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Nearly 50% of youth aged 8-15 didn’t receive mental health services in the previous year

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Credit: University of Liverpool

New research shows a quarter of girls (24%) and one in 10 boys (9%) are depressed at age 14.

Researchers from the University of Liverpool and University College London analysed information on more than 10,000 children born in 2000-01 who are taking part in the Millennium Cohort Study.

At ages 3, 5, 7, 11 and 14, parents reported on their children's mental health. Then, when they reached 14, the children were themselves asked questions about their depressive symptoms.

Based on the 14-year-olds reporting of their emotional problems, 24 per cent of girls and 9 per cent of boys suffer from depression.
Family income
The research, published with the National Children's Bureau, also investigated links between depressive symptoms and family income. Generally, 14-year-olds from better-off families were less likely to have high levels of depressive symptoms compared to their peers from poorer homes.

Parents' reports of emotional problems were roughly the same for boys and girls throughout childhood, increasing from 7 per cent of children at age 7 to 12 per cent at age 11. However, by the time they reached early adolescence at age 14, emotional problems became more prevalent in girls, with 18 per cent having symptoms of depression and anxiety, compared to 12 per cent of boys.

Behaviour problems, such as acting out, fighting and being rebellious decreased from infancy to age 5, but then increased to age 14. Boys were more likely than girls to have behaviour problems throughout childhood and early adolescence.

As 14-year-olds' own reports of their emotional problems were different to their parents', this research highlights the importance of considering young people's views on their own mental health.
'Worryingly high'
The lead author, Dr Praveetha Patalay from the University of Liverpool's Institute of Psychology, Health and Society, said: "In recent years, there has been a growing policy focus on children's mental health. However, there has been a lack of nationally representative estimates of mental health problems for this generation.

"In other research, we've highlighted the increasing mental health difficulties faced by girls today compared to previous generations and this study further highlights the worryingly high rates of depression."

Professor Emla Fitzsimons, Director of the Millennium Cohort Study, said: "These stark findings provide evidence that mental health problems among girls rise sharply as they enter adolescence; and, while further research using this rich data is needed to understand the causes and consequences of this, this study highlights the extent of mental health problems among young adolescents in the UK today."
'Crisis point'
Anna Feuchtwang, Chief Executive of the National Children's Bureau, said: "This study of thousands of children gives us the most compelling evidence available about the extent of mental ill-health among children in the UK. With a quarter of 14-year-old girls showing signs of depression, it's now beyond doubt that this problem is reaching crisis point.

"Worryingly there is evidence that parents may be underestimating their daughters' mental health needs. Conversely, parents may be picking up on symptoms in their sons, which boys don't report themselves. It's vital that both children and their parents can make their voices heard to maximise the chances of early identification and access to specialist support.

"The new research also suggests that signs of depression are generally more common among children from poorer families. We know that mental health doesn't exist in a vacuum and as the government prepares to publish its plans to improve children's wellbeing, it must address the overlap with other aspects of disadvantage."

More information: Mental ill-health among children of the new century: Trends across childhood, with a focus on age 14: www.ncb.org.uk/sites/default/f ... l-Health%20FINAL.pdf

Provided by: University of Liverpool

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One in four girls is depressed at age 14, new study reveals

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New research shows a quarter of girls (24%) and one in 10 boys (9%) are depressed at age 14. Researchers from the University of Liverpool and University College London analysed information on more than 10,000 children born in 2000-01 who are taking part in the Millennium Cohort Study.

