A ddressing Mental Health Needs in Schools

1. Addressing Mental Health Needsin Schools February 20, 2013 Monica Parmley, LCSW

2. Introductions

3. Goals: • Demonstrate the pervasiveness of mental health concerns in young people. • Discuss depression, the most prevalent mental health issue for youth. • Discuss suicide and suicide prevention. • Present community resources.

4. Statistics

5. Approximately 11% of U.S. children and adolescents aged 10-19 suffer from a serious mental disorder that causes significant functional impairment in their day-to-day lives at home, in school and with peers. (Report of the US Surgeon General, 1999 & US Census Estimates, 2008)

6. In Oregon, this translates to an estimated 53,345 young people suffering from serious mental illness with significant functional impairment. (Report of the US Surgeon General, 1999 & US Census Estimates, 2008)

7. It is estimated that one out of eight U.S. children has had some form of an emotional or behavioral health disorder in the past year. (Merikangas et al., 2010)

8. About 2% of children ages 6-12 appear to have major depression at any one time. With puberty, the rate of major depression increases to about 4% overall. (NAMI Minnesota Fact Sheet, 2003)

9. The most common mental health disorder among adolescents is depression with over 25% of adolescents affected by at least mild symptoms. (National Adolescent Health Information Center, 2002)

10. Amongst all U.S. States, Oregon had the highest prevalence of youth (9.57-10.28%) who had experienced a major depressive episode (a depressive period of 2 weeks or longer) in the past year. (SAMHSA, 2012)

11. That’s a start.

12. Signs of Depression • Appears grumpy, sad, or bored most of the time. • Does not take pleasure in things he or she used to enjoy. • Loses or gains significant weight.

13. Signs of Depression • Sleeps too much or too little. • Feels hopeless, worthless, guilty. • Has trouble concentrating, thinking, or making decisions. • Thinks about death or suicide.

14. Developmental Differences Very young children may: • Lack energy and withdraw from others • Show little emotion, seem to feel hopeless and have trouble sleeping.

15. Developmental Differences Grade-school children may: • Have physical symptoms like headaches or stomachaches. • Lose interest in friends and activities that they used to like. • See or hear things that aren't there or have false beliefs.

16. Developmental Differences Teenagers may: • Sleep a lot. • Move or speak more slowly than usual. • Hallucinate or have delusions.

17. Diagnosing Depression • Have physician rule out physical problems. • Consider family mental health history. • Refer to a mental health provider based on health insurance coverage.

18. Treating Depression • Mental Health Counseling • Medication • Coping skills • Self-Care

19. “What do you think I think about what you think I think you’ve been thinking about?”

20. In 2009, 11th grade students in OR reported that within the last year: • 21% felt sad and hopeless enough over a two-week period to halt usual activity • 14% seriously considered attempting suicide • 6% attempted suicide • 2% made a suicide attempt that required medical attention (Oregon Center for Health Statistics, Healthy Teens 2009)

21. Quiz: True or False? • People who talk about suicide want attention and won't do it. • Adolescents from affluent families attempt or complete suicide more often than those from poorer families. • Most suicides occur late at night. • Once their mind is made up, they can't be stopped. • After an attempt, adolescents won't try again. • Talking about suicide will put the idea into their minds.

22. National Problem • Nationally, suicide is the 9th leading cause of death for 5-9 year olds and the 3rd leading cause of death for 10-14 and 15-19 year olds. (2008 data, CDC National Center for Injury Prevention and Control)

23. Suicide is the second leading cause of death among youth aged 11-24 in Oregon.

24. Stats • Most males who completed suicide and/or made serious suicide attempts in adolescence or early adulthood had psychiatric problems by the age of 8 years, indicating a trajectory that persists throughout their lives. (Finnish 1981 Birth Cohort Study, Arch Gen Psychiatry, 2009 APR)

25. Reminders • Talking about suicide in a responsible way does not increase risk. • Those who are suicidal are almost always ambivalent. • Parents are often unaware of a child’s suicidal behavior. • Suicide can be prevented. • When someone is thinking about suicide, s/he almost always reveals risk factors and/or warning signs.

