Clinical Week 4.10-11.13

The Carnegie Task Force on Education stressed, "School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge."

Mental health issues are often viewed as barriers to the learning process. The high rates of under-identification, limited access to treatment, and low quality of mental health services for children and adolescents in the United States prompted the U.S. Surgeon General to declare this area a
national public health crisis.

What action(s) should stakeholders take to address this pressing issue?

Mental health problems in students are certainly barriers to learning in any school level child. The National Association of Secondary School Principals states that “one in ten children suffer from a mental disorder severe enough to cause some level of impairment…Mental health disorders affecting children and adolescents include attention deficit hyperactivity disorder, autism, depression, eating disorders, and schizophrenia…Students suffering from these ailments are at serious risk of academic failure and more likely to drop out” (Promoting Mental Health in Middle Level and High Schools, 2008). Mental health disorders are becoming more prevalent in school systems, and it greatly impacts a child’s ability to learn and succeed in school. They are also more likely to drop out of school. It is important to keep these children in school and learning to the best of their ability. The National Association of Secondary School Principals (2008) state that these issues are due to limited research surrounding mental health issues, limited capacity to address mental health issues, shortages of funding, and traditional stigmas surround the mentally ill.

An action stakeholders can take to address this issue is to increase financial support. The National Association of Secondary School Principals (2008) explains that federal government and states must provide financial support to enable local communities to implement an appropriate school mental health program that incorporates positive behavioral interventions and focuses on development for students. With more funding, school boards can promote social, emotional, and behavioral health of all students. It could also reduce the likelihood of at risk students for developing these health problems, and treatment or referral for students with existing social, emotional, or behavioral health problems can be taken care of. Early identification of mental health problems can help these students progress and develop normally. The National Association of Secondary School Principals (2008) also explains that school leaders can promote mental health in schools by setting high performance expectations for teachers and students, establishing an effective school leadership team, encouraging involvement of parents, modeling positive relationships, encouraging respect for others, strengthening the school curriculum and instruction, and promotion service programs and school activities. Getting students more involved in activities that encourage positive relationships is very important and contributes to good mental health.

The National Association of Secondary Principals. (2008). Promoting Mental Health in Middle Level and High Schools. Retrieved from http://www.principals.org/Content.aspx?topic=57948.

Research shows that Mental Health providers might have not done enough to support the mentally challenged at their young tender age, especially with funding and health insurance aspects. Earlier in the eighties, mentally challenged individuals were thought to be outcasts or rather they were known to be 'cursed' by an evil spirit supposedly. However, this is slowly improving through health promotion and valuing the quality of life/care of the mentally challenged.
Stakeholders have a huge challenge and they need to reduce the Stigma of undermining the mentally challenged. First of all, they need to see the need of providing long (life) term services to this victims, therefore discouraging early termination of services for the mentally compromised community. They also need to modify and effectively look into the short/long term benefits/goals of keeping the services, especially not terminating them at age 21 as determined by the mental programs set.
I feel like after they reach 21 years of age, they shouldn't be terminated from this services, but rather offered a continuation of education in terms of their mental capability. Probably 'special colleges' should be set up whereby any individual above age 21,that qualifies to be mentally challenged, has a free and affordable education progress in all aspects of daily living including social, economic, physical and emotional health, probably set in a given college program.
If America can afford to raise funds and feed some of the other countries lacking basic needs, they sure can take care of their own mentally challenged, supposedly all they need is to plan effectively on how to come up with proficient interventions in caring for the mentally challenged. I also feel like the mentally challenged insurance services should be more user friendly and easy to access, unlike the set protocol, which proofs to be so complicated at times.

http://smhp.psych.ucla.edu/pdfdocs/cultural/culture.pdf

Am glad that your explanation looks into the most simple mental cases and also the most complicated mental disorders. This week I and my clinical school nurse were discussing on how most of the students are showing up with psych issues more than any other kind of disorders. ADHD seems to be the most prevailing where most children are put on meds at a very early age. It honestly shocks me to see how most of the kids are prescribed the most complicated drugs just because of the mental issues they might be having, l always thought some of the meds like prozac was meant for adults only, but kids are taking them more than the adults due to mental issues that are hard to solve.
Probably the media, technology and innovations has a lot to do with it, since am not sure if there was many mental cases in the eighties as compared to nowadays. Also, l feel like too much influence from the society seems to be another effect of mental disorders. This remains a dilemma to many, since every single day a child is diagnosed with a mental issue.

