By Meghan Wenzel, CEI Researcher and Writer, and Christine Mason, CEI Executive Director
Levels of stress, trauma, and mental illness are increasing, particularly within our nation’s students. Children experiencing severe trauma and toxic stress simply can’t learn effectively. Their bodies and brains are on the defensive, experiencing physiological changes that interfere with attention, memory, and learning. One in five youth have a mental health condition, but sadly under half receive any mental health services (NAMI, 2020a). Additionally, teenage suicide rates are on the rise, and it is now the second leading cause of death for individuals ages 10-24 (Abbott, 2019).
As Dr. Lyndonna Marrast, author of Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study (2016), rightfully states, “It has become increasingly clear that minorities are overrepresented in the criminal justice system and underrepresented in the receipt of mental health care. We need to look closely at how equitably our health care institutions are serving all segments of society.” An increased layer of complexity—including higher levels of stigma, underrepresentation of diverse mental health service providers, and lack of access—affects marginalized groups, including LGBTQ youth and youth of color.
In response, schools are beginning to weave trauma-sensitive approaches and activities into their school communities (Stevens, 2012). Teaching educators about the neurobiology of trauma and its multitude of effects, as well as providing strategies and best practices for working with trauma-impacted youth, are great ways to build more supportive and compassionate school environments. However, for a school to be truly trauma-skilled, all staff members must be fully invested in using trauma-informed practices with students. To meet the holistic needs of staff and students, schools can turn to community organizations, mental and behavioral health centers, and medical facilities to provide support.
The Role of Schools
Schools are a critical component for prevention and treatment of mental illness and their precursors. Schools can screen for mental illness, identify at-risk youth, establish Multi-Tier Systems of Support (MTSS), and develop comprehensive systems of support. MTSS has provided a framework to connect students with the necessary resources based on their unique level of academic, social-emotional, and behavioral needs. As they implement MTSS, schools are also strengthening partnerships with community mental health providers, expanding the role of school psychologists, providing training for teachers and school personnel, and offering direct services to students. These additional steps better prepare schools for the delivery of Tier 1, 2, and 3 services.
With MTSS tiers of support, Tier 1 encompasses screening, high quality instruction, and universal services provided to all students. Tier 2 encompasses more intensive support for specific students, and Tier 3 encompasses the highest level of support for a small percentage of students who need more frequent, intensive, and individualized support (Pechacek, 2019). Good implementation involves integrating interventions into instruction, not disrupting it. Interventions can take many forms, such as homework clubs, goal setting meetings, classroom observation, home visits, substance abuse counseling, peer tutoring, or daily check ins (Buckle, n.d.).
MTSS has provided a framework for providing necessary support for underserved students. However, realizing that at any moment any of us may be a step away from trauma, and that we can all benefit from compassionate environments and supports to increase our resiliency, we are recommending that schools also address underlying concerns.
Options for Addressing Mental Health Concerns in Schools
The Center for Educational Improvement’s framework for a Compassionate School Response to Mental Health takes the tiers of the MTSS system and turns them into a wheel of choices that may well be foundational for societal change as well as healing for individuals. We know that what most children—and adults—need to alleviate the pain associated with trauma and toxic stress is connection and communication. By building relationships that allow students to effectively communicate their needs, teaching all students self-regulation and social emotional learning skills, and creating a culture of positivity and courage, schools can reduce the causes of mental illness while helping students develop protective factors and build resiliency. And if those things still don’t address a particular student’s need, there are compassionate ways to directly treat a child’s mental health challenge. With our approach, we believe the emphasis need not be on screening and identifying children who meet certain criteria for needing greater support, but rather on building the skills and capacity of educators, making environmental changes, and providing instruction to strengthen a child’s resiliency.
- Prevention: Within a school setting, enhancing student self-esteem and helping children feel good about themselves can be useful and productive. Additionally, teaching teachers and other adults to recognize the signs and warning signals of deteriorating mental health can lead to earlier service provision and possibly ward off more serious mental health concerns.
- Treat the Child: Therapy is the traditional approach to helping children and youth cope. Most recently there has been a move to deliver therapy in school settings, which offers several advantages in terms of access and the potential impact of high-quality services for the individual student. However, it can be expensive since it is often delivered in one-on-one or small group settings. Additionally, this approach does nothing to address the resiliency or life skills of the general student population.
- Develop Protective Factors: As Harvard’s Center on the Developing Child has indicated (2017), one nurturing adult can make a world of difference in the life of a child impacted by trauma. Nurturing adults can help rebuild pathways to positivity, connectedness, and trust that have been damaged by attachment disorders, chaotic parenting, and abuse. Compassionate environments also provide a gateway to healing by giving children a place to learn rules, experience limits, learn social skills, gain self-awareness, build friendships, and feel a sense of well-being. For students who are most in need, this can be helpful; however, it is often more fully supported with individual treatment or therapy.
