Mental health issues among students are gaining more recognition today. Acts of violence committed by young people, like some shootings in schools, are believed to be related to their destruction and hopelessness. In the 1990s, many researchers showed concern over the growing number of school-age children experiencing mental health problems such as anxiety and mood disorders [1]. It is suggested that at least 20-30% of students in schools suffer from some level of emotional and behavior problems. Some of them are so serious that they need help to function at school and in their everyday lives. Mental health problems persist over time and impair the developmental opportunities of children and adolescents if left untreated. Untreated childhood mental health problems have serious implications such as lower educational achievement, disrupted family life, and economic loss for some countries. This body of knowledge underscores the need for immediate and high investable actions to improve the mental health of students in schools. This essay discusses the importance of mental health in schools, the strategies to improve it, and the barriers to implementing them.
1. Introduction
In schools, where students spend most of their waking hours of the weekdays, a great deal of interactions happens. Students develop their self-identity, self-images, social skills, and notions of rights and responsibilities about themselves and others within the school system. Positive notions of self and others enable students to feel and be safe within the educational system and society. It also contributes to good interpersonal relationships with peers, family members, and teachers. Moreover, besides friendships, strong bonding with peers also promotes positive mental health and well-being among students. Schools are highly relevant and potential settings for promoting the mental health and well-being of students. Within school systems, more resources and interpersonal interactions exist to foster educational and social development than other settings. School systems are also helpful for integrating fragmented services, since they can offer a variety of services that cater to students’ different needs. Those services include health promotion, preventive education, school guidance services, behavioral training, counseling services, and academic supports. In addition, there is a growing recognition that the promotion of the mental health of students is an essential ingredient for holistic educational development, as it directly impacts on their academic performance, behavioral adjustment, interpersonal relationships, and family functioning. Psychologically healthy students are more likely to be active learners, socially integrated, and emotionally stable. These factors foster an environment that is conducive to learning [2].
1.1. Significance of Mental Health in Schools
This section delves into the significance of mental health in schools, emphasizing why it is an essential aspect of overall well-being for students. Mental health encompasses emotional, psychological, and social well-being, affecting how individuals think, feel, and act. It plays a crucial role in determining how students handle stress, relate to others, and make choices. As students progress through school and approach young adulthood, they encounter various challenges that can significantly affect their mental health. For example, mental health conditions impact how well students relate to their families and friends, succeed in school, and function as productive citizens. Good mental health allows students to work productively, make health-promoting choices, and better cope with the challenges of growing up and the stresses of life. It leads to better grades, attendance, relationships, health, and chances of continuing education and finding better jobs [3].
Conversely, untreated mental health conditions often lead to poorer academic achievement and various social, emotional, and behavioral problems that create a barrier to school success [2]. Much like physical health, mental well-being is part of the foundation for overall healthy living. However, with high-stakes standardized testing, the emphasis on increasing student academic achievement narrows the focus on reading and math at the expense of physical and mental health. Inadequate attention to the mental health of students and adults in schools and communities creates a public health crisis. Education leaders must take the necessary actions to develop policies and implement strategies for safe and supportive learning environments that enhance children’s mental health and well-being. As an integral part of the school community, health leaders are positioned to take the lead in these efforts.
2. Understanding Mental Health
Mental and emotional well-being is a core condition for overall health that leads to a happy and productive life. The well-being and mental health of children and adolescents are critical developing the foundation for healthy adults and productive members of society. Their health and safety are essential to the quality of community efforts, efforts to promote strong and successful families, and efforts to ensure children’s readiness to learn [2]. Mental and emotional well-being are interconnected with social conditions such as stress and poverty, as well as issues relating to physical health. As reported by State and National Youth Risk Behavior Surveys, rates of obesity, chronic illness, injury, and disability are increasing in youth populations. Rates of mental health problems and risk behaviors, such as depression, anxiety, suicide, smoking, chemical use, and violence, are also on the rise, affecting youth, schools, families, and communities [4].
Mental Health is a broad term and can mean different things to different people. It describes a range of human thoughts, feelings, and behaviors and can include happy or positive states (e.g., feeling content, confident, or joyful) as well as sad or negative states (e.g., feeling stressed, agitated, or miserable). Conceptually, mental health can be thought of as forming a continuum (also referred to as a mental health spectrum). On one end of the continuum is a good or positive mental health state, and on the other end is a poor or negative state, which may be referred to as a mental health disorder or incapacity. Despite this spectrum view, mental health is commonly referred to in more absolute terms as either mental health or mental illness. A mental health disorder or illness, at its more severe levels, is an affordable impairment of the mental health state and affects the overall functioning of the individual, is unintentional, and is not socially acceptable (i.e., not appropriate and not complying with shared social norms).