Although many people knew that mental illness was greatly affecting the youth of today, the nation felt the impact of adolescent mental illness when 20 children were killed this past year in Newtown Connecticut. With all of the recent school violence, I also agree that adolescent mental illness is a public health crisis. I believe as a community we need to work together to make people aware of the signs of mental illness and more importantly reduce the negative social stigma that mental illness holds.
I think that stakeholders need to focus on the increase in mental illness and try and work with adolescents to overcome the stresses put on them. In my personal opinion technology, specifically the internet is having a negative effect on our youth. Children not only are getting bullied at school, but all day and night for the world to see, because of the easy accessibility to the internet. “Cyber bullying may have more devastating outcomes than traditional forms of violence, due to its potential to reach a wider audience through mass distribution and the sense of anonymity that technology can provide. Recent studies have shown that cyber bullying can result in emotional distress, depression, anxiety, and suicidality” (Chang, Chung-Do, Else, Goebert, Matsu, 2010). Cyber bullying is altering the mental state of these children and stakeholders need to educate parents about the negative effect the social media websites can have on these children. Not only are children exposed to cyber bullying, but if there are no parental blocks on the computers, adolescents can become exposed to content made for adults on the web, for example guns and violence. There are reasons for the increase in mental illness on adolescents today and the first step in this crisis is recognizing these reasons and intervening.
I also think that children and adolescents need more education about mental illness. Adolescents need to recognize when to talk to an adult about either the way they are thinking, or comments a peer may have said. I also think adolescents need to understand that mental illness is a real illness, that people to not choose to get. I hope more is done to help children with mental illness and as a nurse I will continue to educate people that this is an ongoing problem in the United States!

Reference
Goebert, D., Else, I., Matsu, C., Chung-Do, J., & Chang, J. (2011). The Impact of Cyberbullying on Substance Use and Mental Health in a Multiethnic Sample. Maternal & Child Health Journal, 15(8.), 1282-1286. doi:10.1007/s10995-010-0672-x


Sorry But one of the symbols in my citation translates into a smiley face, so I added a period after the eight (which should not be there)

LD makes a very good point that funding is necessary to make a difference in the way mental health in adolescents is addressed. Unfortunately to put plans into place, money is needed. The source used by LD clearly reflects the importance about educating people what mental health issues are facing these children and why efforts need to be made to negate the problem. Keep kids in school and safe from mental illness!

CMUR makes a great point of discussing the stereotyping that occurs with mentally ill patients, especially mentally ill children who are facing developmental challenges (where friends are extremely important). Offering lifetime services to children diagnosed with a mental illness in school is a strong suggestion. Also, following the students past the age of 21 is important. Dropping these children from mental health programs after graduating from high school will not benefit them, and continuing this care would allow the individual more opportunities in an adult life. Offering college programs for these students would also improve their opportunities. These programs would be very beneficial to students. Education looking at the stigmas about mentally health people is also important in school health classes. This would allow mentally ill students to integrate with their classmates more without stereotyping or judgment.

There is no question that schools today are challenged with many students that suffer from mental illness's of all types, and don't always have the best resources available for the children. These mental illness's affect children's learning ability in the classroom and that puts the school in a position where they may feel they need to do something more to help this child. I would absolutely agree that this nation is in a public health crisis because of the amount of children and adolescents who have mental illness and are not being treated. When I was in school you rarely heard of other children suffering from mental illness, and that brings up two suggestions as to why this is. I think that either there was less mental illness years ago, or mental illness wasn't recognized and diagnosed as it is today. Stakeholders need to push that schools have not only a guidance counselor but perhaps a psychologist or psychiatrist that can see these children throughout school and it would be funded through the government so that each child is getting taken care of, and being prescribed the medications they need. Many families can't afford to bring their children to therapists/ psychologists, and then pay for the medications they would most likely be prescribed and that puts children and others at risk. Many school shootings have occurred in the past couple of years, and it makes me wonder if these children were being seen by specialist in the school setting if some of these shootings wouldn't have happened. Parents can't always recognize that there is something going on with their child they might just think they are going through a phase when they are actually suffering from a mental illness, and the child might be afraid to tell anyone. I think that schools should have education programs about mental illness to let children know that they aren't alone, and if they feel that something isn't right with them they can talk to the schools psychologist, and I think it would stop stigmas and bullying at school also when more children become aware that this is a real disease. Another suggestion would be that is not already teachers should have special training to learn how to recognize behaviors that suggest a child might be suffering from a mental illness so that the child can be further evaluated. Most of what needs to be done to improve the care of mental illness in children I think should surround the school setting, because you can't always rely on the parents that they are going to make initiatives to help their child.

