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In the article linked below, an example of a school where all the teachers are trained to be able to recognize mental health problems is mentioned. So it shows that even though it takes a lot of planning and hard work, it can be done. Once schools have most to all of their staffs trained in mental health problems in teens the rate of mental disorders should go down. As stated in the argument, the teachers need to contact the parent about what is going on. An alternative idea is to have several trained professionals in schools so students can talk to them, but that is not possible for schools with small budgets.

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About one in five children in the United States shows signs of a mental health disorder - anything from ADHD to eating disorders to suicide.

And yet, as we've been reporting this month, many schools aren't prepared to work with these students. Often, there's been too little training in recognizing the problems, the staff who are trained are overworked, and there just isn't enough money.

When there are enough people to handle the job, how should all the different roles fit together?

Many experts point to one model. It's got a bureaucratic name - the "multi-tiered system of supports" - but when you picture it, just imagine an upside-down pyramid, or maybe a funnel. It starts with support for everyone and moves on to more and more specialized help.
The Village
Here, everyone in the school has a part to play. The collective mission is broad: Create a school environment of general well-being, and a climate where mental health isn't stigmatized.

It takes a lot of planning - with big decisions often coming from the top. Just askAmanda Aiken.

She is now the Senior Director of Schools at New Orleans College Prep, a charter school network. But before that she was a principal at one of their schools, Lawrence D. Crocker College Prep.

In that role, she made a point to stand outside her New Orleans school every morning. When the buses drove in, she was at each door. Other staff were stationed at the front and back entrances.

Every student, from preschool to eighth grade, shook at least two hands before they even get inside the building.

Every student, every day?

Sometimes, Aiken conceded, it was a hug rather than a handshake.

"They hear a lot of good-mornings and a lot of how-are-you-doings," says Aiken. "I require that human touch."

Now her successor carries on that tradition.

But Aiken wasn't just being nice. It was strategic.

Many students at Crocker, part of a charter school network, have a higher risk for mental health problems. Most students receive free or reduced-price lunches, and Aiken estimates as many as 70 percent have experienced some form of trauma in the last two years: violence in their neighborhoods, family troubles, the daily stress of living in poverty.

"We need to make sure what we're doing is not retraumatizing," she says. "I see the principal as the leader in setting the tone and the culture of how school will support students and families."

That starts in the morning, but extends far beyond. Crocker is a "trauma-informed" school, which means all staff are trained on how to work with, and identify, students who have gone through trauma.

It also means they have a focus on structure, so students know what to expect. They also have a social-emotional curriculum, yoga after school and a focus on keeping suspension rates low through restorative justice.

"They aren't going to be prepared for college if they're suffering," Aiken says.

As principal, she tried to prevent crises, rather than addressing them as they come up.

"If you have everyone trained and take an 'it takes a village' approach, you can do a lot of preventative measures to reduce the risk significantly," says Aiken.

But, she adds, a healthy school environment isn't enough.

"Teachers are trained to teach. We have all taken a child psychology class, but we're not trained to work with kids with mental health needs," she says.

That's where other professionals come in.
The First Responders
When a student does show signs of trouble, one of the first steps is to talk with them. That conversation will dictate what happens next, but getting students to open up? It's easier said than done.

School social worker Ana Bonilla-Galdamez is a pro at that. Her office at Charles Barrett Elementary School in Alexandria, Va., is a testament to the different strategies she uses to unleash the gift of gab in even the most guarded of students.

There's a lot going on in there. First, there's her bookshelf, with titles like: Growing Good Kids, The Special Education Treatment Planner, Small Group Counseling.

And then there's everything else. She has a lot of board games: Candyland, Operation and her favorite, Uno. She also has art supplies, balls, a dollhouse and a sand box. A Superman doll sits in her chair, because even Superman has a weakness.

These are her tools. They help students open up, and they also help build the skills those kids will need throughout life, like managing emotions.

Although now at an elementary school, Bonilla-Galdamez spent most of her 20-year career at the high school level, working largely in what she describes as "crisis mode."

"We would think, 'Man, if we just had met this kid before,' " she says. A few years ago, a job opened up in the elementary school and she decided to apply.

"I thought, this is my chance to see where this starts," she says.

Early intervention for the child - and education for the parent - is key, she says. That's where the games in her office and the phone calls home come in.

"My job is to dig," she says, "For me to do that, I need to build the trust of the parent and the child."

She tells the story of the time a young mom came in, worried about her kindergarten son. He had been telling her he wanted to die. In her office, Bonilla-Galdamez let the boy choose whatever game he wanted. As he grew comfortable, she asked him about life at home.