2.1. Common Mental Health Disorders in Children and Adolescents
Mental disorders are defined in a variety of ways based on cultural norms and social expectations. Outcome variables from the most common diagnostic systems, the Diagnostic and Statistical Manual of Mental Disorders DSM-IV, and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) identify more than 250 separate diagnoses or globally recognized syndrome categories including affective disorders, anxiety disorders, eating disorders, pervasive developmental disorders, psychotic disorders, personality disorders, disorders of adult life adjustment, and sleep disorders [4]. The International Burden of Disease Study has calculated the social mortality associated with all these syndromes (health adjusted life years – whole years of healthy life lost).
The most common mental health disorders among children in the United States are ADHD (11%), mood disorders (8%), depression (3%), conduct disorders (3%), and anxiety (3%). Over one in five children have one or more abnormalities, which can affect their social relationships and academic performance [5]. However, only about 2 in 10 of those children who need mental health services receive appropriate treatment. School is a prominent environment for education, development, and socialization; therefore, children spend most of their time in school. Unfortunately, schools often have limited knowledge of mental health services available and even less access to such services.
3. Challenges in Addressing Mental Health in Schools
Most children and adolescents spend a lot of time at school, and thus the school environment greatly influences their development and wellbeing. Efforts have been made in some countries and districts to provide school-based mental health (SBMH hereafter) services, based on the recognition that schools are a strategically important venue for mental health promotion and enhancement of access to care [2]. However, there is the question of whether such initiatives are effective. This initiative is a working partnership project implemented in reference to the WHO awareness and preemption guidelines. Following the awareness and education initiatives, the identification of stakeholder needs and concerns relative to this project, particularly of teachers who are frontline personnel, was surveyed. The unique roles of teachers and their views on mindset and education regarding SBMH services were also explored. Implementation and effectiveness evaluation plans were also suggested.
In order to achieve success in the implementation of school mental health services, needs assessment must be undertaken with reference to the unique challenges, barriers and assets of the local context. Recent mental well-being and school functioning surveys revealed the teachers’ desires for mental health services, and concerns regarding the effectiveness of existing support measures and the safety of school environments. Nevertheless, their perceptions of the specific nature of mental disorders and the service readiness at schools must then be explored. Subsequently, measures of the effectiveness of services in promoting mental health at schools, including impacts on the students, teachers, parental involvement and the school environment must also be undertaken.
3.1. Stigma and Misconceptions
Stigma and misconceptions surrounding mental health have long persisted within schools and their communities. The stigma of receiving mental health support was identified as an important barrier by local stakeholders. School personnel viewed seeking support as a weakness, while community members believed that mental health was a sign of familial dysfunction. Additionally, there was the worry that mental health concerns would be made public knowledge and that receiving support would result in differential treatment within the school setting. It is evident that stigma has been identified as the largest barrier related to SBMH [2]. School staff perceived stigma on the part of the family as a barrier to the utilization of mental health support services. Language and cultural barriers to providing SBMH supports were also perceived by survey participants. Many non-white families underutilize mental health services and seek therapy only when problems have become severe; this is often portrayed in the media. Cultural values of non-white individuals can be incongruent with traditional mental health practices [6].
In the current study, Hispanic families were of particular concern. Both school personnel and community stakeholders reported family and community stigmas and misunderstanding of mental health as barriers to SBMH. Community stakeholders reported that within some minority cultures, mental health is not discussed and needs to be reframed; developing a strong, culturally congruent relationship with families is essential. It was suggested that former clients of mental health services be recruited to discuss positive experiences to combat stigma and misunderstanding when designing the SBMH program. At the school level, there were internalized stigma concerns that would inhibit service utilization and that families would be fearful of knowledge of mental health issues being revealed.
4. Current Approaches to Mental Health in Schools
As part of a school’s response to students’ emotional and behavioral issues, school systems may provide school-based clinical mental health services. Delivered directly in the school by a mental health professional, these services typically include ongoing mental health assessment, treatment development and monitoring, individual and family therapy, crisis intervention, and medication monitoring [7]. School systems may also provide school-based mental health consultation, which involves ongoing consultation by a mental health professional to teachers and other school staff regarding instructional adaptation, behavioral techniques, school environment change, or parent and community resource involvement designed to help children with emotional and behavioral needs. Schoolwide programs, such as classroom management programs, peer mediation programs, staff training, and other initiatives designed to change the instructional or behavioral environment of schools, may be developed under the consultation framework [1].