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- finding teachers that are certified/willing to teach the classes
- money
- stigma exists outside of just schools

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Source: Canadian Living and Pathstone Mental Health
Myth #1: Mental health problems do not affect children or youth. Any problems they have are just part of growing up.
Reality: One in five children and youth struggle with their mental health. 70% of adult mental illness begins during childhood or adolescence, including: depression, eating disorders, obsessive compulsive disorder and anxiety disorders. However, 79% of youth who receive help improve significantly with treatment, which lasts less than 12 sessions for 66% of them.
Myth #2: It is the parents' fault if children suffer from mental health problems.
Reality: Mental health disorders in children are caused by biology, environment, or a combination of both. They can be caused by genetics or biological factors such as a chemical imbalance or prenatal exposure to alcohol or drugs. They can also be the result of abusive or neglectful treatment or stressful events.
Myth #3: People with a mental illness are 'psycho', mad and dangerous, and should be locked away.
Reality: Most people who have a mental illness struggle with depression and anxiety. They have normal lives, but their feelings and behaviours negatively affect their day-to-day activities. Conduct disorders or acting out behaviours are consistently the primary reason for referral to a children's mental health agency.
Myth # 4: All people with Schizophrenia are violent.
Reality: Very little violence in society is caused by people who are mentally ill (violence and mental illness). Unfortunately, Hollywood often portrays mentally ill people as dangerous. People with a major mental illness are more likely to be victims of violence than perpetrators.
Myth #5: Depression is a character flaw and people should just 'snap out of it'.
Reality: Research shows that depression has nothing to do with being lazy or weak. It results from changes in brain chemistry or brain function. Therapy and/or medication help people to recover.
Myth #6: Addiction is a lifestyle choice and shows a lack of willpower.
Reality: Addictions involve complex factors including genetics the environment, and sometimes other underlying psychiatric conditions such as depression. When people who become addicted have these underlying vulnerabilities it's harder for them to simply kick the habit.
Myth #7: Electroconvulsive therapy (ECT), also known as shock therapy, is painful and barbaric.
Reality: ECT is one of the most effective treatments for people whose depression is so severe that antidepressant medications just don't do the job and who are debilitated by the depression.
Myth #8: People with a mental illness lack intelligence.
Reality: Intelligence has nothing to do with mental illnesses or brain disorders. On one hand, many people with mental disorders are brilliant, creative, productive people. On the other hand, some people with mental disorders are not brilliant or creative. Certain mental illnesses may make it difficult for people to remember facts or get along with other people, making it seem like they are cognitively challenged. Overall, the level of intelligence among people with mental illness likely parallels the patterns seen in any healthy population.
Myth #9: People with a mental illness shouldn't work because they'll just drag down the rest of the staff.
Reality: People with mental illness can and do function well in the workplace. They are unlikely to miss any more workdays because of their condition than people with a chronic physical condition such as diabetes or heart disease. The real problem is the prejudice against hiring people with mental illness (how will disclosing my mental illness affect work/school). The resulting unemployment leaves them isolated, a situation that can add to their stress, and make it more difficult to recover from the illness.
Myth #10: Mental illness is a single, rare disorder.
Reality: Anxiety disorders, mood disorders, personality disorders, addiction disorders and impulse control disorders are all different categories of very different mental illnesses- each with its own features and underlying causes (common mental illnesses). Each mental illness is a variation on the theme of brain chemistry gone awry, affecting things like mood and perception and each has its own specific causes, features and approaches to treatment.
Myth #11: People with a mental illness never get better.
Reality: TREATMENT WORKS! Treatments for mental illnesses are more numerous and more sophisticated than ever and researchers continue to discover new treatments. Because of these advances, many people can and do recover from mental illness.

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Source: Canadian Living and Pathstone Mental Health Myth #1: Mental health problems do not affect children or youth. Any problems they have are just part of growing up. Reality: One in five children and youth struggle with their mental health. 70% of adult mental illness begins during childhood or adolescence, including: depression, eating disorders, obsessive compulsive disorder and anxiety disorders.

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Every day, in every possible way, we need to stand up to stigma. If you're not sure how, here are some ways our Facebook community responded to the question: "How do you fight stigma?"

