Transcript mental disorder

Understanding
Mental Health
in Schools
Dr. Stan Kutcher
Sun Life Financial Chair in
Adolescent Mental Health
November 19, 2008
What is
Mental Health??
Mental health refers to the maintenance of
successful mental activity.
This includes maintaining productive daily activities
and maintaining fulfilling relationships with others.
It also includes maintaining the abilities to
adapt to change and to cope with stresses.
When the brain is not working properly,
one or more of its 6
functions will be disrupted
Behavior
Thinking
Perception
Physical
Emotion
Signaling
When these symptoms
significantly disrupt a person’s life,
and meet internationally agreed
upon diagnostic criteria
we say that the person has a
mental disorder
or a mental illness.
The causes of mental illness are
COMPLICATED!!
+
Genetics
Environment
+
Neuro –
development
Some mental illnesses begin
during childhood and
persist into adolescence.
These include:
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Attention Deficit Hyperactivity
Disorder (ADHD)
Autism Spectrum Disorders (ASD)
Generalized Anxiety Disorder (GAD
BUT… many illnesses begin
during adolescence.
The illnesses that most often
begin during adolescence
include:
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•
•
•
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Major Depression (MD)
Schizophrenia
Bipolar Disorder (BD)
Panic disorder
Social Anxiety Disorder
Eating Disorders
Obsessive Compulsive Disorder
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Addictions
Adolescence: normal development and a
period of risk for mental disorders
• Contrary to myth, most teenagers pass through the
adolescent years without severe and prolonged difficulties
• About 15 percent of teens will experience significant
mental health problems during adolescence
• Mental illnesses are the most prevalent medical disorders
that onset in adolescence
• The Prevalence of Major Depressive Disorder
increases from 1% to 8% post puberty!
Child and Adolescent Health
Comparative Burden of Illness for
Mental Illness
Table: World: DALYs in 2000 attributable to selected causes by age
Ages 0-9
Ages 10-19
Neuro-psychiatric
conditions
(including selfinflicted 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.
Child and Adolescent
Mental Disorders
Disorder
6 Month Prevalence (%)
Age = 9-17
Anxiety Disorder
13.0
Mood Disorder
6.2
Disruptive Behavioral Disorders
10.3
Substance Use Disorders
2.0
Any Disorder
20.9
WHO Health Report, 2001
Mental Health Care for Young People at
Usual Risk* for Mental Disorder
Severe and Persistent
Disorder
Moderate Disorder
Specialist
CAMHC
Mild Disorder/
Demoralization
General Health Care
Prevent Disorder or
Impairment or
Address Distress
Facilitate
Development
Family
Community
Institutions
NGOs
Human Rights-Based
Education & Mental Health
1. Part of the basic human rights framework
for children and youth
2. Integral component of enhancing learning
through the promotion of mental health, the
identification of and accommodation to
mental disorders in the learning environment
and facilitating the development and
application of a mental health friendly
learning environment
Why should we address
mental health in schools?
More dropouts
Difficulties
in performance
Difficulties in
learning
More truancy
Behavioural difficulties
School failure
Schools can be a great location for mental health
promotion, early identification and intervention,
combating stigma associated with mental illness
and possibly interventions and ongoing care
Address Mental Health
Needs to Improve Learning
and Educational Outcomes
• Mental disorders severely impact learning
• Schools are the ideal place to address the
linkage between mental disorder and learning
• Education for all requires attention to mental
health as a learning enabler
Schools as a Vehicle for Stigma
Reduction: A Method for
Addressing Social Exclusion
• Stigma against the mentally ill recognized as one of the
greatest barriers to social justice, appropriate health
care and development of civic society
• Stigma pervades entire social structure
• School based anti-stigma activities may reach all social
elements – parents and communities
• Bottom up – top down
School Curriculum
Development and Application
as Mental Health Promotion
• Student education + normalization of mental health problems
(anti-stigma)
• Teacher training – knowledge and basic counseling skills
• Community inputs into curriculum – dialectic process knowledge against stigma
• Proactive mental health in the learning environment
• Self and Peer identification and help seeking behaviour
Schools as Vehicles for
Mental Health Support for Teachers
• Mental health needs of teachers
may be substantial and may
negatively impact student success
• Issues similar to those faced by
students are also faced by teachers
• “On-site” mental health models can
also provide teacher support – more
effective teacher, more effective
teaching, more effective learner
Schools as Vehicles for the
Provision of Mental Health Care
– on site or facilitated
• Role of school in delivery of basic physical health care
well known – various models applied
• Integration of mental health care delivery (including
case identification/followup) into existing care delivery
frameworks (may require health human resource
training or program modifications)
What is needed to create
mental health integration in
schools?? - Surprisingly little
• Policies and plan that recognize integration of mental health
into educational institutions across a variety of domains – to
enhance learning outcomes
• Mental health curriculum (building promotion and
addressing stigma thru scientific knowledge)
• Teacher training – knowledge and understanding
• Location appropriate infrastructures and supports
(gatekeepers, student services expertise, community links,
etc.