There are other prevention and control strategies adopted by educational systems across the district, and those can be divided broadly into two categories. The first includes services focused on the individual child or family, such as child instruction, family therapy, or medication therapy. These individual-based services may not match the level of need for mental health assistance experienced across the school. A second broad category of prevention and control strategies includes school-wide and community-wide programs. These community-based approaches may not be feasible in all educational contexts, as they require changes to the overall school or neighborhood environment.
4.1. Counseling Services
Having mental health services integrated into schools is one commonly held idea for improving accessibility in order to increase use of prevention and intervention services among primary and secondary school students. Perceptions of the role of school-based mental health counselors were examined among stakeholders in school systems and community mental health providers. Stakeholders agreed that school-based mental health counselors should provide direct student services such as individual and group counseling while providing counseling consultation services to parents and teachers. Out of 22 responsibilities, school key informants and community mental health providers completely or predominantly agreed on three school-based mental health counselor functions: teach health education classes, provide counseling consultation services to families, and provide individual counseling to students. Community and school populations also had significantly different ratings regarding the types of mental health services counselors should provide, which would impact academic and behavioral outcomes. Characteristics of respondents were also examined [8] , [7].
Increasingly, schools are implementing multi-tiered mental health models whereby some school-based prevention and intervention services are provided by outside mental health agencies and providers. The implementation of this mental health model may necessitate the hiring of mental health counselors specifically for school settings. These personnel would be responsible for providing counseling services to students with academic or behavioral difficulties. Accompanying this proactive initiative are many questions concerning who these counselors are as professionals working to promote student success within the school system and how these programs can best be implemented. It is quite possible that in order to avoid miscommunication and incompatible perceptions concerning the role and function of school-based mental health counselors, this population should be adequately educated. Education on this population would assist with awareness of the proficiency and availability of school-based mental health counseling services designed to serve elementary aged students.
5. Incorporating Mental Health Education into the Curriculum
It is vital to incorporate mental health education into the school curriculum effectively. Schools must look for ways to educate students about mental health concerns and strategies, both inside and outside the classroom. Mental health education can benefit teachers as well as students and can extend to parents and the wider community. Schools can deliver projects addressing mental health concerns to the whole school community and create an open atmosphere to report concerns without fear of stigma [9].
It is widely recognized that mental health has a holistic impact on an individual’s overall well-being. Mental health relates to all aspects of health in terms of physical, social, and emotional well-being. Understanding mental health from a young age allows individuals to nurture and overcome mental concerns actively. Understanding mental health literacy prepares young individuals to contribute to their overall well-being. Schools can opt for integrating mental health into subjects like guided reading or OEM [10].
5.1. Benefits of Mental Health Education
Integrating mental health education into the curriculum has many benefits for students. The positive effects of mental health education can be seen in various areas related to mental health, leading to many good results for students. One of the most significant benefits of mental health training is the growth of student awareness and understanding of mental health issues, which includes recognizing the symptoms and causes of mental health problems. This newfound knowledge can help students cope with their behavioral issues in a healthier manner. For instance, they can gain insights into common triggers of anxiety, such as tests or social situations. Consequently, they can discover useful coping strategies, including relaxation exercises or problem-solving techniques. Such guidance in selecting coping methods may lead to greater efficacy and feel less frustrated. The knowledge and skills learned in mental health classes can have positive effects on student behavior and attitudes over the long term [1].
Furthermore, mental health education also appears to have an indirect effect on improving school behavior. Students not only learn about the signs of mental health problems but also about their seriousness. The education then helps students become more responsive towards their peers and encourage them to seek help when they are in need. Another important benefit is the preventive function of mental health education. It helps destigmatize mental ill health around the school by improving awareness. Some students pointed out during the classes that they realized they were not alone in their situation, noticing that others experienced similar problems (such as low self-esteem and anxiety during tests). This can encourage them to share their concerns within the school community and seek help from the school psychologist if needed [2].
6. Collaboration with Parents and Community Resources
School wide approaches for addressing student well-being include community-based partnerships and programming, expanded use of school mental health professionals, and mental health promotion policies [11]. Community-based partnerships and programming include providers of mental health services, youth development, or health supports whose services are made accessible to students through the school. These services may be delivered at school or in the community and may include outreach, school-based or school-linked programs, and referrals to community services. Partnerships can enhance service coordination, increase the availability of mental health services, and expand the type of services accessible to students. Community providers can respond to requests for assistance and ensure that referrals are made to appropriate services outside the school. Most often, it involves links between the school and one or more community providers, yet successful partnerships typically involve the close collaboration of providers in a network offering a range of service options.
