mississippi implemented a new positive model, for example, suspensions and expulsions dropped by 50 percent, while 85 percent of students and teachers surveyed said they felt safer, said Vanita Gupta, a U.S. Justice Department civil-rights lawyer, at the White House event."

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Despite the passage of the Americans with Disabilities Act 25 years ago, students with disabilities are still punished at disproportionate rates.

A quarter-century ago, on July 26, 1990, Congress passed the Americans with Disabilities Act to give people with disabilities equal access to services like public education. But the rate at which special-needs students are disciplined raises questions about how equal that access truly is. In public schools today, children with disabilities are far more likely than their classmates to be disciplined, removed from the classroom, suspended, and even expelled.

A report by UCLA's Civil Rights Project released earlier this year found that just over 5 percent of elementary-school children with disabilities were suspended during the 2011-12 school year, more than double the overall suspension rate. Among secondary-school students, 18 percent of kids with disabilities were suspended, versus 10 percent overall. Even more striking, a third of all K-12 children with emotional disabilities-such as anxiety or obsessive compulsive disorder-were suspended at least once, according to Daniel Losen, the lead author of the UCLA report.

These discrepancies amount to what some researchers and advocates call "the discipline gap," and it potentially matters for tens of millions of K-12 students with conditions such as oppositional defiant disorder, attention-deficit hyperactivity disorder, autism, and depression. These are often kids who can't sit still, who challenge their teachers, or who struggle with social interactions, among other behavioral challenges-all of which can look like deliberate misbehavior or defiance and, in turn, lead to disciplinary action. The disparity widens when race is added to the mix: More than one in four black boys and one in five black girls with disabilities will be suspended in a given school year, according to Department of Education data.

In addition to suspension, disciplinary policies can include having a child sent to the principal's office, barred from recess, or verbally scolded. And in some cases-typically ones involving uncooperative students with severe behavioral challenges, such as those with autism, and educators who aren't trained in proper protocol-kids are pinned down or isolated against their will, a practice known as restraint and seclusion. A 2014 Propublica investigation of federal data found that restraint and seclusion was used more than 267,000 times nationwide in the 2012 school year, and that three-quarters of the students restrained-often by being tied up or strapped to a chair with materials such as bungee cords and duct tape-had physical, emotional, or intellectual disabilities. Some school officials say these practices are a necessary last resort to protect other students' and teachers' safety. Nonetheless, they have resulted in injuries ranging from bloody noses to broken bones-and at least 20 deaths as of 2009, according to a Government Accountability Office report cited by Propublica. Yet as of last year, only about half of states had laws prohibiting schools from using restraint.

Not only does this disciplinary imbalance appear to run counter to the law, it also seems to challenge some of America's core values: that all people are born equal and that anyone can succeed with hard work and determination. "You can't shun or banish kids with disabilities from public education," Losen said. "It's so detrimental to our society as a whole, for economic reasons as well as for our understanding of how all sorts of people can be successful. To be persisting in 2015 with policies and practices which we recognized were so undemocratic and contrary to our values as a nation in the '60s is very upsetting."

The White House spotlighted punitive discipline this week, coincidentally coinciding with the ADA's anniversary, in a gathering of educators, policymakers, and nonprofit leaders. They discussed how each suspension increases a child's odds of becoming delinquent, abusing substances, connecting with gangs, dropping out, and falling into the "school-to-prison pipeline." Studies have found that just one suspension makes a kid three times more likely to be involved with juvenile justice in the following year, and more than twice as likely to drop out of school. These outcomes can come with severe and long-term implications given the connections between dropping out and incarceration, and perhaps even, according to a recent study, premature death. The dire situation has prompted an Obama-administration initiative to improve "school climate" and efforts in some large, urban school districts, such as Los Angeles, to ban suspensions for non-violent offenses.

Why are more than 3 million children suspended nationwide annually, despite scant scientific evidence that removing children from the classroom improves their behavior or learning? Some educators have told me they feel they have no other option when children are misbehaving, regardless of whether their acting out stems from an underlying learning or emotional disability. With strained resources, large classes, and the placement of special-needs children in mainstream classrooms, teachers feel poorly equipped to manage the kids who are especially challenging or uncooperative; some assume that any non-punitive models of school discipline will demand too much money and time. So they fall back on punishment as a reflex.

