# data[].attributes.body
-Limited capacity to address mental health issues.With increased accountability for academic results under the Elementary and Secondary School Act
(ESEA) and subsequent regulations, school counselors-who represent
the majority of student support professionals in schools-have seen
their responsibilities shift away from the overall personal, social,
emotional, academic, and career development of each student toward an
academic achievement-only focus, creating a rapidly widening gap in support services
-Disinvestment in school-based mental health programs.
-Stigma surrounding mental health issues. This stigma is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, and/or avoidance. Addressing psychosocial and mental health concerns in schools is typically not assigned a high priority, except when a high-visibility event occurs, such as a shooting on
campus, a student suicide, or an increase in bullying.
-Death by suicide. There is a great deal of stigma around suicide, which is why schools must work with parents, children, school staff, and principals to discuss teen suicide in a careful and effective manner.

# data[].attributes.body
-The New York legislation, which was written in 2015 and enacted on Sunday, directs all K-12 classrooms to get instruction about mental health as part of the overall health curriculum. Virginia’s law, which is set to take effect this fall, is less wide-reaching, requiring mental health education for the first two years of high school.
-NASSP believes, and recent research has confirmed, that school leadership
affects student achievement (second only to instruction, particularly for
at-risk students).

# data[].attributes.body
-Federal and state governments must provide financial support to enable local communities to implement a
comprehensive culturally and linguistically appropriate school-based mental health program that supports
and fosters the health and development of students.
-Federal and state governments should encourage local communities to focus on schools as the hub for
delivery of mental and other health and social services.

# data[].attributes.body
-A U.S. Surgeon General report indicates that one in five children and adolescents will face a significant mental health condition during their school years (Students suffering from these conditions face significant barriers to learning and are less likely to graduate from high school.)
-According to the Coalition to Support Grieving Students, death by suicide is the third leading cause of death in children ages 10–14 and the second leading cause of death in children ages 15–19. Close to one in five high school students has considered suicide, and 2 percent to 6 percent of children attempt suicide. There is a great deal of stigma around suicide, which is why schools must work with
parents, children, school staff, and principals to discuss teen suicide in a careful and effective manner.

# data[].attributes.attachment_link.readable_text
New York and Virginia are the first states to enact laws that require schools to include mental health education in their curriculums.

The New York legislation, which was written in 2015 and enacted on Sunday, directs all K-12 classrooms to get instruction about mental health as part of the overall health curriculum. Virginia's law, which is set to take effect this fall, is less wide-reaching, requiring mental health education for the first two years of high school.

The New York law does not specify an additional curriculum but clarifies that mental health falls under the purview of the state's overall health curriculum.

"By ensuring that young people learn about mental health, we increase the likelihood that they will be able to more effectively recognize signs in themselves and others, including family members, and get the right help," the New York law reads, adding that the new education requirements seek to open up dialogue about mental health and combat the stigma around the topic.

Glenn Liebman, CEO of the Mental Health Association in New York State, one of the lead groups that lobbied for the law, said, "We didn't fight for specific curriculum because we recognize that what is taught in one part of the state might not be relevant in another part of the state." The association developed nine core concepts that should be incorporated into the mental health curriculum, including identifying appropriate professionals and services, and the "relationship between mental health, substance abuse and other negative coping behaviors."

The Virginia law says that the state's board of education will collaborate with mental health experts to update education standards.

"Such health instruction shall incorporate standards that recognize the multiple dimensions of health by including mental health and the relationship of physical and mental health so as to enhance student understanding, attitudes, and behavior that promote health, well-being, and human dignity," the law reads.

More than 90 percent of youth who die by suicide suffer from depression or another diagnosable and treatable mental illness, and students who have mental illnesses are less likely to succeed in school, according to the New York law.

In 2017, 11.01 percent of youth ages 12 to 17 reported experiencing at least one major depressive episode that year, according to Mental Health America. For people 10 to 24 years old, suicide is a leading cause of death, according to the Centers for Disease Control and Prevention (CDC).