Collaboration alone does not guarantee a positive impact on student care and outcomes. Each partner should retain its own unique philosophy and mission while aligning resources to achieve interdisciplinary goals. Participation in formal partnerships typically requires some level of shared funding. Creating cross-system teams composed of representatives from each partner agency helps to break down traditional provider roles and develop mutual responsibility for student outcomes. Community-based partnerships and programming are supported by prioritizing student needs over implementation costs or ease of programming. Building comprehensive partnerships that involve several providers rather than one single agency. Like school programming, policy support for community partnerships frequently lags behind prevailing research, funding priorities, and best practice models that involve collaborative approaches.
6.1. Engaging Parents in Mental Health Discussions
While the involvement of students and school staff is emphasized, parental engagement is equally important in the context of mental health (MH) discussions, and it is also strongly advocated in many of the country policies reviewed in Chapter 3. Involvement can extend to the development and implementation of preventive and early intervention activities and initiatives. For example, recent initiatives in Finland have sought to extend mental health promotion activities in schools to elementary school grades to improve coping skills and resilience. One of the main objectives of this initiative was to enhance the ability of schools to identify and intervene with MH problems at an early stage, and school staff is trained to implement such programs. However, parents are not involved in these activities, which diminish their effectiveness [12]. There are several major reasons to support the involvement of parents in school-based discussions on MH. First, in many cases, it is the parents who note the signs of decreasing mental well-being before school staff (and, of course, before the students themselves). Second, schools are generally aware that MH problems tend to cluster in families. Schools take notice of the preventive efforts aiming to support the entire family and to share the sense of responsibility for the MH of the children. Third, the school context is appropriate for reaching parents. In many cases, it is easier for parents to visit the place of school than go to another institution such as health care. Involving parents requires the agreement and effort of the schools, but it cannot succeed without the parents’ desire to become involved. It is therefore important that the parents’ point of view also be acknowledged. Nevertheless, the responsibility for sharing the ideas on involvement rests with the schools.
7. Training and Support for Educators
Mental health problems among school-aged children are prevalent and can have a significant impact on their functioning and development. The school is seen as a practical context for supporting students’ mental health needs at a population level [1]. Mental health promotion and problems preventive programmes are a number of evidence-based strategies that have been implemented in many schools. There is increasing interest in approaches to promote a healthful school environment to prevent risk behaviours, i.e. mental health issues and also chronic diseases, among children and youth. Universally implemented health promoting school approaches attempt to target the student population and the entire school community. These approaches focus on the overall school environment, encompassing the material environment, the psychosocial environment and relationships at school, the governance of the school/community. However, little attention is given to the capacity building of these improvement strategies. The initiatives of schools and communities are often isolated and lack an overall improvement framework.
Schools are increasingly expected to play a role in promoting students’ mental well-being and preventing mental health problems. There has been a growing recognition that teachers and other educators are key stakeholders in such initiatives, given their daily contact with students and their capacity to detect signs of mental health problems [13]. Thus, it is essential to provide training and support for educators to adequately recognize and address the signs of mental health issues. They play an important role in implementing mental health promotion in schools since their involvement is expected to facilitate the effective delivery of programs in the school setting.
7.1. Recognizing Signs of Mental Health Issues
As an educator, you are in a unique position to notice if something is wrong with a student. You may be the first to see the warning signs and symptoms of mental health issues, especially if they occur at school. It’s essential to be aware of what to look for and to take action, as early intervention can help prevent more serious issues from developing.
This chapter focuses on signs and symptoms of mental health issues that you should recognize. It describes how these problems might look in children and teenagers. It also discusses how to access mental health assessment and treatment services. Knowing what to expect will help you support students, reassure parents who may be concerned, and assist schools in becoming more supportive environments for mental health [2].
Be concerned if a student suddenly changes how they act, feel, or learn. It may be a sign that something is wrong. Here are some specific behaviors to look for: feeling sad, anxious, or angry for no reason; not caring about things they used to; becoming withdrawn, nervous, or overly concerned; trouble falling asleep; lowering grades; frequent absences from school; trouble focusing or making decisions; behavior that is too silly or silly at inappropriate times; physical complaints with no obvious medical cause; involvement in fights or getting into trouble [14].
8. Promoting a Positive School Environment
Schools play a critical role in establishing environments conducive to the mental health and well-being of children and young people. Creating a school culture that values and promotes mental health is a protective mechanism that can prevent the development of mental health problems. Schools are ideally positioned to provide children and young people with evidence-based interventions that promote mental health and reduce the incidence and impact of mental health problems given their universal access to children and young people [15]. The school environment encompasses the school culture, ethos, and organizational structures and policies that shape the everyday experience of students, teachers, and other members of the school community. Bullying is a major concern in schools, as it has a profound impact on a child or young person’s academic performance, school attendance, and socialization, as well as increased feelings of loneliness and depression [16].
