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Caden Bosch is a 15-year-old boy that is suffering from a mental illness. He lives in two different worlds, the one that is real and the other that is in his head. In the beginning of the book, Caden and his family believe Caden is suffering from the average social anxiety. He is falling behind in school and believes some people at school want to kill him. In Caden's mind, he is on a voyage to the Mariana Trench, more specifically Challenger Deep. This is the deepest place on earth. As Caden's mental illness becomes worse, he becomes closer and closer to the Mariana Trench. Soon enough, in the real world, Caden begins to show more significant signs that he may need help. He begins to go on walks barefoot for hours on end. He also sits at the grocery store yelling to unsuspecting shoppers. Caden's parents soon bring him to a hospital for him to receive treatment. This upsets him and he begins to lash out to the point where he must be sedated. Caden lives through his real life and the one he has made in his head throughout his stay at the hospital. He attends daily therapy sessions and begins to make friends while in the hospital. Sadly, his roommate attempts suicide and is sent to another facility. Caden eventually is released from the hospital and treated for his mental illness. At this time, in his head, Caden is left at a dock while the ship starts a new voyage without him. He knows that he may see this ship again in the future but continues to live in the real world until that time comes.

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The beginning of the book talks a lot about Caden and his education. He works in groups with his friends and in one part is taking a test. In his group, he has an inability to focus on the task at hand. He often talks about how he hears another person talking but is not listening. During his test taking, Caden fills in the bubbles based on a pattern that he finds appealing. Caden also has fears about people being out to kill him or are working against him. All of these behaviors describe a child with emotional disturbance. Emotional disturbance is a large umbrella of mental illnesses. These can include anxiety, schizophrenia, and phobias. In class we learned that emotional disturbance could be a result of biology, failure in school, violence within the family, or cultural influences. The book never identifies what the cause or what his emotional disturbance is. We also learned some ways to assist students that may have an emotional disturbance. One way is to maintain a positive relationship with the student. This will make them feel welcome and comforted in your classroom. We also learned that having clear rules and using positive reinforcement can be helpful. Emotional disturbance is very common in the newer generations, and I believe this class has supplied me with skills that will help me assist my students in the future.

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It seems that everyone has some sort of mental illness in this generation. Anxiety is very common within my age group. While I cannot relate to Caden on the level of falling deeper and deeper into an illness, I can relate to him about my focus in school and social situations. When it comes to test taking or starting in a new class, I start to become anxious and panic. It is hard to focus on what my teacher is saying when all I can think about is how this next 50 minutes will go. I have begun to work on breathing techniques and calming myself down when I begin to feel an anxiety attack happen. I am pretty lucky that my anxiety has not made my life unbearable. I have known a girl since middle school that suffers from severe mental illness. I used to be very close with her and I was so upset when she would inform me of the way she felt. Like Caden, she had a lot of lows but also has come out from that voyage. Caden knows he will embark on another voyage again but continues to persist in his life. I cannot help but feel some sort of connection to Caden when I have a friend that has been going through the same experience as he has.

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Centers for Disease Control and Prevention

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Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although some fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Learn about anxiety and depression in children.

Facts

Anxiety and depression affect many children

9.4% of children aged 3-17 years (approximately 5.8 million) had diagnosed anxiety in 2016-2019.

4.4% of children aged 3-17 years (approximately 2.7 million) have diagnosed depression in 2016-2019.

Anxiety and depression have increased over time

"Ever having been diagnosed with either anxiety or depression" among children aged 6-17 years increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011-2012.

"Ever having been diagnosed with anxiety" among children aged 6-17 years increased from 5.5% in 2007 to 6.4% in 2011-2012.

"Ever having been diagnosed with depression" among children aged 6-17 years did not change between 2007 (4.7%) and 2011-2012 (4.9%).

Learn more facts about children's mental health
Anxiety

When children do not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include

Being very afraid when away from parents (separation anxiety)

Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)

Being very afraid of school and other places where there are people (social anxiety)

Being very worried about the future and about bad things happening (general anxiety)

Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Depression

Occasionally being sad or feeling hopeless is a part of every child's life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.

Examples of behaviors often seen in children with depression include

Feeling sad, hopeless, or irritable a lot of the time

Not wanting to do, or enjoy doing, fun things

Showing changes in eating patterns - eating a lot more or a lot less than usual

Showing changes in sleep patterns - sleeping a lot more or a lot less than normal

Showing changes in energy - being tired and sluggish or tense and restless a lot of the time

Having a hard time paying attention

Feeling worthless, useless, or guilty

Showing self-injury and self-destructive behavior

Extreme depression can lead a child to think about suicide or plan for suicide. For youth ages 10-24 years, suicide is among the leading causes of death. Read about youth suicide prevention

Some children may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed, or to incorrectly label the child as a trouble-maker or lazy.

