Mental Health Education for Teens and Adolescents

Contextualizing the Problem

Josh Falk, Amy Marx, Elana McGaughy and Jason Utley

December 10th, 2014

Introduction

This paper addresses the stigmatization of mental health in adolescents. The issue of focus is societal perceptions of mental illness that exacerbate symptoms of depression/anxiety and impact individuals, families, and education within school systems. Potential causes of mental illness are addressed and the causalities are vast. Stigma is thought to perpetuate undesirable symptoms experienced and contribute toward the ill effects of depression/anxiety by acting as a barrier to receiving health services. Various stakeholders are involved when considering mental health stigma, and these stakeholders include but are not limited to; individuals with a mental illness, their families, school systems, as well as numerous organizations dedicated to mental health.                 

The Issue

For adolescents in Utah, suicide is the second leading cause of death (Utah Department of Health, 2012). Teenagers are seen daily in emergency departments and millions of dollars are spent each year treating/hospitalizing youth that have attempted suicide. Unfortunately the suicide rates in Utah continue to be higher in comparison to other states in the country. The main risk factors identified in those who are more likely to attempt suicide are depression and anxiety (Galaif, Sussman, Newcomb, Locke, 2007). Symptoms of depression are unpleasant and can be exacerbated by stigma, negative perceptions and misinformed beliefs held by general society. This is troublesome when considering youth with depression and other mental disorders are commonly perceived as less popular, are likely to act out violently and to be socially rejected (Walker, Coleman, Lee, Squire, Friesen, 2008). This can undoubtedly lead to isolation, judgment, and discrimination, thus perpetuating the illness.  

Similarly, individuals are less likely to seek assistance from family members or health professionals due to perceived mental illness stigma. It is not uncommon for youth with depression or anxiety to experience unwarranted assumptions, distrust, avoidance, pity, and/or gossip (Moses, 2010). Thus, undesired symptoms of mental illness are often not addressed until one’s life is at stake. The issue at hand is the stigma and lack of resources dedicated toward mental health education within school districts in the state of Utah.

Only recently in 2013 has state legislation required school districts to provide annual seminars to the parents of all 11,000 students enrolled in the district, discussing in the seminars mental health, depression, and suicide (NAMI, 2013). Noteworthy, “ (5) (a) A school district is not required to offer the parent seminar if the local school board determines that the topics described in Subsection (2) are not of significant interest or value to families in the school district” (Programs for youth protection, 2014, 53A-15-1302). However the school board must explain to the State Board of Education reasoning behind not offering the seminar.  Conceptualizing the issue further, according to the U.S. Department of Education Office for Civil Rights, 1 in 5 high schools nationwide lack a school guidance counselor to provide timely support to those seeking help (Teacher Equity, 2014). In a classroom setting, health educators are left with the daunting task of teaching consumer health, safety, nutrition/fitness, disease prevention, drug prevention, human sexuality, and emotional/mental health. An argument could be made that the stigmatization of mental health disorders are often an afterthought discussed in brief stints, or not addressed at all. This is worrisome when considering there are various ideologies behind the causality of mental illness in regards to depression and anxiety.    

Cause of the Issue

Psychologists, psychiatrists and scientists alike have tried for years to understand what causes one of the most outdoorsy states in the nation to have such high rates of mental illness. Conclusions range from possible religious expectations, a cultural focus on perfectionism, various genetic factors, high levels of elevation and most significantly, the social stigma surrounding these disorders; as was stated in the 2007 study, An Analysis of Depression Across the States: “Mental illness, disability, and suicide are ultimately the result of a combination of biology, environment, and access to and utilization of mental health treatment” (NAMI, 2007). Leslie Klein, who works at Wasatch Mental Health, stated that Utah has the highest rate of mental illness in US: “because there is a stigma associated with mental illness and people often postpone getting help. People wait to get diagnosed, therefore their condition is far worse than it needs to be and I think they suffer needlessly because of it” (Christiansen, 2014). Sadly, mental health education is virtually absent in our public school system. This lack of education is perhaps one reason why this stigma around mental health continues to be perpetuated in our society.

       In addition, parents may find it challenging to confront these issues on the home front. Families may not know what warning signs to look for and hence the issues go unaddressed at home. In addition, “social workers in public schools are forced to focus their attention on getting their student’s graduated rather than on mental health issues”, as stated by Richard Landward, LCSW, a professor at the University of Utah’s College of Social Work and former school social worker (R. Landward, personal communication, November, 6 2014).

        Rates of depression in Utah are extremely high compared to other states. In fact, according to the Ranking America’s Mental Health Survey, Utah came in 51st for depression status, with 10.14 percent of adolescents experiencing a major depressive episode in the last year. South Dakota, ranked the “happiest state,” reported an average of 7.31 percent of adolescents having experienced a similar depressive episode (NAMI, 2007).

Effects/Consequences of the Issue?

        There are many effects relating to teens’ lack of knowledge and awareness around the subject of mental health. Of course not all students experience anxiety or depression themselves, nor does each student experience mental health at close proximity. Not having a basic understanding of the seriousness of mental health can lead to misunderstanding and fear. These traits in turn breed judgment and discrimination which, as discussed previously, can lead to further problems and escalate the likelihood and severity of serious incidents such as bullying, self harm and suicide.

