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This article on self-help and communication from The New York Times expresses the importance of listening to others. Too often conversations are reduced to logistics such as times, plans, and schedules. This article reminds people to stop and listen. Frequently, a lack of listening is a primary contributor to feelings of loneliness. This article on self-help and communication can help teachers recognize the importance of conversations within the classroom. Communication is a two way street and can make students feel welcomed and free to a safe environment. When teachers connect with their students through conversation a line for great success is opened up. Students will learn from their teachers and eventually open up and advocate for themselves. It is important for teachers to listen to their students and differentiate in order to provide access for success.

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There's an unconscious tendency to tune out people you feel close to because you think you already know what they are going to say.

Credit... María Medem

"You're not listening!" "Let me finish!" "That's not what I said!" After "I love you," these are among the most common refrains in close relationships. During my two years researching a book on listening, I learned something incredibly ironic about interpersonal communication: The closer we feel toward someone, the less likely we are to listen carefully to them. It's called the closeness-communication bias and, over time, it can strain, and even end, relationships.

Once you know people well enough to feel close, there's an unconscious tendency to tune them out because you think you already know what they are going to say. It's kind of like when you've traveled a certain route several times and no longer notice signposts and scenery.

But people are always changing. The sum of daily interactions and activities continually shapes us, so none of us are the same as we were last month, last week or even yesterday.

The closeness-communication bias is at work when romantic partners feel they don't know each other anymore or when parents discover their children are up to things they never imagined.

It can occur even when two people spend all their time together and have many of the same experiences.

Kaleena Goldsworthy, 33, told me it was a shock when her identical twin, Kayleigh, decided to move to New York City 10 years ago to pursue a career in music. Kaleena, now the owner of a company that makes cocktail bitters in Chattanooga, Tenn., said she and her twin had previously been inseparable. They had spent most of their lives sleeping in the same room, going to the same schools, attending the same parties, competing in the same sports, and playing in the same band.

"When my sister moved, we were forced to recognize we had all these preconceived notions about who the other was," Ms. Goldsworthy said. "We weren't really listening to each other, which made it harder for us to really know each other."

Social science researchers have repeatedly demonstrated the closeness-communication bias in experimental setups where they paired subjects first with friends or spouses and then with strangers. In each scenario, the researchers asked subjects to interpret what their partners were saying. While the subjects predicted they would more accurately understand, and be understood by, those with whom they had close relationships, they often understood them no better than strangers, and often worse.

"Accurately understanding another person often requires a second thought, to think, 'Wait a minute, is this really what this person meant?' and to check it," said Nicholas Epley, a professor of behavioral science at the University of Chicago Booth School of Business who studies the closeness-communication bias. "We just don't do that as much with those we are close to because we assume we know what they are saying and that they know what we are saying."

A prime example, he said, was when he gave his wife what he thought was the perfect gift: a behind-the-scenes tour of the Shedd Aquarium in Chicago, during which she would get to feed the dolphins, beluga whales and penguins. He thought she'd love it because she'd once expressed interest in swimming with dolphins. But she didn't love it. At all. She was annoyed because she was pregnant at the time and suffering from morning sickness. Just the thought of touching a dead fish made her want to vomit.

"I didn't stop to think, 'Is this the right gift given where my wife is now in her life?' I hadn't really been listening well enough to know where she was," Dr. Epley said. "We all develop stereotypes of the people we know well, and those stereotypes lead us to make mistakes." Now he said he asks his wife for a list of gifts she wants.

The closeness-communication bias not only keeps us from listening to those we love, it can also keep us from allowing our loved ones to listen to us. It may explain why people in close relationships sometimes withhold information or keep secrets from one another.

In an in-depth study of 38 graduate students, confirmed in a larger online survey of 2,000 people representative of all Americans, the Harvard sociologist Mario Luis Small found that slightly more than half the time, people confided their most pressing and worrisome concerns to people with whom they had weaker ties, even people they encountered by chance, rather than to those they had previously said were closest to them - like a spouse, family member or dear friend. In some cases, the subjects actively avoided telling the people in their innermost circle because they feared judgment, insensitivity or drama.

You've probably experienced this phenomenon when someone close to you revealed something that you didn't know while the two of you were talking to someone else. You might have even said, "I didn't know that!"

The revelation most likely occurred because the additional person was listening differently than you previously had. Maybe that person showed more interest, asked the right questions, was less judging or was less apt to interrupt. Again, it's not that people in close relationships are purposefully neglectful or inattentive, it's simply human nature to become complacent about what we know.

So what can you do about it? The British anthropologist and evolutionary psychologist Robin Dunbar said the primary way to maintain close relationships is through "everyday talk." That means asking, "How are you?" and actually listening to the answer.

Too often spouses, and also parents with their children, reduce conversations to logistics such as what to have for dinner, whose turn it is to do the laundry, or when to leave for soccer practice. Friends might run down their latest accomplishments and activities. What often gets left out is what is really on people's minds - their joys, struggles, hopes and fears. Sometimes people keep conversation light with friends and family because they assume they already know what's going on, but also, they may be afraid of what they might learn.

But what is love if not a willingness to listen to and be a part of another person's evolving story? A lack of listening is a primary contributor to feelings of loneliness.

In a 2018 survey of 20,000 Americans, almost half said they did not have meaningful in-person social interactions, such as having an extended conversation with a friend, on a daily basis. About the same proportion said they often felt isolated and left out even when others were around.

Of course, technology doesn't help. Devices are a constant distraction, and people tend to be woefully inaccurate at interpreting feeling states through text and emoji. What exactly does a smiley face with its tongue sticking out mean?

"Technology magnifies the closeness-communication bias because you have less information to work with," said Dr. Epley, referring to the brevity of texts and absence of cues like tone of voice and body language.

It turns out the best way for us to really understand those closest to us is to spend time with them, put down our phones and actually listen to what they have to say.
Kate Murphy is the author of "You're Not Listening: What You're Missing and Why It Matters."

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There's an unconscious tendency to tune out people you feel close to because you think you already know what they are going to say. "You're not listening!" "Let me finish!" "That's not what I said!" After "I love you," these are among the most common refrains in close relationships.

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Child and Adolescent Mental Health. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

This article is based on mental and emotional health with children and adolescents. Tells about what the warning signs are such as often talking about fears or worries or sleeping too much or too little. How mental illness can be treated or helped. It gives emergency numbers to call and generally who to call if you need help with mental illness.

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This current article introduces a new therapy for depression called Mindfulness-based Cognitive Therapy (MBCT). This therapy combines the practice of meditation and mindfulness with tools of cognitive therapy to teach patients adaptive ways of regulating their emotions. This type of care for mental health patients can treat a wider range of people at a lower cost. MBCT can be used moderately in a classroom. Mindfulness in a class can benefit the students mental health in the long run.

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An online version of a pioneering therapy aimed at reducing the lingering symptoms of depression can offer additional benefits for patients receiving care, according to a new U of T Scarborough study.

When added to regular depression care, the online version of Mindfulness-based Cognitive Therapy (MBCT) can help treat depression symptoms and help prevent its return, notes U of T Scarborough Professor Zindel Segal, a clinical psychologist and lead author of the study.

"Treatments work well for many suffering from depression, but there remains a considerable group who continue to struggle with lingering symptoms such as sleep, energy or worry," he says.

Clinical data shows that in the absence of treatment, these patients face a significantly higher risk of becoming fully depressed again, notes Segal.

"Patients with these residual symptoms face a gap in care since they are not depressed enough to warrant re-treatment, but receive few resources for managing the symptom burden they still carry."

The digital version of MBCT, called Mindful Mood Balance (MMB), is an online adaptation of the effective treatment developed by Segal and his colleagues. It combines the practice of mindfulness meditation with the tools of cognitive therapy to teach patients adaptive ways of regulating their emotions.

The practice of mindfulness meditation helps patients observe rather than act automatically to any thought, feeling or sensation that comes to mind, setting them up for being able to choose how best to respond, explains Segal.

"Our goal has always been for people to develop skills that they could continue to rely on once treatment had ended," he says.

While research indicates that MBCT is as effective as antidepressant medication in preventing relapse, access remains limited and nearly impossible for those living outside large cities.

"What drove us to develop MMB is to improve access to this treatment. The online version uses the same content as the in-person sessions, except people can now avoid the barriers of cost, travel or wait times, and they can get the care they need efficiently and conveniently," he says.

Segal, along with colleagues Arne Beck (Kaiser Permanente Institute for Health Research) and Sona Dimidjian (University of Colorado Boulder), received a $2 million grant in 2015 from the National Institute for Health (NIH) in the U.S. to develop MMB. The program was tested in a randomized clinical trial of 460 patients in clinics at Kaiser Permanente Colorado, a large American HMO in Colorado.

The results of the study, published in JAMA Psychiatry, found that adding MMB to depression care offered by Kaiser led to greater reductions in depressive and anxious symptoms, higher rates of remission and higher levels of quality of life compared to patients receiving conventional depression care alone.

"An online version of MBCT, when added with usual care, could be a real game changer because it can be offered to a wider group of patients for little cost," says Segal.

Segal admits that even with the positive results, there is work to be done. A common trade-off with online programs is that drop-out rates tend to be higher than in-person treatment. An important next step is looking at ways to cut down on the dropout rate.

"The higher rates of dropout are somewhat offset by fact that you can reach many more people with online treatment," he says. "But, there's still room for improvement and we will be looking at our user metrics and outcomes for ways to make MMB more engaging and durable."

