Mental Health Education and Support at School can be Critical

A Brief Overview

  • Two Washington students die from suicide each week. In a typical high-school classroom of about 30 students, chances are high that 2-3 students have attempted suicide in the past year. Read on for more detail from the 2018 statewide Healthy Youth Survey.
  • Approximately one in five youth experience a mental illness before age 25. About half of those with diagnosed conditions drop out of school.
  • These outcomes make adolescence a critical time for mental health promotion, early identification and intervention. Read on for ideas about how to seek help.
  • The Adolescent Behavioral Health Care Access Act, signed into law May 13, 2019, provides for more parent involvement in mental healthcare for youth 13-18.
  • Seattle Children’s Hospital has a new referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is for families statewide.
  • A mom in Graham, WA, launched a program to improve education about mental health after her son died by suicide in 2010. The Jordan Binion Project has trained about 500 Washington teachers with an evidence-based curriculum from Teen Mental Health.
  • Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). A student might qualify for an Individualized Education Program (IEP) under this category, regardless of academic ability. To qualify, a disabling condition must significantly impact access to learning. An educational evaluation also must show a need for specialized instruction.
  • Parents can share these resources with school staff, who may be seeking more information about how to help youth struggling to maintain their mental health.
  • Help is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK.
  • Another crisis option is to text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.
  • For youth who need support related to LGBTQ issues, the Trevor Project provides targeted resources and a helpline: 866-488-7386.

Full Article

The thousands of young people who send thank-you letters to Deb Binion didn’t always believe their lives were going to work out. One writer had attempted suicide and been hospitalized many times because of her bipolar disorder. Two years after finishing high school, she reported she was doing well and offered thanks for a course in mental health that helped her understand her illness, its impacts on her brain, and how to participate in her treatment. “It made a total difference in my life,” she said in her thank-you letter.

“Until she got the educational piece and understood her illness, nothing was helping,” Binion says. “No one had ever explained to her why she had this illness and what was occurring.”

The program, which Binion started after her son Jordan’s suicide in 2010, has trained about 500 school staff throughout Washington State to help young people understand mental illness and what to do to support themselves and others. Although the numbers are difficult to track, Binion estimates that about 100,000 Washington students receive education through the curriculum each year.

“My mission is to get this information to the kids,” says Binion, who runs the non-profit Jordan Binion Project from her home in Graham, WA. She says a short-term, limited pilot project with the Office of Superintendent of Public Instruction (OSPI) showed promising results, with 60 teachers throughout Washington informally reporting that about 85 percent of students showed improvement in their “mental health literacy,” a key feature of the program.

Teachers are specially trained to provide the Mental Health Curriculum

The curriculum, available through TeenMentalHealth.org, was developed by a world-renowned adolescent psychiatrist and researcher, Stan Kutcher. He observed that classrooms often struggle to provide an emotionally safe learning environment for students with psychiatric conditions. Some attempts to provide education about mental health have created confusing and triggering circumstances for students impacted by illness and/or trauma, he found.

Kutcher, professor of psychiatry at Dalhousie University in Nova Scotia, Canada, responded with a model for training school staff in how to teach sensitive topics of mental illness:

  • eating disorders
  • anxiety/depression
  • attention deficit hyperactivity disorder (ADHD)
  • obsessive-compulsive disorder (OCD)
  • bipolar disorder
  • schizophrenia
  • post-traumatic stress disorder (PTSD)
  • suicidal thinking

Deb Binion says the program was designed for students in grades 9-10, but middle-school and older students are also learning from it.  She says the program takes about 8-12 hours to teach and that teachers in regular health classes, psychology classes, family and consumer science classes and others have taught the lessons.

Binion suggest that staff receive in-person training to understand how to create a safe learning environment for students. For example, teachers learn to provide individualized help without disclosing a student’s disability or medical condition to the class.