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- 1 in every 5 children ages 13-18 have or will have a serious mental illness
- 50 percent of students age 14/older with a mental illness drop out of high school
-According to the National Institute on Drug Abuse, people with a mood or anxiety disorder are more than twice as likely to develop an addiction to opioids and other drugs.
-According to the CDC, the suicide rate among boys ages 15 to 19 increased by nearly a third between 2007 and 2015; the suicide rate among girls the same age more than doubled.

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The best way to begin resolving the mental health crisis in America is by defeating the stigmas surrounding it. Schools can do this through mental education courses to teach about the reality of mental illness, address misconceptions that lead to stigma, and empower students struggling with mental illness.

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Amid sharply rising rates of teen suicide and adolescent mental illness, two states have enacted laws that for the first time require public schools to include mental health education in their basic curriculum.

Most states require health education in all public schools, and state laws have been enacted in many states to require health teachers to include lessons on tobacco, drugs and alcohol, cancer detection and safe sex.

Two states are going further: New York's new law adds mental health instruction to the list in kindergarten through 12th grade; Virginia requires it in ninth and 10th grades.

Nationwide, cities and states have been adopting a variety of initiatives over the past decade to address the rising need for mental health care in schools.

But until this year, mandated mental health education had not been part of the trend.

"We're seeing a huge increase in youth anxiety and depression," said Dustin Verga, a high school health teacher in Clifton, New York, who was an early advocate for the state's new law.

"We teach them how to detect the signs of cancer and how to avoid accidents, but we don't teach them how to recognize the symptoms of mental illness," Verga said. "It's a shame because, like cancer, mental health treatment is much more effective if the disease is caught early."

A report from the Centers for Disease Control and Prevention this month shows the U.S. suicide rate rose by a quarter between 1999 and 2016. That and two celebrity deaths this month - those of fashion designer Kate Spade, 55, and chef Anthony Bourdain, 61 - have raised the nation's consciousness about depression and suicide prevention.

But mental illness can set in much earlier than adulthood. More than half of lifetime mental illnesses begin before age 14, according to the National Alliance on Mental Illness. Yet the average person waits 10 years after the first symptoms occur before getting treatment.

By educating children of all ages about mental health, the hope is that they will learn how to recognize early symptoms in themselves and their friends and seek help before a crisis develops, said Paul Gionfriddo, president and CEO of Mental Health America, a nonprofit that advocates for better mental health care.

"People are talking more about youth mental health and the effects of trauma on kids, but it's taken a long time to get traction. I think what we've seen recently in terms of school shootings is spurring this," Gionfriddo said. "It wouldn't surprise me to see a number of states go in the same direction over the next few years," he said, referring to New York and Virginia.

The rate of adolescents experiencing major depression surged nearly 40 percent from 2005 to 2014, according to a study by researchers at the Johns Hopkins University School of Medicine, rising to an estimated 2.2 million depressed children ages 12 to 17, according to the most recent federal data.

Teen suicides also have spiked. According to the CDC, the suicide rate among boys ages 15 to 19 increased by nearly a third between 2007 and 2015; the suicide rate among girls the same age more than doubled.

But that only accounts for the deaths. Nearly 9 percent of youths in grades nine through 12 attempted suicide in the past year, according to the CDC's 2015 Youth Risk Behaviors Survey.

In response, many states have increased funding for school counseling and added psychologists to their health staffs. Others are thinking of doing the same. Republican Texas Gov. Greg Abbott this month recommended adding more counselors to schools following a mass shooting at a Santa Fe school. His is one of 20 states that don't require school counselors.

And most states have adopted so-called mental health first aid programs to train first responders, primary care physicians, teachers and other school personnel to detect the signs of mental illness and addiction and provide preventive measures including referral to treatment.

In addition, a slim majority of states mandate suicide prevention training for school personnel, and close to a dozen states require annual courses. More than a dozen states encourage and facilitate training, but do not require it.

Different Paths

In New York, it was a nonprofit mental health group that came up with the idea of requiring schools to educate students about mental illness in all grades. That was seven years ago.