Cinthia Randolph, an office manager in Redding, California, was shocked when her son's fifth-grade teacher regularly disciplined him by making him stand outdoors, unsupervised, even in the coldest winter days-simply because, according to Randolph, he would get out of his seat or talk when he wasn't supposed to. "By November or December I figured out he was spending an average of an hour a day outside the classroom," Randolph said in a phone interview. "He missed a lot in math."

But education reformers are promoting new discipline methods that they say nudge even the most-challenging students onto the right path without a school official having to yell, use threats, or resort to suspension. The models vary district to district, but what they tend to have in common is an understanding that educators should look beyond a child's actions to address the root causes of misbehavior, rather than labeling the student as a problem. Whether or not a child has a diagnosed disability, the issue may be a learning struggle that makes the student embarrassed or resistant to beginning an assignment. Or it could be an undiagnosed emotional or neurological condition. Discipline can be especially challenging when it comes to preschoolers, who are just becoming accustomed to a school environment and are more likely to have undiagnosed disabilities. The Justice Department in March released the first-ever report on the thousands of children suspended from preschool each year, some of them multiple times.

At the White House event, which featured new discipline guidelines and other resources for educators, a teacher Juan Govea said his Salinas, California, high school cut suspensions by 70 percent through "positive behavioral interventions and support," or PBIS, giving students the kind of acceptance they may have otherwise sought in gangs. In PBIS, which is one of the most studied and validated new discipline models being used in schools, educators are expected to teach kids both appropriate behavior and the consequences for inappropriate behavior, acknowledging when students follow the rules, whether with kudos from a teacher or a reward such as quarterly lunch with the principal.

Broward County School Superintendent Robert Runcie, for example, said his Florida district (which is one of the country's largest) saw a dramatic drop in student arrests and suspensions after implementing its new disciplinary program. The initiative, he said, focuses on giving students support, including by pairing each student with a caseworker who follows up with the kid over the course of as many as four months after a suspension. More than 90 percent of students didn't commit a second offense, according to Runcie, who attributed the strides to the district's move away from punitive discipline. "It's about changing the culture; it's about changing beliefs," Runcie said.

Indeed, "beliefs"-or flawed assumptions about the realities of school discipline-may be the biggest obstacle to disrupting the status quo. Some critics, for instance, have dismissed these more progressive models as impractical and too expensive. But it could be a worthy investment. One Maine school I recently wrote about used a $10,000 grant to implement school-wide collaborative discipline. That's pennies compared to what it costs annually to incarcerate a young person in the same state: $224,960, according to a Justice Policy Institute report that estimates it costs $8 billion a year to incarcerate young people nationwide.

Meanwhile, some skeptics of non-punitive discipline argue that schools put safety at risk by eschewing harsh punishment. Yet data from a handful of existing programs suggests that these approaches can actually improve safety. After the Meridian Public School District in Mississippi implemented a new positive model, for example, suspensions and expulsions dropped by 50 percent, while 85 percent of students and teachers surveyed said they felt safer, said Vanita Gupta, a U.S. Justice Department civil-rights lawyer, at the White House event.

Schools that fall short of their legal obligation to provide equal access to students could face lawsuits. The Obama administration last January released guidelines detailing how school districts should address educational disparities based on race, which serve as both a resource for schools looking to improve their practices and a basis for legal action on all issues involving unequal educational opportunity. Some school districts are already taking action. In Syracuse, for instance, a New York state attorney general investigation of unequal suspensions forced the city's school system to change its discipline practices, under the oversight of an independent monitor. The education department is currently developing similar guidance on disabilities.

And according to Losen, that's sure to bolster the already-growing interest among government officials, educators, and advocates in closing the gaps. "It's both race and disability-often it's black students with disabilities," he said. "The confluence of race and disability is getting more attention."

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Katherine Reynolds Lewis is a writer based in Maryland. She is the author of The Good News About Bad Behavior: Why Kids Are Less Disciplined Than Ever-And What to Do About It. Her work has appeared in Fortune, Mother Jones, The New York Times, Slate, and The Washington Post.

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Why Do Schools Over-Discipline Children With Disabilities?