Bullying prevention programs are important as they have a statistically significant impact on reducing victimization and are a desirable prevention approach given their ability to reach the whole school population. There is also growing evidence that anti-bullying interventions are associated with improved student mental well-being. School policies on bullying appear to be unsuccessful in reducing problem behaviors and improving the school climate. Yet, it is very likely that they play a nurturing role and are positively correlated to students’ mental well-being. Mental health is defined and quantified using items from the World Mental Health Survey Initiative Short-Form Questionnaire that asks about the experience of feeling happy, calm and peaceful, full of life, and having a lot of energy. School policies on bullying are drafted using the Indicators of Schooling and Social Capital, and a school’s bullying climate or network is constructed using a social network approach to distinguish between hierarchical, social, and social-hierarchical bullying.
8.1. Bullying Prevention Programs
Bullying can be a serious violation of personal safety and can lead to a climate of fear and hostility, inhibiting a student’s capability to learn. Bully-proofing programs in schools have as its objectives to help students develop skills to safely refuse to participate in bullying, focus on a positive caring climate in the school, and educate adults in handling and reporting bullying. Randomized trials of “Keeping Kids Safe,” a bully-proofing program that treats violating behaviours comprehensively, are reported. Statistically significant reductions were found in students’ self-reports of bullying and being bullied, which resulted in fewer reports of violations to adults. These results were positive with respect to long-term treatment effects when follow-up data were collected 1–3 years post-treatment [17].
The use of drama as a medium to prevent bullying in schools was evaluated after a planned drama in education program was implemented in four primary schools in Ireland. Using a quasi-experimental pre-test–post-test design, differences between cases and control schools were evaluated using a standardized questionnaire. The program revealed statistically significant positive changes in students’ attitudes and awareness of bullying. Focus groups with teachers and students illustrated how the drama program raised awareness of bullying, changed student attitudes towards helping bullied children and prevented further victimization after the drama was performed.
9. Utilizing Technology for Mental Health Support
Online Mental Health Services: Online counseling services for mental health should be established and made readily available to all school communities. Such services could include chat, e-mail, or telephone counseling, and information on local mental health resources and services. Counseling services through existing social media content such as Facebook could be planned. These services could not only be provided directly by the school but also in partnerships with local health services and schools in the broader community. Special encouragement and promotion of the utilization of technological services to schools would be needed. Such services could be marketed specifically to schools using teachers and school administrators as advocates. Schools, meanwhile, could ensure students understand the availability and appropriateness of such services [1]. New technologies, including social networking sites like Twitter, Facebook, or SMS services, could be utilized to extend support for students or schools.
Using Technology in Promoting Young People’s Mental Health: Similar to the findings of [18] , students were mostly positive towards using technology in giving or receiving support regarding mental health issues. The openness is promising in light of the establishment of new emergency technology services for young people. However, the concern was raised that such services may counteract peer support, which may be better for addressing young people’s issues, as it is perceived as more relevant and acceptable than that of trained professionals. In terms of privacy and confidentiality, young people accepted this may be compromised based on the nature of social networking or texting; however, they were more concerned with its risk than supporting adults.
9.1. Online Counseling Services
Online counseling services, also referred to as tele-counseling or e-counseling, employ technology to provide mental health treatment or consultation [19]. Questions investigation the application of online counseling services in public high schools in the City University of New York (CUNY) seek to learn how schools currently use these services and what concerns must be addressed before implementing services on a wider scale. Answers are based on a review of relevant literature and policies as well as interviews with various mental health professionals involved with school-based services across seven colleges. Particular attention is paid to the group dynamic web services model developed by the health communication initiative of the CUNY School of Public Health, with Web0923 as a prototype. Also examined is whether a translation of the Hotline Model would be feasible in schools, using the Bronx Children’s Initiative as a case study. Four research questions guide the investigation.
The Internet has changed the personal, social, and economic lives of many Americans. With over half of the nation’s households “wired,” [1] and a rapidly growing number of minors possessing computers and access to online services, including the Internet, electronic forms of counseling, or “e-therapy,” have the potential to reach thousands of youth. New technology offers alternatives for those seeking information and support. School-based online counseling services can extend existing health service resources, reach unserved populations in need of care, and proactively identify and reach youth before symptoms escalate. Schools offering online preventive services can consider themselves providers using a media channel, as opposed to passive bystanders needing to defensively respond to unsolicited communication from Web vendors.