The topics can be confusing or triggering to some learners. Some of the videos might be difficult to watch because they include personal stories of self-harm, hospitalization and people suffering from emotional stress. The program may need individualized modifications for students in special education programs because of intellectual or developmental disabilities.

For information about how to bring a training to your area, individuals can contact Deb Binion through the Jordan Binion Project website or directly through her email: deborah@jordanbinionproject.org.

Washington State recognizes a need for more education and direct support

OSPI, which oversees all school districts in Washington, provides an overview of Kutcher’s work and its connection to the Jordan Binion Project as part of the Mental Health & High School Curriculum Guide. Content in the guide was a collaboration between Kutcher and the Canadian Mental Health Association. At Dalhousie University in Nova Scotia, Kutcher serves as Sun Life Financial Chair in Adolescent Mental Health and Director of the World Health Organization Collaborating Center in Mental Health Training and Policy Development.

Washington State is aware that a lack of mental health services is impacting students. In 2018, OSPI released data that two children enrolled in Washington schools die by suicide weekly.

According to the 2018 Washington Healthy Youth Survey, at least one in three youth in all grades report feeling sad or hopeless for enough time to impact their activities. In ten years, those numbers increased by 10-20 percent across all grades. More than 900 schools administered the survey, representing all 39 Washington counties and 228 school districts.

About one in three 10th and 12th graders report feeling nervous, anxious or on edge, with an inability to stop worrying. From 2016 to 2018, the percentage experiencing these feelings increased for all grades. Rates of reported suicide have remained alarmingly high, with about 10 percent of students reporting that they have attempted suicide recently.

This means that in a typical high-school classroom of about 30 students, chances are high that two or three students have attempted suicide in the past year.

Female students and students who identify as lesbian, gay, or bisexual report higher rates of considering, planning, and attempting suicide. For youth who need support related to LGBTQ issues, the Trevor Project provides targeted resources and a helpline: 866-488-7386.

High rates of suicide attempts also are reported among students who identify as American Indian or Alaskan Native (18 percent) and students who identify as Hispanic (13 percent). Help for all is available 24/7 from the Suicide Prevention Lifeline: 1-800-273-TALK. Another crisis option is to text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.

Despite the alarming data and evidence that adult support can impact outcomes, only half of students say they have access to direct adult support when they feel extremely sad or suicidal.

The 2018 Healthy Youth Survey introduced a modified Children’s Hope Scale, which measures students’ ability to initiate and sustain action towards goals. Across grades, only about half of students feel hopeful for their futures. Students who identify as lesbian, gay or bisexual and students of color were less likely to report adult support and were less likely to be highly hopeful for their futures.

State, local, community and school efforts are crucial for supporting youth mental health. With the release of the survey in Spring, 2019, the state issued a guide to information and resources to provide more detail about the survey and to direct families and school staff toward sources for support.

Latest data for 10th graders female students and lesbian, gay or bisexual students report higher rates of considering making a plan for and attempting suicide

An OSPI survey in 2018 found that the number one concern statewide is that students don’t receive enough direct support in mental health, counseling and advising at school. The Washington School-Based Health Alliance (WASBHA) is working with some districts who have varied grants throughout the state to build on-campus health clinics to address a range of student health-care needs, including mental health. The Alliance sponsored an all-day summit May 3, 2019, at the Seattle Flight Museum that was attended by several hundred professionals invested in building collaborations between public health agencies and schools. Throughout the day, professionals discussed how students are much more likely to seek a counselor at school than in the community and that outcomes improve when providers and school staff collaborate and provide individualized help focused on relationship-building.

New state law expands parent involvement in mental-health treatment

Youth older than 13 have the right to consent or not consent to any medical treatment in Washington State. Parents and lawmakers throughout 2018-2019 engaged in conversations about how that creates barriers to care for may teens who don’t fully grasp their mental condition or how to recover.