I agree with your comment about technology being a major problem for our youth, and how it really is the surrounding cause of bullying. Parents really need to be educated I think by the schools, if they can have some type of parents night, about monitoring what their children are doing on the internet. These children are searching the web and finding information about guns, violence, sex, and other things that are not appropriate for young minds to see because they don't comprehend right from wrong when looking on the computer. I agree with you also that children and adolescents need more education on mental health because it's something that is not really discussed in schools like sex education and drug/alcohol use is. I think that sex and drug/ alcohol abuse stems from mental illness and people don't see that if we did more mental health education that it could solve more problems then they think.

The Carnegie Task Force on Education could not be more off in their stance on meeting the needs of students. If you read that statement you will find they say that essentially everything around the student is there responsibility but don’t hold them responsible. This semester I have learned that much of public health is to teach and when that doesn’t work to use force through policy and increased intrusion. If the student states he/she cannot concentrate at home, then they potentially need to see the home and force you to let them enter, or the children be taken away.

I don’t necessarily believe that there are high rates of under identification for the would-be mentally ill. According to Kids Health Issues (2011) there has been a considerable rise in the rates of psychiatric diagnosis in children. It also seems that the list of behaviors being categorized as systematic of a mental illness is growing, beginning to cover “abnormal” behavior as illness (Will, 2010). The view point of this area being a crisis as stated by the Surgeon General is an incorrect one. It seems today, that any issue a politician or group wishes to take up utilizes that term and others (healthcare crisis, financial crisis, mortgage crisis, obesity epidemic). It’s seems like to gin up any support or funds for issues, it must be presented in dooms day scenario.

The truth is we have a pretty good system in place for our children as far as identifying and treating the mentally ill. We have families that are on the lookout, pediatricians, teachers, and continuing education for parents and child throughout maturation. Healthcare is subsidized, to include screenings as well as treatment. Clinics are available in every major city and in many towns.

As stakeholders we need to return to the idea that the parent is responsible for the child’s care and subsequent treatment, not the collective. Please see my link or that comment may not make sense https://www.youtube.com/watch?v=N3qtpdSQox0 The healthcare system needs to address the lack of follow up care for many of these children, lack of long term facilities, and the rush to drug with medicine. As a society we need to have a truly open dialogue on the issues. We mustn’t be disingenuous celebrating the differences of other cultures while dismissing the ugly side of them. We need to say, why do the majority of black children live in a fatherless home and so on. This is an area for public health to improve the mental health of children but remains silent, afraid of being labeled. As stallholders we owe it to our kids to let them lose a game and to fail in life. As a society we are hurt our children’s mental health down the road.


George, W. F. (2011). Handbook suggest deviation from normality are disorders. The Washington Post. Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2010/02/26/AR2010022603369.html?hpid=opinionsbox1
The Rise of Psychiatric Diagnoses in Younger Kids. (2011). Kids Health Issues. Retrieved from http://kidshealth.org/parent/positive/issues_2011/2011_psychiatric.html
[url=https://www.youtube.com/watch?v=N3qtpdSQox0 ]https://www.youtube.com/watch?v=N3qtpdSQox0 [/url]

I don't agree with the position that we need greater financing of our schools in order to have all the things you have outlined. We already spend more on education than any other nation on earth while getting only half the results. You see, we have these organized groups called unions. These unions with there members demand outrages petitions, and salaries. You cant fire the bad teachers and hire good ones. In fact if there are layoffs, the better teachers don't get to stay, the most senior do. The teachers union take away from the children/mental health as much as the give. Until this problem and others like it are solved we will not be able to truly give the children the things you've outlined so well for us. Uhm.. not a money problem, its a spending problem as they say.

“It is commonly reported that 12% to 22% of school- aged children have diagnosable mental health disorders (Berzin, 2011).” With numbers that high it is obvious that something needs to be done to help foster the mental health of school age children. Stakeholders should address this pressing issue by making sure the school staff, particularly teachers, are trained to understand mental health disorders and are taught how to best help those who suffer from mental health disorders. “Frey etal suggest that the vast majority of interventions at the primary and secondary prevention level, where the evidence is most compelling, must be implemented by teachers; they suggest that school social workers, psychologists, and counselors’ role in this context should be to support teachers as the primary interventionist, rather than the sole provider of direct services (Berzin,2011).” Since teachers are the ones who interact with students the most, they really need to know when to report the mental health needs of children and when to refer their students for assessments. Unless children are identified and referred to mental health services they may not receive the help they need. Therefore, more programs need to be available to train our teachers how to deal with the mental health issues of students and more funding needs to be available to create these training programs.