10. Evaluation and Monitoring of Mental Health Programs
Schools take on a significant role in the mental health and well-being of children and youth. Mental health programs in schools, particularly those which are research-based, seem sound investments, given the potential to improve children’s educational outcomes and quality of life. School mental health programs are interventions applied in school settings aimed at promoting the mental health of children and adolescents. A review describes (1) the focus of school mental health programs (the target population, problem, strategy and type of service); (2) the extent of evaluation effort across selected programs and (3) recommendations for consideration by personnel involved in developing, implementing or evaluating school mental health programs [20].
Few mental health programs in schools have been seriously evaluated. A number of specific impediments to evaluation efforts have been identified including lack of staffing, training and money. In general, programs with more obvious objectives and well-defined target populations are more likely to be evaluated and the results publicized. In education as well as in other fields, evaluation activities often do not receive serious attention until programs have been running for some time or until problems start to arise. In an attempt to buffer against hurried and unproductive program evaluation in school mental health, recommendations for tackling school mental health program evaluation issues, including programming type, planning and staff training, hope to help mental health practitioners work responsibly and productively in school systems [2].
10.1. Measuring the Impact of Interventions
A key issue in the provision of school mental health services is making the data predictable enough that it is perceived as useful. Concerns about confidentiality and risk adjusters (proxies to identify the more difficult to treat enrollees) thwarted the development of ways to insure, pool, and share the financial risk. More difficult was the linking of financial implications of any pricing structure and data used to assess “actuarial soundness;” that is, the extent to which income or the plan may compensate for projected costs [3]. However, it was agreed that some financial data would be necessary to come to grips with the issue of price to deal with better the most difficult enrollees. This concern with price and risk would underscore the need for profit-loss analysis across services and net gain-loss models within a specific service. Models were employed and deemed functional.
Due to limited comprehension and practical application, no behavioral or monitoring outcome data were employed on a widespread basis. Nevertheless, the notion of growing beyond rudimentary set measures such as dollars, gain, loss, and frequency of contacts was operationally crucial. The potential for significantly different effects within the same service and similarly in different services was conceded. These data would include standard clinical/behavioral dimensions (e.g., absences, school performance measures) monitored against some agreed baseline. Attempts would be made to measure consequences, feedback user perception, and “recidivism” rates. This would be risky due to the likely initial unfavorable estimates of program effectiveness, nevertheless, initial numbers are necessary to begin to penetrate the magnitude of the seeming paradox that this very concern with greater precision and objectivity could fuel perceptions of diminished quality [20].
11. Crisis Intervention and Response Plans
Crisis intervention and response plan development is also essential in an overall school mental health framework. Crisis teams and crisis intervention protocols are created to deal with, respond to, and follow up on mental health crises or emergencies [21]. It is accepted within school mental health that mental health emergencies such as unplanned student suicides require a coordinated and thoughtful response. Schools need to be prepared for the occurrence of crises and emergencies and to have protocols in place to respond to and support a school community following such crises. However, while the good crisis intervention work is occurring before, during, and after a crisis, this “first responder” work occurs not only within a mental health but also typically within district preparedness for and overall response to large, school-wide crises [22]. Crisis teams, typically made of both mental health professionals and other school administrators and staff, are created. These crisis teams are designed to maintain the social, emotional, and psychological well-being of students and staff in the wake of a crisis, usually large or school-wide in scale. Preparedness, response, and recovery are the three general phases of school crisis team work. Careful preparations prior to a crisis includes creating protocols, assigning roles, and providing training and practice for team members. Generally, it involves creating specific tools and guidelines for responding to the identified crises. Forms for documentation of individuals directly or indirectly affected by the crisis, staff- and student-less-needs forms, and coordinated responses are included in many plans. Information dissemination plans and coordinated student and community follow-up plans can also be part of these created protocols. After a crisis, the response phase covers the immediate reaction to the event. It usually addresses the logistical crisis management including crowd control, danger to students and staff in the affected area, mobilizing resources to address immediate needs, and securing the affected area against further crises as is similarly done in larger emergencies such as major disasters. Finally, the recovery phase is focused on individual needs created from the experience of the crisis and supporting those individuals, usually through intervention and follow-up work.
11.1. Creating a Crisis Team
The school crisis team generally will consist of the school principal, school counselor, school psychologist, school social worker, school nurse, and any community service provider who has a prominent role in the school system. The intent of the crisis team is to narrow the task responsibilities of the crisis management plan and provide and document on-going support and postvention for school staff and students who are affected by the death of a school community member [22]. The principle role of the school principal is to unleash the crisis management plan in the event of a school crisis, particularly the death of a school community member. As the team leader, the principal is responsible for managing the needs of the family of the deceased.
