How Schools Are InvolvedÂ
Lynn D. Miller, PhD, RPsych
Angela* was a shy grade seven girl with few friends. She did very well in school until the spring term when she had to give a speech in her language arts class. She knew that a big percentage of her term mark would be based on her speech. She was well prepared, but even thinking about standing in front of her classmates made her feel faint and nauseous. She had remembered that her older brother, before going to a job interview, drank a beer to feel “more courageous.†Angela also overheard several of the popular kids laughing about having sneaked wine coolers into one girl’s basement on the weekend. Angela decided to try drinking a wine cooler before giving her speech at school. She did very well giving her speech—so well that one of the popular kids asked her for help drafting their speech. Angela thought that she might even be invited to go to a party the next weekend at this girl’s house.
* pseudonym
Approximately one in five school-aged youth (ages 4 to 19) experience mental health problems.1 More than 80% of those in need of mental health treatment don’t get the treatment they need.2 Schools are often the first place where mental health problems can be identified.
School staff and teachers historically have little or no training or background in issues of mental health. Children and youth are left to struggle in classrooms with teachers who are concerned, but don’t have the resources to help. For example, in an average classroom of 25 students, five could meet the criteria for a diagnosable disorder. Only one of these students might actually receive psychological help, either in or outside of school.1-2
What happens to the other students who are struggling with mental health problems? These youth and their families may suffer in silence. Some youth, seeking relief, develop poor coping strategies such as skipping school, social withdrawal and high-risk behaviours, including substance use.
Mental health issues showing up in classrooms
A BC study was done on the prevalence of various mental health problems among children and youth. The most common concern is anxiety disorders, estimated to affect 6.4% of kids in BC. Attention deficit/hyperactivity disorder (4.8%) was the second most common concern, followed by conduct disorders (4.2%) and depression (3.5%).3
The study also found that the most likely age of onset for most disorders was 11 years old. And, of youth with some form of mental disorder, most suffer from more than one type of disorder.
The link to substance use
Early adolescence is when some youth try substances for the first time. For youth with mental health problems, this time can mark the beginning of a vicious spiral into self-medication. When a student has a mental health problem as well as a substance use problem, it is called a concurrent disorder.
Even experimental use can make existing symptoms worse for a youth with mental illness. Substance use can also cause mental health problems such as anxiety and psychosis.
BC’s McCreary Centre Society,4 which has been conducting research on adolescent health since 1992, is a reliable source for information about drug and alcohol use. In the latest province-wide survey,5 60% of youth had used alcohol at some point in their lives. Of youth who had tried alcohol, 45% had engaged in binge drinking (i.e., consuming five or more drinks in one sitting or relatively short period of time). Ten percent of all youth had used alcohol on 100 or more days in their lifetime and would be considered ‘regular’ drinkers. Twenty percent used cannabis (marijuana) and 11% used tobacco.
Given the high rates of mental health problems and the high rates of substance use, it is likely that many youth will present with a concurrent disorder. Approximately half of adolescents who seek treatment for alcohol also report psychological distress.6
Youth with concurrent disorders are at highest risk for negative outcomes, including suicide, homelessness, sexual exploitation and incarceration. Untreated mental health issues clearly contribute to addiction problems in a big way.
Early, quality treatment is crucial
Without proper treatment, mental health disorders can last for a lifetime. The presence of one mental health problem creates risk for developing more. For example, recent research has shown that untreated anxiety disorders are the leading predictor for developing depression, for future drug and alcohol use/abuse, and for suicidality.7
Children respond better to psychological intervention treatment when it is offered early on.8 This highlights the important role of schools in the early identification of such problems.
MCFD: a resource for schools
The BC Ministry of Child and Family Development (MCFD) is the primary treatment provider of psychological services for children and youth. MCFD has developed a multi-faceted plan (BC Mental Health Plan) that targets each common disorder, both in school and community settings.
Over the past few years, MCFD Child and Youth clinicians have been getting certified in cognitive-behavioural therapy (CBT) for anxiety disorders. This has increased the treatment capacity for children and youth in BC.