In response, lawmakers wrote and passed the Adolescent Behavioral Health Care Access Act (HB 1874), signed into law by Gov. Jay Inslee May 13, 2019. The new law allows behavioral health professionals to provide parents or guardians with certain treatment information if they determine the release of that information is appropriate and not harmful to the adolescent. The bill also permits parents and guardians to request outpatient treatment for their adolescent, expanding the current parent-initiated treatment process so that adolescents can get treatment before they reach the point of hospitalization.

“Parents across the state are desperate to be allowed to help their children struggling with mental health issues or a substance use disorder,” says Rep. Noel Frame from the Seattle area. “At the same time, we need to protect the rights and privacy of these youth. This bill strikes a balance by ensuring adolescents can continue to access treatment on their own, while giving concerned parents an avenue to help their children and be involved with their treatment.”

Parents also have a new option for helping their children and youth by contacting Seattle Children’s Hospital, which in 2019 launched a new referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is for families statewide. In addition to helping to connect families with services, the hospital will be positioned to identify gaps in the system through its engagement with families.

One in five youth are at risk

The Teen Mental Health website cites an international statistic that 1 in 5 youth experience a mental illness before age 25. Many of those illnesses lead to life challenges that require help, the agency concludes, and this makes adolescence a critical time for mental health promotion, prevention, early identification, and intervention. The agency provides a School-Based Pathway Through Care that promotes linkages between schools and healthcare agencies, parent involvement and strong educational programs that reduce stigma through knowledge and timely treatment access.

One way that Washington State has responded to the crisis is through promotion of trainings in Youth Mental Health First Aid. Through Project AWARE (Advancing Wellness and Resilience in Education) and other initiatives, Washington has grown a network of about 100 trainers for Youth Mental Health First Aid and about 4,000 first aid providers. These trained individuals can listen actively in order to offer immediate caring and can also refer youth to providers. OSPI reports that Project AWARE has led to 3,964 referrals for youth to connect with community- or school-based mental health services.  

Washington has a program for treatment response for youth experiencing psychosis. The New Journeys Program is designed for youth 15-25 who are early in their diagnoses, but there is some flexibility in who might be eligible to participate. Families can contact the program for additional information about how to apply.

Information about psychosis, early warning signs and places to seek help are available through the website of the Washington Health Care Authority (HCA). The website contains a link to information about the Wraparound with Intensive Services program (WISe), which provides community case management for children and youth experiencing a high-level of impact from a mental illness.

Special Education is one pathway toward more help

Students access some aspects of mental health support through the special education system. Emotional Disturbance is a federal category of disability under the Individuals with Disabilities Education Act (IDEA). In Washington State, the category is referred to as Emotional Behavior Disability (EBD). The IEP might list any set of these words or the initials EBD or ED.

A student might qualify for an Individualized Education Program (IEP) under this category, regardless of academic ability. A comprehensive educational evaluation can determine whether a student’s mental condition causes a significant disruption to the student’s ability to access school and learning and whether the student needs specialized instruction. Generally, that specialized instruction is provided through a category of education known as Social Emotional Learning (SEL). SEL can be provided in multiple tiers that might include schoolwide education, small group training and individualized programming. OSPI provides recommendations from a 2016 Social Emotional Learning Benchmarks Workgroup.

A student with a mental health condition also might qualify for an IEP under the category of Other Health Impairment (OHI), which can capture needs related to anxiety, ADHD, Tourette’s Syndrome or another specific diagnosis. Students with a mental health condition that co-occurs with another disability might qualify under another category, and Social Emotional Learning might be an aspect of a more comprehensive program. PAVE’s articles about the IDEA and the IEP provide further information about IEP process, the 14 categories of qualifying disabilities and access to special education services. A student with a mental health condition who doesn’t qualify for an IEP might qualify for a Section 504 plan.