The Legislature was immediately interested, said John Richter, the public policy director for the Mental Health Association in New York State Inc. "The problem was finding a way to cut in line ahead of dozens of other competing educational issues."

It was the opioid crisis and its strong connection with mental illness that ultimately allowed the New York Assembly's education committee to bring the mental health bill to a vote in 2016, Richter said. Armed with research showing that people with mental conditions often self-medicate with drugs and alcohol, the chairman found an eager audience of lawmakers who wanted to do everything they could to quell the overdose epidemic, he said.

According to the National Institute on Drug Abuse, people with a mood or anxiety disorder are more than twice as likely to develop an addiction to opioids and other drugs.

New York's law doesn't prescribe a specific classroom curriculum for mental health, leaving the details up to the board of education. But the state is giving $1 million a year to the mental health association to offer an online mental health resource center and free training services for teachers starting in July.

In the fall, New York public school teachers will be encouraged to incorporate the topic of mental illness into subjects such as science, literature, history and social studies whenever possible, according to Richter. And health teachers will be called on to develop lesson plans that describe the disease of mental illness, methods of treating it, and healthy coping techniques students can use to protect themselves and their friends from the mounting pressures of school life.

"The life students live today is very different from what it was just 10 years ago," Clifton's Verga said. "Technology and social media have taken over. Kids are getting cellphones at an earlier age and facing escalating academic expectations and standardized assessments starting in third grade."

In Virginia, the path from idea to statute was much shorter.

The new law was the brainchild of three students who attended summer classes on political leadership at the University of Virginia. For them, the biggest political issue for high school kids was an urgent need for more mental health resources.

With that in mind, they decided that the best approach would be a statewide educational program that would explain the brain science behind mental illness, help students learn how to improve their own mental well-being, and reduce the stigma around mental health.

They found a receptive legislative sponsor in state Sen. Creigh Deeds, a Democrat from Charlottesville whose son stabbed him and later killed himself after being denied emergency psychiatric services in 2013.

Their bill flew through the Legislature and Democratic Gov. Ralph Northam signed it into law in March. It is set to take effect in the fall.

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Many Recommend Teaching Mental Health In Schools. Now Two States Will Require It.

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Amid sharply rising rates of teen suicide and adolescent mental illness, two states have enacted laws that for the first time require public schools to include mental health education in their basic curriculum.

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More than 50 million students are enrolled in public schools across the United States. Of those, one in five meet the criteria for a mental health condition. About 70-80% of these students won't receive any kind of treatment or therapy. Because children and adolescents spend most of their time at school, teachers, administrators, school nurses, and other staff are often in a unique position to be the first to identify any problems or issues in a child's life. Here are some ways for public schools to better address this rising mental health crisis.

Mental Health Screening in Public Schools

Most schools do not have any type of mental health screening in place for students. The National Association on Mental Illness supports mental health screenings for several reasons. Half or more of chronic mental health issues begin at or before age 14. Early identification and treatment can help prevent more serious problems down the road.

Just as screenings are done for a variety of physical health problems, mental health screenings in public schools could greatly benefit vulnerable students. Conducting mental health screenings in schools allows teachers to recognize the warning signs of various mental health issues, allowing for earlier identification and quicker connections to the treatment resources students might need.

The Role of Public School Nurses in Mental Health

While school nurses are usually the most likely to catch any mental health issues early on, many schools only have one on-staff nurse, and many of these nurses only work part-time. It is not uncommon for entire school districts to share one nurse, meaning that one nurse may see hundreds or even thousands of students (depending upon the size of the district). This makes it more unlikely that a school nurse would be able to spot symptoms of mental health issues, as the nurse may not be available or have enough time with each student to address their needs.

According to the American Association of Pediatrics, schools function as the mental health system for approximately 80% of students. For this reason, school nurses play a critical role in identifying problems so they can be treated as soon as possible. Unfortunately, school nurses typically receive little to no training in mental health.