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mental health research; patient education and counseling; today's healthcare; wounds and healing; depression; mental health; psychiatry; behavior

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New online therapy for lingering depression symptoms could fill important gap in care: Online therapy for lingering depressive symptoms developed greater access to those in need

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An online version of a pioneering therapy aimed at reducing the lingering symptoms of depression can offer additional benefits for patients receiving care, according to a new U of T Scarborough study.

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Students Struggling with Mental Health Crisis'

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Students Struggling with Mental Health Crisis'

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This article about effective school outreach programs from PBS NewsHour discusses the prevalence of mental health issues in our youth today. The author tells multiple stories of different students that went through a program called BRYT (Bridge for Resilient Youth in Transition) and reaped great benefits. This can be seen in a PK-4 classroom by teachers or schools establishing their own versions or methods similar to BRYT. Rather than waiting until students face certain adversities the early childhood educators can create a foundation for students to be comfortable seeking help in their specific classrooms.

Serrano, A. (2020, February 6).

Students often struggle after a mental health crisis. Can this support system help? PBS NewsHour. Retrieved from

https://www.pbs.org/newshour/education/students-often-struggle-after-a-mental-health-crisis-can-this-support-system-help

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CAMBRIDGE, Mass. - Ava had always felt comfortable at the small, private K-8 school she attended just north of Boston. But in high school everything changed.

Ava first began to experience anxiety and depression after her parents divorced, when she was still in grade school. These problems increased as she entered her teen years, and became even more severe in ninth grade, when she enrolled at Cambridge Rindge & Latin School, a vast campus with nearly 2,000 students. Faced with large, noisy classrooms, Ava froze with fear. By her sophomore year, she felt unable to cope. When her mother dropped her off one morning, Ava looked out at the school building, but couldn't open the car door to go inside.

She began to miss two or three days of school a week. In April of that year, she stopped attending altogether.

"Some days I couldn't even get out of bed. I'd find anything to hold on to physically, so I wouldn't have to move."

"Some days I couldn't even get out of bed," said Ava, who is 17 with light auburn hair. "I'd find anything to hold on to physically, so I wouldn't have to move." (The last names of students featured in this story have been withheld to protect their privacy.)

Ava's physician suggested she look into BRYT, or Bridge for Resilient Youth in Transition, which helps students return to school after extended mental health-related absences. Ava, now a junior, was skeptical at first. But eventually she agreed to transition back to school while spending one period a day in the program's dedicated classroom, where she received emotional and psychological support and assistance catching up on the schoolwork she'd missed.

READ MORE: Another tool to improve student mental health? Kids talking to kids

Ava was fortunate. As many as one in five children need help with a mental health condition such as anxiety or depression. These students often have trouble processing information or focusing, which can contribute to a cycle of increased anxiety, dropping grades and missed school days, say experts. Yet schools typically lack the money and staff to help students cope with what experts describe as a mental health epidemic. One study found that nearly 80 percent of students failed to receive the mental health care they needed, and more than 50 percent of students ages 14 and older with emotional and behavioral disabilities drop out of school.

"Districts that are less resourced might be sharing one psychologist for the entire school district, or one psychologist who is responsible for 3,000 kids," said Kelly Vaillancourt Strobach, policy director for the National Association of School Psychologists (NASP). "When you have these shortages of these professionals, you're really only able to serve those kids who are in extreme crisis."

Absent a national blueprint for helping students cope with mental health conditions, states are scrambling to identify potential prototypes. The BRYT program, which was founded and pioneered in a Boston-area school in 2004 by the nonprofit Brookline Center for Community Mental Health, has emerged as a successful model for helping kids re-enter school after a mental health crisis. The Brookline Center works with school districts to help them plan and implement BRYT programs, which are staffed by school employees. Although the center doesn't finance programs, it helps schools identify potential sources of funding.

Ninety percent of students in BRYT remain on track to graduate, and their attendance rates have increased from 52 percent before participation to above 80 percent after. The program itself is expanding. BRYT's director, Paul Hyry-Dermith, said 137 schools in Massachusetts now employ the program and pilots are starting to roll out in Rhode Island, New York and New Hampshire. Partnerships are also in the works with school districts in Washington state and Oregon.

At Cambridge Rindge & Latin, an ethnically diverse school that in 2018 sent 82 percent of its graduates to college, the BRYT classroom is tucked at the end of a quiet hallway. Blue parchment covers the fluorescent ceiling lights, showering the space in a balmy azure. A walnut-stained rocking chair with an embroidered cushion that reads "Be Kind" rests in one corner. In another corner, a noise machine beckons for attention before it's soon forgotten.

Eleven students spend one assigned period a day here, where they chat with counselors, prepare for and work on homework assignments with the program's academic liaison, or simply rest and relax. Students are also welcome in the room any time they feel overwhelmed.

"Many of the kids in our program are coming out of a psychiatric hospitalization," said Ashley Sitkin, BRYT clinician/program leader at Rindge & Latin. "Some of the kids haven't been hospitalized but they've missed a lot of school because they've gotten stuck in this avoidance cycle, which is really common for kids who struggle with anxiety and depression."

At Rindge & Latin, Sitkin and her colleague, academic coordinator Nkrumah Jones, disrupt that cycle with a three-to-four-month reintegration plan that includes emotional support and mental care coordination. That includes a clinical diagnosis of students before they enter the program, and constant contact with outside health providers who also provide each student with care. Sitkin and her staff also reach out to parents and keep them informed. Academic coordination is crucial, too. Both BRYT coordinators and teachers acknowledge it is unrealistic to expect students who miss weeks of school to make up all class work, so care coordinators serve as a liaison between student and teacher, indentifying key assignments and ironing out a make-up plan.

Eli, a trans student at Rindge & Latin, began to battle with depression in eighth grade, a condition that worsened the following year when he entered high school. By his sophomore year, therapy and medication proved fruitless. Eli stopped going to school. He checked into a psychiatric hospital, an experience that his mother said replenished Eli's hope and helped him kick his meds. But the thought of returning to school tormented Eli. Unable to walk into the building, he met Sitkin and Jones at the school door before being escorted to the safe space.

"I was dealing with pretty severe anxiety and depression. I would miss school, which would make me more stressed, which meant I would want to miss more school," said Eli. Before participating in BRYT, Eli, now a senior, would attend just three or four classes a day, he said. Gradually, with help from Sitkin, he returned to classes full time. "I was behind on school work before I left, so the academic coordination, having someone else deal with my teachers, was really, really helpful."

At Rindge & Latin, the mental health challenges students contend with have become more severe in recent years. Student suicide is a growing worry. Several students attempted suicide this semester, teachers and staff said. "I had a student today tell me she's feeling very suicidal," said Sitkin.

That's part of a national trend. The suicide rate for children and young adults, ages 10 to 24, rose by 56 percent from 2007 and 2017 and is now the second leading cause of death among teenagers, according to the Department of Health and Human Services. Some 3,000 high school students across the U.S. attempt suicide every day.

"It's hard to meet these expectations when you're going through a lot outside of school."

Duncan MacLaury, a history teacher in his fourth year at Rindge & Latin, said he often sees students struggling with depression and suicidal ideation. Ibrahim Dagher, who teaches Arabic at the school, also sees the symptoms, though often they are hard to detect.

"I have a student who has been through a very traumatic experience," said Dagher. "She attempted suicide this year, and I had no idea, meaning I saw no signs. She was present in class the day of, so that really shocked me."

Experts point to the increased use of smart phones and social media as the likely culprit for the spike in teen suicide over the last decade. New technology keeps kids in front of screens instead of interacting face-to-face with their peers, they say, which leads to increased isolation. It can also expose them to feelings of insecurity and to cyber harassment and bullying.

Social media helped exacerbate emotional problems for Tashin, 17, a junior at Rindge & Latin. She first started experiencing anxiety after exposure to family violence, but her slide into depression hastened when she was in eighth grade, after students began to bully her online. They would create group chats on Instagram mocking her and then send posts her way. The social bullying continued when Tashin was a sophomore at Rindge & Latin, and she began to miss school. Shortly afterward, she entered a hospital after she began to cut herself.

"That has stayed with me," said Tashin, now a junior and a BRYT alum, of the social media bullying. "A lot of people told me I wouldn't get anywhere in life."

READ MORE: A new movement to treat children as 'sad, not bad'

Dorchester, just south of Boston, wallows in hardship. The per capita income is just $26,292, the second lowest in the Boston area, and almost more than $10,000 less than the city average. Just 14 percent of residents hold bachelor's degrees. The 460 students at Boston Arts Academy reflect these economic burdens: Two thirds come from economically disadvantaged families, and one third entered ninth grade reading below grade level.

Students at the Academy, the Boston school system's only public high school for the arts, carry the weight of stress and community violence, said Charmain Jackman, the school's dean of Health & Wellness. Students embody these stressors with increased levels of depression and trauma. Thought disorders like schizophrenia and delusional disorder are also up here, all made worse, said Jackman, by the recent death of a beloved teacher.

That has placed pressure on the school's mental health services, and its Bridge program, which is similar to the BRYT model used at Rindge & Latin. Besides helping students reenter school after mental health-related absences, the program, started in 2014, focuses on what directors call pre-emptive help. If program coordinators notice a student becoming high risk - excessive absences or tardiness -they will intervene.

The dedicated classroom here is tiny, a roughly 12- by 15-foot room crammed with a few 5-foot-long desks and two computers. A tack board welcomes the program's nine participants and helps coordinators keep track of student comings and goings.