If a student, because of a disability, is not accessing school and learning, then the school district holds the responsibility for appropriately evaluating that student and determining the level of support needed to provide access to a Free Appropriate Public Education (FAPE). Questions about FAPE might arise if a student with a mental health condition is not accessing school because of “school refusal,” which sometimes leads to truancy, or because a student is being disciplined a lot. Students with identified disabilities have protections in the disciplinary process; PAVE provides an article about school discipline.

Help NOW can mean a lifetime of better opportunities

The Center for Parent Information and Resources (ParentCenterHub.org) has a variety of resources related to mental health awareness, including a link to a video that details results from a national study. The study showed that students who qualified for special education programming because of Emotional Disturbance experienced the highest drop-out rates when they went into higher education, work and vocational programs. Meaningful relationships with adults who cared about them in school provided a significant protective factor. Students were more likely to succeed in life-after-high-school plans if specific caring adults provided a soft hand-off into whatever came next after graduation.

Here are a few additional resources:

 Here are some articles specifically about Bipolar Disorder in Youth:

Accommodations for Students with Bipolar Disorder and Related Disabilities

Educating the Child with Bipolar

Bipolar & Seasons: Fall Brings More Than Just a Change in Colors

 

So you’re at College…What Next?

Navigating the Higher Education Environment When You Live With Disability

Research over the past 20 years indicates that a fairly high percentage of college students with disability choose not to disclose that disability to a college administration.  They are tired of “being labeled” or singled out because of their situation and simply want to participate in the same way as students without disability.  This doesn’t necessarily mean hiding their disability (pretty difficult to hide a mobility device or service animal), they’ve just “had it” with permissions, meetings, and forms.

At the same time, many students get onto campus wanting not to disclose, and discover that yes, they *do* have to jump through the hoops at Disability Services in order to access strategic supports.

[If you’ve already met with the disability/access services office at your campus, and provided documents to receive services and equipment, you can skip this next section]

If you’re just beginning the access process, this is what you have to do:

Be able to clearly explain your disability and your specific requirements for services and equipment. It’s better to ask for more than you might expect to get, but be aware of the possibility that if the school can’t provide a service or equipment and you absolutely need it, you and your family will have to bear the expense, or you will have to find a school where such services/equipment is available.

Make an appointment at Disability/Access Services

Fill out any forms requesting services and equipment (usually available online)

Make certain you have all required documentation.

Below is an example of typical required documentation.  It can vary from school to school, and you will find a similar list again, usually on the school’s website under “Disability/Access Services”.

“In order for a student to receive an educational accommodation due to the presence of a disability, documentation from a professional service provider must be obtained. Professional providers may include, but not necessarily be limited to, those identified below:

Disability Category         Professional Provider

ADD ADHD                        Psychologist/Psychiatrist

Emotional disability       Psychologist/Psychiatrist

Auditory disability          Certified Otologist, Audiologist

Visual disability               Ophthalmologist, Certified Optometrist

Learning disability          Psychologist, Neuropsychologist, Learning Disability Specialist

Physical disability           Medical Doctor, Physical Therapist, Orthopedic Surgeon, Doctor of Rehabilitation

Chronic health impairment         Medical Doctor, Medical Specialist

Documentation from a professional service provider must be in writing, must be current within three years, and must include the following when appropriate:

A description of the student’s disability and how he/she is affected educationally by the presence of the disabling condition.

Identification of any tests or assessments administered to the student.

For students identified as having a specific learning disability, the assessment must be specific to the student, comprehensive, and include:

Aptitude

Achievement

Assessment of the student’s information processing capabilities,

Raw data and interpretation of the data

Specific educational recommendations based on the data interpreted.

Effect on the student’s ability to complete a course of study.

Suggestions for educational accommodations that will provide equal access to programs, services, and activities…”

-Source: Tacoma Community College, Tacoma, WA at: http://www.tacomacc.edu/resourcesandservices/accessservices/forms/

What Happens After the Appointment with Disability Services?

After the appointment, you’ll get an official notification from the Disability/Access Services administration informing you of your eligibility for services, and if eligible, what services you can expect to receive.

