With law passed, mental-health curriculum is being incorporated into the classroom

The Enterprise — Michael Koff

Mental health is tied to physical health. Exercise can help prevent anxiety and is a self-help concept students can do themselves. These kids are racing before the recent Jean Forti 5K, sponsored by  the Berne-Knox-Westerlo Parent-Teacher Association.

It’s been called a hidden crisis; a silent epidemic.

Stories about the well-being and mental health of students only recently have become grist for the national evening news and the cause célèbre of longform features in major magazines.

Mental-health advocates, however, have known about the problem for years.

Now, New York State has a law that is meant to have staff across all subjects in public schools teach about mental health.

John Richter, director of public policy for the Mental Health Association in New York State, said that one example he cites often is using the novel, “The Scarlet Letter,” to teach students about stigma. Nathaniel Hawthorne’s 1850 novel tells the story of a young Puritan women in 17th-Century Massachusetts who has a child of wedlock and is ostracized by her community.

He also cites ways science teachers and physical-education teachers can help students learn about mental health in an era where such education is desperately needed.

One in five children in the United States, according to the Centers for Disease Control and Prevention, lives with a mental-health disorder, and 80 percent of those children do not receive proper treatment, according to National Institutes of Health. One study from Harvard Medical School found that it took about 10 years from when a person first shows signs of a mental-health issue to when he or she finally seeks help.

Between 2005 and 2014, according to one study from Johns Hopkins University, teens experiencing major depression increased 40 percent. In that same time period, the suicide rate among teen boys, ages 15 to 19, increased by a third, according to the CDC; for teen girls, ages 15 to 19, the rate of suicide doubled. The suicide rate for teen girls in 2015 was higher than at any point in the previous 40 years.

According to the CDC, about 7.5 percent of high school students attempted suicide last year.

It was only this year that local governments began tackling the intractable issue. Two states — New York and Virginia — now require public schools to incorporate into their curriculum mental-health education.

Implementing the law

New York’s first-in-the-nation law took effect on July 1, and applies to students in kindergarten through grade 12; in Virginia, where standards are still being developed, only ninth- and tenth-grade students are required to receive some kind mental-health education.

New York’s law doesn’t dictate the mental-health curriculum that should be used in the classroom, nor are regulations set by the State Education Department, although the department does offer a few guidelines and resources, said Richter.

“We’re sort of following a tradition here, of how education is done generally in the state,” Richter said. Save for certain standards that are set by the state, each school district ultimately has control over establishing its own curriculum.

Teachers are not required by the new law to receive any training.

“So, there was some legislation, separate and apart, from [the new law] that does require our schools — actually all staff in schools — to get some mental-health training,” Richter said “Oddly enough, there is no provision in this bill that that requires it … That may seem a little odd, like you’re putting the cart before the horse.”

Some proposals would have required teachers to get a minimal amount of mental-health training, Richter said, but that was met with stiff resistance from teachers’ unions. The Mental Health Association in New York State advocated for five years before the law was passed two years ago.

“They’re not really going anywhere,” said Richter of teachers’ unions. “What we decided was a different tack.”

The association instead proposed to the state legislature what is now its School Mental Health Resource and Training Center, which offers training to teachers.  

“So, part of this school resource center is to make online training available for teachers that’s attractive, convenient, free, and [teachers] can get [professional development] credit for it,” said Richter. “And so, more of a carrot than a stick method of getting them some training.”

At its training center, the association offers a number educational resources and lesson plans for kindergarteners through seniors in high school that districts can use to create their own curriculum.

However districts choose to implement mental-health into their classroom, Richter said, the association offers a list of core elements that should be in mental-health curricula:

— The concept of wellness including self-care and personal responsibility for one’s own mental health and wellness;

— The concept of mental health as an integral part of health;

— The recognition of the signs and symptoms of developing mental health problems;

— Instruction in the awareness and management of mental health crises such as the risk of suicide, self-harm, and other mental-health crises;

— The relationship between mental health, substance use and other negative coping behaviors;

— The negative impact of stigma and cultural attitudes toward mental illness on treatment seeking behavior and as a contributing factor in discrimination against people with mental illnesses;

— The concept of recovery from mental illness;

— The implications of risk factors, protective factors and resiliency on wellness, mental health, and recovery; and

— Instruction in identifying appropriate professionals, services, and family, and social supports for treating and maintaining recovery from mental illness.