- Build Resiliency: Resiliency is a crucial ingredient in the recipe for well-being. Resilient individuals encounter the inevitable potholes in life’s roadway and are able to navigate through them with grace and ease. Fortunately, resiliency is a factor that can be developed, and it can be strengthened in classrooms and community settings. Resilient students have a conscious awareness of and confidence in their own capabilities as well as the accompanying skill set to handle disappointments, stress, conflict, and even trauma. As with strengthening protective factors, this component will be enhanced with treatment or therapy.
Creating Compassionate School Communities
Creating compassionate school communities where students feel engaged, supported, and connected are powerful ways to combat students’ stress, trauma, and mental illness. Having established processes and structures in place will make crisis response much smoother. Providing all staff with mental health literacy training turns everyone into a mental health first aid responder while also teaching them how to interact with all students more compassionately. Providing non-judgmental support, a safe and supportive environment, and professional services and counseling can help the community recover following a crisis (MHTTC, 2019a).
Programs are most likely to promote positive youth development when they provide the following (Eccles, Barber, Stone, & Hunt, 2003):
- Physical and Psychological Safety
- Appropriate Structure
- Supportive Relationships
- Opportunities to Belong
- Positive Social Norms
- Support for Efficacy and Mattering
- Opportunities for Skill Building
- Integration of Family, School, and Community Efforts
Simply letting students know that you are there is the first step to creating a strong foundation of trust and openness. Providing strong role models, healthy relationships, positive self-images, a growth mindset, and effective ways to cope with stress will reduce students’ risk of mental illness. Cultivating resiliency will help protect them throughout their lives. This has never been more important than now as our structures and routines have been upended by uncertainty.
SAMHSA is leveraging its resources, forming partnerships, and funding innovative initiatives to improve care for individuals experiencing significant trauma and at-risk for developing serious mental illness. Prioritizing early identification and intervention for youth by promoting evidenced-based practices and technical assistance for mental health screening and school-based services is key (SAMHSA, 2019). Here are some resources to support school leaders in developing, re-evaluating, and enhancing their mental health support team:
- MHTTC National School Mental Health Curriculum: Guidance and Best Practices for States, Districts and Schools, a comprehensive guide to creating mental health support systems that effectively serve students with evidence-based practices.
- Supporting Student Mental Health: Resources to Prepare Educators, a brief about the current best-practices in mental health literacy training for educators and the needs they have expressed.
- After a School Tragedy…Readiness, Response, Recovery, & Resources, a guide to prevention, preparing for, and responding to school tragedies such as school shootings, suicide completion of a staff member or student, or natural disasters.
Students face myriad stressors, from pressure to get good grades to navigating unsafe neighborhoods to dealing with family violence, and they need to develop resiliency and coping strategies to effectively manage these stressors. Schools have a huge opportunity to intervene and provide a more compassionate and supportive environment for students. Schools can make sure students feel engaged, supported, and connected and ensure teachers are educated on the impact of stress, trauma, and mental illness and how they can identify warning signs and connect students with necessary resources as early as possible. Schools can also build community partnerships to provide students with the resources and services they need in a more accessible and manageable setting.
For a more complete guide to developing A Compassionate School Response to Mental Illness, see our guide here.
Abbot, B. (2019). Youth suicide rate increased 56% in decade, CDC says. The Wall Street Journal.
Berardi, A. A. & Morton, B. M. (2019). Trauma-informed school practices: Building expertise to transform schools. George Fox University Library.
Buckle, J. (n.d.). The state of MTSS in education: Infographic. Panorama Education.
Center on the Developing Child. (2017). Three principles to improve outcomes for children and families. Harvard University.
Eccles, J. S., Barber, B. L., Stone, M., & Hunt, J. (2003). Extracurricular activities and adolescent development. Journal of Social Issues, 59(4), 865-889.
Marrast, L., Himmelstein, D. U., & Woolhandler, S. (2016). Racial and ethnic disparities in mental health care for children and young adults: A national study. International Journal of Health Services, 46(4), 810-824.
Mental Health Technology Transfer Center (MHTTC). (2019). After a school tragedy…readiness, response, recovery, and resources.
Mental Health Technology Transfer Center (MHTTC). (2020). National school mental health projects.
Mental Health Technology Transfer Center (MHTTC). (2020). Supporting student mental health: Resources to prepare educators.
National Alliance on Mental Illness (NAMI). (2020). Getting treatment during a crisis.
Pechacek, K. (2019). MTSS tiers & MTSS interventions 101. Illuminate Education.
Substance Abuse and Mental Health Services Administration. (2019). Ready, set, go, review: Screening for behavioral health risk in schools. Rockville, MD: Office of the Chief Medical Officer, Substance Abuse and Mental Health Services Administration.
Trauma and Learning Policy Initiative (TLPI). (n.d.). Trauma-sensitive schools help children feel safe to learn.