The Virginia law was passed after state Sen. R. Creigh Deeds (D-Charlottesville) saw that three high school students had researched, developed and presented the proposed legislation, which struck close to home for the legislator, who had lost his son to suicide in 2013. He introduced it in the Virginia General Assembly earlier this year, and the legislation was signed by Gov. Ralph Northam in March.

Debbie Plotnick, vice president for mental health and systems advocacy at Mental Health America, said that the laws are a major step forward in addressing mental health. She said she hopes other states will follow suit.

"We think it is essential that mental health not be something that is spoken about in whispers but is something that is part of overall health, both practice and education," Plotnick said. "Major mental health conditions are almost always manifest in, if not childhood, certainly by adolescence."

Young children also experience mental health conditions, though they don't always know how to speak about it.

Regarding the Virginia law, Plotnick said, "It's never too early to have folks being educated."
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

# data[].attributes.attachment_link.title
New York, Virginia Become First States To Mandate Mental Health Education

# data[].attributes.attachment_link.description
New York and Virginia are the first states to enact laws that require schools to include mental health education in their curriculums. The New York legislation, which was written in 2015 and enacted on Sunday, directs all K-12 classrooms to get instruction about mental health as part of the overall health curriculum.

# data[].attributes.attachment_link.title
Five things schools can do to help pupils’ mental health

# data[].attributes.attachment_link.description
What schools should be doing to deal with the crisis in children’s mental health.

# data[].attributes.attachment_link.readable_text
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."

# data[].attributes.attachment_link.title
Mental Health In Schools: A Hidden Crisis Affecting Millions Of Students

# data[].attributes.attachment_link.description
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.

# data[].attributes.body
Today, teens and adolescents are facing greater pressure and stress surrounding school than seen by past generations. This pressure can greatly affect their everyday life and be detrimental to one's mental health. Considering the negligence that the topic of mental health has faced in the past, the time for change is now. An action as small as the education of mental health and mental illness within classrooms can equip students with educated  views and understanding of mental health.

# data[].attributes.attachment_link.readable_text
Behavioral health has become a public health crisis. No other public health crises are as widespread or contribute as much to the burden of illness in the U.S. as do behavioral health disorders. By 2020, mental and substance use disorders will surpass all physical diseases worldwide as major causes of disability.

Around the world we are gradually winning public health battle after public health battle. The CDC list of "Ten Great Public Health Achievements, 2001-2010" includes significant improvements globally with respect to infant mortality, vaccine-preventable diseases, access to safe water & sanitation, malaria, HIV, tuberculosis, tropical diseases, tobacco, road safety, and response to pandemics.

Meanwhile, developed nations are leading the world with respect to a new generation of public health crises relating to physical health (chronic diseases, such as heart disease and diabetes) and behavioral health (mental illness & substance abuse). As noted above, by 2020, "mental and substance use disorders will surpass all physical diseases worldwide as major causes of disability."

The perspective of the public health establishment is that the behavioral health crisis must be met with increased funding for "public behavioral health services." From their perspective, we need massive new investments in treatment centers, counselors, therapists, psychologists and psychiatrists, community interventions, etc.

The Hippocratic Oath exhorted doctors to "first do no harm." In order to scale back the accelerating public health crisis stemming from mental health and substance abuse issues, I propose that public health officials first reflect on the role of government-managed secondary education in causing our epidemic of mental illness and substance abuse.

Stated so bluntly, my thesis is controversial. But it is not controversial that lifelong substance abuse (see here, here, and here) and mental illness typically start in adolescence. As the National Institute of Mental Health notes, "Mental disorders are really the chronic diseases of the young." The appropriateness of focusing on adolescent years is not controversial.

There are those who regard behavioral health as strictly a matter of genetics. That said, the Center for Disease Control has firmly stated the role of "school connectedness" in preventing adolescent dysfunction:
School connectedness was found to be the strongest protective factor for both boys and girls to decrease substance use, school absenteeism, early sexual initiation, violence, and risk of unintentional injury (e.g., drinking and driving, not wearing seat belts). In this same study, school connectedness was second in importance, after family connectedness, as a protective factor against emotional distress, disordered eating, and suicidal ideation and attempts.