Despite its narrow confines, the room served as a home for Dashawn, a senior here, at a time he desperately needed shelter. As a sophomore, Dashawn lost his father. Devastated family members went their separate ways. Dashawn's mother slid into depression, exacerbated by her inability to afford the rent after her husband's death; she moved to Georgia to start a new life. Penniless and alone, Dashawn drifted from friend's house to friend's house. Inevitably, he was asked to leave after a few weeks. He slept in hallways at times.

"Outside it's like, 'Damn, where am I going to sleep tonight?'" said Dashawn, now 19. "Coming to school is the part where, 'O.K., you're good for now.'"

Dashawn credits Bridge with giving him a space where he could be vulnerable and let his emotions out. Sarah Nichols, coordinator of the Bridge program, and Jackman helped just by being there and reassuring him he could get through a rough patch in his life, he said. The program also helped him communicate with his teachers and make up assignments. Program coordinators gave him gift cards for food and helped him fill out applications for housing. But they also gave him a space to sit down and gather his thoughts.

"I've had tensions with teachers because they think, 'Oh, you're not working, your quality is not good enough,'" said Dashawn, who now lives with an uncle in a stable setting.

"It's hard to meet these expectations when you're going through a lot outside of school," he said, crediting Bridge with helping him sprout into adulthood. "I'm starting to walk now, and I'm just thankful."

Boston Arts Academy does not have the resources that Rindge & Latin enjoys. Students shuffle through dim corridors. The school's makeshift library spills from one dedicated classroom into an adjacent hallway. Substance abuse is up among students, 90 percent of whom are people of color, mostly Latino and black. Jackman, who said her mornings are filled with "back-to-back" students, described the Academy as an urban school with a lot of stress and few resources.

"Every school personnel I've spoken to have talked about increased stress and anxiety of students in general," said Jackman. "It's relentless right now."

"Early intervention is much more effective than waiting until a kid is in a crisis, and that's what happens in a lot of schools."

But staff at both schools said one of their biggest frustrations is that, although anxiety is widespread, they only have time for the students with the most acute problems.

"Early intervention is much more effective than waiting until a kid is in a crisis, and that's what happens in a lot of schools that don't have these adequate members of mental health staff," said Vaillancourt Strobach of the National Association of School Psychologists. "There is an entire population of students who really aren't getting the care that they need, or it's putting the responsibility on the community, where there is also a significant shortage."

Sitkin at Rindge & Latin emphasized that BRYT is a short-term stabilization model. She agrees with Vaillancourt Strobach - schools need to be better equipped to help students cope with social-emotional issues when they're younger, before the problems grow. Only focusing on students in crisis is unsustainable, she said.

Sitkin, referring to herself, said, "Ten Ashleys can help 100 more students, but it's not going to solve the problem. But how do we help the majority of students who also have struggles? There is always going to be those students."

But for struggling students like Ava at Rindge & Latin, the help they receive at school can alter the course of their lives.

"BRYT is a miracle worker in a way. I wasn't going to finish high school," said Ava. "It's about getting out of the car. It's about being here and being O.K."
This story about mental health in schools was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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Students often struggle after a mental health crisis. Can this support system help?

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CAMBRIDGE, Mass. - Ava had always felt comfortable at the small, private K-8 school she attended just north of Boston. But in high school everything changed. Ava first began to experience anxiety and depression after her parents divorced, when she was still in grade school.

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Bracho-Sanchez, D. E. (2019, February 11). Nearly 1 in 7 US kids has a mental health condition, and half go untreated, study says. Retrieved from https://www.cnn.com/2019/02/11/health/children-teens-mental-health-untreated-study/index.html

This article on mental and emotional health from CNN describes how more children are being diagnosed with mental health disorders, but over half of them are being untreated. The cost for therapy and treatment for mental health conditions is not cheap, which alters families for seeking out help for their children. The article continues to talk about the cost for these services, as well as the shortage of providers to help children with mental health disorders. It is growing rapidly, and faster then doctors and providers can come together to help the condition. Important information is given in this article, like the impacts of untreated mental health disorders. A mental health illness that goes untreated can result in serious consequences as severe as suicide. The growth in mental health disorders is affecting children in school and in their communities. The information pertains to teaching elementary students because this is such a growing topic and growing illness that needs attention. As a community and as educators, we can not ignore the mental health crisis that our children are in. We need to educate not only students, but parents also. In the classroom, we can teach students coping strategies to feelings they may have. We can also teach them how to deal with things that can influence a mental health disorder. This article can be used to bring more knowledge to teachers in regards to mental health and how to help the students who have untreated mental illnesses. Teachers can help push to evaluate students and provide them with the help and services they need.

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This article about mental health from CNN explains the pros and cons of technology and what technology is doing to our future generations. This article also discusses happiness as a deflation due to possible technology. It is important to recognize this data as we step into the classroom because of the push for technology in the classrooms. As educators we should know when and when not to push in technology. We should also know the warning signs for students who are using technology too much or inappropriately.

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screen time: mental health menace or scapegoat? - cnn

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Screen time: Mental health menace or scapegoat?

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Teens' happiness and self-esteem can be linked to the amount of time they're spending in front of their screens, a new study says.

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This article on mental health from CNN Health describes a new study that was recently published in the journal Lancet Psychiatry. The article talks about the long-term effects associated with light activity compared to a rather sedentary lifestyle as well as rates of adolescent mental disorders and what signs of mental illness to look out for in children. The study concluded that just 60-minutes of exercise at age 12 was linked to an average 10% reduction in depression at age 18. This article reminds individuals that activity does not always need to be strenuous to make an impact on your overall health and that light exercise or actively doing chores is enough to benefit your mind and body. This article suggests that schools integrate light activity into their students’ days by incorporating standing or active lessons. This article on activity and mental health reminds teachers that it is important to have their students get up and move during the day not only for physical health, but the mental aspect as well. Teaching children the importance of exercise for their body and mind should be done at a young age from grades PreK-4 and reinforced as children get older. Children should participate in active lessons and learn about the importance of a healthy mind by practicing exercises and strategies in the classroom to help regulate and recognize their emotions.

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Science shows moderate to vigorous aerobic exercise is good for us - it improves sleep; lowers blood pressure; protects against heart disease, diabetes and cancer; reduces stress; boosts mood; and fights anxiety and depression.

It's especially important in adolescence, where the first signs of depression often begin, studies show. But unless your child is an athlete, it can be tough to wean them away from social media and the ever-present screento swim laps or go for a blood-pumping jog.

A new study has some good news: even light exercise may help protect children against developing depression.

The study, published Tuesday in the journal Lancet Psychiatry,found that 60 minutes of simple movement each day at age 12 was linked to an average 10% reduction in depression at age 18. The types of movement ranged from running and biking to walking, doing chores, painting or playing an instrument.

"It's not just more intense forms of activity that are good for our mental health," Aaron Kandola, a PhD student in psychiatry at University College London and lead author of the study, said in a statement.

"A lot of initiatives promote exercise in young people, but our findings suggest that light activity should be given more attention as well," senior author Dr. Joseph Hayes, a psychiatrist and clinical research consultant at University College London, said in a statement.

"Schools could integrate light activity into their pupils' days, such as with standing or active lessons," Hayes said. "It doesn't require much effort and it's easy to fit into the daily routines of most young people."

Long-term results

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health and health care (by demographic group)

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Keep your teen moving to reduce risk of depression, study says | CNN

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Science shows moderate to vigorous aerobic exercise is good for us - it improves sleep; lowers blood pressure; protects against heart disease, diabetes and cancer; reduces stress; boosts mood; and fights anxiety and depression. It's especially important in adolescence, where the first signs of depression often begin, studies show.

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Website Article
Self-Care for Teens: a Boon for Mental Health. (n.d.). Retrieved from https://health.usnews.com/wellness/for-parents/articles/self-care-for-teens-a-boon-for-mental-health

In this article on self care for teens reported by US News, self care is a way to promote mental health among teens. Sleep deprivation is one of the leading causes of mood swings and mental health struggles among children and teens.
Other suggestions for self care among teens is eating well, exercising, participating in after school activities, and relaxation. All of which help teens to feel more at ease. The study states that limiting screen time will promote healthy brain growth.

As teachers, we are encouraged to support our students and their mental health. In order to do so, perhaps teachers can assign less homework per day to students, to reduce stress and encourage relaxation after school. So many of our students stay up late trying to get their homework done, and it is effecting their well-being.

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Teens are getting too little sleep, not enough exercise and spending far too much time online. Research tells us so (if you need proof), and it's also clear that when teens don't take care of themselves, it can affect their mental health.

That's all the more reason parents should teach their kids about the fundamentals of good self-care. And that means getting back to the basics, such as eating well, getting plenty of sleep and exercising more. That may be easier said than done, as adults know. But if you want your teen to live a healthier life, it's important to pay attention to these three pillars of health.

Here's what you should know about the benefits of these forms of self-care for kids - and what happens if they're ignored.
Establishing Healthy Eating Habits
Most have heard the saying, "You are what you eat" - and nothing could be more accurate when it comes to food and mental fitness. Food choice really does have an impact on how we feel and look. For example, it's not uncommon to hear people say that when they eat better, they feel better. The food we put in our mouths is the fuel that we run on. And when we opt for premium nutrients, we simply run better.

