Three-quarters of people with mental illnesses like major depression, anxiety or psychotic disorders experience their first symptoms before age 24. Half of them become mentally ill by age 14.
But these diseases often go undiagnosed and untreated until later in life, sometimes after they have wreaked havoc on school, work or relationships.
Noting these grim statistics, two years ago the Obama administration called on schools across the country to heighten their awareness of children’s mental health issues.
Despite the urgency, screening all school kids for mental health issues has raised privacy concerns and worries that kids could be medicated unnecessarily.
Instead, the government decided to offer grants that encourage states and local school districts to offer mental health first aid classes to school staff members from teachers to bus drivers to school cafeteria workers, to offer counseling to kids and partner with counseling agencies in local communities.
The eight-hour mental health first aid course teaches adults how to spot kids with unmet mental health needs and to get them the help they need. The program was developed in Australia by a nurse who faced her own mental health challenges and introduced in the U.S. in 2008.
“We are more likely to encounter someone with behavior challenges than to have to use the Heimlich maneuver,” said the National Council’s Tramaine El Amin, who works to promote the program nationwide. Yet far more people learn how to help someone who’s choking than someone in a mental health crisis, she said.
In Southeast Los Angeles County, the ABC Unified School District, with some 15,000 students, is one of 18 in the state that receives federal funding for the program.
In addition to launching mental health first aid classes, the district has used its money to place wellness coordinators in each of its schools. The coordinators both work with kids one on one and refer them to school support groups or counseling agencies and other resources outside the school.
The ABC district is ethnically diverse, with large Asian and Latino populations and more than 40 languages spoken. It’s far better off economically than the nearby Los Angeles Unified School District, with about half the kids qualifying for free lunches, and it’s high performing academically.
The district’s focus on mental health began about seven years ago when administrators began looking at ways to help kids whose problems got in the way of learning or social relationships, said Terri Villa-McDowell, the district’s safe schools coordinator
“There was a huge gap in teachers’ and administrators’ abilities to identify children in mental distress and knowing what to do,” Villa-McDowell said.
“The missing component is kids not having coping skills,” said Jessica Boles, who teaches Bragg Elementary School’s youngest students how to handle their feelings in her special education kindergarten classroom. “You have kids in high school who don’t know how to deal with anger and frustration. Through time, our kids are going to know these coping skills.”
Sometimes kids’ mental health issues are more urgent, even in elementary school.
“We had a fourth grader who shared that he’s having serious thoughts of harming himself,” said Andy Long, who is assistant principal at Leal Elementary School in Cerritos. The child had confided in the school’s wellness coordinator who was able to help him.
Long took mental health first aid a month ago and said he felt just as he had when he took medical first aid as a boy scout. “It gives me more confidence and gives me ideas on what to look for,” Long said.
Kids who are withdrawn, who cry a lot or lash out in anger or who are truant or tardy all might need help. Adults certified in mental health first aid learn to assess for risk of suicide or harm, to listen without judgment, and to give reassurance and information. They also command a list of local resources, and can encourage professional help or self-help or other support when appropriate.
At Leal Elementary where academic pressure is intense, Long noted that anxiety is a big issue for many children.
“We have kids who get an 80 on a test and feel they’re going to get in trouble at home because they didn’t get a 100.”
Kids across the state have similar problems. In 2011-13, the California Healthy Kids survey found that 25 percent of seventh graders said that in the past year they’d been so sad or hopeless every day for two weeks that they didn’t do normal activities. The percentages were higher for older kids, with 31 percent of ninth graders and 33 percent of eleventh graders reporting the same feelings.
Villa-McDowell said preliminary 2016 survey results for her district show that 20 percent of eleventh graders reported feelings of sadness or hopelessness that got in the way of daily activities.
Those numbers mean that even with the federal grant, some kids are still falling through the cracks because of lack of resources, Villa-McDowell said.
Still, between September and March of this year, the district referred about 14 percent of its students for help, and because of its focus on on-campus and off-campus mental health services, kids got what they needed right away.
“We are literally able to offer help at the time student needs it instead of waiting for it to become a crisis,” Villa-McDowell said.
The vast majority of students were offered support groups like girl’s self-esteem or boy’s anti-gang recruitment. Villa-McDowell thinks the number of kids sent to individual counseling—just 183—or about one percent of the district’s students is under-reported because the on-campus wellness coordinators provide a lot of one-on-one counseling in-house.
The mental health first aid approach with on-campus support is a good one, said Michael Wilkes, a professor at the University of California Davis School of Medicine, who specializes in adolescent health.
“I think there is enormous benefit in having teachers, coaches and people who are interacting with students be aware of those who are at risk and raise a flag and know where they can go.”
Wilkes opposes universal screening because he argues accurate tests for mental health issues don’t exist, and mental health services are still hard to find.
“If you take a kid who’s depressed or anxious, what do you do? The easy solution is to put him on drugs. We know teenagers don’t do well with anti-depressants.”
Similarly, the United State Preventive Services Task Force has taken a conservative approach to screening, recommending that it be done in medical facilities only for major depression in 12-18 year olds.
Some mental health advocates say that’s not enough.
“We wait until kids are sick and drop out of school,” said Theresa Nguyen of Mental Health America. “You see the signs long before a child meets real criteria, which is why diagnosing is often a struggle.”
Nguyen contended that mental health problems are more like diabetes; the earlier you catch them, the better chance of living a healthy life.
At ABC Unified, Villa-McDowell said she has seen universal screening work. At one time, ABC screened about half of its kindergarten to third graders. Villa-McDowell noted that the screenings picked up problems in quiet kids who didn’t act out, but who were nonetheless troubled. The district might consider screening all of its kids for mental health issues in the future, she said. But a major barrier to universal screening is the stigma attached to mental illness.
Mental health first aid is partly aimed at erasing the stigma, but for now it’s firmly in place.
Villa-McDowell said currently she and other school staff members choose their words carefully when talking to parents. They say that children need additional social or emotional support, not mental health services.