"He had witnessed people being killed," she says. "He had witnessed a lot of violence."

What to do next all depends on what that child needs. That kindergartner might have ended up in a small group, working on coping skills or managing his emotions. But, in this case that wasn't the answer: She had also learned that the young boy had run out into traffic when he was upset.

"The threat was imminent, so I referred him to emergency services," says Bonilla-Galdamez. "Our environment isn't suited to clinical interventions."

At that point, Bonilla-Galdamez continued working with the family, but she also helped them connect to more specialized help, and the kindergartner moved on to the third level for more support.
Clinical Care
At this level, a doctor or therapist may get involved for the first time. Often, school plays a vital role in connecting the student to a clinic.

Vital, but not necessarily easy. When school psychologists Monique Leopold and Danielle Palmer refer students to a mental health clinic, they know that a lot of the time, the appointment never happens.

The two women have a handful of high-quality programs that they rely on for referrals near their schools - a network of public charter schools in the nation's capital called DC Prep. Sometimes though, families can't get an appointment for months. And when they do, with so many living in poverty, getting there is one more complication in already chaotic lives.

"It's not that [those families] don't love their kids, it's that they don't have the capacity," says Palmer.

And even when the students do get professional treatment or medication, sometimes prescriptions lapse before the child could be seen again.

"Triggers are brought from the community into school," says Leopold, "They go to school without what they need."

To try and meet those needs, DC Prep started a partnership with Children's National Health System. Now, a psychiatrist visits the schools once or twice each month.

"I told a family this morning, 'Listen, we have a doctor here,' " Leopold says, "and the mom's eyes lit up."

Lisa Cullins, one of those psychiatrists who visits, says school is a logical place for students to get clinical mental health care.

"At school, they're going to be there anyway. It's something they do everyday," she says. The partnership isn't just easy on families. It's also easier on her.

"To know our patients, we have to know their school setting," she says. "When I walk in, I have a comprehensive packet of information on how the child has been doing since the beginning of the year."

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Here's How Schools Can Support Students' Mental Health

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About one in five children in the United States shows signs of a mental health disorder - anything from ADHD to eating disorders to suicide. And yet, as we've been reporting this month, many schools aren't prepared to work with these students.

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Obviously the biggest barrier that comes with this potential solution is funding in large schools. Big public schools do not have enough money to pay for all of their teachers to get this kind of training. Also, many teachers are already overworked as is, and they do not need any more stress brought into their lives. So the two main barriers are a time constraint and budget problems.

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In public schools with thousands of kids, many of them can feel alone or friendless. This loneliness can lead to seriously low mental health, and eventually even to a mental illness. It is in these situations that a serious problem arises, a problem that schools everywhere should know how to deal with. The problem begins to be a continuous cycle for these kids who are struggling. They feel alone, then they feel even more helpless because no one around them knows what they are going through, so they can not talk to anyone, and after a period of time they have isolated themselves so much they start to feel depressed, or get anxiety, because they genuinely cannot handle normal social experiences. This is where teachers and school administrative staff come in. In an article about schools in California titled "New push for mental health training for teachers and principals",

it is stated that at a school with over 2000 children there is only one full-time nurse and one full-time mental health counselor. This shows how little prepared this school is to deal with the hundreds of children who could possibly have low mental health. The fact that they even have a mental health counselor is impressive though. At my old high school, White Station, there was no such thing. The guidance counselors were there, but they were really only used for disciplinary action. Large public schools all over the country have the same problem: not enough teachers with sufficient training in this area.

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Teachers should be trained on how to identify and respond to mental health problems they are likely to encounter among their students, a high level group of educators and mental health experts is recommending.

A 35-member Student Mental Health Policy Workgroup, convened in 2012 by State Superintendent of Public Instruction Tom Torlakson, is hoping that its recommendation will gain traction this summer when the California Commission on Teacher Credentialing takes up a slew of reforms on various aspects of teacher preparation in August. "Research indicates that teachers feel they lack the training needed for supporting children's mental health needs," the work group group said in a statement. The group cited a 2011 study in the research journal School Psychology Quarterly that found that only 34 percent of teachers surveyed felt they had the skills they needed to identify and find help for students with mental health needs.

"We feel this is a crying need in California credentialing programs," said David Kopperud, a consultant in the State Department of Education who chairs the work group. "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."