Research indicates that fuel choice may be hurting their bodies and mental health. In one study published in Physiological Reports, researchers followed 84 middle school students. They monitored sodium and potassium excretion and depressive symptoms for a year and a half. The findings suggested that for adolescents, consuming foods that are high in sodium, a mineral frequently found at high levels in junk food, and those that are low in potassium was related to an increase in depressive symptoms. The researchers concluded that poor diet was, in fact, a risk factor for depression.

What we eat impacts how we think, feel and act. That's why it's essential to help your teen establish healthy eating habits. Many teens gravitate toward junk food because it's convenient and fits into their busy lifestyles, but that doesn't have to be the case. It's just as easy to opt for an apple as it is for a bag of chips. There is just no way around it - a healthy body helps support a healthy mind.

The National Sleep Foundation recommends that children ages 14 to 18 sleep eight to 10 hours a night, but the vast majority of youth aren't even coming close to that recommendation. On average, most teens get about 7.5 hours of sleep a night. It comes as no surprise that sleep deprivation takes a toll on their mood.

As reported by the American College of Neuropsychopharmacology, researchers at the University of Pittsburgh found that when teens experience sleep loss, even for short periods, it increased their risk for mood disorders. In this particular study, 35 participants, aged 11 1/2 to 15 years, were monitored in a sleep lab for two nights, with half of them sleeping for 10 hours and the remaining sleeping for four hours.

A week later, they returned to the lab and switched sleep schedules from their initial visit. During their time at the lab, they underwent brain scans monitoring the reward center of their brain while playing a game and also completed emotional functioning and depressive symptoms assessments. The data indicated that sleep deprivation affected the putamen, an area of the brain that is responsible for goal-based movements and learning from rewards.

Consequently, there was a link between sleep deprivation and their reported depressive symptoms, too. Participants who did not get enough sleep reported feeling more depressed than their well-rested peers.

Overall, the results suggested that inadequate sleep during adolescence may affect how the brain processes reward and increase the likelihood of depression and risk-taking behavior. When teens were sleep-deprived, they didn't make the best choices. According to this study, sleep not only helps kids feel better, it also helps them make better choices.

Make sure that your teen is getting enough sleep by limiting screen time before bed and establishing a good bedtime routine, particularly on school nights when they are more apt to sleep less. It's also important for kids to keep their phones away from their beds at night. Just a few simple tweaks in their bedtime routine can make all the difference, because a well-rested teen is a happier and healthier teen.

The U.S. Department of Health and Human Services recommends that teens get at least an hour of moderate or vigorous physical activity each day. Still, according to a study in Preventive Medicine, young people are getting about as much exercise as a 60-year-old.

In Latin, there's a saying: "mens sana in corpore sano." When translated, it means: "a healthy mind in a healthy body." And researchers have shown that a healthy body does indeed contribute to a healthy mind, especially when it comes to anxiety and depression.

A study published in the American Journal of Psychiatry reported that exercise could reduce the risk of developing depression. In this study, researchers monitored the physical activity of 266,939 participants from around the world for more than seven years. Their findings showed that when people were more active, their risk of developing depression decreased regardless of how old they were and where they lived.

These findings support a large body of literature that has linked physical activity with improved mood. In fact, there's some evidence to suggest that exercise is as effective in treating depression as antidepressants. Now, that's something to consider.

Establishing healthy habits begins early. It's important to get our kids moving because an hour a day can go a long way toward promoting physical and mental well-being.

All things considered, it's incredible how some of life's most basic tasks, such as eating well, getting a good night's sleep and exercising, can positively impact our children's well-being. There's just no way around it: A healthy body and a healthy mind really begin with the basics of self-care.

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Self-Care for Teens: a Boon for Mental Health

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Teens are getting too little sleep, not enough exercise and spending far too much time online. Research tells us so (if you need proof), and it's also clear that when teens don't take care of themselves, it can affect their mental health. That's all the more reason parents should teach their kids about the fundamentals of good self-care.

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This article on mental health from PBS describes the story of many different students between middle and high school ages who struggled before or after transitioning to high school. They were able to take time off from school to help their depression and anxiety get better. Since it is hard for many students to come back to school and return to their typical schedules, a program was put in place to provide emotional and academic support as they come back to ensure they are improving. Every day for one period, she would go to the BRYT program’s classroom for these supports. This was also created to increase student's attendance rates after coming back from a long break due to mental health. Teachers should realize it’s hard for students to meet expectations when they have hard things going on outside of school. This article is important for PK-4th grade teachers because students will always have baggage they bring to school, but we have to provide them with support, and the tools to help them. We need to teach them it’s okay to have emotions, but you are safe at school, and it’s okay to ask for help when you need it! This BRYT program would also be helpful in an elementary school for students who suffer from trauma, but set up differently to form to an elementary schedule.

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CAMBRIDGE, Mass. - Ava had always felt comfortable at the small, private K-8 school she attended just north of Boston. But in high school everything changed.

Ava first began to experience anxiety and depression after her parents divorced, when she was still in grade school. These problems increased as she entered her teen years, and became even more severe in ninth grade, when she enrolled at Cambridge Rindge & Latin School, a vast campus with nearly 2,000 students. Faced with large, noisy classrooms, Ava froze with fear. By her sophomore year, she felt unable to cope. When her mother dropped her off one morning, Ava looked out at the school building, but couldn't open the car door to go inside.

She began to miss two or three days of school a week. In April of that year, she stopped attending altogether.

"Some days I couldn't even get out of bed. I'd find anything to hold on to physically, so I wouldn't have to move."

"Some days I couldn't even get out of bed," said Ava, who is 17 with light auburn hair. "I'd find anything to hold on to physically, so I wouldn't have to move." (The last names of students featured in this story have been withheld to protect their privacy.)

Ava's physician suggested she look into BRYT, or Bridge for Resilient Youth in Transition, which helps students return to school after extended mental health-related absences. Ava, now a junior, was skeptical at first. But eventually she agreed to transition back to school while spending one period a day in the program's dedicated classroom, where she received emotional and psychological support and assistance catching up on the schoolwork she'd missed.

READ MORE: Another tool to improve student mental health? Kids talking to kids

Ava was fortunate. As many as one in five children need help with a mental health condition such as anxiety or depression. These students often have trouble processing information or focusing, which can contribute to a cycle of increased anxiety, dropping grades and missed school days, say experts. Yet schools typically lack the money and staff to help students cope with what experts describe as a mental health epidemic. One study found that nearly 80 percent of students failed to receive the mental health care they needed, and more than 50 percent of students ages 14 and older with emotional and behavioral disabilities drop out of school.

"Districts that are less resourced might be sharing one psychologist for the entire school district, or one psychologist who is responsible for 3,000 kids," said Kelly Vaillancourt Strobach, policy director for the National Association of School Psychologists (NASP). "When you have these shortages of these professionals, you're really only able to serve those kids who are in extreme crisis."

Absent a national blueprint for helping students cope with mental health conditions, states are scrambling to identify potential prototypes. The BRYT program, which was founded and pioneered in a Boston-area school in 2004 by the nonprofit Brookline Center for Community Mental Health, has emerged as a successful model for helping kids re-enter school after a mental health crisis. The Brookline Center works with school districts to help them plan and implement BRYT programs, which are staffed by school employees. Although the center doesn't finance programs, it helps schools identify potential sources of funding.

Ninety percent of students in BRYT remain on track to graduate, and their attendance rates have increased from 52 percent before participation to above 80 percent after. The program itself is expanding. BRYT's director, Paul Hyry-Dermith, said 137 schools in Massachusetts now employ the program and pilots are starting to roll out in Rhode Island, New York and New Hampshire. Partnerships are also in the works with school districts in Washington state and Oregon.

At Cambridge Rindge & Latin, an ethnically diverse school that in 2018 sent 82 percent of its graduates to college, the BRYT classroom is tucked at the end of a quiet hallway. Blue parchment covers the fluorescent ceiling lights, showering the space in a balmy azure. A walnut-stained rocking chair with an embroidered cushion that reads "Be Kind" rests in one corner. In another corner, a noise machine beckons for attention before it's soon forgotten.

Eleven students spend one assigned period a day here, where they chat with counselors, prepare for and work on homework assignments with the program's academic liaison, or simply rest and relax. Students are also welcome in the room any time they feel overwhelmed.

"Many of the kids in our program are coming out of a psychiatric hospitalization," said Ashley Sitkin, BRYT clinician/program leader at Rindge & Latin. "Some of the kids haven't been hospitalized but they've missed a lot of school because they've gotten stuck in this avoidance cycle, which is really common for kids who struggle with anxiety and depression."

At Rindge & Latin, Sitkin and her colleague, academic coordinator Nkrumah Jones, disrupt that cycle with a three-to-four-month reintegration plan that includes emotional support and mental care coordination. That includes a clinical diagnosis of students before they enter the program, and constant contact with outside health providers who also provide each student with care. Sitkin and her staff also reach out to parents and keep them informed. Academic coordination is crucial, too. Both BRYT coordinators and teachers acknowledge it is unrealistic to expect students who miss weeks of school to make up all class work, so care coordinators serve as a liaison between student and teacher, indentifying key assignments and ironing out a make-up plan.

Eli, a trans student at Rindge & Latin, began to battle with depression in eighth grade, a condition that worsened the following year when he entered high school. By his sophomore year, therapy and medication proved fruitless. Eli stopped going to school. He checked into a psychiatric hospital, an experience that his mother said replenished Eli's hope and helped him kick his meds. But the thought of returning to school tormented Eli. Unable to walk into the building, he met Sitkin and Jones at the school door before being escorted to the safe space.

