Living among America’s 74 million children are growing numbers experiencing mental illness. The American Academy of Child and Adolescent Psychiatry (AACAP) finds that roughly 20% of adolescents ages 13 to 18 and 13% of 8 to 15 year-olds experience severe mental disorders in a single given year. Behind the statistics are millions of young lives hampered by fear, shame, confusion or pain.
Mental illness makes daily activities and interactions a challenge, sometimes overwhelming and overtaking work, school and socializing with others. Children living with mental illness are at greater risk of developing disabilities and/or social pathologies in later years, as determined by the CDC’s School Health Policies and Practices Study (SHPPS). Unhealthy childhood behaviors tend to extend into adulthood, and place students at risk for the leading causes of morbidity and mortality. The CDC study concludes that working to prevent such behaviors among youth is far more effective than trying to change unhealthy behaviors later in life.
Early intervention and treatment benefits society through better educational outcomes, lower crime rates, stronger economies, stronger families, lower health care costs, higher overall productivity, longer lives and improved quality of life.
Unfortunately, most children are not diagnosed or treated for mental illness in the early stages. Symptoms of anxiety disorders tend to emerge by age six, behavior disorders by age 11, mood disorders by age 13, and substance abuse disorders by age 15. Although access to treatment for children in New Jersey is somewhat better than in many other states, the delay between the onset of symptoms and intervention averages eight to ten years nationwide—critical developmental years in the life of a child. Further, a large majority, nearly 80%, of these children do not receive treatment at all, according to the U.S. Surgeon General.
The American Academy of Pediatrics (AAP) promotes the use of schools in providing access to health care for students not receiving this care elsewhere. Schools are in every community, in direct contact with more than 95% of America’s young people aged 5 – 17. For some 52 million children and adolescents, spending six hours a day, and for up to 13 years of a child’s growth, schools play a vital role in promoting healthy development and helping youth establish beneficial behavior patterns that will continue into adulthood.
While schools cannot address every societal problem, new resources are becoming available for health services, including mental health. For example, the 2010 Affordable Care Act, section 4101(a), allows funds to be used for capacity-building activities in order to increase the number of students served, especially those eligible for Medicaid and other public health insurance. School-based programs can efficiently screen for mental health conditions and also offer access to diagnoses and treatment.
The entire school community benefits from effective mental health programs. The American Academy of Pediatrics calls on schools to establish a multidisciplinary student support team that includes school nurses, school counselors, and school physicians to provide interventions for students identified with a mental health problem. School nurses are often the first to identify students with mental health needs, advocate for their care, and link them to school counselors. In many cases, students would be referred to community-based mental health services, while schools continue to serve as the front line for safe and confidential help by bringing together parents and educators to support improved cognitive, behavioral and emotional health.
Mental illnesses occur at similar rates around the world, in every culture and in all socioeconomic groups. The Mental Health, United States 2010 report pegs ADHD as the dominant mental health disorder among children, at 8.6 percent of the population, followed by depression ( 3.7 percent), conduct disorders (2.1 percent), anxiety (0.7 percent) and eating disorders (0.1 percent). ADHD is more than twice as prevalent among males as females.
Mental illnesses are disorders of brain function. They have many causes and result from complex interactions between a person’s genes and their environment. Schools are required by law to accommodate students with emotional disturbances under the Individuals with Disabilities Education Act (IDEA), which defines emotional disturbance quite broadly:
“A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child’s educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory, or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems. The term includes schizophrenia. The term does not apply to children who are socially maladjusted, unless it is determined that they have an emotional disturbance.”
IDEA requires accommodations when a child’s educational performance is adversely affected due to the disability. This does not mean a child has to be failing in school to qualify. The law reads that states must make available a free, appropriate public education to “any individual with a disability who needs special education and related services, even if the child has not failed or been retained in a course or grade, and is advancing from grade to grade.” [section 300.101.(c)(1)]
In daily practice, teachers are often tasked with sorting out a child’s willful “behavior issues” from emotional disturbances which are more difficult for the student to control. Good classroom management and a structure of discipline are important aspects in preventing problem behaviors from disrupting the learning environment. When concerns escalate, teachers can use the Functional Behavior Assessment (FBA) process, which looks for reasons behind disruptive activity and generates interventions to teach new behaviors in their place. Like the Individualized Education Plan (IEP) approach, the FBA process brings the teacher together with parents, counselors and other “team” members to observe, analyze and recommend concrete ways to head off future disruptions.
Beyond the school itself, parents may turn for help to PerformCare (877-652-7624), an agency that helps steer New Jersey families through the range of publicly funded services for children ages 5 to 21. The agency serves as a single point of contact, coordinating services offered by the New Jersey Division of Child Behavior Health Services (DCBHS).
Public education in New Jersey ranks among the nation’s best, but some schools and some students need extra help to achieve their potential. Special attention should be directed for the needs of students with disabilities, including those with behavioral and emotional disturbances. The future of everyone in the Garden State depends on it.
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