Treatment for Anxiety and Depression

The first step to treatment is to talk with a healthcare provider, such as your child's primary care provider or a mental health specialist, about getting an evaluation. Some of the signs and symptoms of anxiety or depression in children could be caused by other conditions, such as trauma. A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. For very young children, involving parents in treatment is key; the school can also be included in the treatment plan. Consultation with a healthcare provider can help determine if medication should be part of the treatment.

If you need help finding treatment, visit MentalHealth.gov.

Managing Symptoms: Staying Healthy

Being healthy is important for all children, and can be especially important for children with depression or anxiety. In addition to getting the right treatment, leading a healthy lifestyle can play a role in managing symptoms of depression or anxiety. Here are some healthy behaviors that may help:

Having a healthy eating plan centered on fruits, vegetables, whole grains, legumes (beans, peas, and lentils), lean protein sources, and nuts and seeds

Participating in physical activity each day based on age

Getting the recommended amount of sleep each night based on age

Practicing mindfulness or relaxation techniques

References

1. Bitsko RH, Claussen AH, Lichtstein J, Black LJ, Everett Jones S, Danielson MD, Hoenig JM, Davis Jack SP, Brody DJ, Gyawali S, Maenner MM, Warner M, Holland KM, Perou R, Crosby AE, Blumberg SJ, Avenevoli S, Kaminski JW, Ghandour RM. Surveillance of Children's Mental Health - United States, 2013 - 2019 MMWR, 2022 / 71(Suppl-2);1-42. [Read article]

2. Bitsko RH, Holbrook JR, Ghandour RM, Blumberg SJ, Visser SN, Perou R, Walkup J. Epidemiology and impact of healthcare provider-diagnosed anxiety and depression among U.S. children. Journal of Developmental and Behavioral Pediatrics. 2018;39:395-403. [Read article]

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Anxiety and depression in children: Get the facts | CDC

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Information about Children's Mental Health. Provided by the Centers for Disease Control and Prevention (CDC).

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With the prevalence of mental health issues in our society, it's astounding that we still tend to stigmatize mental illness. Many mental health misconceptions still exist.

Mental health issues often begin during the school-age years. It follows, therefore, that education about mental health should to also start at an early age. Because children spend so much of their daily life at school, mental health education logically should begin in schools.

Some facts about mental illness

Millions of people globally are affected by mental illness. In America, an estimated one in five adults experiences mental illness in a given year, according to the National Alliance on Mental Health.

The Centers for Disease Control and Prevention reports that one in five children in the U.S. currently have, or at some stage have had, a debilitating mental illness. Fifty percent of mental illness begins by the age of 14, according to the American Psychiatric Association.

Depression is on the rise

Mental illness, particularly depression, is predicted to become one of the major health burdens in the future. The World Health Organization (WHO) states that depression is the leading cause of disability worldwide. Over 300 million people of all ages suffer from depression.

As childhood and adolescent mental health disorders are so common, it's baffling that we are not equipping our children with an understanding of mental health.

Undiagnosed, inadequately treated or untreated mental illness can seriously affect their ability to learn and grow. It can lead to negative coping mechanisms and at worst, may result in suicide.

Opportunities for mental health education in schools

The breaking down of stigma and misconceptions about mental illness has to start in schools. School is where friendships begin. It is where teens hone their sense of self-worth.

It's also the place where children need to learn that their behavior towards others can cause serious self-worth issues. Many students experience conflicts, bullying and social exclusion at school.

Alex Crotty was only eleven when she started feeling miserable all the time. She felt disconnected from other children and empty. She suffered alone and even switched schools, but that did not help. It was only when she was 14 that she told her mother what was going on.

She was diagnosed with major depression and anxiety and was able to receive treatment. Her story reveals the difficulty young people experience when it comes to speaking out about their depression or anxiety.

Anxiety symptoms in children are often minimized or ignored

In the school environment, children face many challenges. Some are better at managing these than others.

Many children feel anxious, ranging from mild symptoms to more severe forms, such as panic attacks. When these symptoms are ignored, they can lead to depression, lack of performance and increased risk of substance abuse.
Related Content: The Importance of Teaching Health in High School We Need a Focus on Mental Health, Not Just Violence, In Schools
The teen suicide epidemic

The Netflix show " 13 Reasons Why " is currently in its second season. Teenager Hannah Baker is a victim of gossip, bullying, rape and body shaming. She commits suicide and leaves behind 13 tapes explaining why.

The show has many detractors, including health awareness professionals and parents who believe that it offers very little insight into the psychology of suicide. They believe it highlights just how bad things can get and how cruel teenagers can be and may even contribute to new ways for teens to think about suicide.

