Mental Health Promotion in Schools: Opportunities and Challenges Stan Kutcher and the SLFCAMH Team Health Promoting Schools: Mental Health Promotion – Halifax, Dec. 4, 2009
What is the Answer? • What intervention for children and youth has a greater impact on their self-esteem and social self measures: martial arts training or wall climbing? • Youth with high self esteem are more likely to demonstrate: high rates of risky sexual behaviour; low rates of risky sexual behaviour; no effect of self esteem on risky sexual behaviour
Here are the Answers! • Martial Arts – no effect on: self esteem, self confidence, concentration, self discipline (Straghan. Child Adol Psych M. Health, 2009).
• Wall Climbing – no effect on self perception of athletic competency, social competency, self worth (Mazzoni. Adapt Phys Achiv Q. 2009). • High self esteem related to INCREASED high risk sexual behaviors and INCREASED numbers of sexual partners (J Assoc Nurse AIDS Care, 1997).
So What Does This Mean? • Lots of good ideas may not translate into effective outcomes • Some good ideas may be wrong • Just because your mother/your friend/your lover said it was so does not mean it is so • Independent empirical testing is needed to help us determine if good ideas work, for whom, for what purpose and at what cost • Bottom Line: sounds good – show me the $ (evidence) --- absence of evidence however is not evidence of absence (we need to find out)!
Does Giving Free Fruits and Vegetables to Students Matter? • Results: increased familiarity with fruits and vegetables; willingness to try new fruits (but not vegetables); increased consumption of fruits (but not vegetables) • Caveat: at least in kids who go to school in Mississippi • Conclusion: its hard to get kids to eat vegetables! (Coylee. Public Health Rep. 2009).
Why Should We Promote Mental Health in Schools? • To help facilitate normal development (the genes are fundamental and the environment matters – no more nature/nurture debates please). • To help achieve success in related domains (such as improved social and academic outcomes – learning enablers). • To help address important social justice and human rights issues (stigma against those living with a mental illness) • To help individuals, responsible caretakers and groups understand, identify and help those with substantial problems or defined disorders (illnesses). • Because schools are a better place for our kids to grow up in than jails are!
Mental Health Care for Young People at Usual Risk* for Mental Disorder Severe and Persistent Disorder
Moderate Disorder Specialist CAMHC Mild Disorder/ Demoralization
Prevent Disorder or Impairment or Address Distress Facilitate Development
General Health Care
•Family •Community •Institutions •NGOs
A barrier to learning: Mental health disorders among Canadian youth Canadian Council on Learning, 2009 “Poor mental health in Canadian school children poses a significant risk to their academic development and puts them at greater risk of dropping out of school, substance abuse and suicide. Schools are well positioned to be at the vanguard of public health strategies designed to prevent and detect mental health disorders among young people.�
Importance of Mental Health to Student Achievement (Short, Ferguson, & Santor, 2009)
Extremely Important Very Important Somewhat Important A Little Important Not Important 0
10
20
30
40
50
60
70
80
90
100
Burden of Illness (Disability Adjusted Life Years) DALYs attributed to selected causes by age, 2000, WHO 0 – 9 years
10 – 19 years
Neuro‐psychiatric conditions (including self‐inflicted injuries)
12
29
Malignant Neoplasms
3
5
Cardiovascular Diseases
2
4
Adapted from: World Health Organization (2003). Caring for children and adolescents with mental disorders. Setting WHO directions. Page 3, Figure 1. World: DALYs in 2000 attributable to selected causes, by age and sex.
Prevalence of Mental Disorders in Young People Population Prevalence • Depression (6%) • Psychosis (1%) • Anxiety Disorders (10%) • ADHD (4%) • Anorexia Nervosa (0.2%) • Total (15 – 20%)
• • • • • •
Translation to the “average” Classroom Depression (2) Psychosis (rare) Anxiety Disorders (3) ADHD (1) Anorexia Nervosa (rare) Total (4 – 5)
Do I Have It?
Model Pathway to Care – Integrating a Public Health Approach with Clinical Care Mental health promotion Early identification Triage Intervention Continuing care
Mental Health Promotion must be based on Mental Health Literacy • Understanding and “knowing” are the foundation stones of promotion to continuing care pathways (in all components) • Misunderstanding and mis-knowing (or even not knowing) lead to difficulties, potentially harmful outcomes and substantive challenges to modify and change when embedded
Our Vision To help improve the mental health of youth by the effective translation and transfer of the best available scientific knowledge.
Health Information Online • 75 % Youth Access Health Info Online • • • •
#1 sexual health #2 mental health #3 substance use and misuse #4 diet and exercise
• 50% reported talking to a parent or adult about health info from internet Generation Rx Survey, Kaiser Family Foundation, 2001
Problems: access, credibility, and relevance of info Gray, 2004
Connecting to the Internet (24/7) • MindMatters- whole school approach to mental health promotion ( teacher, school resources) • YOOMagazine- interactive health literacy tool for youth and schools
– Interactive resources, screening, evaluation, Promoting health and help seeking
- School Mental Health Models - Mental Health Curriculum - Teacher Training Resources - Transition to University Book - Multimedia Presentations - Mental Health Library
Teenmentalhealth.org
Sun Life Financial Chair In Adolescent Mental Health
TRANSITIONS For entering post‐secondary students Provides information on a variety of health and well‐being issues including mental health Provides information about campus counseling services and other places to seek help
95% positive feedback about materials 40% discussed with a friend 20% sought help because of it Currently schools in NS, ON, AB, BC & NWT are using Transitions
Understanding Adolescent Depression and Suicide • Contextualized training program developed for and delivered to: student services providers, health care providers (public health nurses, youth health center staff, mental health services staff, primary care physicians) • Over 700 people received training – average knowledge increment is 24% (pre – post): ongoing and still available
Educator Training Programs • Masters level training: summer courses at MSVU – 2008, 2009, ongoing • “Go to teachers” training – modification of the training module in the curriculum – pilots underway (Bridgewater; Digby County) • Primary care physicians: depression and suicide (national program, BCMA); anxiety under development
Systematic Critical Reviews • School based suicide prevention programs • Web based youth suicide information sites • School based CISD, CISM, PD post traumatic incidence programs • Suicide postvention programs* • School based prevention programs for depression and anxiety disorders** • We take commissions and contracts!
School Mental Health Model COMMUNITY
SCHOOL PARENTS
STAKEHOLDERS POLICY MAKERS
MENTAL HEALTH LITERACY ADMINISTRATORS
MENTAL HEALTH CURRICULUM
STUDENTS
TEACHERS
STUDENT SERVICES PROVIDERS
MENTAL HEALTH SERVICES PROVIDERS MENTAL HEALTH LITERACY SCHOOL-BASED HEALTH CENTRE PROVIDERS GATEKEEPER TRAINING
PRIMARY CARE PROVIDERS
Sun Life Financial Chair In Adolescent Mental Health
Our Website
www.teenmentalhealth.org