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Despite the passage of the Americans with Disabilities Act 25 years ago, students with disabilities are still punished at disproportionate rates. A quarter-century ago, on July 26, 1990, Congress passed the Americans with Disabilities Act to give people with disabilities equal access to services like public education.

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"Without proper planning and the requisite skills and resources to manage their conditions, the more than 3 million transitional-age teens in this country who have been diagnosed with a serious mental illness face daunting obstacles"

"These teens also have significantly higher rates of substance abuse than any other age groups of mentally ill individuals and are at an increased risk for contemplating or attempting suicide, according to the U.S. Public Health Service's 2000 Report of the Surgeon General's Conference on Children's Mental Health"

"A developmentally appropriate approach is one that is tailored to the cognitive and functional development level of each individual. Toward this end, a model program developed at the University of South Florida under the direction of Dr. Clark has proven effective in preparing and supporting young adults with serious mental illness in their transition into employment, education, independent living, personal adjustment, and community life functioning."

"Called the Transition to Independence Process (TIP), the model facilitates access to appropriate services for young adults with mental illness and their families, involves the young adults in the planning of their futures, and fosters the use of services that optimize each individual's strengths.

Various implementations of the TIP-based program have been developed. In Vermont, for example, the TIP-based Jump on Board for Success (JOBS) program was designed to help 16- to 20 - year-old young people with serious emotional disturbances secure employment, increase community integration, acquire appropriate living and job skills, build self-esteem, and decrease dependence on public assistance programs.

Young adults who participate in the program meet the state's ACT 264 criteria for severe emotional disturbance, and as such qualify for the program's "person-centered" intensive case management services, through which a transition facilitator identifies services across delivery systems that best meet individual client's needs and interests.

In a 2004 evaluation of the outcomes of 80 people across three Vermont communities who graduated from the JOBS program, Dr. Clark and colleagues identified changes in a positive direction across each of the indicators studied."
- This is evidence that extra programs do have some impact on high schoolers with mental disorders. These programs are specifically designed to help these students in areas like getting jobs or getting more involved in their communities. The overall goal is to ultimately decrease student's independence to other assistance programs.

"According to the findings, the rate of high school graduation or GED completion rose from 53% to 83%. Involvement in the corrections system decreased from 43% to 13%. Reliance on Social Security or welfare benefits dropped from 51% to 15%, and the percentage of youth requiring services from community mental health agencies dropped from 80% to 7% (in "Transition Issues and Strategies for Youth and Young Adults with Emotional and/or Behavioral Difficulties to Facilitate Movement Into Community Life." [Arlington, Va.: The Council for Children with Behavioral Disorders and the Division of Career Development and Transition, 2004], pp. 201-26)."

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This article is an opinions article where the author talks about her own experience with her kids and their treatment in school. She explains how her son was prevented from being in the gifted program because of his speech impediments and taking AP classes because of his autism.

Instead of punishing/suspending that student out of the misconception that he or is she is violent/will disturb the class, schools should educate teachers on how to work with students with mental health problems.

"One in five children has a debilitating mental illness, and exclusionary and punitive practices are the norm for dealing with their symptoms"

"But according to the U.S. Department of Education, our educational system punishes, suspends and expels children with mental disorders at double or more the rate of their peers."

"In disciplinary meetings, administrators wondered out loud whether a more restrictive environment would better meet his needs. With a strict warning, they simply suspended him."

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As a clinical child psychologist and associate professor of social work, I'm concerned by the national discourse around mental health, violence and schools, as pundits offer misguided and simplistic solutions to the very complex issue of student mental health:

Arm the teachers. Install metal detectors. Practice lockdown procedures.

We can all agree that safety in schools is paramount, but by focusing on the intersection of violence and mental health, we are missing the point.

Our society is failing to effectively address the tremendous need for mental health supports for our children, my son included.
Related: Willing, able and forgotten
When I was growing up, springtime at school was reinvigorating: a time of warmer weather, spring break and even renewed enthusiasm for classes. Now that I'm a mother, each new season, or day for that matter, brings worry: worry that my teenage son won't make it out of bed and out the door in the morning; worry that if he does, he will be misunderstood in the classroom, the cafeteria or, worse, the band hall.