The data above is taken from a study of 36,000 teens.

Researchers are only now discovering just how deeply these connections go. For instance, a 2007 article in the Journal of Adolescent Health discovered a direct connection between early teen experiences and mental health. They surveyed a cohort of almost 3,000 teens at grade 8, grade 10, and one year after graduation:

Overall, young people's experiences of early secondary school and their relationships at school continue to predict their moods, their substance use in later years, and their likelihood of completing secondary school. Students with good school and good social connectedness are less likely to experience subsequent mental health issues and be involved in health risk behaviors, and are more likely to have good educational outcomes.

In a world in which an estimated one third of teens are on prescription medication, and almost half of those are on psychiatric drugs ( ADHD, anti-depressent, anti-psychotics, and anti-anxiety), it is important for more parents to realize that school may be a causal factor with respect to their child's depression.

Another cohort study of 2,000 teens states bluntly in its report title: " School Connectedness Is an Underemphasized Parameter in Adolescent Mental Health."It explicitly suggests that a lack of school connectedness is a causal factor in mental health issues.

School connectedness also predicted depressive symptoms 1 year later for both boys and girls, anxiety symptoms for girls, and general functioning for boys, even after controlling for prior symptoms. . . . Results suggest a stronger than previously reported association with school connectedness and adolescent depressive symptoms in particular and a predictive link from school connectedness to future mental health problems.

Pharmaceutical companies invest significant marketing dollars into persuading parents and health care practitioners that depression is a biochemical disorder to be corrected by pharmaceuticals. But what if a significant portion of adolescent dysfunction and mental illness is actively caused by a child's feeling of disconnection from the school community?

A recent dissertation on schools and depression summarizes the scale of the issue:

Depression is a debilitating condition that is increasingly recognized among youth, especially adolescents. Nearly a third of adolescents experience a depressive episode by age 19 and an increasing number of youth experience depressed mood, subsyndromal symptoms, and minor depression. The prevalence of depression is particularly high among female, racial minority and sexual minority youth. . . . major depression and subthreshold depressive symptoms often first appear during the adolescent years. Rates of depression steadily increase from ages 12 to 15. Based on retrospective studies of depressed adults and prospective studies of youth, major depression is most likely to emerge during the mid-adolescent years (ages 13-15). Prospective studies that follow the same children over time reveal a dramatic increase in the prevalence of major depressive episodes after age 11 and again after age 15, with a flattening of rates in young adulthood.

Moreover, the importance of school connectedness extends to suicide as well:

The protective associations of higher school connectedness for suicidality in adolescents after accounting for the presence of depressive symptoms suggests that enhancing school connectedness may be a useful universal strategy for preventing suicidal behaviours in adolescents.

There is growing mainstream recognition that "school connectedness" is a significant risk factor for adolescent dysfunction, including substance abuse, mental illness, and suicide. Certainly "family connectedness" is also important. But as Judith Rich Harris showed twenty years ago, for adolescents peers are much more important an influence on behavior than are parents. In prominent surveys, "School connectedness" includes

I feel close to people at this school.

I am happy to be at this school.

I feel like I am part of this school.

The teachers at this school treat students fairly.

I feel safe in my school.

Clearly relationships to peers and educators are key variables here. Guess what? Human relationships are important to adolescents.

Meanwhile, a Gallup poll finds that only 44 percent of high school students feel engaged at school. Beyond a "smoking gun," this is an obvious catastrophe. For decades pop culture has been celebrating teen loathing of school: Alice Cooper, "School's Out," Pink Floyd, "Another Brick in the Wall," or as Rolling Stone describes Mogwai's "I Love You, I'm Going to Blow Up Your School,"

And what better way to show that special someone how much you care? For seven minutes the Scottish noise-rock monks of Mogwai ride a slow fuse from somber restraint to explosive chaos, adding their own unique contribution to rock's rich canon of school-as-murderous-hellhole songs - from Hüsker Dü's "Guns At My School" to the Dead Milkman's "Violent School" to the Boomtown Rats' school-shooting lament "I Don't Like Mondays."