The school counselor’s principal role is as a liaison/coordinator for outside agency involvement. Crisis teams are encouraged to supplement their school staff resources with additional mental health professionals from outside agencies. The role of the outside counseling service providers is to provide psychological first aid and crisis counseling for those who are adversely affected [23]. School social workers are presented as vital members of crisis teams due to their knowledge of community support systems and agency services. The school team can only function properly if there is a healthy response from the school staff. Regardless of how careful and well-prepared the team is, its success will be compromised if school personnel are not adequately prepared to cope with their feelings related to the loss of their colleague.
12. Case Studies and Best Practices
In this section, a few cases of successful programs that have been implemented in schools are presented. It is often said that it does not matter how the concept is presented, if it can be proven it can work very well. Each of the examples below can be taken to improve the approaches to mental health in schools.
“The Gates County and Perquimans County Schools implemented Family Support Teams (FST) as a multi discipline approach to meet the needs of students with multiple barriers to success. FST is a family-centered model that creates a core team of professionals who come together to assess the needs of a family and develop plans to support them within their own communities” [4]. “Using a Community-Weighted Demographic Index scores were assigned to 34 areas of perceived need. This index weighted each area by factors including custody arrangements, family history of mental illness, family history of substance abuse, family income levels, school performance issues, signs of neglect, etc. Once areas of need were prioritized, neonatal health, domestic violence, housing issues, temperament, and family stressors were identified as concerns that warranted FST involvement. To address the comprehensive needs in those areas, FST staff and families collaboratively developed a support plan outlining services to be provided, expected outcomes, and timelines. Oversight of the plan was the responsibility of the core team, and they were held accountable for any necessary adjustments in the original plan to ensure family involvement and positive outcomes” [2].
“After two years of implementation, 30 families who received assistance through the FST Program were interviewed regarding their experiences. Parents reported satisfaction with involvement in a collaborative process, and results from the widely used and validated Strengths and Difficulties Questionnaire revealed that student’s overall functioning improved following FST involvement”.
12.1. Successful Mental Health Programs in Schools
An important consideration regarding successful programs involves the types of preventive strategies being utilized. Although the focus of this discussion is on successful school-based programs for students, several effective parenting programs are being conducted in conjunction with the schools. Another population that is being targeted is the teachers, who are being taught coping strategies for better managing student behaviors as well as their own stress. There are also efforts being directed to changing the school environment itself. Although environmental approaches are difficult to evaluate due to their disruptive nature and often long-term goals, there is some evidence that they can be effective. For example, the school environment may be altered to remove potential stressors (e.g., reducing class size, increasing adult/student ratio, providing resources to support teachers, improving funding). Changes may also be made to increase social support (e.g., transition programs for 1st graders entering schools, recreational programs in the community). Other programs that the schools are using to address the broader context of student behavior include peer mediation, conflict resolution training, substance abuse prevention, and school-wide systems of discipline. These programs have been undertaken to proactively increase social competence, self-discipline, and responsible behavior of all children [20].
Upon reviewing the successful school mental health programs, several findings emerged which may benefit those agencies wishing to design and implement such programs. Programs funded by a combination of local, state, and federal sources are often more successful than those entirely reliant on local funding. Grant funding through local or state sources often has too many restrictions, and federal funding sources may be inconsistent and difficult to access. Programs which are developed jointly by the schools and the mental health agency tend to be more successful than those developed separately. Creating an environment based on mutual trust, respect, and commitment from the start is imperative [2]. For existing school programs that are considering expansion, the most effective approach for new services may be the gradual addition of new components rather than the development of an entirely comprehensive program at the outset. Once the structure is created, it should be viewed as a continual process of evolution. Evaluation of school mental health services is a complex and controversial issue that needs to be addressed early in the planning stages. Programs that designed their own internal means of continuous evaluation and assessment, and quality assurance were more successful than those utilizing outside evaluators. Finally, the preservation of existing informal networks that develop among school personnel and agency staff can be very important for continuity and for getting services to children who have been identified as needing them.
13. Future Directions and Innovations
Future Directions for Mental Health in Schools In addition to the immediate improvements in school-based mental health, steps should be taken to develop and innovate the system to meet the changing needs of students and schools. Innovations should be proposed that are technically, operationally, and financially feasible. The elements of service provision put forward in this case can be taken as a base model for schools looking to expand landing programs or fill gaps in existing provision. Options that can be explored include school-community partnerships, the employment of mental health educators to work in schools, and collaborations between multiple schools. Local schools may decide to integrate these delivery models and share roles and responsibilities, or to collaborate with local organizations that are already on a strong footing. Additionally, as a solution to some of these barriers, the employment of telehealth services within schools would demonstrate flexibility and scalability and could be made financially viable for schools [4]. Emerging telehealth innovations should be explored to consider how they work in harmony with hawth outside of school models. The rapid adaptation of telehealth for student mental health care during the COVID-19 pandemic triggered a significant surge in enthusiasm for technology in mental health services.