The band hall has long been his refuge, where he retreats to get lost in the comfort of music. But last semester, after a series of absences and missed assignments, he was temporarily suspended from playing in the high school band. His suspension was no surprise; it is the latest in a string of punishments by adults who do not understand his depression. And it is just one small example of how our society punishes and criminalizes, rather than prevents and treats, mental health problems.

"Our educational system punishes, suspends and expels children with mental disorders at double or more the rate of their peers. The disparity is largest for black and brown teenage boys ... "

One in five children has a debilitating mental illness, and exclusionary and punitive practices are the norm for dealing with their symptoms. Few educators would consider reprimanding a child to "just breathe" during an asthma attack, or sending a child to detention because he or she had a seizure and disrupted the class.

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Related: A new movement to treat troubled children as 'sad, not bad'
But according to the U.S. Department of Education, our educational system punishes, suspends and expels children with mental disorders at double or more the rate of their peers. The disparity is largest for black and brown teenage boys, who are shepherded out of school into the juvenile justice system as part of the well-documented school-to-prison pipeline. I often wonder whether my son would be among them if we lived in a different zip code or if his skin were the darker shade of some of his cousins'.

A few years ago, my son pushed into his brother as they passed in the school hallway, causing my younger son to stumble backwards. The incident was reported to the administration because of my older son's documented "emotional disturbance." Under the guise of safety, the school filed a police report alleging peer-to-peer assault and initiated a child welfare investigation for neglect and physical and emotional abuse. In disciplinary meetings, administrators wondered out loud whether a more restrictive environment would better meet his needs. With a strict warning, they simply suspended him. At age 12, my son became one of approximately three million public school students suspended from school each year.

Dozens of times since then, in instances big and small, I have seen how we misunderstand, exclude and punish students with mental health problems. I think of the 5-year-old who qualified for gifted education in his local magnet school but was denied admission because of his speech difficulties; of the high school student with autism spectrum disorder who was discouraged from taking an AP class he qualified for because his behavior might become challenging; of the college student who was failing all of her classes because she was homebound with debilitating panic attacks.

And I think of the countless parents who have told me, eyes cast down, about their child's mental health struggles. They know that empathy in our society is reserved for other illnesses. Their hushed tones are meant to protect their children and their family from stigma.
Related: STUDENT VOICE: Don't blame autism for the Florida school shooting
Rhetoric following the Parkland school shooting has deepened stigmatization. By labeling a teen with depression, ADHD and autism-spectrum disorder "sicko" and calling for troubled youth to be kept out of communities through institutionalization practices that have proven both ineffective and inhumane, President Donald Trump reinforced archaic notions of mental illness as a character flaw to be punished. And our collective silence only breeds misunderstandings of our children's symptoms and needs.

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So what if, instead, we were to speak up and call for better understanding and treatment of mental health disorders within our educational system? What if, in response, the educational system were to share the responsibility of meeting the mental health needs of our children?
Related: What happens when a regular high school decides no student is a lost cause?
Educators report that they have limited time and training to deal with mental health issues. Their focus, rightly, is to ensure that students acquire the requisite knowledge and skills in core academic subjects, an enormous and complicated undertaking in itself.

But to teach, educators must be able to engage their students, including the 20 percent who are too hyperactive, impulsive, depressed, panicked or distracted to listen. According to research, these children will be more likely to get poor grades, skip classes and drop out of school, especially when they have been suspended or expelled for misbehavior. The National Center for Education Statistics reports that just over half a million students drop out of high school each year, leading to a cascade of costly and negative consequences, including lower rates of employment, lower earnings when employed, and higher rates of both welfare and incarceration.
This story was produced by Dr. Esther Calzada is a clinical child psychologist, an associate professor of social work at The University of Texas at Austin and a fellow in the OpEd Project. Her program of research, focused on family and intergenerational processes and interventions, aims to reduce racial/ethnic disparities in mental health problems and academic achievement. The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for our newsletter.
We can invest in mental health services in schools instead. Well-developed, empirically validated, school-based treatments are available for childhood mental health disorders. They reflect decades of research showing that a supportive, inclusive and skills-building approach to dealing with mental health problems is most effective. In fact, the U.S. Department of Education's Office of Special Education Programs has long invested in the development, testing and implementation of programs to address mental health needs, including the widely recognized Positive Behavioral Interventions & Supports (PBIS). Researchers have estimated the cost of PBIS to be as high as $62 per student, compared with a cost of $163,340 per dropout. What will we choose to pay for?