While nurses aren't expected to be psychologists or therapists, they should be aware of emotional, physical, and behavioral warning signs for common mental health problems. Awareness and recognition of problems as soon as they arise could prevent a suicide.

Integrated Mental Health Strategy in Public Schools

Researchers suggest the best way to help students with mental health issues may be to have teachers, counselors, administrators, and school nurses work together to spot and handle mental health issues. Saddling this responsibility on one teacher or administrator is not likely to be effective because they typically do not have the necessary training or time. On average, school counselors see around 500 students. School nurses may see even more students, especially if they are the only nurse for an entire district. Teachers also see a significant amount of students, ranging from 20-30 in elementary schools to hundreds of students in middle schools and high schools where students change classes and teachers throughout the day.

Integrating mental health care and strategies in public schools can help all staff who encounter students. They will likely be better able to recognize mental health problems and provide early intervention as well as prevention for many issues, including thoughts of suicide, drug and alcohol use, and relationship abuse. To recognize these potential problems, some degree of training in mental health will likely be necessary.

Some signs that a student may be experiencing a mental health condition include:

Sudden changes in a student's mood or behavior

Frequent mood swings

Behavioral problems such as aggression, temper tantrums, or lashing out in school

Poor academic performance

Poor hygiene

Frequent absences

No longer participating in extracurricular activities

Isolation from peers

Difficulty paying attention in class

Excessive worrying or anxiety

Hyperactivity

Difficulty relating to others

Somatic complaints (stomachaches, headaches) with no clear physiological cause

Providing Mental Health Services in Public Schools

According to the 2016 Children's Mental Health Report, young people with access to mental health treatment and services in school are 10 times more likely to seek help for mental health and substance abuse concerns than those who do not have such programs available. Many schools are choosing to address the rising mental health crisis in the public-school system by hiring a professional psychotherapist, counselor, or psychologist on staff. Other schools have therapists come in from community mental health centers to see students who are struggling with mental health issues beyond the guidance counselor's scope of expertise.

Congresswoman Grace Napolitano is currently working on implementing the Mental Health in Schools Act, which would provide $200 million in funding through competitive grants of $1 million each to 200 public schools across the country. This funding would help them provide on-site licensed mental health professionals in public schools. Napolitano has been executing these programs since 2001 in 14 public schools in her congressional district. This approach has proven successful and will be expanded nationwide through the funding provided by the Substance Abuse and Mental Health Services Administration.
References:

1. Anderson, M. & Cardoza, K. (2016, September 7). A silent epidemic: Our public schools are struggling to handle millions of students with mental health problems. Retrieved from http://apps.npr.org/mental-health/

2. Association for Children's Mental Health. (n.d.). Problems at school. Retrieved from http://www.acmh-mi.org/get-help/navigating/problems-at-school/

3. Cardoza, K. (2016, September 3). School nurses can be mental health 'detectives' but they need help. Retrieved from http://www.npr.org/sections/ed/2016/09/03/478835294/school-nurses-can-be-mental-health-detectives-but-they-need-help

4. Child Mind Institute. (2016). 2016 children's mental health report. Retrieved from http://childmind.org/report/2016-childrens-mental-health-report/

5. Facts on the Mental Health in Schools Act. (n.d.). Retrieved from http://napolitano.house.gov/resources/additional-resources/mental-health-schools-act/facts-mental-health-schools-act

6. Firth, S. (2015, February 20). Hospitals see alarming increase in suicidal children. Retrieved from http://www.medpagetoday.com/pediatrics/preventivecare/50117

7. National Alliance on Mental Illness. (n.d.). Mental health screening. Retrieved from http://www.nami.org/Learn-More/Public-Policy/Mental-Health-Screening

8. Shefall, A., Asti, L., et al. (2016, September). Suicide in elementary school-aged children and elderly adolescents. doi:10.1542/peds.2016-0436

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Addressing the Rising Mental Health Crisis in Public Schools

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More than 50 million students are enrolled in public schools across the United States. Of those, one in five meet the criteria for a mental health condition. About 70-80% of these students won't receive any kind of treatment or therapy.