"I was dealing with pretty severe anxiety and depression. I would miss school, which would make me more stressed, which meant I would want to miss more school," said Eli. Before participating in BRYT, Eli, now a senior, would attend just three or four classes a day, he said. Gradually, with help from Sitkin, he returned to classes full time. "I was behind on school work before I left, so the academic coordination, having someone else deal with my teachers, was really, really helpful."

At Rindge & Latin, the mental health challenges students contend with have become more severe in recent years. Student suicide is a growing worry. Several students attempted suicide this semester, teachers and staff said. "I had a student today tell me she's feeling very suicidal," said Sitkin.

That's part of a national trend. The suicide rate for children and young adults, ages 10 to 24, rose by 56 percent from 2007 and 2017 and is now the second leading cause of death among teenagers, according to the Department of Health and Human Services. Some 3,000 high school students across the U.S. attempt suicide every day.

"It's hard to meet these expectations when you're going through a lot outside of school."

Duncan MacLaury, a history teacher in his fourth year at Rindge & Latin, said he often sees students struggling with depression and suicidal ideation. Ibrahim Dagher, who teaches Arabic at the school, also sees the symptoms, though often they are hard to detect.

"I have a student who has been through a very traumatic experience," said Dagher. "She attempted suicide this year, and I had no idea, meaning I saw no signs. She was present in class the day of, so that really shocked me."

Experts point to the increased use of smart phones and social media as the likely culprit for the spike in teen suicide over the last decade. New technology keeps kids in front of screens instead of interacting face-to-face with their peers, they say, which leads to increased isolation. It can also expose them to feelings of insecurity and to cyber harassment and bullying.

Social media helped exacerbate emotional problems for Tashin, 17, a junior at Rindge & Latin. She first started experiencing anxiety after exposure to family violence, but her slide into depression hastened when she was in eighth grade, after students began to bully her online. They would create group chats on Instagram mocking her and then send posts her way. The social bullying continued when Tashin was a sophomore at Rindge & Latin, and she began to miss school. Shortly afterward, she entered a hospital after she began to cut herself.

"That has stayed with me," said Tashin, now a junior and a BRYT alum, of the social media bullying. "A lot of people told me I wouldn't get anywhere in life."

READ MORE: A new movement to treat children as 'sad, not bad'

Dorchester, just south of Boston, wallows in hardship. The per capita income is just $26,292, the second lowest in the Boston area, and almost more than $10,000 less than the city average. Just 14 percent of residents hold bachelor's degrees. The 460 students at Boston Arts Academy reflect these economic burdens: Two thirds come from economically disadvantaged families, and one third entered ninth grade reading below grade level.

Students at the Academy, the Boston school system's only public high school for the arts, carry the weight of stress and community violence, said Charmain Jackman, the school's dean of Health & Wellness. Students embody these stressors with increased levels of depression and trauma. Thought disorders like schizophrenia and delusional disorder are also up here, all made worse, said Jackman, by the recent death of a beloved teacher.

That has placed pressure on the school's mental health services, and its Bridge program, which is similar to the BRYT model used at Rindge & Latin. Besides helping students reenter school after mental health-related absences, the program, started in 2014, focuses on what directors call pre-emptive help. If program coordinators notice a student becoming high risk - excessive absences or tardiness -they will intervene.

The dedicated classroom here is tiny, a roughly 12- by 15-foot room crammed with a few 5-foot-long desks and two computers. A tack board welcomes the program's nine participants and helps coordinators keep track of student comings and goings.

Despite its narrow confines, the room served as a home for Dashawn, a senior here, at a time he desperately needed shelter. As a sophomore, Dashawn lost his father. Devastated family members went their separate ways. Dashawn's mother slid into depression, exacerbated by her inability to afford the rent after her husband's death; she moved to Georgia to start a new life. Penniless and alone, Dashawn drifted from friend's house to friend's house. Inevitably, he was asked to leave after a few weeks. He slept in hallways at times.

"Outside it's like, 'Damn, where am I going to sleep tonight?'" said Dashawn, now 19. "Coming to school is the part where, 'O.K., you're good for now.'"

Dashawn credits Bridge with giving him a space where he could be vulnerable and let his emotions out. Sarah Nichols, coordinator of the Bridge program, and Jackman helped just by being there and reassuring him he could get through a rough patch in his life, he said. The program also helped him communicate with his teachers and make up assignments. Program coordinators gave him gift cards for food and helped him fill out applications for housing. But they also gave him a space to sit down and gather his thoughts.

"I've had tensions with teachers because they think, 'Oh, you're not working, your quality is not good enough,'" said Dashawn, who now lives with an uncle in a stable setting.

"It's hard to meet these expectations when you're going through a lot outside of school," he said, crediting Bridge with helping him sprout into adulthood. "I'm starting to walk now, and I'm just thankful."

Boston Arts Academy does not have the resources that Rindge & Latin enjoys. Students shuffle through dim corridors. The school's makeshift library spills from one dedicated classroom into an adjacent hallway. Substance abuse is up among students, 90 percent of whom are people of color, mostly Latino and black. Jackman, who said her mornings are filled with "back-to-back" students, described the Academy as an urban school with a lot of stress and few resources.

"Every school personnel I've spoken to have talked about increased stress and anxiety of students in general," said Jackman. "It's relentless right now."

"Early intervention is much more effective than waiting until a kid is in a crisis, and that's what happens in a lot of schools."

But staff at both schools said one of their biggest frustrations is that, although anxiety is widespread, they only have time for the students with the most acute problems.

"Early intervention is much more effective than waiting until a kid is in a crisis, and that's what happens in a lot of schools that don't have these adequate members of mental health staff," said Vaillancourt Strobach of the National Association of School Psychologists. "There is an entire population of students who really aren't getting the care that they need, or it's putting the responsibility on the community, where there is also a significant shortage."

Sitkin at Rindge & Latin emphasized that BRYT is a short-term stabilization model. She agrees with Vaillancourt Strobach - schools need to be better equipped to help students cope with social-emotional issues when they're younger, before the problems grow. Only focusing on students in crisis is unsustainable, she said.

Sitkin, referring to herself, said, "Ten Ashleys can help 100 more students, but it's not going to solve the problem. But how do we help the majority of students who also have struggles? There is always going to be those students."

But for struggling students like Ava at Rindge & Latin, the help they receive at school can alter the course of their lives.

"BRYT is a miracle worker in a way. I wasn't going to finish high school," said Ava. "It's about getting out of the car. It's about being here and being O.K."
This story about mental health in schools was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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Students often struggle after a mental health crisis. Can this support system help?

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CAMBRIDGE, Mass. - Ava had always felt comfortable at the small, private K-8 school she attended just north of Boston. But in high school everything changed. Ava first began to experience anxiety and depression after her parents divorced, when she was still in grade school.

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Philly woman changes the world one heart at a time. (2020, February 14). Retrieved from https://6abc.com/community-events/philly-woman-changes-the-world-one-heart-at-a-time/5931785/ 

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Philly woman changes the world one heart at a time. (2020, February 14). Retrieved from https://6abc.com/community-events/philly-woman-changes-the-world-one-heart-at-a-time/5931785/ 

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his article, found on 6abc, highlights the power of choice. Danni's mental and emotional health struggles began as she grew up feeling insecure and unsure about herself. When her last surviving grandparent was unable to contact her for a month due to Hurricane Maria in Puerto Rico, Danni felt great stress and was faced with depression. Danni's next choice turned out to be a powerful one. She decided that she was going to brighten others' days by cutting out hearts with positive messages written on them and randomly handing the hearts out to strangers. She wants to share a common message; if you are unsure about yourself and feel doubtful, you are adored by Danni. She calls this The Adore Project. As a future educator, it is important that I understand that my students are faced with not only daily challenges related to education but challenges that come along with childhood, such as changing bodies, friendships, relationships, loss, and so much more. Children are faced with many choices and questions as they learn and grow into the human beings they are becoming. Every child deserves to have someone who believes in him or her and shows him or her unconditional support and encouragement. Strong positive relationships are so important for children's mental and emotional health. I will strive to be that positive role model and cheerleader for all my students.

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PHILADELPHIA, Pa. -- If you are ever feeling down about yourself, always know you are adored by Danni.

As a child growing up in Philadelphia, Danni started growing insecure towards her self-image. In 2017, Danni's last surviving grandparent was affected by Hurricane Maria in Puerto Rico and was unable to make contact for a month. This made Danni stricken with stress and depression.

To tackle this head-on, she started loving herself and then sharing that love with the whole city. She calls it "The Adored Project," where she creates heart-shaped cut-outs and writes special messages on them such as, "Open your eyes to the beauty around you," and "It's your time to shine. Do it for you."

With over 8,000 hearts and counting, she roams around the Philadelphia area to hand them out to total strangers just to brighten their day. She has sent them with local travelers around the world as well. Having quit her job last year, Danni is now a "full-time lover."

Danni constantly wants to spread a message of love, compassion and confidence. Last year, she married the love of her life, Cathy, a barber from Philadelphia. The couple frequently travels to various community hotspots to distribute each and every carefully crafted heart. Together, they hope to spread hope and joy throughout the entire world.

RELATED: A LOVE story: How a sculpture came to symbolize Philadelphia

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Philly woman changes the world one heart at a time

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PHILADELPHIA, Pa. -- If you are ever feeling down about yourself, always know you are adored by Danni. As a child growing up in Philadelphia, Danni started growing insecure towards her self-image. In 2017, Danni's last surviving grandparent was affected by Hurricane Maria in Puerto Rico and was unable to make contact for a month.