This semester, my son has been allowed to play with the band again, but I struggle to find a sense of hope with this fresh start. I can't help but wonder when the next suspension will come. But in the meantime, I'm ready to drop my hushed tone. We can demand that others stop punishing our children for their illnesses. We can push for access to programs designed to support our children. We can stop the criminalization of mental health problems in schools.

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OPINION: We must stop the criminalization of mental illness in schools

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As a clinical child psychologist and associate professor of social work, I'm concerned by the national discourse around mental health, violence and schools, as pundits offer misguided and simplistic solutions to the very complex issue of student mental health: Arm the teachers. Install metal detectors. Practice lockdown procedures.

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Schools need to stop punishing kids with mental illnesses/mental disorders. Rather than calling out a student and bring attention to him/her, school administrators need to learn how to properly deal with that student. They should be able to find the balance between giving too much attention or not enough. Right now the problem is that schools have misconceptions that students with mental illnesses cannot function with students without these disabilities. Even for simple mistakes, they will blame the child, which could result n the child's condition worsening.

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"Teachers are missing signs of poor mental health among pupils by treating behavioral issues with discipline and punishment, researchers have warned."

"A lack of proper mental health training means teachers “often” fail to spot psychological distress and mistake it for simple bad behavior, a new report has found"

The author says that many schools recognize these problems with their students, however they don't have the resources, knowledge, or time to help that student.

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Teachers are missing signs of poor mental health among pupils by treating behavioural issues with discipline and punishment, researchers have warned.

A lack of proper mental health training means teachers "often" fail to spot psychological distress and mistake it for simple bad behaviour, a new report has found.

Researchers at the Centre for Mental Health also said in their "state-of-the-nation" study on mental health provision in schools that an untreated, badly behaved child will cost a school £3,000 a year on average.

Extraordinary

Andy Bell, deputy chief executive at the Centre, said a failure to identify the mental health issues suffered by some pupils - and signpost them and their parents towards supportive programmes - was commonplace.

"Schools are often seeing behaviour problems as a disciplinary problem rather than a mental health problem," he told The Daily Telegraph.

"There's always a few in every classroom, but I'm talking about children who regularly and persistently are behaving badly.

"Instead of just being a behaviour problem, it very often masks a serious level of distress."

Of the one in 10 children - or one million at least - who suffer from mental health issues in the UK, only a quarter ever go on to receive professional help, according to the new report.

Many teachers wish to spot children suffering from anxiety, depression or conduct disorder, but few have the time within their main roles as educators, or the initial training, said Mr Bell.

"Schools are recognising it as a problem, but they don't have the wherewithal to deal with this," he said.

"Teacher training still doesn't include healthy child development as standard. It's extraordinary."

Crisis point

The report also found that in the absence of early intervention, students endured a full 10 years of distress before the situation reached " crisis point " and proper treatment was sought a decade later.

Lorraine Khan, associate director for children and young people at the Centre, said: "Waiting for a child's mental health to deteriorate until it hits crisis point causes untold distress and damage to their lives, and carries a heavy social and economic cost."

The report said that while a distressed child costs a school £3,000 in extra staff time, a £1,000 parenting programme over 10 weeks can tackle the issue much better than detention.

But with cuts to NHS-funded services like CAMS (Children and Adolescent Mental health Services,) treatment remained a "postcode lottery" and patchy across the nation, researchers added.

"We have to take action now to offer high quality help quickly to children and young people everywhere," said Ms Khan.

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Teachers 'are punishing children with mental health issues'

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Teachers are missing signs of poor mental health among pupils by treating behavioural issues with discipline and punishment, researchers have warned. A lack of proper mental health training means teachers "often" fail to spot psychological distress and mistake it for simple bad behaviour, a new report has found.

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Why Schools Should Screen Their Students' Mental Health

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A pair of reports argue for in-school mental health screenings

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Part One in an NPR Ed series on mental health in schools.
You might call it a silent epidemic.