Children who have mental health problems should be assessed and treated according to the best known practices. CBT is the psychological treatment of choice for anxiety and depression, the two largest diagnostic categories for mental health problems in children and adolescents.9-11 CBT focuses on identifying and changing poor ways of thinking and behaving, thus helping a child or adult think and act in ways that are more successful.
Since 2002, MCFD has provided training to teachers on how to identify anxiety and depression in school kids. If teachers recognize mental health concerns early and refer students to MCFD community health teams, more children will be getting psychological help earlier.
MCFD also pays for materials for a curricular program that is based on CBT principles called the FRIENDS program.12-13 Students enjoy 10 weekly lessons about identifying unhelpful thoughts, understanding the link between thoughts and feelings, identifying body symptoms associated with worries, and developing coping plans for when they feel distressed.
Angela remembered her FRIENDS program from school and decided to use the lessons she learned from it when she thought about her next speech assignment. Instead of using alcohol (wine coolers) to calm herself down, she made a coping plan. In her plan she identified unhelpful thoughts (“I can try drinking a wine coolerâ€) and came up with more helpful thoughts (“I’ll give it my best effort; the popular kids even see that I can be clever because they asked for my help; I didn’t like feeling I had to drink to give my speechâ€). She also offered to help practise with one of her new friends.
Footnotes
1.   Kessler, R.C., Berglund, P., Demler, O. et al. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
2.   Hoagwood, K. & Johnson, J. (2003). School psychology: A public health framework: I. From evidence-based practices to evidence-based policies. Journal of School Psychology, 41(1), 3-21.
3.   Waddell, C. & Shepherd, C. (2002). Prevalence of mental disorders in children and youth: A research update prepared for the British Columbia Ministry of Children and Family Development. Vancouver: Mental Health Evaluation and Community Consultation Unit (MHECCU), Department of Psychiatry, University of British Columbia.
4.   McCreary Centre Society is a non-profit organization with a mission to foster wider understanding of the importance of youth health, increase knowledge about youth health needs and issues, promote a continuing commitment to youth health issues, and initiate and implement innovative projects which directly address unmet health needs of young people. www.mcs.bc.ca.
5.   McCreary Centre Society. (2004). Healthy youth development: Highlights from the 2003 Adolescent Health Survey III. Vancouver: author. www.mcs.bc.ca/pdf/AHS-3_provincial.pdf.
6.   Adlaf, E. & Paglia, A. (2001). Youth & drugs and mental health: A resource for professionals. Toronto: Centre for Addiction and Mental Health.
7.   Sareen, J., Cox., B.J., Afifi, T.O. et al. (2005). Anxiety disorders and risk for suicidal ideation and suicide attempts: A population-based longitudinal study of adults. Archives of General Psychiatry, 62(11), 1249-1257.
8.   Durlak, J.A., Weissberg, R.P., Quintana, E. et al. (2004). Primary prevention: Involving schools and communities in youth health promotion. In L.A. Jason, C.B. Keys, Y. Suarez-Balcazar et al (Eds.). Participatory community research: Theories and methods in action. Washington, DC: American Psychological Association.
9.   (2002). Compton, S.N., March, J.S., Brent, D, et al. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry, 43(8), 930-959.
10.   In-Albon, T. & Schneider, S. (2007). Psychotherapy of childhood anxiety disorders: A meta-analysis. Psychotherapy and Psychosomatics, 76(1), 15-24.
11.   Kazdin, A.E. (2003). Psychotherapy for children and adolescents. Annual Review of Psychology, 54, 253-276.
12.   Barrett, P.M. (2004). Friends for Life! For youth. Participant workbook and leaders manual. Brisbane, Australia: Australian Academic Press.
13.   Ministry for Children and Family Development. (n.d.). FRIENDS for Life. www.mcf.gov.bc.ca/mental_health/friends.htm.
Lynn is an Assistant Professor in the Department of Education and Counselling Psychology, and Special Education at UBC, and Director of the Counselling Psychology doctoral program. She is also the lead trainer for the FRIENDS program
*reprinted from Visions: BC's Mental Health and Addictions Jourmal, 2009, Vol. 5 No. 2, p. 6-7.