You may have to place additional calls to Disability/Access Services to determine when services begin, where to pick up equipment, arrange meetings with note takers, etc.

At most schools, YOU are responsible for notifying each of your instructors (every semester!) of your requirements for accommodations. Hang on to that eligibility letter–better yet, make multiple copies to hand out to instructors.  Having known many college instructors, I suggest you don’t send this by email alone. Hard copy rules in this case.

Informing instructors about accommodations means giving plenty of notice for them to order alternatives to conventional textbooks. If you’re doing this at the beginning of a semester, expect delays getting the material. This sometimes happens even when you had your appointment with Disability/Access Services many months in advance of the semester. If so, you may have to negotiate with your instructor for extensions on assignments.

Make sure you understand the limits of what the school is providing for assistive technology. For instance, many schools limit the loan of portable screen-readers to specified uses or time frames. You may have to provide your own equipment or software outside those limits.

Some Disability/Access offices are one-stop shopping, and can set you up with tutors, any necessary remedial courses and on-campus health services (including mental/emotional health).  At other schools, it’s very fragmented, and YOU will have to find these services separately, even when they are related to your disability.

Most such services are available through departments labeled “Student Services”, “Student Success Services”, “Counseling”, “Health Services” and the like.  If you are unsure of where to find services, you can contact staff in an office usually labeled “Dean of Student Services”.  College Deans are top-level administrators who oversee a number of related departments.  Their staff are knowledgeable about all departments under that Dean’s authority.

Who to Talk with About Issues

What if you have issues with instructors not allowing or ignoring your accommodations?

Your first step should be to re-issue your eligibility letter to that instructor, following up by requesting the Disability/Access office to notify the instructor of your eligibility through their office. If this doesn’t resolve the issue, all schools accepting federal funds will have a Section 504 Coordinator (or similar title) on campus. This person is probably on staff in the Disability/Access Services office, wearing additional hats. Complaints regarding your access to materials, instruction, and class activities go to this person.

If you’re not using a Section 504 plan but still require accommodations, all schools accepting federal funds will also have an ADA Coordinator (or similar title). This person may or may not be located in the Disability/Access Services office but that office will be able to direct you to them.

[The ADA Coordinator is also the person to see when you have an unresolved issue around physical access on campus or with any program offered away from the main campus.]

Complaints about instructors *not* relating to your accommodations are usually addressed to the Dean of Academic Affairs (yes, another Dean), or the Chairperson of the academic department for that instructor.

In most cases, it’s appropriate to discuss any concerns with your instructor before escalating a concern or complaint up the line.

Navigating the Campus:

If your disability includes physical limitations you’re already aware of how many barriers exist to full participation in any environment. Many, many schools were built prior to ADA, and their facilities reflect lots of poor accessibility design. [I attended a school that only had accessible restrooms on every other floor, and in each case those restrooms were at the opposite end of the hallway from the elevators! At another school, I had classes in a building that underwent (planned) replacement of the only building elevator during the height of the semester].

If possible, move onto campus (or visit the campus) early for some “dry runs”. Acquire a campus map to figure out the quickest to get to classes, dining halls and sports facilities.

Make friends with the administrators working at Campus Police. (They’re the ones who assign parking spaces and they also know the best and quickest ways around grounds and buildings.)

It also doesn’t hurt to know the phone number for the folks who run the facilities. This department is sometimes called Physical Plant, Facilities, or Buildings and Grounds. They’re really useful when the accessible restroom is out of order, when the elevator breaks down, and when you want to know if certain areas are clear of snow and ice.

Lots of Fuss-Why Bother?

All this navigation of a college’s bureaucracy seems overwhelming, listed here all at once. Don’t get discouraged. I’ve listed these possibilities here so you can make notes for yourself and be prepared. With luck, you’ll never need to contact some of these offices or people. On the other hand, “entropy happens”—things sometimes go sour. Knowledge is power!