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Here it is!

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"Teaching children about mental illness won’t prevent it from occurring, but it can arm students with skills needed to understand it and to know when to seek help for themselves or others."
- The Buffalo News

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"The visibility of the school nurse in delivering mental health education classes promoted an awareness of
the important role of the school nurse in mental health education, prevention, and early intervention."
- The Journal of School Nursing

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"[After taking part in a mental health education program] Students voiced increased comfort in seeking help from the school nurse, teachers, and counselors regarding mental health issues. "
- The Journal of School Nursing

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"over the last 25 years... in the UK, it has been estimated that anxiety and depression has increased by 70%."
- Hart, Education and Health

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Students should be taught about mental health and mental disorders throughout school to help raise awareness and understanding and to reduce the stigma surrounding them.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Advancing mental health in schools

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

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

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

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

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

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

Ending the marginalization

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

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

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

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

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Millions of American students suffer from mental health problems, and only a fraction are receiving necessary treatment, warns a brief from the American Institutes for Research.

And the prevalence of mental health problems appears to be growing. Sixty-two percent of college students reported feeling "overwhelming anxiety" over the previous year in 2016, up from 50 percent just five years prior. More alarming still, hospitalizations for mood disorders among children ages 17 and under leaped by 68 percent between 1997 and 2011.

Building largely on government data, including a blockbuster 2013 analysis from the Centers for Disease Control and Prevention, the brief observes that up to 20 percent of Americans under the age of 18 suffer from mental, behavioral, or emotional disorders. (That translates to approximately 15 million children across the country, according to 2010 U.S. Census figures.) The most common disorders include ADHD, depression, conduct problems, autism, substance abuse, and Tourette's syndrome.

Yet estimates show that almost half of all children with those emotional or psychological conditions don't receive either medication or psychological services, and only 7.4 percent of adolescents report visiting with a mental health professional over the course of a year. Since the onset of these problems can be difficult to detect, and millions of families lack health insurance, children must often rely on mental health resources provided by their schools.

"Schools sometimes serve as the de facto mental health system for children in the United States," write authors Elizabeth Freeman and Kimberly Kendziora.

The report recommends that schools develop "multilevel, evidence-based interventions" to reverse the tide of young adults - particularly those living in poverty - struggling with depression, anxiety, and a host of other ailments.

Yet in-school supports are already overstretched. Although the National Association of School Psychologists recommend a ratio of no more than 700 students per school psychologist when comprehensive mental health services are being provided, the ratio across American schools in 2014-15 was estimated to be nearly twice that. Teachers, already responsible for academic achievement and classroom management, typically receive little training in dealing with mental health problems.

That's why schools need to lead the way in collecting mental health information among students and family and developing working relationships with local doctors, hospitals, and mental health agencies, according to the brief.

The authors recommend that school leaders use one of a number of free tools to develop surveys for both parents and school staff, inquiring about the most common mental health problems students experience and the availability of community-based services to address them. Next, leaders can develop school-level mental health plans that specify which interventions (support groups, youth mentoring, outpatient treatment) are most needed and how to target them.

"Partnerships between schools and community mental/behavioral health professionals offer students and families an extended network of services that are easily accessible," the authors write. "When programs are able to identify and address student mental and behavioral challenges early, students are more likely to gain resiliency skills and be successful in school and life while the threat of later harm is reduced."

That harm is both real and severe. Children with mental health problems are vastly more likely to develop substance abuse problems, become involved in criminal activity, and drop out of school. Among Americans ages 10 to 24, suicide is the third-leading cause of death.

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The Hidden Mental Health Crisis in America's Schools: Millions of Kids Not Receiving Services They Need

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Millions of American students suffer from mental health problems, and only a fraction are receiving necessary treatment, warns a brief from the American Institutes for Research. And the prevalence of mental health problems appears to be growing. Sixty-two percent of college students reported feeling "overwhelming anxiety" over the previous year in 2016, up from 50 [...]