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This article from ABC News talks about mental and emotional health and how we have improved and where we need to do better in 2020. Over the course of the past decade, a lot more light has been shed on mental health and ways to recognize it and spread awareness. Mental health has had its fair share of misrepresentation and shame. Finally, this term is losing the stigma. In the past, mental health had been talked about as being a severe mental illness. Now, mental health can also mean more common conditions such as anxiety and depression. Since peoples’ awareness on the topic is shifting, mental health is finally coming out of the shadows. This article includes helpful pieces of writings such as, “How to talk about mental health issues at work” and “A mental health check-in: 14 questions to ask your child.” Just the fact that such pieces of writing exist is a huge red flag for how far the topic has come over time and how important it is to talk about at the workplace and at home with our children and families.

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By and large, physical health is still more straightforward and (often) more tangible than mental health, but over the course of the past decade, there's been increased willingness to recognize mental health as an essential part of one's well-being. In short, we've come a long way. As a mental health advocate and reporter, I've seen the advancements up close and personal and can say with certainty that in 2010 I wouldn't have dreamed of writing pieces like " How to talk about mental health issues at work" or " A mental health check-in: 14 questions to ask your child " for a national news outlet. Such topics just weren't so, well, topical back then.

With the help of mental health experts, we've taken a look at some of the most significant breakthroughs concerning mental health over the last 10 years, as well as where we need to do better going forward.

After centuries of shame and misrepresentation, the term 'mental health' is losing the stigma

"Historically, when people have talked about 'mental health', they usually meant severe mental illness," Dr. Mark van Ommeren, a mental health expert who works with the World Health Organization, tells NBC News BETTER. "Today, 'mental health' can also mean common conditions like anxiety and depression. In more places (though it depends on where you are), people understand mental health simply as an aspect of overall health. Our awareness is shifting, and mental health is coming out of the shadows."

What has helped to advance our awareness of mental health as an integral part of overall health on a global level? There's no distinct "trigger moment", as van Ommeren sees it.

"I think about this a lot because it's absolutely true internationally," van Ommeren says. "I see more and more governments getting interested in [mental healthcare], and more people talking about it, but unlike say, the #MeToo movement, which is also about a problem that has been in the shadows, there's not one thing that triggered awareness about mental health and caused everyone to see it as a huge thing."

Instead, a constellation of factors and moments have led to our amplified awareness of mental health and the roles it plays in our daily lives. Traditional media (including TV dramas like " This Is Us "), social media (which sees countless individuals and groups sharing #mentalhealth stories) and perhaps above all, mountains of clinical research, have helped steer us in a more enlightened direction.

"Years of study after study showing that [mental health] conditions are common have created a snowball effect," says van Ommeren. "Media has played a positive role here, as have influential people who are starting to speak more about their mental health, which helps to reduce the stigma."

Dr. Don Mordecai, MD, Kaiser Permanente's national leader for mental health, also credits celebrities for being outspoken about their own mental health challenges, as well as younger generations who have "become more vocal about the need to break stigma and encourage people to get help."

But mental illness has yet to be normalized the way physical illness has been

"While we have come a long way with normalizing discussions about mental healthcare and showing different versions of it in the media, we have significant lengths to go to remove the stigma and to increase access to mental healthcare," says Kryss Shane, a social worker and educator. "We continue to see mental healthcare as a response to problems, rather than something recommended for everyone as a way to improve life in general. If we are able to alter this understanding, it will not only further remove stigma, it will encourage people to seek out help before they are in crisis. In addition, we must advocate for recognition that all [people] in minority groups ought to have access to affordable and reliable mental healthcare, in order to have a healthy outlet for coping with the ever-present (and the increase of) micro-aggressions and hate."

We're learning how words matter in conversations about mental health

Over the past decade, there's been a growth spurt in our evolution of understanding the importance of language in the role of talking about mental health issues. Many of us have come to embrace gestures like "trigger warnings" when sharing sensitive/mental illness-related content online, just as we're grasping why it's better to say that someone has " died by suicide ", rather than employ the crasser but previously perfectly acceptable alternative, "killed themselves".

"The conversations we have now we would never have had 10 years ago," says Mike Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, and past president of the New York City chapter of the National Alliance for Mental Illness (NAMI). "We're more open and interested in talking about mental health and about respecting it."

We're also paying more attention to the words we use and how we use them (take for instance the fact that the nonbinary pronoun "they" was Merriam-Webster's word of the year in 2019), just as we're opening our minds to the reality of "gaslighting" and other toxic behaviors. We're increasingly sensitive about how to talk to and empathize with others who may be suffering, which serves as a subtle but significant win for the advancement of our mental health as a society.

Federal laws put mental health on par with physical health

But in the opinion of Keith Humphreys, professor of Psychiatry and Behavioral Sciences at Stanford and former Senior Policy Advisor, White House Office of National Drug Control Policy, by far the "best thing that has happened" recently happened on the governmental end of things, chiefly under President Obama.

"The best thing that happened is multiple sweeping federal laws putting mental health on the same level as physical health," says Humphreys, referencing both The Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act (ACA) of 2010. "I was at the White House at the time [from 2009 to 2010] and it was so extraordinary for me to look and see an essential healthcare benefit defining mental health. It was the dream."

But people who need help often fail to get it, and the demand overwhelms the supply

These federal laws may have looked like the dream, but Humphreys is quick to note that they were followed by something of a nightmare.

"The worst thing of the last decade has been the undermining of the [federal] protections by multiple sources," says Humphreys. "Insurers, as proven in court in some cases, have denied care that people are entitled to. More recently, you have the undermining by our current administration of the financial structure of healthcare markets. All this makes it harder to get protections that were promised. It is the most tragic thing, and people - children - are dying because of it. We created the greatest opportunity we ever had, but there was a rollback against much of the revolution. The Parity Act passed at the end of 2008, and people thought they won - but the industry fought back and still is fighting. Of course, it's not just mental health patients that have been harmed but anyone relying on health insurance for care."

Mental health clinicians like Shannon Curry, a clinical psychologist and director of the Curry Psychology Group, see firsthand just how dire the need for mental health care is - and perhaps more appallingly, just how bad people are actually trying to get the said care to no avail.

"It is incredibly upsetting to be unable to treat so many people who need care," says Curry. "Our practice provides pro-bono services to the beneficiaries of a charity for women who have experienced trauma and are recovering from substance use disorders; however, the need for care far extends beyond one charity, and this is an issue that desperately needs addressing from our policymakers."

The most important step we can take toward advancing mental health care in 2020 and beyond, is giving people - all people - access to it.

The advent of telemedicine and meditation apps are a helpful boost

Getting an affordable appointment with a therapist in person might be humiliatingly difficult, but at least there has been wide advancement in the accessibility of mental health support online.

"If you think of the conventional way of how people receive mental health support it would be once a week driving to the therapist and then going home. That takes time, but with telemedicine and meditation apps, people can do it from home in little bits," says van Ommeren. "This is a reason for optimism. In this way, mental health support is being made more available."

But here too, there's room for improvement - room that Dr. Mordecai expects will be filled.

"Technology will continue to evolve as a way to deliver mental health care, ranging from stand-alone skills-based apps, to coaching, to interaction with licensed professionals," Mordecai says. "We also expect technology to help keep track of someone's mental health in both active monitoring (ask the person in various ways) and passive monitoring approaches which will take advantage of machine learning and AI techniques to identify those who may need assistance long before a crisis emerges."

We need to step up our prevention and mitigation game

If technology can help people before the onset of a mental health crisis, that would be a significant help - because right now, we're not doing so great in the department of prevention.

"Generally speaking, relative to a number of other countries, we do a bad job in preventing illness in our society," says Dr. John Krystal, MD, chair of the Psychiatry Department at Yale Medicine. "As much as possible, as we expand the health literacy of Americans, we need to make sure that we also increase their understanding of mental illness and addiction. We can do a better job of early detection and early intervention when we do a better job of looking out for ourselves, our families, our friends and our co-workers. Stigma is what develops when we view a problem like depression or addiction as something that happens to others; stigma goes away when we appreciate that mental illness and addiction could happen to us and those that we care for. When that happens broadly in our society, we will invest more in providing access to assessment and treatment. We will also invest more in discovering the causes and better treatments for these illnesses. After all, if we can have a war on cancer, why can't we have a war on depression?"

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Mental health in America: How we've improved and where we need to do better

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By and large, physical health is still more straightforward and (often) more tangible than mental health, but over the course of the past decade, there's been increased willingness to recognize mental health as an essential part of one's well-being. In short, we've come a long way.

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The article introduces the website Mood Spark, which is beneficial for children’s emotional health. This website was created because a lot of young children stated that they needed a trusted place to get information, advice, and support. Mood spark is a website that lets children learn about mental health, find tips and resources to help them stay emotionally healthy and cope. This website lets children take a quiz and then get results. If a child’s test comes back that they are struggling, it offers suggestions on how to help. It also introduces the website Kent Resilience Hub which can be used for parents to help support their child’s mental health. It helps parents understand emotional health, how to nurture good emotional health and how to respond appropriately if their child is finding life difficult and unable to cope. In the PK-4th grade classroom, I would introduce Mood Spark to children and introduce the site as a safe place for them to go to if they are feeling sad. I could also send parents Kent Resilience Hub and encourage them to use it to nurture their child’s emotional health.

