By Helen Buttery
Autumn 2004, Vol 8 No 1
Another assignment not handed in. This is becoming a habit for Joanne, 17, who has just returned to school after being hospitalized with severe obsessive-compulsive disorder and depression. Her teachers have tried to be encouraging and have even given her extensions on assignments, but she’s just not keeping up. At this rate, Joanne is going to fail the year.
This fictional scenario is a common one among students struggling to get through high school with a mental health problem. One in ten Ontario students report experiencing three or more mental health issues, including depression and anxiety, according to the 2003 Mental Health and Well-Being of Ontario Students Report, published by the Centre for Addiction and Mental Health (camh) in Toronto. And roughly the same number of students visited a mental health professional at least once during the past year. This comes as no surprise to Phil Hedges, executive director of the Ontario School Counsellors’ Association, who says guidance counsellors have recently seen an increase among students in self-injuring behaviour, which is often linked to depression and anxiety.
Yet while there is a basic level of support available to people with psychiatric disabilities in post-secondary education, only fragments of such services exist in high schools. Many educators and counsellors who work with youth agree that the key to helping these students is better integration and collaboration between the school and youth mental health systems. “We need to do a better job connecting with outside mental health organizations,” says Hedges.
Sounds simple enough, but this is the first step toward the cumbersome task of addressing institutional discrepancies between the two bureaucracies. For example, each system has its own language. “As a physician, when I speak about functional capacity, I mean something different than when a teacher says how well a student is functioning in the classroom,” says Dr. Samuel Chang, an adolescent psychiatrist at Foothills Hospital in Calgary, Alberta. There is also the need to tackle the stigma surrounding mental illness, and issues of confidentiality. “As a physician, I’m reluctant to let the school know everything because I’m worried about the welfare of my patient,” says Chang. This of course creates a dilemma for schools because they can’t help students with mental illness if they don’t know what they are dealing with.
Yet the two systems ultimately share the same goal. “The education system and the adolescent mental heath system are both in the business of doing what’s in the best interests of the child, so we have to learn to work collaboratively,” says Michael Shaughnessy, clinical director of program services for Central Toronto Youth Services, a community-based children’s mental health centre.
Returning to school after an absence is difficult for any student – falling behind in work, missing exams, catching up with friendships. But for students with mental illness, the transition is fraught with even more problems. “It’s a vulnerable period, and that transition needs to be handled with great care,” says Chang. These students often have difficulty with socialization, and their cognitive abilities, for example, being able to focus on complex algebra calculations, are diminished. Being thrown back into a classroom with the same expectations increases the one thing these students need to avoid – stress. And that can lead to serious setbacks, says Chang: “If development goes off in the wrong direction during that critical period [of youth], it’s very difficult and can take years to get back on track.”
The responsibility of keeping these kids on track falls largely on teachers. But that wasn’t always the case. Changes to how youth receive mental health treatment over the past 30 years has left teachers in this tenuous position. Peter Chaban, a former high school teacher who worked for almost 10 years in the youth psychiatry inpatient program at Sunnybrook and Women’s Health Sciences Centre in Toronto, saw this change firsthand. In the 1970s, he explains, the average length of stay in the program was about one year. By the late 1990s, kids were being turned around in 14 or 15 days. The change was attributed to improved diagnosis skills, new pharmaceutics and changes to the health care model.
But these innovations haven’t translated into easier school reintegration for kids with mental illness. “Kids are being medicated and that’s about it,” says Sharon Warden, a special education teacher with the Contact Program at Mayfield Secondary School in Brampton, Ontario. Through the initiative, which serves 28 schools in the region, Warden works with 45 students, eight of whom have a mental illness, who need extra support. A student with anxiety, for example, has the option of staying in the regular classroom or going to the Contact room to work on assignments. “It’s safe, “ says Warden. “Students are supported, so they don’t have to put on a false front. If they need to talk, that’s what we’re here for.”
Another much-needed support for students is someone to act as advocate. “Why should a kid who just spent three weeks in a hospital have to go to a teacher and say, ‘Can you give me a few more weeks for this assignment because I suffer from bipolar disorder?’” says Chaban. Without a transitional program like Contact, Warden says many of these kids would not make it through school. “Without some kind of support and understanding these kids just feel overwhelmed, and it’s easier just to say ‘I give up.’”Unfortunately, programs like Contact are rare. “Solutions are driven by need, instead of being system-wide,” says Chaban. Shaughnessy, who is often asked by schools to help them develop socialization groups for students with mental health issues, agrees. “There isn’t a well-coordinated, seamless connection that exists as a partnership between schools and children’s mental health centres,” he says. “Such a coalition is one that we could use to build a safe, healthy community for these young people.”
But such collaboration requires addressing the limitations of current official school procedures. For example, in Ontario, if a student is not identified as having a problem, based on criteria set by the education system, modifications cannot be made to help that student. “There could be a medical diagnosis of depression, but without that formal identification [by the education system], there is no legal ground for requiring the teacher to modify a program or assessment,” Warden explains. One of Warden’s students was in the process of changing medications, which made it impossible for her to write first semester exams. “Had she received an identification of some sort, we could have waived the final evaluation,” says Warden. With no mental illness category to legitimize a depression diagnosis, the only way a student with depression will be identified is if he or she matches the criteria of another grouping.
Both Warden and Chaban would like to see more flexibility in the school system. “There is a rigidity around credit accumulation in high school that needs to change,” says Chaban. And because the burden of easing kids back into the classroom is falling more and more to teachers, they need better training and new ways of teaching. “There used to be a split,” says Shaugnessy. “Teachers taught, and any problem that had to do with behavioural, emotional or mental problems belonged in a hospital or the children’s mental health centres. Today, we need teachers who are well educated around different ways of learning, and not simply modifying or simplifying their program, but using new strategies,” he says. To start, teachers need to understand the needs of students with mental illness.
“I’ve had intelligent, caring, capable teachers say to me, ‘I think Kyle just needs to get on with it, instead of dwelling on his problem,’” says Warden. But getting on with it means that the education system and adolescent mental health systems need to help these kids. Together.
The Canadian Psychiatric Research Foundation has recently published When Something’s Wrong: Ideas for Teachers. The quick reference offers classroom strategies to help elementary and high school teachers and administrators understand and help students with mood, behaviour or cognitive disorders.
A new booklet published by the Canadian Mental Health Association, Mental Health and High School: A Guide for Students, is being distributed this autumn to high school students across the country. It aims to help students better deal with and understand mental illness. The guide, based on focus groups with youth, educators and mental health professionals, lists these mental health issues that may affect a student’s school experience:
difficulty getting up for school and staying awake in
having a hard time getting along socially
feeling really low and down on yourself
having weird and scary thoughts that make it hard to concentrate
being distracted by everything around you
being organized – setting priorities, keeping track of time and responsibilities
trouble solving problems and coping with everyday stuff
behaving in weird ways – feeling unpredictable and impulsive
isolating yourself from friends and family