All of these criticisms may be fair, but the show has certainly provoked dialogue about the epidemic of teenage suicide, a very real problem. Suicide is the second leading cause of death for people aged 15 to 24 in the U.S.

The influence of social media on mental health

Current research indicates a possible connection between increased social media use and mental health although it's still unclear exactly how they are connected. What is clear is that young adults are the most active users.

Some studies show that online connections to small groups of people may be beneficial, while other research indicates a connection with anxiety, depression and eating disorders. With no long-term studies having been completed, we are still largely guessing at its influence.

The upside of social media is that teens are hardwired to socialize, and social media makes it easy and immediate. Teens in marginalized groups may find it easier to make friends and find support.

The downside of social media is that those using social media may be faced with many negatives such as toxic comparisons, cyberbullying and less face-to-face interactions. Someone's reputation can be destroyed in minutes and face the consequences for years.

The importance of early intervention

Family, friends, teachers, and individuals themselves often notice small changes in thinking and behavior before a mental illness appears in the full-blown form. Learning about early warning signs, and taking action can help.

It can reduce the severity of the illness, and it may even be possible to prevent or delay the development of a major mental illness. Some of these signs are apathy, feelings of disconnection, nervousness, unusual behavior, withdrawal, mood changes and a drop in performance.

Mental health awareness in schools

In an article written by Nancy Barile, M.A.Ed. on the importance of mental health awareness in schools, she relates how she noticed some drastic changes in one of her students over a short period of time.

The student no longer did her homework, and she would come to school in the same clothes, although she'd previously been meticulous about her appearance. She was withdrawn and distant when Barile tried to speak to her.

Barile had some training in mental health issues and recognized that the student was in trouble. Social workers on the staff were able to speak to the student and found that she was depressed, suicidal and in need of immediate psychiatric intervention.

She was admitted to the hospital for a short while, given medication and therapy and managed to graduate with her class.

Mental health education should be part of the curriculum

We need to be working towards a school environment where students are able to recognize when they're dealing with mental health issues and feel they can ask for help.

79% of British parents feel that mental health education should be a part of the curriculum in schools. Across the globe, parents understand the need for mental health education for children. With 50% of mental health conditions developing in children of age 14 or below, the support for the cause is growing rapidly.

Adding mental health education to the curriculum

Open lines of communication between home and school should exist where parents are able to share their concerns about their children and collaborate with teachers to address them.

Just as physical education is part of the curriculum in schools, mental health awareness and education should be too. Our children spend most of their day at school. We need to empower them with knowledge about mental illness.

Related content:
A Back-To-School Checklist for Children with Special Needs
Five Tips for an Effective Health Education Curriculum

Progress is being made

A growing number of schools are beginning to realize the importance of mental health education. They are working to create an environment where mental health issues are recognized and support is offered.

School-employed mental health professionals work with teachers to provide support and with parents to better understand students' needs and implement appropriate support.

In July 2018, New York became the first state in the U.S. to require mental health education for all students. The School Mental Health program will promote the healthy emotional, social, and behavioral development of all the students.

It will also take into account the general well-being of school staff and families, and collaborate with other student support and services. Mental health needs will be assessed, and access will be provided to mental health services and programs.

What do we know about the effectiveness of these programs?

As reported in US News and World Report, a few small studies have found "that teaching high school students about mental health improved their attitudes toward treatment, increased willingness to seek help from a counselor and boosted their overall mental health literacy." There is a pressing need for more studies to determine programs' effectiveness and identify ways to improve them.

Mental health education is not yet mandatory in schools. Until it is, teachers and administrators need to help shine the light on the concept of self-care. And, they need to emphasize the fact that mental health is an integral part of health.

THE BOTTOM LINE

A cultural shift in attitudes about mental health needs to start with the young. The only way they're going to understand more about mental health and stop stigmatizing is if they receive the necessary education.

Schools need to foster an environment in schools where mental health issues can be identified and addressed without being stigmatized. Awareness should be raised about mental health crises, such as self-harm, substance abuse, eating disorders and other negative coping behavior needs to be created.

If everyone in schools is empowered with knowledge, and dialogue is encouraged, students will have the freedom to open up about what they are going through. This will allow them to get the support they need before it's too late.
Making mental health education a mandatory part of the school curriculum is long overdue.

Joe McLean, taught high school students for many years and has a particular interest in mental health. This interest developed when his son started experiencing severe panic attacks in high school. He is currently studying for his masters in psychology and writes for Assignment Masters when he's not studying. In the little time he has left for relaxation, he loves hiking and traveling to interesting new places.

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Why Mental Health Education in Schools is So Important?

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With the prevalence of mental health issues in our society, it's astounding that we still tend to stigmatize mental illness. Many mental health misconceptions still exist. Mental health issues often begin during the school-age years. It follows, therefore, that education about mental health should to also start at an early age.