Up to one in five kids living in the U.S. shows signs or symptoms of a mental health disorder in a given year.

So in a school classroom of 25 students, five of them may be struggling with the same issues many adults deal with: depression, anxiety, substance abuse.

And yet most children - nearly 80 percent - who need mental health services won't get them.

Whether treated or not, the children do go to school. And the problems they face can tie into major problems found in schools: chronic absence, low achievement, disruptive behavior and dropping out.

Experts say schools could play a role in identifying students with problems and helping them succeed. Yet it's a role many schools are not prepared for.

Educators face the simple fact that, often because of a lack of resources, there just aren't enough people to tackle the job. And the ones who are working on it are often drowning in huge caseloads. Kids in need can fall through the cracks.
"No one ever asked me"
Katie is one of those kids.

She's 18 now. Back when she was 8, she had to transfer to a different school in Prince George's County, Md., in the middle of the year.

"At recess, I didn't have friends to play with," she recalls. "I would make an excuse to stay inside with the teachers and finish extra work or do extra credit."

We're not using Katie's last name to protect her privacy. She's been diagnosed with bulimia and depression.

She says that in the span of a few months, she went from honor roll to failing. She put on weight; other kids called her "fat." She began cutting herself with a razor every day. And she missed a ton of school.

"I felt like every single day was a bad day," she says. "I felt like nobody wanted to help me."

Katie says teachers acted like she didn't care about her schoolwork. "I was so invisible to them."

Every year of high school, she says, was "horrible." She told her therapist she wanted to die and was admitted into the hospital.

During all this time, she says, not a single principal or teacher or counselor ever asked her one simple question: "What's wrong?"

If someone had asked, she says, she would have told them.
Who should have asked?
We talked to educators, advocates, teachers and parents across the country. Here's what they say a comprehensive approach to mental health and education would look like.
The family
The role: The first place to spot trouble is in the home, whether that trouble is substance abuse, slipping grades or a child who sleeps too much. Adults at home - parents, siblings, other relatives - are often the first to notice something going on.

The reality: Many families do not know what to look for. Sometimes a serious problem can be overlooked as "just a phase." But it's those sudden changes - angry outbursts, declining grades, changes in sleeping or eating - that can signal problems. When something unusual crops up, families can keep in close touch with the school.
The teacher
The role: During the week, many students see their teachers even more than their own families. Teachers are in a prime spot to notice changes in behavior. They read essays, see how students relate with other kids and notice when they aren't paying attention.

The reality: Teachers already have a ton on their plates. They're pressured to get test scores up, on top of preparing lessons and grading assignments. Plus, many teachers receive minimal training in mental health issues. But when they do see something concerning, they can raise a flag.
The social worker
The role: Social workers act like a bridge. If teachers come to them with a concern - maybe a child is acting withdrawn - one of the first things they'll do is call home. They see each child through the lens of their family, school and community. They might learn that a family is going through a divorce or homelessness.

The reality: There aren't enough of them. According to one model, every school should have one social worker for every 250 students. The reality is that in some schools, social workers are responsible for many more.
The counselor
The role: In some schools, counselors focus solely on academics: helping students pick classes and apply to college. But in others, they also act a lot like social workers, serving as a link to families and working with students who need support.

The reality: Like school social workers, there just aren't enough counselors. On average nationwide, each counselor is responsible for nearly 500 students. The American School Counselor Association recommends a caseload nearly half that size.
The special education teacher
The Role: Special education teachers may start working with students when a mental health problem affects the ability to do school work. They are primarily responsible for working on academic skills.

The reality: Again, there aren't enough of them. Nearly every state has reported a shortage of special education teachers. Half of all school districts say they have trouble recruiting highly qualified candidates.
The school psychologist
The Role: Here's one job that, on paper, is truly dedicated to student mental health. School psychologists are key players when it comes to crisis intervention and can refer students to outside help, such as a psychiatrist.

The reality: If you sense a pattern here, you're right. In the U.S., there is just one school psychologist for every 1,400 students, according to the most recent data available from the National Association of School Psychologists.
The school nurse
The role: Most any school nurse will tell you, physical and mental health are tough to separate. That puts nurses in a prime spot to catch problems early. For example: A kid who comes into the nurse's office a lot, complaining of headaches or stomach problems? That could be a sign of anxiety, a strategy to avoid a bully, or a sign of troubles at home.