Berzin, S., McManama, Frey, A., Kelly, M. S., Alvarez, M. E., & Shaffer, G. L. (2011). Meeting the Social and Behavioral Health Needs of Students: Rethinking the Relationship Between Teachers and School Social Workers. Journal Of School Health, 81(, 493-5

I actually agree with you in that I believe many children are over diagnosed with mental health issues. If students are not paying attention in class, are fidgety and just getting average grades teachers and parents immediately assume ADHD and soon after these kids get prescriptions to help their “problem.” I use quotations because in many cases I do not think this is actually a problem, I think it is normal for kids to be fidgety and to have short attention spans but our society wants perfect students will put children on drugs to get the outcome they want. I also agree parents should be more responsible for their own children’s care, unfortunately I think many parents these days do not have their priorities right and they let the schools and televisions raise their children instead of being actively involved in their lives. If these parents were involved with their children they would know when something was seriously wrong and when treatment was necessary instead of listening to people that may not have the right motives for suggesting treatment. Oh and to add to your statement saying let the children lose a game, I also think that not every kid should get a trophy for participating, we truly are hurting our children’s mental health and we need to teach them life skills instead of protecting them from everything because more harm than good comes from that.

I believe that mental health issues in school should be addressed so that these children can have the same oppurtunity that children without mental health issues have. I do however strongly believe that mental health disorders can often be misdiagnosed. It seems more often than not, classmates are being misdiagnosed with attention deficit hyperactivity disorder simply because those children are the youngest and/or least mature of their peers. According to a study at Michigan State University by health economist Todd Elder, "Nearly 1 million children in the United States are potentially misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest – and most immature – in their kindergarten class" (Henion & Elder, 2010). This innapropriate treatment with stimulant medications such as ritalin is not only unintelligent and potentially dangerous but it is also wasting an estimated 320 - 500 million dollars of our healthcare (Henion & Elder, 2010). Often times, these diagnosis are driven by teachers when they observe that their youngest students aren't as attentive as their older counterparts. A label is given to the student by the teacher, next the parents see the child as different than other children and then intern, the child acts differently to meet the diagnosis. Instead of rushing into diagnosing our children with mental health issues, we need to allow our children time to mature.
As for children who have REAL mental health issues, they need to be screened by a specially trained school nurse in mental health and get the necessary treatment that they need to succeed.

Henion, A., & Elder, T. (n.d.). Nearly 1 million children potentially misdiagnosed with adhd. (2010). Michigan State University, Retrieved from http://msutoday.msu.edu/news/2010/nearly-1-million-children-potentially-misdiagnosed-with-adhd/

In a perfect world, I would love to see free health care for the mentally ill throughout their entire life but in our world it is not practical. Following them up until the age of maybe the age of 26 might be sufficient in the amount of cognitive behavioral therapy and to develop a therapeutic medication regimine that will allow the mentally ill to function in society. There will never be separate colleges for the mentally ill and I don't even believe they would want that. Everyone just wants to be treated as an equal and to segregate the mentally ill from those who aren't wouldn't be doing them any favors. I do agree that we need to increase funding for the mentally ill and we need to research effective treatments and therapies for the mentally ill.

This week, I was looking at the list that the school nurse had of all of the students with health issues or significant health history. I was taken aback byt not only how long these lists were, but also by how many students had a mental illness and an IEP plan to help meet their needs as a student. The number of students with a mental health issue was above and beyond any other category or health problem and the school nurse said that it has increased and is still increasing dramatically from what it has been. I think that mental health issues are having less of a stigma and teachers/health workers are encouraging teens to voice feelings of depression, anxiety, suicidal ideations, etc. Though the issue of mental health is being addressed better than it used to be, it is still an issue that needs even more attention and intervention available to children and adolescents. One way that the school I am at is trying to meet the needs of their students is the use of councelors that are constantly available to students. They meet with students on a regular basis, especially those students who are struggling and they council them. They help manage school work, teach students ways to deal with stress and anxiety, and they also work with the students who are in and out of school because of mental health issues. The high school that I attended didnt have a service like that. We had guidance councellors but they were more for things like applying to college. I think that life councellors should be available at every school to help address this public health crisis.

The idea of teaching students more about mental health like you mentioned in your post is a great idea. I remember in health class we learned about drugs, drinking and addiction which can all lead or attribute to mental illness, so why wouldnt they incorporate mental illness into the health education? I do not remember learning about depression, anxiety, self harm, etc. and I think that this type of education could be potentially life saving. Children and adolescents dont always necessarily know whats going on with their body or mind, and a lot of them feel very alone in their struggle. If provided the proper education, students would be able to say- thats exactly how I feel and what I am going through, I thought I was crazy. Students would be more apt to reach out for help. Even if this saved one life, it would be worth the funding and the extra few hours of teaching.

glad to read your topic....