Schools undergoing or considering service integration should leverage touching positive school, family, and professional factors imminent in the outside-of-school development of care systems. School leaders can thoughtfully consider how the changing role of schools as service delivery hubs will be framed within the context of their school communities. Schools can play an enhanced role in improving student and family access to services while fostering supportive school climates and cultures, provided their outside-of-school community partners have previously established strong relationships and trust within the school community and among students and their families [1].
13.1. Integrating Telehealth Services
Focusing on the integration of telehealth services, including school-based telehealth programs and partnerships with telehealth providers, can increase student access to mental health care. Using telehealth technology, students can meet with mental health professionals in real-time. The advantage of telehealth is that it keeps health care services directly in the center of their care when students are at school. School-based telehealth also helps overcome some of the barriers to accessing mental health services. This includes the need for transportation, loss of school time, and parental involvement [24]. The mental health care provider comes to the school instead of the student going to the provider’s office. Telehealth also opens access to licensed providers in different geographic areas. By exploring telehealth, schools can advocate for their students and expand important mental health services.
Technology like teleconferencing, video conferencing, and virtual visits could be utilized by schools and mental health providers to increase access to services. Smart phones, tablets, and laptops are common devices that could be used to deliver remote mental health services. Implementing telehealth services will require both one-time and ongoing costs. Schools interested in pursuing telehealth should consult with health care providers to better understand potential start-up costs including hardware, software, installation, and training. Schools can work with providers to determine how costs could be shared and how programming could be structured to maximize funding sources [1]. Considerations for integrating telehealth services include the role of school staff, establishing policies, and developing a communication strategy to increase awareness of telehealth options.
14. Conclusion
Schools play a crucial role in promoting mental health and providing early intervention. Teachers are critical gatekeepers, positively influencing various aspects of children’s development including behavior, self-esteem, and mental well-being. Moreover, schools can promote better awareness of mental health issues among children, adolescents, parents, and educators, as well as reduce stigma. It is vital to intervene early enough because mental disorders often begin during childhood and adolescence, typically before age 14. Schools have the potential to serve as a platform to address student mental health problems because of their accessibility and the time students spend in this environment. A whole-school approach to mental health promotion involves integrating mental health into all levels of school functioning, using a multi-component system that encompasses universal social-emotional learning programs, community links, teacher education, and parent training [10].
To promote mental health in schools, stakeholder awareness and support are key. Policymakers need to be aware of the evidence that promotes mental health and encourages the adoption of such programs. Community members should also recognize the importance of mental health and have the right connections with local schools. As education is a local government responsibility, coordination between health and education departments is vital to ensure the successful adoption of mental health promotion at the school level. Support from the Ministry of Education, Department of Health, and agencies responsible for students with special needs will ensure there are no gaps and duplications in service delivery [25]. Local educational authorities can oversee the coordination of community resources, building links between schools, government departments, health agencies, and the police. Finding “champions” at every level who recognize the benefits of involving schools in mental health promotion is useful to gain support for the development and transfer of programs across institutional boundaries.
14.1. Key Takeaways and Recommendations
Mental health is essential to overall health, well-being, and quality of life. While mental health problems affect people of all ages, mental health problems during childhood and adolescence can affect education, development, and relationships. Currently, mental health problems are projected to increase among children and young people globally. However, more than three-quarters of children and young people with the need for mental health support do not receive it. Therefore, schools have been selected as natural and promising settings for addressing the mental health needs of children and young people [10].
Recommendations for Improving Mental Health in Schools
Establish mental health programs in schools: Mental health programs should be initiated in schools to address mental health concerns with proactive and preventive approaches. For instance, several programs, such as the “MindMatters” program in Australia and the “School Mental Health” program in Quebec, aim to enhance the social-emotional health of students and provide mental health literacy training for teachers.
Implement verification systems: A verification system can facilitate the school-based mental health assessment process. The system can provide resources to schools, such as a mental health policy implementation framework, assessment guidelines, and access to student mental health data. The collected data will be analyzed and fed back to the schools to promote improvement in mental health practices [26].
Enhance collaboration: Whole school approaches to mental health promotion are most effective when they involve a wide range of stakeholders inside and outside the school environment. Thus, it is essential to involve members of the local community, voluntary sector, consulting psychiatrists and psychologists, professionals in the field of child social welfare, children and young people who use mental health services, and their parents to establish collaborative forums for discussing and developing the components of school- and community-based mental health promotion programs.
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