Destigmatizing mental health starts in schools

How one district helps students in crisis get the help they need
By: and | August 10, 2017

The number of young people suffering from depression has increased almost 40 percent in the last three years. And, as the Hamilton Southeastern School District has found, mental health issues are hardly limited to teens.

After the city of Fishers, an Indianapolis suburb of about 90,000, had 13 suicides in 2016, city officials launched a campaign to destigmatize mental health issues—including in the school system.

Last year, Hamilton schools passed a referendum to provide mental health services to its 21 schools, serving more than 22,000 students.

This fall, 12 licensed therapists will spend 2.5 days or more at each school alongside traditional guidance counselors.

District Mental Health Coordinator Brooke Lawson and Assistant Superintendent of Staff and Student Services Michael Beresford discuss the challenges of addressing mental health issues, and how a student-launched club is helping to remove the stigma attached to mental illness.

You’ve said that there was an increase in mental health events in your district. Tell us about that.

Beresford: It wasn’t a dramatic jump, but it was a steady increase. Prior to that, most of the time if you had a despondent student, or a student who needed mental health services, it was in high school or occasionally junior high. We’re talking about a handful of kids.

Then that climbed to 10 or 12 per year, then 20, and we were starting to see kids from the intermediate school, which is fifth- and sixth-grade. Occasionally we’d hear about a kid from the elementary school, and that’s when we started seeing there was a trend.

We knew we wanted to get some support, and having that available at school was going to be much more effective for our kids.

Is there one mental health issue that is prevalent among these youths?

Lawson: In our school district, anxiety is a really big issue for our students. We are a high-performing city. We have a lot of really successful parents, and I think the kids in our school district feel a lot of pressure to perform well.

Beresford: I would say that stress and anxiety are the top two struggles even in our community. People are bombarded with bad news and personal problems constantly from many different sources.

What accounts for the increase in problems among elementary students?

Lawson: There are many factors that play into that. Social media certainly plays a part. Before social media, kids could do things and no one knew about it. You didn’t have to see what everyone else was doing and compare yourselves to them, and I think adolescents really struggle with that.

They feel they’re missing out on what’s going on or that they don’t fit in.

Many kids don’t know how to cope with their feelings and haven’t developed the social-emotional skills that are so important for children to learn. It’s not always being taught at home like it used to be. Kids don’t know how to express themselves—they can’t find the words to say how they’re feeling to even ask for help.

Tell us about Stigma Free HSE.

Lawson: In my second week here, I got an email from a student asking for my help in creating a mental health club at his high school. I’m a licensed clinical social worker, but I had never really heard about a school mental health club.

We helped him identify the vision of this club—we wanted to be very careful that it wasn’t going to be a support group for kids. We knew there would probably be some kids who would come to the club who were themselves struggling with mental illness, but that wasn’t really the goal of the club.

This student wanted to raise awareness of mental illness and educate his peers on what mental illness is. He wanted to be a voice for other kids and a resource for his friends if they were struggling.

I didn’t know whether kids would want to come to a mental health club, but we had 30 students show up to our first meeting. Since then we’ve had between 50 and 70 students attend each meeting.

Beresford: What’s remarkable is that from the onset, we’ve identified stigma as the No. 1 barrier to helping people who are suffering in silence. Just the idea that these kids are that open and will go that distance to normalize mental health just as you would a physical ailment, is just amazing.

So it is really more about awareness and acceptance rather than intervention?

Lawson: Right. We’ve done a lot of talking with the kids about how it’s not their job to save someone, and we trained them in QPR—a prevention strategy—so that they would know how to respond if they had a friend who was struggling.

Tell us about QPR—the suicide prevention strategy.

Lawson: It’s called Question, Persuade and Refer. It teaches how to respond to someone who might be in crisis, who might be thinking about hurting themselves or others. It’s a specific way to help them get the help they need. All our teachers have been trained in QPR, as are new teachers to the district each year.

Where does the first indication come from that a student has a problem?

Lawson: It comes from a lot of people. In the younger ages our teachers end up noticing it or their parents might notice that something is off. Older kids sometimes talk to their friends, and we’ve had many kids tell us they’re worried about a friend.

Beresford: Several years ago we launched a Text-a-Tip program. We thought it would be for crime or for kids who were bullied—that sort of thing. But we probably have more kids who text concerns about another student’s welfare. So students are using that to reach out if they think there’s something going on with a kid.

The text goes to the police department and to the administrators in the school district. We get on that very quickly.

Having a district mental health coordinator is not very common. Why is that, when it’s so vital to young people?

Beresford: That’s a great question. I can tell you what my motivation was for making this essential to our mental health plan.

Guidance counselors are taught to give academic and social-emotional support. They’re not trained therapists and they’re not trained to do therapy.

I found it was vital to have someone who had those credentials, who knows about therapy and has the training to be able to lead our staff and guidance counselors on the mental health side of life so we could better support our kids.

What can a district do, especially one that is financially challenged, to replicate your approach?

Beresford: We began this with really no funding. We were in bad financial shape when we started.

Step one is to get with your mental health providers. We started out with services in the school that were basically just Medicaid-reimbursable so that they could work with kids who are in Medicaid.

The other key was giving them access to the building, because parents who work have trouble making and keeping off-site appointments regularly. Being in school, where the action was, we were able to get that started along those lines.

Lawson: I think that’s such a crucial role for a mental health therapist, because there are students who spend the majority of their day at school. It makes sense to have a mental health provider at the school because they can support the student, but they can also help the teacher and other school staff put things in place to help that student be successful.

Have you been able to measure the effectiveness of your unique program?

Beresford: Yeah, we’re definitely getting more success stories. The numbers of students who have expressed suicidal thoughts went up. Now, you may take that as a negative, but my hunch is that the stigma is reduced and kids are more comfortab

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