The call resonates with a request by President Barack Obama earlier this month at the administration's National Conference on Mental Heath, when he asked teachers to help identify mental health disorders in students. At the conference, 40 organizations, including the National Education Association and the American Federation of Teachers, pledged to provide some training in recognizing mental health issues to teachers, administrators, staff, students and families.
Unmet needs
According to the 2008-2010 statewide California Healthy Kids Survey, 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. In 2011, California children between the ages 5 to 19 were hospitalized for mental health issues more than 35,000 times.

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 research organization.

"We see it all - clinical depression, panic disorder, eating disorders in both sexes, hallucinating that is auditory or visual, post-traumatic stress," said Susan Kitchell, a high school nurse in the San Francisco Unified School District. "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," said Stephanie Haluck, a school psychologist in the Campbell Union High School District.

In the past year, she said she provided grief counseling to students, faculty and parents after a student committed suicide, ate lunch regularly with a student who had been hospitalized with an eating disorder, and helped a student who was re-entering school after being hospitalized for attempted suicide. But she said there were many more students who could have used mental health support.

Resources for student mental health prevention and treatment vary from tremendously from school to school. The majority are unable to provide enough services to meet demand, advocates say. "Given the budget cuts, schools now have to decide whether to hire an assistant principal, an instructional aide, a librarian or a social worker," said Pia Escudero, director of Los Angeles Unified School District's School Mental Health Crisis Counseling Services. "The choices schools have to make really push mental health services to last place, almost like a luxury."

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.

Without adequate mental health services in schools, the burden falls on teachers, said Rusty Selix, executive director of the Mental Health Association in California, who is a member of Torlakson's work group. The teachers themselves need more support, he said. "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," he said.
Start with teachers
The first step, said Kopperud, is to help teachers recognize mental health disorders when they see them. He 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."

Serena Clayton, executive director of the California School Health Centers Association, said that because the work group does not have any power to affect change on its own in teacher and principal credentialing, much will depend on how actively Torlakson promotes its agenda. Said Clayton, "Torlakson is going to have to be a vocal advocate - and bring other advocates on board."

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New push for mental health training for teachers and principals

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Teachers should be trained on how to identify and respond to mental health problems they are likely to encounter among their students, a high level group of educators and mental health experts is recommending.

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It is, of course, not a new insight that physical and mental health concerns must be addressed if schools are to function satisfactorily and students are to succeed at school. It has long been acknowledged that a variety of psychosocial and health problems affect learning and performance in profound ways. Such problems are exacerbated as youngsters internalize the debilitating effects of performing poorly at school and are punished for the misbehavior that is a common correlate of school failure. Because of all this, school policy makers, have a lengthy (albeit somewhat reluctant) history of trying to assist teachers in dealing with problems that interfere with schooling. Prominent examples are seen in the range of counseling, psychological, and social service programs schools provide.

Adding to what school education support staff do, there has been renewed emphasis over the past 20 years in the health and social services arenas on increasing linkages between schools and community service agencies to enhance the well-being of young people and their families. This "school-linked services" agenda has added impetus to advocacy for mental health in schools.

More recently, the efforts of some advocates for school-linked services has merged with forces working to enhance initiatives for community schools, youth development, and the preparation of healthy and productive citizens and workers. The merger has expanded interest in social-emotional learning and protective factors as avenues to increase students' assets and resiliency and reduce risk factors.

Thus, varied policies and initiatives have emerged relevant to efforts to enhance mental health in schools. Some directly support school programs and personnel; others connect community programs and personnel with schools. As a result, most schools have some programs to address a range of mental health and psychosocial concerns (e.g., school adjustment and attendance problems, dropouts, physical and sexual abuse, substance abuse, relationship difficulties, emotional upset, delinquency, violence.)

School-based and school-linked programs have been developed for purposes of early intervention, crisis intervention and prevention, treatment, and promotion of positive social and emotional development. And, available research suggests that for some youngsters schools are the main providers of mental health services. As Burns and her colleagues report from the study of children's utilization of MH services in western North Carolina, "the major player in the de facto system of care was the education sector - more than three-fourths of children receiving mental health services were seen in the education sector, and for many this was the sole source of care."

Advancing mental health in schools

Clearly, mental health activity is going on in schools. Equally evident, there is a great deal to be done to improve what is taking place. The current norm related to efforts to advance mental health policy is for a vast sea of advocates to compete for the same dwindling resources. This includes advocates representing different professional practitioner groups. Naturally, all such advocates want to advance their agenda. And, to do so, the temptation usually is to keep the agenda problem-focused and rather specific and narrow. Politically, this make some sense. But in the long-run, it may be counterproductive in that it fosters piecemeal, fragmented, and redundant policies and practices. Diverse school and community resources are attempting to address complex, multifaceted, and overlapping psychosocial and mental health concerns in highly fragmented and marginalized ways. This has led to redundancy, inappropriate competition, and inadequate results.

