"I just don't want to be sad anymore."
In 30 years as a middle school teacher, I have never felt more inadequate than when one of my favorite students spoke that simple sentence to me before class one day.
As an 8th grader, my student, whom I'll call Lucy, had distinguished herself. In addition to acing her classes, she read extensively and liked to draw. Her social life included a small but dependable group of friends. She could be silly and eccentric, but could also engage in deep and original conversation.
I thought Lucy was a happy child, but I was wrong. On the first day after winter break, I saw her standing in front of the school and could tell something was off. After exchanging pleasantries, I asked if she was OK. She didn't deny she wasn't, but she said "it" didn't have anything to do with school. Respecting her privacy, I left it at that.
Over the next few weeks, Lucy's engaging attributes remained in place, but she was clearly in distress. Then the crying started. She would be in the breezeway before class, tearing up and hugging a friend. But then she would shake it off and join the class.
One day she could not be consoled. As the students filed into class, I held her back and asked her to please confide in me.
"I just don't want to be sad anymore."
I asked if something was going on at home and she said no, that she was just sad all the time. I asked if she'd like to see a counselor and she said no, in no uncertain terms. Clearly out of my depth, I tried to insist. Again, through her tears, she told me she didn't want them to make her take medicine.
One of my favorite students had just all but told me that she suffered from clinical depression, and I had no clue how to help her. The rest of the class would soon be needing attention, and I needed to act. I asked Lucy if she wanted to stay in the empty classroom next to mine for a while, and she said yes. I let her in and told her I would check with her in a few minutes.
After getting the class to work independently, I went and talked to Lucy. I told her that knowing her condition and caring about her, I had a professional obligation and personal wish to ask some questions. In her answers, she told me her mother knew about her condition and was getting her into a support group with an outside agency and looking for individual therapy. Lucy affirmed that she had never thought of hurting herself and had no means or plans to do so. She promised that she would let me know if she ever did have those thoughts. I told her she could decide on a daily basis whether she wanted to work alone or with the class.
Over the balance of the year, Lucy worked alone about half the time. She did get into a support group and was about to start individual counseling. Once, she confided learning that her father "has the same thing." By the end of the year she felt better, but I expect her depression is a challenge she'll have to manage her whole life.
The Mental Health Training Gap
The National Alliance on Mental Illness (NAMI) estimates that 20 percent of youths aged 13–18 live with a mental health condition. Statistically, then, five other students in Lucy's class of 8th graders might have been battling struggles of their own—all beneath my radar. If I had to guess which other students might struggle with mental illness, I would probably have pointed to those who frequently acted out or were always sullen and withdrawn. I would not have suspected anyone like Lucy, who functioned well, got good grades, and never misbehaved. I'd have been right about as often as if I'd selected names out of a hat.
That's because, in spite of the obvious need, I've received zero training in issues related to student mental health. And that's true for the vast majority of my teaching colleagues. Instead of professional knowledge, we're left with our own estimates, wondering if that student is "passive aggressive" or that one is "OCD," as if we even knew what those things truly mean.
To help these students, we rely heavily on informal conversations with colleagues about what seems to work. Counselors and school psychologists do their best to help, but too many students fall through the cracks. And small wonder: The American School Counselor Association recommends schools should staff one counselor for every 250 students, a target that was met only by New Hampshire, Vermont, and Wyoming in 2013–2014. Nationwide, the average was one counselor for every 491 students. (With two counselors for about 700 students, my school fares better than the average, but is still at well below the recommended ratio.)
This is a poor way to do things. Every teacher, administrator, psychologist, and counselor with whom I've talked agrees that teachers need professional development on issues and best practices regarding student mental health. And the data back us up. According to NAMI's stark statistics, 50 percent of all mental illness begins by age 14. The average time between the onset of symptoms and treatment is 8–10 years. Approximately 50 percent of students age 14 and older who suffer with a mental illness drop out of school. And 70 percent of youth in state and local juvenile justice systems have a mental illness. Clearly, we need to do better.
What Should Training Entail?
Training for teachers in student mental health should be limited and conditioned by the contexts in which teachers work with students. But two focal points of the training should be classroom practice and legal and ethical considerations.
Classroom Practice
Any training regarding student mental health should seek to help teachers become better teachers, not mental health experts or therapists. Content should improve the dynamics of teaching and learning, not overtake it. To that end, here are some of the points student mental health training should address:
▪ What do the most reliable data say about the extent of mental health issues among our students?▪ What specific mental illnesses occur, and how may each be expressed in school?▪ When is clinical language such as "oppositionally defiant" OK to use as a descriptor for students, and when should it be left to mental health professionals?▪ In what ways do specific mental illnesses limit students' life prospects and quality of life?▪ What treatment options are available?▪ How can teachers make their classroom environments more accommodating, both physically and socially, for students battling mental illness?▪ What behaviors should educators address in class and when should they call for assistance?▪ How can teachers avoid inadvertently exacerbating students' problems or setting off disruptive behavior?▪ What risk factors and warning signs merit immediate referral to mental health professionals?