“All of these things, at a minimum, are the things that ought to be part of your curriculum,” Richter said, and, if educators want to know how to teach about the signs and symptoms of mental health, there are recommended best practices in the the Mental Health Association’s online resource center.

As for how the core list of elements are incorporated, Richter said, in biology class, for example, when discussing the brain, teachers could talk about synapses, which transmit signals between neurons in the brain, and what is known about the role they play in contributing to our understanding of mental illness.

The loss of “synaptic stability,” according one study from the National Institutes of Health, may lead to a disruption of “neuronal circuits,” which can lead to brain disease. This disruption “is almost certainly the underlying cause of many psychiatric and neurologic diseases,” according to the study, such as such as mental retardation, schizophrenia, Parkinson’s disease, autism, Alzheimer’s disease, compulsive behavior, and addiction.

In physical education class, Richter said, the teacher could talk about the benefits of exercise and how it helps to treat anxiety, and, how it is one of a number of self-help concepts that students can do for themselves.

“Hopefully, when you’re talking about substance use, you’re not just teaching the way it’s traditionally been taught. But you’re also saying, ‘You know, a lot of times mental-health issues have a role in why people use drugs or alcohol or develop addictions,’” Richter said, noting that there is a lot of “comorbidity,” the simultaneous presence of two chronic diseases.

Karen Jones, the pupil personnel services director for the Voorheesville Central School District, supervises the district’s counseling team, which is made up of counselors, a social worker, a school psychologist, and the school nurse.

When her team is providing support in the classroom, Jones said, that can mean counselors providing lessons to elementary-school students about how to be a student, or teaching middle-school students about organization, or prepping high-school students for the next step with college- or career-readiness lessons.

The high-school social worker, Jones said, does class lessons in health and teaches how to be in safe relationships.

“Nothing out there”

While the issue of student mental health only recently has seeped in the national consciousness, Richter is, obviously, well aware of what has been happening in schools.

“So, because, we’re mental-health advocates, this is all we do; we live and breathe this stuff,” he said. “We’ve been aware for forever, really, about the prevalence rates [of mental-health issues] in various populations of adults, children, and young people.”

Several years ago, Richter said, as part of a program to raise awareness about mental health in the community, the Mental Health Association in New York State trained adults in mental-health first aid. “Just like the Heart Association teaches first aid and CPR,” he said.

But there was nothing out there, Richter said, to educate young people — no classes, no training modules, no programs, nothing that brought the information directly to them. That was a problem because, through the adult training, association staff were hearing about the struggles young people were facing.

“Most of the focus in policy discussions is around putting more social workers, more psychologist in the school — trying to just put services in the school,” Richter said. “Which is fine and laudable but not always politically feasible, and usually expensive.”

His organization’s thought was: Why not go directly to the youth and give them the information, just like any other public-health initiative?

“We really hadn’t done much with young people. So, we launched this initiative ... We did that for six years; we advocated for that. And it was just in the last couple of years that it kind of caught fire,” Richter said.

School staff members had, to a certain degree, always known what was going on in their halls, Richter said, but they had not necessarily acknowledged it, nor did they fully understand their place with regard to teaching about mental health.

“I think most schools would have said before this law passed, it’s not really their role or they didn’t feel comfortable talking about things like suicide and so forth,” he said. “So while it’s on our radar screen — and it always has — it doesn’t necessarily mean it’s on everybody else’s.”

But certain things bring mental health into the forefront — not always for the better.

On any given day of the week it can be very difficult to get the general public to focus on mental-health issues; however, when a classroom full of 6- and 7-year-olds is murdered, suddenly everybody’s paying attention to mental health.

“For many of the wrong reasons,” Richter said.

“I’m conflating violence and mental health, which is problematic. But that’s how things work,” he said. “We understand that.”

The outburst of self-righteousness that follows horrific mass shootings tends to fade quickly, along with any hope of real reform, often because of powerful interest groups. In New York, the victories achieved by mental-health advocates has been, in no small part, because all sides saw there was problem and knew it needed to be addressed.

“The school boards, school superintendents — even the teachers’ unions — within the last couple of years, I started hearing more and more about mental health being a priority,” Richter said, and was told: “We need help. We’re seeing more anxiety. We’re seeing more depression,” He said a lot of those problems were driven by social media.

The teachers and school leaders, Richter said, asserted, “We’re seeing more bullying, we’re seeing all of these issues, and, quite frankly, we need help.”

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