Sometimes I wonder what planet public health researchers live on. Haven't they noticed that school is hell?

Here we find the key problem: Academic research is generated by individuals who underwent a self-selection process. Those who found school tolerable are more likely to continue formal education. Some eventually become degreed experts with the authority to dictate to others what education should look like. Meanwhile, most who find school a living hell leave and never look back.

Although I was a straight A student who got into Harvard, to this day I regard my secondary school years as the most boring and cruel years of my life. I was completely sympathetic then and now to those who hate school - many of whom self-medicated to address the boredom and cruelty (often thereby starting on the path to substance abuse) and/or were horribly depressed.

What if the institution of school itself is only appropriate for a fraction of our population? Perhaps those 44% who are engaged according to Gallup? What if school was actively harmful for most of the rest? Not just, "bummer" harmful, but contributing to lifelong substance abuse and mental illness harmful?

In Mind, Modernity, and Madness, Liah Greenfeld argues that reforming education is the only real solution we have to addressing the mental health epidemic. While she acknowledges there are genetic and familial factors that may predispose one to mental illness, the fact that rates of mental illness increase as nations transition from traditional cultures to modern cultures, and continue to increase with prosperity, is evidence that a cultural variable is essential to explain the growing prevalence of mental illness. Because some believe that the increased prevalence of mental illness may be a reporting artifact, note the increased prevalence of teen suicide in the modern world: rates in the U.S. are up about 3x since 1950. An astute student of Durkheim, she recommends greater urgency in addressing the growing anomie in the modern world that has resulted in higher rates of suicide, substance abuse, and mental illness.

What does "school connectedness" and "identity formation" have to do with public schools "causing" mental illness? By and large, there is little evidence that private schools are much better. Indeed, while Catholic students at Catholic schools are at a lower risk of suicide than the population as a whole, non-Catholic students at Catholic schools faced a 2-4 x higher risk of suicide. Private religious schools might actually be more dangerous if there is a mismatch.

Is it possible to create better schools, or should we simply accept that a growing percentage of our population will be depressed, try to counsel alienated teens from suicide and substance abuse, and accept the associated health care costs anticipated by the public health establishment?

I've spent most of my life creating small private and charter schools where teens who were previously miserable become happy and well. I've worked with dozens of teens who had been depressed, suicidal, and medicated with various pharmaceuticals become happy and well without "medication." Let's hear from a teen who was suicidal but is no longer thanks to a change in school environment,

I walk through the hallways of the public middle school on my way to the bathroom. I stop in the center of hallway staring ahead at the overwhelming endless hallway, no one in sight. clenching my fists I look around panicky around the solid brick white wall. No sign of anyone or anything living anywhere. I scratch my fingernails hard on the plastered wall. not making a dent. I do this several times until the tips of my fingers look like the tops of roses. I then start hitting my head then slamming my body against the wall still hitting my head trying to get out . . .

A backpack of melancholy weighs down on my shoulders so I free the questions inside with my thoughts: Why did I have to be depressed?, Why couldn't I learn like everyone else?, Why did I have to be scared? . . . I figured something was wrong with me. Just an idiot with issues, too stupid to learn and too ungrateful to be happy. All I could ever do was make my parents and the people around me worry. I was angry at myself, I was angry that I couldn't learn or be happy. If all I could do was make my parents worried I was just a waste of time to them. I didn't deserve to live I wanted to hurt myself. . . .

I stayed up all night in bed fearing the next day of school. I eventually did start talking to the school counselor about my problems. At first I would come in calmly and just talk to her. Then I started coming in every single day crying and more depressed than the day before. Sometimes I just came in asking to call my mom. I never told anyone that I wanted to commit suicide. Until the day I told my mom.