Legal and Ethical Issues
Training should also address key legal and ethical issues, such as protecting student privacy and knowing the difference between responsible professional intervention and practicing psychiatry without a license. Consider my experience with Lucy. I often wonder if I should have reported her condition to an authority, or was required by law or district policy to do so, in spite of her pleas not to. Should I have let her mother know that we talked about her condition? If we hadn't had a close student-teacher bond, and if she hadn't been open about her mother's efforts to find her therapy, I definitely would have. But without a doubt, for the sake of our students and ourselves, teachers should know when legal or ethical obligations outweigh our personal judgment.
We also need to know what liability we might face when we do exercise our judgment. Whereas I'm clear on my state's laws regarding mandatory reporting of potential child abuse, I know little about my responsibilities—and potential liabilities—in connection with student mental health issues. Could conversations like the ones between Lucy and me lead to civil or criminal charges against me if I fail to report them? What if, without consulting an authority, I do a little online research about a child's behavior and tell parents I think the child is suffering from a particular mental illness and suggest how they might address it at home? How is that different than presuming to diagnose and recommend treatment for a student's physical illness?
Personally, I think that frequent, cavalier use of technical mental health language such as "obsessive-compulsive," "passive-aggressive," "personality disorder," and "on the spectrum" is inappropriate, even unethical, and I'm trying to stop using them myself. These are not laymen's terms, and teachers should be trained when and when not to employ them. But what language can we use in their place?
Mental Health Teacher Training in Practice
Last spring an opportunity arose to directly address the lack of student mental health teacher training. Teach to Lead, launched in 2014 by the U.S. Department of Education, The National Board of Professional Teaching Standards, and ASCD, is a program designed to bring visibility to teachers as experts on policy and practices and provides time and resources for teams of teachers to develop solutions for issues they face. I submitted an application to attend a Teach to Lead conference with a team including teacher Cody Dahms, counselor Jeannette Gabaldon, professional development specialist Robbie Ramirez, and principal Steve Gabaldon. Our proposal was to combine our broad range of education experience to create a primer on student mental health that could help educators better meet the needs of students with mental illnesses.
The biggest outcome of our initial meetings was to realize how large a task we were taking on. We are still in the vision stage, but our ultimate aim is to create training materials that are open-ended, flexible, portable, and teacher-friendly. We'd like to provide training resources that could be delivered face-to-face to a whole faculty by a staff member, accessed online by a professional learning community, or studied independently by a single teacher. The content would cover all the mental health training tips I mentioned earlier, but also be customizable to suit educators' particular context and training needs. The platform will likely be a website to ensure accessibility. We hope to have an extensive section of tagged resources for participants who wish to go deeper into specific topics.
Three examples illustrate how this training tool might look. First, a district might mandate a one-hour survey on the topic of student mental health that includes data on mental health, acute warning signs, and legal and ethical considerations. Second, a grade-level team could dedicate several meetings to accessing sections of the training that cover the best responses to specific student behaviors. Finally, a school might set aside several hours of professional development for the entire training.
The platform may still be a couple of years down the road, however. Our initial steps include collecting and assembling content from currently available sources; producing a test version, probably as a slideshow; finding mental health professionals to vet our work for accuracy; and sampling the training in small groups. Our goal is to have those steps done by the 2018–2019 school year.
Helping the Lucys in Your Classroom
Lucy is a junior in high school now. I think about her having to carry a burden that she didn't ask for, isn't her fault, and she'd rather not have. I have faith that as she finds her path in life, she'll continue to seek and receive help, thus minimizing the impact of her depression on her future.
But as I write, the first quarter of the school year is winding down. I pause and scan the students in my classes and wonder who among them wages private battles against mental illness. I want to be their ally, but I don't know how. Perhaps one day, with the right kind of training, I—and many other teachers—will learn how.
Key Resources for Educators on Student Mental Health
The Mighty | We Face Disability Together
This blog features first-person contributions by people telling their stories.
PBISworld.com
This site does not address mental illness directly, but it offers many interventions that address multiple student behaviors.
The Child Mind Institute
The Child Mind Institute is a national nonprofit dedicated to "transforming the lives of children struggling with mental health disorders and learning disabilities." The site includes a section for educators.
NHS Choices—Your Choice, Your Health: Student Mental Health
A section from the United Kingdom's Health Service on student mental health. A good site for both teachers and students.