Gatekeepers
Educators
Students
Site Based Mental
Health Responsibility
Gatekeepers
Educators
Students
Mental Health
Care Providers
Site Based Mental
Health Responsibility
Administration
Gatekeepers
Educators
Students
Curriculum
Mental Health
Care Providers
Site Based Mental
Health Responsibility
Administration
Gatekeepers
Educators
Site Based Mental
Health Responsibility
Students
Curriculum
Mental Health
Care Providers
Parents
Keys to Success
• Promotion
• Prevention
• Early identification
• Early intervention
• Ongoing collaborative care
What does this mean?
• Work from the school out, not from outside the school in
• Collaborative cross-sectoral frameworks and action:
Policy and Practice
• Build evidence driven programs based on local
population characteristics and needs
• Evaluate, evaluate, evaluate - modify
Sun Life Financial Chair
in Adolescent Mental
Health Model
Chair
Team
Youth
Advisory
Group
Educator
Advisory
Board
Projects
Chair
Advisory
Board
What is the Chair doing
to address youth mental
health in schools
1.
Student Services Staff Training
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2.
Understanding Adolescent Depression Suicide Training
Program for Educators
Data collected
CDHA School Health Staff Centre Training
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3.
Understanding Adolescent Depression Suicide Training
Program for Health Professionals
Gatekeeper Model
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Temporary – Millwood
Under Development with Dept. of Education
What is the Chair doing
to address youth mental
health in schools
4.
Health Promoting Schools
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5.
Invited to integrate mental health into the health promoting
school health policy
Curriculum & Teacher Training
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6.
Teacher Training program – CMHA - piloted in Canada
MSVU teacher training courses
Educator Advisory Board
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Dept of Ed, Dept of Health, HPP, NSTU, Guidance counselors
& principals
Youth Advisory Group
What is the Chair doing
to address youth mental
health in schools
7.
Jr. High Chats
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8.
Public talks with schools with CHOICES
Transitions
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9.
Data from high school – university
Next project – Jr. high to high school transition
Needs assessment of school mental health needs
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Directed by IWK
How do we work collaboratively with schools?
Next Steps…
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What are the barriers to integrating mental health in
schools?
How do we meet the needs of educators?
How do we develop a framework for action?
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Action
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Response to educators needs
Timely cohesive and collaborative approach
Develop a framework for action and policy
Sun Life Financial Chair
In Adolescent Mental Health
For more information visit
WWW.TEENMENTALHEALTH.ORG
Symptoms can include
Thinking difficulties
or problems
focusing attention
Extreme emotional
highs and lows
Sleep problems
Mental illness can occur when the brain
(or part of the brain) is not working well
or is working in the wrong way.
What do we know about the
causes of mental illness?
The symptoms of mental
illness are a result of
abnormal brain functioning.
Mental illness is a brain
disorder.
Mental illness is rarely if
ever caused by stress alone
What do we know about the
causes of mental illness?
It is not the consequence of poor
parenting or bad behavior.
It is not the result of personal
weakness or deficits in personality.
It is not the manifestation of
malevolent spiritual intent.
Only in exceptional cases is it caused
by nutritional factors.
It is not caused by poverty.
Leading causes of years of life lived
with a disability: Ages 15-44
Disorder
% Total
Unipolar Depression
16.4
Alcohol Use Disorder
5.5
Schizophrenia
4.9
Iron-Deficiency Anemia
4.9
Bipolar Disorder
4.7
WHO Health Report, 2001
Epidemiology of
Mental Disorders
Disorder
1 Year Prevalence (%)
Age = 18-54
Any Anxiety Disorder
16.4
Any Mood Disorder
7.1
Any Major Depressive Disorders
5.3
Bipolar Disorder
1.1
Schizophrenia
1.3
Any Disorder
21
WHO Health Report, 2001
How Extensive Should
Specialty Child and Adolescent
Mental Health Services Be?
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What best meets population mental health care
needs – the development of needs based mental
health care or the development of specialty mental
health services
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Traditional models have focused too strongly on
access to specialty mental health services and not
enough on access to needs based mental health care
Age of Onset of Selected Psychiatric Disorders –
example: Alberta, Canada
What is the Opportunity of
Schools in Addressing C/A
Mental Health Needs
• Mental health education and stigma reduction
• Mental health promotion (from safe schools to pro-social
learning), case identification
• Mental health care delivery (onsite/facilitated)
• In the school and in the community – Promotion,
Prevention, Care
Schools as a Vehicle for Stigma Reduction:
A Method for Addressing Social Exclusion
• Stigma is…
– Social Stigma
– Professional Stigma
– Personal Stigma
Canadian Medical Association Report on Stigma
Survey of 1,002 Canadian adults conducted by Ipsos-Reid
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Findings:
– One in 10 thinks that people with mental illness could "just snap out of
it if they wanted"
– One in four Canadians is afraid of being around someone who suffers
from serious mental illness.
– Only half of those surveyed would tell friends or co-workers that a
family member was suffering from mental illness.
– Only 16 per cent said they would marry someone who suffered from
mental illness, and 42 per cent said they would no longer socialize
with a friend diagnosed with a mental illness. By contrast, 72 per cent
would openly discuss cancer and 68 per cent would talk about
diabetes in the family.
– Half of Canadians think alcoholism and drug addiction are not mental
illnesses.
– One in nine people think depression is not a mental illness, and one
in two think it is not a serious condition.