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This Children's Mental Health Week, young people in Kent are being invited to visit a new website designed to help keep them emotionally healthy - and there is a separate site aimed at helping parents support their children's mental health too.

MoodSpark ( www.moodspark.org.uk) has been developed for young people in Kent, with young people in Kent by HeadStart Kent, which sits within Kent County Council's Children, Young People and Education Service. The Kent Resilience Hub, which can be found at www.kentresiliencehub.org.uk, is aimed at parents and carers but can be accessed by young people as well.

MoodSpark is a place where young people can learn about mental health, find tips and resources to keep emotionally healthy and find ways to help them bounce back when life gets tough.

The website, which is aimed at young people aged 10 to 16, was developed in response to many young people telling HeadStart they needed a trusted place to get information, advice and support on resilience and emotional health. The site will continue to grow, and young people are encouraged to submit content; everything from suggested chillout playlists to storyboards or things they have found helpful in difficult times. The young people's editorial board will help the website grow. The board is a group of young people interested in the website's content, in website development and design, or writing and creative processes. This group will continue to develop ideas for MoodSpark and approve content submitted by young people across the county for inclusion.

MoodSpark is already proving popular with some of its users.

Abigail, 14, from Folkestone, said: "I think the website is really good and it would really benefit young people who are struggling at home or in social life. It's a really good way to stop people from thinking negatively."

Elizabeth, 16, from Gravesham, added; "I really like how interactive MoodSpark is as there is a great deal of useful information and the overall layout is really easy to navigate. The whole website is very inviting."

The Kent Resilience Hub has been designed to help parents and carers understand emotional health, how to nurture good emotional health and how to respond appropriately if their child is finding life difficult and unable to bounce back.

Following a survey of parents in Kent, HeadStart responded by providing information on the main topics parents had sought advice on regarding mental health. Parents said they wanted a better understanding of how resilience and emotional health work and what proactive or early reactive steps they could take themselves to support their families. This website will continue to grow, and parents are invited to submit content too - perhaps recommending articles, books or websites they have found helpful or sharing ways they have dealt with a difficult situation. There is also a comprehensive page on further support and access to help identify whether families need a bit more than the website can offer.

Parent Jo, from Canterbury, said: "This is a vital resource and it's so helpful to have a list of services in Kent in one place. I've looked for ways to help my child but it's hard to know where to start or what information is good. This is very much needed."

Sue Chandler, Kent County Council's Cabinet Member for Integrated Children's Services, said: "It's great that children and young people in Kent, and their families, now have two websites dedicated to promoting positive emotional health. Children's Mental Health Week is the perfect opportunity to remind everyone to take care of their own mental health as well as supporting others in doing so. MoodSpark and the Kent Resilience Hub are brilliant tools to assist with this."
...Ends...Notes to journalists:
About HeadStart:

Kent County Council was awarded £10 million to support young people's emotional wellbeing and resilience over five years. The funding is from The National Lottery Community Fund, which is the largest funder of community activity in the UK

HeadStart Kent is part of Children, Young People and Education Services and aims to help young people cope better when faced with difficult circumstances in their lives, preventing them from experiencing common mental health problems

HeadStart Kent aims to make changes through schools, families and within communities and has been designed with young people at its heart to make young people's mental wellbeing everybody's business

The HeadStart Kent Mission Statement was developed by young people and their families and is as follows: "By 2020 Kent young people and their families will have improved resilience, by developing their knowledge and lifelong skills to maximise their own and their peers' emotional health and wellbeing; so to navigate their way to support when needed in ways which work for them."

Children and young people living in Kent, together with their parents, have told HeadStart Kent what support they need to build their resilience:

My Wellbeing is not impacted by the pressure to achieve and be perfect

There is always someone for me to talk to

People around me understand wellbeing and how to promote it

The programme is on track to deliver the programme to the planned number of 133 schools over the five years

The National Lottery Community Fund is the largest funder of community activity in the UK. It puts people in the lead to improve their lives and communities, often through small, local projects

It is responsible for giving out 40% of the money raised by National Lottery players for good causes. Last year it awarded £583 million and supported around 12,000 projects across the UK for health, education, environment and charitable purposes

Since June 2004 it has awarded over £8 billion to projects that change the lives of millions of people

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Two new websites promote positive emotional health this Children's Mental Health Week - KCC Media Hub

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This Children's Mental Health Week, young people in Kent are being invited to visit a new website designed to help keep them emotionally healthy - and there is a separate site aimed at helping parents support their children's mental health too. MoodSpark (www.moodspark.org.uk) has been developed for young people in Kent, with young people in...

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Holcombe, M. (2020, February 23). Law students say they don't get mental health treatment for fear it will keep them from becoming lawyers. Some states are trying to change that. Retrieved from https://www.cnn.com/2020/02/23/health/law-school-bar-exam-mental-health-questions/index.html

This CNN article on anxiety in law school addresses the serious circumstances law students face. Law students are required to answer questions about any diagnosed or symptoms of mental health issues before they can become a lawyer. If they do come forward by saying they seek help, it could hinder their chances of becoming a lawyer. This article talks about how many law students don’t seek mental health help for that reason and are now trying to get those questions removed from the exam. While this is the college level, this teaches us future PK-4 teachers that we should normalize students’ emotions. They are young, but they can still struggle with mental health. We need to teach them how it’s okay to feel sad sometimes and that they have someone to talk to if they are feeling stressed.

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Sitting still linked to increased risk of depression in adolescents

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Sitting still linked to increased risk of depression in adolescents

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Sitting still linked to increased risk of depression in adolescents. (2020, February 11). Retrieved from https://www.sciencedaily.com/releases/2020/02/200211193051.htm

In this article, it is described how there could be a potential link between adolescents sitting around and depressive symptoms. It is beneficial to adolescents to be performing some sort of physical activity whether it is actually exercising or simply doing chores. The overall results of the depressive symptoms were measured from self-reports and also accelerometers. Research found that even the lightest amount of activity that was not sedentary helped overall mood a lot and adolescents did not necessarily have to participate in vigorous physical activity.

This article can be useful for teachers because as teachers, they have students in their classroom for most of the day. Light movement can easily be included into lessons or even just transitions. Teachers could also assign homework assignments that include physical activity such as writing a paragraph after taking a nature walk rather than just assignments that only involve sitting still. I think it also is important for teachers to fight for recess and gym classes to make sure students achieve a healthy amount of physical exercise.

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Too much time sitting still -- sedentary behaviour -- is linked to an increased risk of depressive symptoms in adolescents, finds a new UCL-led study.

The Lancet Psychiatry study found that an additional 60 minutes of light activity (such as walking or doing chores) daily at age 12 was associated with a 10% reduction in depressive symptoms at age 18.

"Our findings show that young people who are inactive for large proportions of the day throughout adolescence face a greater risk of depression by age 18. We found that it's not just more intense forms of activity that are good for our mental health, but any degree of physical activity that can reduce the time we spend sitting down is likely to be beneficial," said the study's lead author, PhD student Aaron Kandola (UCL Psychiatry).

"We should be encouraging people of all ages to move more, and to sit less, as it's good for both our physical and mental health."

The research team used data from 4,257 adolescents, who have been participating in longitudinal research from birth as part of the University of Bristol's Children of the 90s cohort study. The children wore accelerometers to track their movement for at least 10 hours over at least three days, at ages 12, 14 and 16.

The accelerometers reported whether the child was engaging in light activity (which could include walking or hobbies such as playing an instrument or painting), engaging in moderate-to-physical activity (such as running or cycling), or if they were sedentary. The use of accelerometers provided more reliable data than previous studies which have relied on people self-reporting their activity, which have yielded inconsistent results.

Depressive symptoms, such as low mood, loss of pleasure and poor concentration, were measured with a clinical questionnaire. The questionnaire measures depressive symptoms and their severity on a spectrum, rather than providing a clinical diagnosis.

Between the ages of 12 and 16, total physical activity declined across the cohort, which was mainly due to a decrease in light activity (from an average of five hours, 26 minutes to four hours, five minutes) and an increase in sedentary behaviour (from an average of seven hours and 10 minutes to eight hours and 43 minutes).

The researchers found that every additional 60 minutes of sedentary behaviour per day at age 12, 14 and 16 was associated with an increase in depression score of 11.1%, 8% or 10.5%, respectively, by age 18. Those with consistently high amounts of time spent sedentary at all three ages had 28.2% higher depression scores by age 18.

Every additional hour of light physical activity per day at age 12, 14 and 16 was associated with depression scores at age 18 that were 9.6%, 7.8% and 11.1% lower, respectively.

The researchers found some associations between moderate-to-vigorous activity at earlier ages and reduced depressive symptoms, although they caution that their data was weaker due to low levels of activity of such intensity in the cohort (averaging around 20 minutes per day), so the findings do not clarify whether moderate-to-vigorous activity is any less beneficial than light activity.

While the researchers cannot confirm that the activity levels caused changes to depressive symptoms, the researchers accounted for potentially confounding factors such as socioeconomic status, parental history of mental health, and length of time wearing the accelerometer, and avoided the possibility of reverse causation by adjusting their analysis to account for people with depressive symptoms at the study outset.

"Worryingly, the amount of time that young people spend inactive has been steadily rising for years, but there has been a surprising lack of high quality research into how this could affect mental health. The number of young people with depression also appears to be growing and our study suggests that these two trends may be linked," Kandola added.