I fiddle with lock and push open the steel door to the inside of my small house. Immediately I drop my school bag near the the front door. Mom is still at work. Slowly walking to the kitchen I stare at the sharp kitchen knife tucked into the knife block. Slowly still walking toward it I carefully take out the knife and feel the blade across my finger. I endeavor to conceive how much it would hurt if I were to stab it into my chest. I pose the knife back in its place. i'm too afraid too and cowardly of the pain. I think of less brutal ways but all thoughts fail. . . .

There is nothing abstract about these issues for me. Sure we could add more counselors and medication. But simply changing schools, from a one-size-fits-all public school to one at which she was allowed to learn at her own pace in her own way, in a warm, supportive peer culture, eliminated the misery.

But our system creates unreasonable obstacles to the creation of such schools. Because of my experience creating small, personalized schools, I am intimately familiar with the obstacles to creating them. For instance, my current school, The Academy of Thought and Industry, with campuses in San Francisco, New York, and Austin is working to persuade accrediting organizations that students should be allowed to take advanced academic courses whenever they want rather than follow grade-level curricula. Even in the world of private schools, mainstream accreditation agencies tend to force mainstream expectations on schools.

Because I know it is possible to create schools that integrate emotional well-being with academic performance, if it was not so challenging to create such schools the demand would be great for them. If parents could choose schools at which their children were happy and well, they would do so. Indeed, in light of the high stakes associated with school connectedness, as recognized as the CDC, I go ballistic when I read about education researchers insulting the judgment of parents who choose to leave public schools, such as this summary of a famous 2006 paper by Judy Jackson May:

"Many parents base their school choice decision on factors that have nothing to do with the quality of education" (May, 2006, p. 28). In her study, parents reflected on positive feelings, which translated into smaller class sizes, teacher familiarity, one-on-one attention, and a sense of belonging. May refers to this construct as "the perception gap" - the positive expressions parents charter schools that are consistent more with their feelings rather than with achievement results, but are ultimately defined as "academic satisfaction."

She calls parents' decision to put their children in a school with " smaller class sizes, teacher familiarity, one-on-one attention, and a sense of belonging" a "perception gap"? I perceive I don't want my child to kill herself, and you call that a "perception gap" that has "nothing to do with the quality of education"? WTF?

I used to be optimistic about the charter school movement. Indeed, I co-created a charter school in rural New Mexico that was ranked the 36th best public high school in the U.S. (and ranked the best public high school in NM by K12.Niche.com in 2016). But federal control restricts charter school autonomy too much to address our public health crisis. In order to create fundamentally new kinds of schools, educators need freedom from all existing curricular constraints, licensing constraints, and testing constraints. As long as opportunities for "innovation" in education are constrained by the same constraints faced by public schools, innovators only have small parameters within which to innovate.

In order to develop robustly healthy personal identities in a world of anomie and constant change, adolescents will need to be embedded in new subcultures which have not yet been developed. Thus rather than new technology, new pedagogies, new evaluations, and so forth, the educational project of the future is the creation of new, deliberately developed teen subcultures that will support lifelong happiness and well-being.

Thus it is not so much that public schools per se are causing mental illness. But their existence and dominance are preventing the evolution of a better system much as the existence and dominance of the Soviet Union prevented the evolution of an innovative technology sector. We need an innovative humanities sector to address the behavioral health crisis coming our way. It must be based on radical freedom to create new systems of education and new subcultures of well-being.

What will they look like? We don't know. But if you'd like to explore ten school designs that are "eye-poppingly liberating to the pedagogical imagination" (in the words of the poet Fred Turner), please do so. And improve upon them. And allow them. Let's get started now.

# data[].attributes.attachment_link.title
Are Public Schools Causing an Epidemic of Mental Illness?

# data[].attributes.attachment_link.description
Behavioral health has become a public health crisis. No other public health crises are as widespread or contribute as much to the burden of illness in the U.S. as do behavioral health disorders. By 2020, mental and substance use disorders will surpass all physical diseases worldwide as major causes of disability.