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Five things schools can do to help pupils’ mental health

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What schools should be doing to deal with the crisis in children’s mental health.

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- "Participants who indicated that they believed in stereotypes of dangerousness and believed that SMI defines an individual's identity were more likely to express desire for both social distance and restrictions." -- people suffering from mental illness feel silenced by the stigma: they don't want to be defined by their illness or be marginalized because of it; therefore, they are less likely to seek help
- need to teach about the reality of mental illness; kids (and teachers) need to realize and learn that mental illness is the result of biology - it is no one's fault, it's nothing to be ashamed of, it does not define a person's identity, but it is real.
- teach about symptoms and warning signs to help kids and teachers identify signs in themselves and others
- address misconceptions: mentally ill people are violent, mentally ill people are weak, mental illness is a character flaw/choice, mentally ill people are unintelligent, treattment is not possible, mental illness makes a person crazy; this is especially important for those who don't have mental illness because misconceptions often contribute to labels and stigmas that will prevent students who need help from being honest about it; misconceptions often lead to shame and silence
- empower students to seek help: make it possible for them to see a psychologist or counselor; students struggling with mental illness & give them hope for improvement; when students realize that not only is help available, but people actually want to help them, they are more likely to reach out and get help

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Every day, thousands of teens attempt suicide in the U.S. - the most extreme outcome for the millions of children in this country who struggle with mental health issues.

As we've reported all week, schools play a key role, along with parents and medical professionals, in identifying children who may be at risk of suicide. And one of the biggest challenges: myths that can cloud their judgment.

"People are afraid of the whole topic," says David Jobes, the head of Catholic University's Suicide Prevention Lab. "It just feels like something that's left unsaid or untouched."

Jobes says one of the most common - and most dangerous - myths about suicide is that young children just don't kill themselves.

It's just not true.

Children as young as 5 take their own lives every year. Another myth? Suicides are an impulsive decision, made in the heat of the moment.

Again, not true.

Jobes says kids can spend weeks thinking about and planning for their own deaths. And that, he says, is where schools have a role to play.

"They're going to be letting their friends know, dropping hints, writing essays that their English teacher might pick up, telling coaches," Jobes says. One thing teens considering suicide won't do is tell their parents.

We asked Jobes to walk us through a few other common misperceptions of suicide.
Myth 1: Asking someone about suicide will cause him to become suicidal
"There's already issues and struggles around mental illness within our culture and society. It's highly stigmatized, and suicide is even more stigmatized. It feels like something that's just best left unsaid or untouched, kept under the rug, and that's a problem in terms of saving lives. Because we need to ask, and we need to intervene to actually save lives. You need to be direct. 'Sounds like you're really down, have you thought about taking your life?' Just very direct. The more direct the better."
Myth 2: Depression causes all suicides
"That's just not true. So, we have millions of Americans who are depressed. A small fraction of them take their lives, a very small fraction. So depression and suicide are not synonymous.

"On average, about a hundred and some Americans die each day [from suicide]. About 40 to 50 of them might be depressed. Other diagnoses are relevant - like schizophrenia, psychotic disorders, substance abuse, anxiety disorders. It's not just all about depression."
Myth 3: We cannot really prevent suicides
"We know very clearly that, with proper identification, proper support and treatments that are suicide-specific, we absolutely can make a difference and save lives. Most suicidal people who talk about suicide don't really want to be dead. They're giving other people lots of indications, lots of warning signs, lots of communications that this is something that they would like to not do, but it requires people identifying that and getting them the proper help.