The study's senior author, Dr Joseph Hayes (UCL Psychiatry and Camden and Islington NHS Foundation Trust), said: "A lot of initiatives promote exercise in young people, but our findings suggest that light activity should be given more attention as well."

"Light activity could be particularly useful because it doesn't require much effort and it's easy to fit into the daily routines of most young people. Schools could integrate light activity into their pupils' days, such as with standing or active lessons. Small changes to our environments could make it easier for all of us to be a little bit less sedentary," he added.

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healthy aging; fitness; mental health research; children's health; depression; mental health; intelligence; psychiatry

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Sitting still linked to increased risk of depression in adolescents

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Too much time sitting still -- sedentary behaviour -- is linked to an increased risk of depressive symptoms in adolescents, finds a new UCL-led study. The Lancet Psychiatry study found that an additional 60 minutes of light activity (such as walking or doing chores) daily at age 12 was associated with a 10% reduction in depressive symptoms at age 18.

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Teen Authors Urge Boys to Express Their Feelings

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Teen Authors Urge Boys to Express Their Feelings

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“Teen Authors Urge Boys to Express Their Feelings.” Newsela, newsela.com/read/authors-boys-feelings/id/2000002757/.
This article from Newsela speaks about a group of students who wrote a book about the importance of allowing boys to be emotional and recognize their feelings. Too often, masculinity is driven to be held as a way to mask emotions such as sadness, loneliness, weakness, and hurt feelings. In this article, the students developed a book that confronted male masculinity toxicity and brought up the concerns that avoiding feelings can have a lasting affect on young boys. For students in early grades, especially boys, this article would allow them to identify with characters, or look further into possibly obtaining the text. The article acts as a gateway for boys to be allowed to socially be able to express the same feelings as girls do on a day to day basis. This article would be beneficial for teachers to bring up when talking about expressing emotions, or mental health topics.

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Newsela | Teen authors urge boys to express their feelings

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A story by three Washington, D.C.-area teens tries to undo the myth that boys shouldn't show their feelings.

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Nolan, P. (2020, Feb 23). Rise in Mental Health Challenges for a New Generation. Fox 4 News. Retrieved from https://www.fox4now.com/news/local-news/rise-in-mental-health-challenges-for-a-new-generation
This article on mental health from Fox 4 News talks about how anxiety and depression is rising among teens and young adults. Some of that anxiety stems from social media influences and how most individuals feel uncomfortable seeking help. Drug use and vaping was also mentioned as a a toxic way to cope with those feelings. Trying to understand what the child is going through is crucial in identifying a cry for help along with seeing if counseling is needed to manage. Parents also need to create a safe space with children to listen to their child's feelings and for those feelings to also be recognized. Children's growth and development patterns also need to be accounted for. Resources were provided as a starting point for those who need help and shows where to receive that help. This article relates to the PK-4 classroom because as educators, our children may be suffering from these anxieties and feel school is making these issues worse. They often may feel unsupported and afraid to ask for help & guidance. In the classroom, teachers can create a check-in each morning that can be done anonymously with post-it notes in which the teacher can identify which students need support.

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This article discussed whether or not students should take mental health days.  Only two states allow students to take mental health days.  By allowing students to take mental health days, it allows them to take care of themselves that way they don’t too stressed or overwhelmed.  Having mental health days would be beneficial so that way students don’t have to lie about being sick just to stay home.  If students are lying about being sick because they don’t want to go to school, then parents might not get the chance to talk about their child’s mental health.  This article would be beneficial for teachers of PreK-4 students to read and discuss with their students, because students should know that it’s okay to talk about their feelings and what’s going on.  If teachers know what’s going on with their students, then they would be able to take the right steps to help the student that way they don’t feel like they can’t talk to anyone.

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Should Students Get Mental Health Days Off From School? (Published 2019)

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Two states recently passed laws that allow students to take time off for their mental health. Do you wish your school gave you the option?

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DeeDee Price- How Does Teaching Mental Health in Schools Benefit Students? 

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DeeDee Price- How Does Teaching Mental Health in Schools Benefit Students? 

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This article talks about how teaching mental health in schools can benefit your students. A school district in Indiana noticed that their student’s mental health has been decreasing due to the effects of social medial and other factors. This school district decided to do something to help their students. They taught all of the teacher’s mindfulness techniques and started everyday doing it on the morning announcements. They said the nurse was the first to notice a difference, there was a decrease in the number of students that came in everyday with stomachaches and teachers noticed less conflict among kids. This article is great for teachers because it is a great idea to implement in your classroom. It shows that teaching mental health in your classroom can help your students in so many ways.

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This article on bullying from CNN discusses the viral video of a 9-year-old boy crying into a video camera about how badly he is being bullied. Quaden Bayles is from Australia and has a condition of dwarfism and therefore is constantly facing bullying from his peers in school. He has reportedly attempted suicide in the past and is not afraid to verbally express so, in the video he is yelling “give me a knife, I want to kill myself.” While the mother is video taping her child in his car seat after she picks him up for school, she is expressing that this has been a consistent issue for her child growing up and he cries every single day for his height and appearance. Without knowing her video would be viral, celebrities have reached out to Quaden expressing their sorrow and support for him to live his life to the fullest and expressing how bullying is not OK. Both this article and the viral video is a source for teachers to recognize bullying and talk about it in the classroom. Getting to know every child and having the students get to know one another is essential to building kind relationships to prevent bullying. The teacher can express effects bullying can have on a person and only promote individuality and uniqueness.

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Celebrities rally to send Quaden Bayles to Disneyland after bullying video goes viral | CNN

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Bullied at school for his dwarfism, 9-year-old Quaden Bayles sobs uncontrollably in the back of his mother’s car – saying to the camera: “Give me a knife, I want to kill myself.”

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This article discusses how depression and other mental health issues are linked to over-usage of social media in teenagers. By using social media, teens are exposed to cyber-bullying which has been linked to depressive behaviors. With 97% of adolescents using at least one social media platform, this has been looked at extensively and further linked to anxiety, loneliness, aggression, antisocial behaviors, and internalizing behaviors.

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For some adolescents and teenagers, using social media like Twitter or Instagram can be as easy as breathing, and costs about as much. But a new study released Wednesday suggests there could be a hidden price: their mental health.

Young people who spend more than 3 hours a day on social media are susceptible to depression, anxiety and other illnesses and are more likely to internalize bad feelings about themselves, according to the study produced by Johns Hopkins University Bloomberg School of Public Health.

"Time spent on social media may increase the risk of experiencing cyberbullying, which has a strong association with depressive symptoms," according to the study, published in JAMA Psychiatry, an online platform of the Journal of the American Medical Association. Seeing others' lives on social media platforms like Snapchat "may also expose adolescents to idealized self-presentations that negatively influence body image and encourage social comparisons."

Kira E. Riehm, the paper's lead author and researcher at the Bloomberg School of Public Health, says social media use "has exploded in the past few decades among adolescents." But it comes at a hazardous time, she says, because "adolescence is a time where a lot of mental health problems have their onsets."

"It's important to consider that every minute that adolescents spend on social media, they're not doing something else," says Riehm. "It might be socializing (with friends) face to face, it might be exercising" or something else to support their mental health.

But it might be difficult to break the grip between young people and social media -- something that's ubiquitous and seemingly an extension of their personal lives.

"A 2018 Pew Research Center poll found that 97% of adolescents report using at least 1 of the 7 most popular social media platforms (YouTube, Instagram, Snapchat, Facebook, Twitter, Tumblr, and Reddit)," according to the study. "Moreover, digital media use by adolescents is common: 95% report owning or having access to a smartphone, and almost 90% report they are online at least several times a day."

The study sought to examine the effects of that level of exposure using longitudinal data from the Population Assessment of Tobacco and Health, "a nationally representative, longitudinal cohort of adolescents," according to the study.

Data was examined for some 6,600 adolescents ages 12 to 15 who reported spending time on social media during a typical day but who also reported mental health difficulties, according to the study.

After weighing factors including mental health history, the research found that the youngsters who spent more than three hours a day on social media were more likely to report "internalizing" their problems, including depression, anxiety and loneliness, along with symptoms like aggression and antisocial behavior, compared with adolescents who didn't use social media, according to the study.

"In fact, the (data) suggest that if adolescents using social media for more than 30 minutes per day had instead used it for 30 minutes or less, there would have been 9.4% fewer high internalizing problem cases and 7.3% fewer high externalizing problem cases," according to the study. It's a correlation, but researchers point out "this is not meant to imply that reductions in mental health problems would definitely happen if social media use were reduced or that all social media use is harmful."

Though the data suggests a link between excessive use and mental health issues, Riehm says "a lot of positive things" can come from connections teens make over social media. Besides providing an online support system for marginalized young people, like those in the LGBTQ community, "who can be isolated in their day-to-day lives," she says, Snapchat and other platforms also can help keep adolescents informed about current events.

One potential solution is to help young people curb the amount of time they spend online, says Riehm. She points to an American Academy of Pediatrics online "toolkit" that can help parents and children manage social media use, including curfews and "screen-free" rooms where they can't use computers or cell phones.

More importantly, Riehm adds, parents should teach their children to think critically about what they're seeing online, and that "idealized" photos of their friends don't necessarily represent an ideal life.

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Social Media Use May Increase Teens Risk of Mental Health Issues

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For some adolescents and teenagers, using social media like Twitter or Instagram can be as easy as breathing, and costs about as much. But a new study released Wednesday suggests there could be a hidden price: their mental health.