The reality: The U.S. Department of Health and Human Services recommends at least one nurse for every 750 students, but the actual ratio across the country can be much higher.
The principal
The role: As the top dogs in schools, principals make the big decisions about priorities. They can bring in social-emotional, anti-bullying and suicide-prevention programs.

The reality: Principals also have a lot on their plates: the day-to-day management of student behavior, school culture and teacher support.
Getting help, and "excited for life"
Katie says things started to turn around for her when she met a nurse at the Children's National Health System in Washington, D.C., who finally showed interest in what was wrong.

Now, she's begun college and wants to be a pediatric nurse.

"I'm doing a lot better now" she says. " Obviously, I mean, I'm a lot happier. I'm excited for school. I'm excited to graduate. I'm excited for life."

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Mental Health In Schools: A Hidden Crisis Affecting Millions Of Students

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An estimated 20 percent of children show signs or symptoms of a mental health problem. It's a destructive force in schools, but most educators don't have the training or resources to help.

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The Connecticut consultation program that Yale studied follows specific guidelines as laid out by the Center for Early Childhood Mental Health Consultation. However, experts agree that whenever educators collaborate with mental-health professionals to support students with social, emotional, and behavioral challenges, whether it's a consultation program or on-the-ground mental-health professionals, the outcome results in more well-adjusted students.

Michael Rosenblum, a fourth-grade teacher at the private McLean School in Potomac, Maryland, has seen the success of this approach in action. The school is in part targeted to students who have learning differences including ADHD, dyslexia, and anxiety, which can make just getting through the school day difficult. Although the school does not use the same mental-health consultation program that Connecticut has adopted, through working closely with on-site mental-health professionals, teachers are able to help their students reach their greatest potential.

"We've had students that come to McLean in third, fourth, fifth grade that basically have been told by educators that they will not be able to graduate from high school and that they are not capable of going to a college," said Frankie Engelking, McLean's director of student and community wellness. "Those exact students come to us, are very successful academically, grow emotionally, build confidence, graduate from McLean, go on to four-year programs, and have very meaningful lives and careers."

It's through McLean's comprehensive approach to mental health, which gives children coping strategies rather than punishing them for poor behavior, that allows children to succeed. Teachers are encouraged to give equal importance to teaching skills like kindness, communication, and building strong relationships as teaching subjects like math and science. Using approaches and curricula such as Responsive Classroom and Second Step, educators are able to weave activities that promote mental wellness into daily classroom activity.

"From a teacher's point of view, being in a type of environment where administration, from Frankie and from others-just having the support to make issues of mental health, and stress, and anxiety a priority-is really important," Rosenblum said. "We're really empowered to try these different strategies, and it works wonders with these kids."

While McLean's students don't take any standardized tests, making it difficult to empirically assess the impact of the school's mental-health focus on their achievement, Rosenblum sees the McLean School's success in his students' increased confidence and excitement to participate in class. As students progress through McLean, Rosenblum said, many begin to advocate for themselves more often and learn to cope with anxieties and stressors that were once debilitating to their learning experience. And most students make progress on reading as evaluated at the beginning and end of the school year-a sign that the school's model is effective considering many students enroll at below grade level.

McLean School's approach, however, is not something that all children and their parents can afford to experience. The school does offer financial aid, but without assistance the price tag for kindergarten enrollment is upwards of $30,000 - and tuition only increases as students get older. This reinforces the need for programs like Connecticut's statewide model that provide mental-health resources for all children, not just those with the means to afford it.

This story is part of our Next America: Early Childhood project, which is supported by grants from the Annie E. Casey Foundation and the Heising-Simons Foundation.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Emily Goldberg is a former editorial fellow at The Atlantic.

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Mental Health Is Not Just an Adult Problem

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The Connecticut consultation program that Yale studied follows specific guidelines as laid out by the Center for Early Childhood Mental Health Consultation. However, experts agree that whenever educators collaborate with mental-health professionals to support students with social, emotional, and behavioral challenges, whether it's a consultation program or on-the-ground mental-health professionals, the outcome results in more well-adjusted students.