26. Counselor Tips Your job is : • To know the warning signs, language and messages to watch for • To listen and encourage the child to talk more, not less • To gain enough of their trust that they’re willing to accept help • To not leave them alone if you think the threat could possibly be imminent • To check back to be certain that a referral for mental health services was made and followed up upon. (Cheri Lovre, MS; Crisis Management Institute)

27. Counselor Tips Your job is not: • To decide whether they are serious – let a professional who does suicide assessment make that decision • To keep it a secret to gain their trust (you’re very liable for this!) • To tell any other students or school staff unless they have a valid need to know. (Cheri Lovre, MS; Crisis Management Institute)

28. The Bluebird of Happiness long absent from his life, Ned is visited by the Chicken of Depression.

29. Identification (Risk Factors) • 42-66% of adolescent suicide victims experienced mental illness - primarily major depression • Previous suicidal behavior** • Family history of suicide • Bullying and/or harassment • Sexual/Physical abuse • Social isolation and loneliness • Problematic parenting or family environments

30. Warning Signs for Suicide • Thinking, talking or writing about suicide (Ideation) • Plan – Method, Location and/or Time • Increasing or persistent depression • Withdrawal from friends, family, or society • Expressing feelings of being trapped • Feelings of hopelessness or purposelessness             • Unbearable pain often associated with loss • Perceived lack of internal or external resources

31. 5 Steps if you Suspect Suicide • Discretely, but directly, ask the question, “Are you thinking about suicide?” • If “yes,” then do not leave this student alone. • Listen and support to establish rapport and build understanding. • Offer some comforting things to say. Do not attempt to counsel the student beyond your skill level. • Involve another person. Evaluate available resources. Assess for imminence and determine next steps.

32. Is Path Warm? • Ideation—Threatened or communicated • Substance abuse—Excessive or increased • Purposeless—No reasons for living • Anxiety—Agitation/Insomnia • Trapped—Feeling there is no way out • Hopelessness • Withdrawing—From friends, family, society • Anger (uncontrolled)—Rage, seeking revenge • Recklessness—Risky acts, unthinking • Mood changes (dramatic)

33. Determining Next Steps • Imminent • (Has plan and means) • Contact Parent/ Guardian • Engage Crisis Line • Hospitalization or police involvement • Safety plan • Non-Imminent • (No plan and no means) • Contact Parent/ Guardian • Refer to mental health services or get a release of information to speak to current provider • Safety/prevention plan

34. Protective Factors • Family cohesion (mutual involvement, shared interests, and emotional support) • Good coping skills • Support from parents, teachers, coaches and other relevant adults • Perceived connectedness to school • Supportive educational environments • Reduced access to means • Impulse control

35. Protective Factors • Reasons for living • No substance use • Connection to spirituality • Healthy, supportive relationships • Positive peer support/relationships • Ability to be optimistic • Ability to problem-solve/conflict resolution skills • Sense of worth

36. Protective Factors • Stable living environment • Responsibilities for others (children/elderly/pets) • Participation in sports teams, clubs, activities • Access to and delivery of effective mental health care • Strong connection to community

37. When I learned, ‘You are what you eat, I realized I was nuts.

38. Maintain work-life balance Maintain professional boundaries Seek supervision and consultation Get enough sleep Engage in pleasurable activities General Self-Care Ideas

39. Learn strategies that help you leave work at work Recognize your work can be stressful and be kind to yourself Exercise regularly Be assertive about your needs at work Eat healthy General Self-Care Ideas

40. Furthering Your Knowledge • Applied Suicide Intervention Skills Training (ASIST) • A 2-Day intensive, interactive and practice-dominated workshop designed to help caregivers recognize an individual at risk for suicide and learn how to intervene and prevent the immediate risk of suicide. • QPR (Question, Persuade, Refer) • A 1.5 hour workshop helping individuals recognize the warning signs of a suicide crisis and how to question, persuade, and refer someone to help.

41. Local Resources • 1-800-273-TALK – National Suicide Prevention Lifeline • Oregon County Crisis Lines http://public.health.oregon.gov/PreventionWellness/SafeLiving/SuicidePrevention/Pages/cntymap.aspx

42. National Resources http://www.afsp.org/ http://www.suicidology.org/home

43. National Resources www.sprc.org SPRC online library http://library.sprc.org/

44. Youth-Specific Resources http://www.thetrevorproject.org http://us.reachout.com/

45. Local Survivor/Grief/Loss Resources • American Foundation for Suicide Prevention Northwest Chapter, Phone: 503-291-0373. Conducts suicide prevention presentations for schools and community groups. Assists survivors of suicide in accessing resources. • Dougy Center, Phone: 503-775-5683. Provides peer support for children, teens, young adults and families who have experienced the death of a loved one. • Me, Too, Phone: 503-220-1000. Free grief and bereavement support groups for children, teens and their adult guardians. • Peace House, Phone: 503-285-1714. Suicide bereavement support group for adults.

46. Contact Information Monica Parmley Licensed Clinical Social Worker PSU School of Social Work 503-725-5001; mparmley@pdx.edu Foundations Counseling & Consultation Services foundationsccs@gmail.com; 503-481-2515