"Some of the warning signs would certainly be depression and ... loss of concentration. People not seeming like themselves. Insomnia can be a big risk factor. Other warning signs might include irritability, withdrawal. And the thing that's really critical: Lots of people have those symptoms and are not thinking about suicide. It's really when the symptoms add up in the mind of that person, where they think 'The way I deal with this is to take my life.' "
Myth 4: Suicides always happen in an impulsive moment
"People contemplate, think about it, imagine it, fantasize about it, write suicide notes, post things on the Web. After many days or weeks, [they] then perhaps make a fatal attempt. There is a major theory in the field that says that no suicides are impulsive. That there is always a history if you dig deep enough.

"The idea that they come out of the blue may happen, but it's actually quite rare. A small number of people, especially among adolescents or school kids, are not going to communicate their intent. But that's the exception. They're going to be mostly letting their friends know, dropping hints, writing essays that their English teacher might pick up, telling teachers and coaches. So when people say this, they're not crying wolf. It's something to take seriously.

"Kids telling other kids is really critical because that's who they're gonna tell. They are not going to typically tell their parents. They get oftentimes a very negative reaction, even a punitive reaction. So, schools are in a position to try to communicate to kids that talking to your friends is fine, but if you really are a friend of this person, keeping a secret about something as serious as suicide is not in their best interest. And they need to pass that information up to teachers or the principal or to ... counselors who are in a position to get professional help involved."
Myth 5: Young children, ages 5 through 12, cannot be suicidal
"Young children do take their lives. In the United States each year, about 30 to 35 children under the age of 12 take their own lives.

"It's hard for a lot of us to imagine that a child that young - a 5-, 6-, 7-year-old - could actually know what it means to say, 'I want to kill myself.' But we do research with young children and know that kids are saying these words.

"They do intend it, and they do sometimes take their lives. Oftentimes, by running into traffic and getting hit by a car. We don't know a lot about young children taking their lives. The suicide prevention literature kind of begins at age 12 to 14. It's almost as if, even in the professional literature, young children can't be suicidal. And it's just not the case."
Myth 6: When there has been a suicide, having a school assembly seems like a good idea
"There's literature and a professional take on all this that in post-vention, which is intervening after a suicide has occurred in a school, you want to find a response that is not overreacting, which would cause other kids to copycat or to follow that behavior.

"Alternatively, you don't want to underreact. And so there is a very useful literature out there, professional associations that provide guidelines where we try to find that sweet spot of attending to the fact that this happened, providing necessary information and then resources, but not letting the whole school out to go to the funeral. Or not having an assembly where everybody comes to hear from an expert about suicide.

"We really want to have these conversations in smaller groups, especially among those kids who were most affected by the suicide. So, just a wholesale didactic event is not necessarily in the school's best interest. And not necessarily the best way to prevent copycat suicides or additional suicides.

" The American Foundation for Suicide Prevention does have very useful guidelines that are specific to schools. The American Association of Suicidology has also had a task force. There is extensive literature that is accessed through those organizations about what is optimal, school-based post-vention.

"We certainly know that children and adolescents are heavily influenced, especially teenagers, by their peers. And that's developmentally normal. So one of the things that we do worry about with kids is the idea of copycat effects, or modeling effects. That a child in a school system who may seem sort of invisible takes their life and then suddenly everybody is abuzz about this horrific event.

"For other kids who look at that, they might say, 'Wow, that's something I could do, too.' And that's the nature of the suicidal mind in a child - to not really think about this in a rational way. And that's where modeling effects are especially worrisome. And then we, of course, worry about clusters or contagion effects. And there is an extensive literature on how to manage that modeling effect so that there aren't additional suicides to add on top of what is a tragic event in most school systems.

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6 Myths About Suicide That Every Educator And Parent Should Know

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Every day, thousands of teens attempt suicide in the U.S. - the most extreme outcome for the millions of children in this country who struggle with mental health issues. As we've reported all week, schools play a key role, along with parents and medical professionals, in identifying children who may be at risk of suicide.

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

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

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

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

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

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

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

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

Every student, every day?

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

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

Now her successor carries on that tradition.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Here's How Schools Can Support Students' Mental Health

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