        Perhaps more important is the wellbeing of those students who do experience anxiety, depression, or other mental health related concerns. It has been found that as many as 90 percent of adolescents and young adults who die by suicide experience mental illness preceding death (Brent, Perper, & Moritz, 1993). Despite the prevalence of mental health concerns, less than half of these victims were in contact with any sort of mental health service in the 12 months prior to death (Renaud et al., 2014). In the Utah Youth Suicide Study: Barriers to Mental Health Treatment for Adolescents, Moskos, Olson, Halbern and Gray examined 49 suicide cases from a larger sample of 151 successive youth suicide deaths. In this research, many common obstacles were found that prevented the victims from getting mental health treatment. Five of these obstacles are as follows: 1) the belief that nothing could help them 2) the belief that seeking help is a sign of weakness or failure 3) a reluctance to admit to having mental health problems 4) a denial of problems and 5) being too embarrassed to seek help (Moskos, Olson, Halbern & Gray, 2007). Increasing the amount of education junior high and high school students receive about mental health could decrease stigmatization. This greater awareness as to how mental illness can be treated may empower students to support their friends who may be in need, or to know how and where to seek help for themselves. Overall, this might lead to more students receiving the help they need before it’s too late.

In a massive review of 207 Social and Emotional Learning (SEL) interventions in schools, it was found that there was an overall average of  25% improvement in the students’ social and emotional skills, a 10% reduction in symptoms of anxiety and depression as well as a 10% decrease in student misconduct within the classroom after these programs were implemented. Even more noteworthy was that these effects were sustained for at least six months after completion of the intervention (Weare & Nind, 2011). The author notes that while the results may seem small to moderate in statistical terms, they represent effects that in the real-world are actually quite significant, and urges that mental health education in schools continue to be sanctioned and expanded (Weare & Nind, 2011).

Population Most Affected

The major population we decided to focus on was junior high and high school students in the state of Utah, although parents, teachers, and educators alike will undoubtedly be involved. We decided to focus on this particular population because we felt like it would be the most beneficial if we started with the students themselves and because the school setting is one of the few places where nearly all children can be reached, it seemed like a perfect strategy to improve outcomes. In the article “ Screening and Early Psychological Intervention for Depression in Schools,” promising results were found when interventions were provided within the school systems, with an average effect size of .55 after treatment (Cuijpers, et al., 2006).  

An issue here arose as we considered our ability to actually gain access to the students in these schools. This led us to the discovery of the various stakeholders that exist in the bigger scheme of things. These stakeholders include the parents, teachers, administration and/or members of the school board; each of which have a unique but important role in allowing us to intervene within classroom setting. Richard Landward, LCSW suggests that the most significant impact on students is achieved when we are able to focus on all stakeholders, including the adults in the lives of the students (R. Landward, personal communication, November, 6 2014).

Stakeholders

In light of the fact we are focusing on students under the age of 18, it is required by law to obtain permission from their legal guardians in order to give out any information on this topic. This poses a problem as we live in a very conservative state and some parents may have the opinion that mental health awareness could have a negative effect on their children, bringing more attention to the issue, leading to exploration and thus increasing the prevalence. This idea is outlined in a study by Dr.’s Nanayakara, Misch, Chang and Henry entitled, “Depression and Exposure to Suicide Predicts Suicide Attempt.” These authors claim there is evidence pointing to an increased risk for adolescents who have had more exposure to depression and suicide to be depressed or to attempt suicide themselves.

Other stakeholders who play an important role here are the teachers, administrators and members of the school board. Their job is to ensure that students graduate and prepare themselves for life afterwards. Most of these individuals do not like having to hold back educational time from their students. We realized that we would have to approach this project from an academic standpoint in order to gain their support. By focusing on the idea that if students have high self esteem, positive connections and good role models, which can come from increased education and awareness of mental health issues, we can help them to become more successful in all facets of life, including academics.

Through researching this topic, we found some organizations that are already invested in the integration of mental health education in schools. The National Alliance on Mental Illness, aka NAMI, has created a specific program called  “Parents and Teachers as Allies,” an in-service mental health education program for school professionals.  This two-hour in-service program focuses on helping school professionals and families within the school community better understand the early warning signs of mental illnesses in children and adolescents and how best to intervene so that youth with mental health treatment needs are linked with services. It also includes education on how schools can best communicate with families about mental health related concerns. Another program NAMI has created that we feel will be helpful to us is a presentation called “Ending the Silence,” a free 50-minute presentation led by a team of professionally trained presenters which includes a young adult living in recovery of mental illness. We have been in contact with Julie Schwartz, NAMI’s school based prevention specialist. We believe that through partnership with NAMI, we will be better able to make schools and educators more aware of the amazing resources that already exist and therefore, increase mental health education across the state of Utah.

References

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Christiansen, B. (2014, March 1). Utah has highest rate of mental illness in US. Daily Herald. http://m.heraldextra.com/news/local/utah-has-highest-rate-of-mental-illness-in-us/article_053ef820-584d-5930-953e-c75548be7c5c.html?mobile_touch=true

Civil Rights Data Collection Data Snapshot: Teacher Equity. (2014, March). Retrieved from http://ocrdata.ed.gov/Downloads/CRDC-Teacher-Equity-Snapshot.pdf

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