One response to this state of affairs is seen in the calls for realigning policy and practice around a cohesive framework based on well-conceived models and the best available scholarship. With specific respect to mental health in schools, it has been stressed that initiatives must connect in major ways with the mission of schools and integrate with a restructured system of education support programs and services.

From our perspective, it is time to take a close look at all the pieces. To date, there has been no comprehensive mapping and no overall analysis of the amount of resources used for efforts relevant to mental health in schools or of how they are expended. Without such a "big picture" analysis, policymakers and practitioners are deprived of information that is essential in determining equity and enhancing system effectiveness. The challenge for those focused on mental health in schools is not only to understand the basic concerns hampering the field, but to function on the cutting edge of change so that the concerns are effectively addressed.

Systemic changes must weave school owned resources and community owned resources together to develop comprehensive, multifaceted, and integrated approaches for addressing barriers to learning and enhancing healthy development. Moreover, pursuit of such changes also must address complications stemming from the scale of public education in the U.S.A. Currently, there are about 90,000 public schools in about 15,000 districts. Thus, efforts to advance mental health in schools also must adopt effective models and procedures for replication and "scale-up."

Needed: Strategic approaches & comprehensive frameworks to enhance policy & practice

Although efforts to advance mental health in schools often are hampered by competing initiatives and agendas, the diversity of initiatives has laid a foundation that can be built upon. There is a need, however, for increased emphasis on strategic approaches for enhancing policy and practice. Such strategic approaches can be fostered through efforts to unify thinking about mental health in schools, adoption of well-conceived guiding frameworks, and by support for development of focused networking. To these ends, the Center for Mental Health in Schools at UCLA (1) highlights the need for a broad perspective in thinking about and justifying "mental health" in schools, (2) promotes a working draft of comprehensive and multifaceted guidelines that provide a basis for operationally defining mental health in schools, (3) proposes an integrated framework for promoting healthy development and addressing barriers to learning at a school site in ways that can expand the impact of mental health in schools, and (4) pursues a wide variety of strategies designed to advance the field.

Ending the marginalization

Clearly, enhancing mental health in schools in comprehensive ways is not an easy task. Indeed, it is likely to remain an insurmountable task until school reformers accept the reality that such activity is essential and does not represent an agenda separate from a school's instructional mission. For this to happen, we must encourage them to view the difficulty of raising achievement test scores through the complementary lenses of addressing barriers to learning and promoting healthy development. When this is done, it is more likely that mental health in schools will be understood as essential to addressing barriers to learning and not as an agenda separate from a school's instructional mission.

Then, we must show how all policy, practice, and research related to mental health in schools, including the many categorical programs funded to deal with designated problems, can be woven into a cohesive continuum of interventions and integrated thoroughly with school reform efforts. In the process, we will need to stress the importance of school-community-home collaborations in weaving together the resources for comprehensive, multifaceted approaches.

In sum, advancing mental health in schools is about much more than expanding services and creating full service schools. It is about establishing comprehensive, multifaceted approaches that help ensure schools are caring and supportive places that maximize learning and well-being and strengthen students, families, schools, and neighborhoods.

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It is, of course, not a new insight that physical and mental health concerns must be addressed if schools are to function satisfactorily and students are to succeed at school. It has long been acknowledged that a variety of psychosocial and health problems affect learning and performance in profound ways.

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The best solution to fix the problem of unrecognized mental disorders is for teachers to have proper training so that they can be capable of recognizing when a child is suffering. If a teacher was to do something a simple as spend a few hours over a period of time to learn how to recognize signs of depression it would could seriously impact a kid's life. Once the teacher recognizes this, though, it is not their job to reach out to the student, because many of these students will believe that their teachers do not know what they are going and will not want to talk to them. It is the teacher's job, however, to inform the parent of the child that they think the kid is going through a hard time. A parent knows their own kid much better than a teacher does, and they know how to handle the situation more cautiously than a teacher. So the plan I am suggesting is simple, that teachers desperately need to get proper training so they can recognize a child in pain easily, and then they contact the parents. Hopefully in doing this, the parent will know what to do and they can help the child out, or at least get the kid help in a therapist or someone else they would be able to trust.