“Oh, the conversations to be had to undo the ‘mental health education’ my son is likely to get at school.” I posted these words on Facebook in response to recent news that mental health education will now be required in the Virginia and New York public school systems. I have a child in the Virginia public schools, where this education will be mandated for 9th and 10th graders.
I am guessing some readers might ask: “What’s wrong with teaching young people about mental health? Shouldn’t we bring this issue out of the shadows and talk about it at school?”
I understand the desperate desire to do something — anything. The statistics are horrifying and getting worse: the number of American children contemplating or attempting suicide has tripled between 2008 and 2015, according to a study published in the journal Pediatrics. In 2016, suicide rose from the 3rd to the 2nd leading cause of death for young people in the U.S. Recent statistics show Black youth taking their lives at twice the rate of their white counterparts. Studies indicate that as many as fifty percent of trans and gender non-conforming youth have attempted suicide.
Given this state of emergency, isn’t it our responsibility to educate youth about their mental health?
Don’t get me wrong: of course I care deeply about the mental and physical health of children, including my own son’s. I don’t want students to suffer in silence and shame. But I am very concerned about just how this topic will be taught in schools.
Currently, there is a master narrative about mental health and suicide that dominates in our society. According to this medical model narrative, mental illnesses are genetically-based, biological brain diseases caused by “chemical imbalances” in the brain. Suicide is often said to be caused by these “brain diseases.” But this master narrative has been debunked time and again, even within the medical profession itself.
In an insightful talk called “Capitalism Makes us Crazy,” physician and internationally-renowned trauma expert Gabor Mate provides the best deconstruction of the medical model that I’ve yet encountered. In this talk, he notes: “What we see is a society that literally makes people sick… What the medical model does, whether with mental illness or physical illness, it makes two separations. It separates the mind from the body, so that what happens emotionally is not seen to have an impact on our physical health… and number two, it separates individuals from their environment. So that we try to understand individuals in separation from their actual lives.” He goes on to say that “those separations are socially imposed, they’re culturally defined, and scientifically they are completely invalid…”
I am afraid that it is this invalid and shaming narrative that students will be taught — a medicalized, individualistic view that locates “brokenness” completely in their “chemically-imbalanced” brains and not at all in the world that shapes those developing brains and the bodies that house them.
I come at this issue not just as a suicide prevention advocate, and not even just as a concerned parent. I myself was a suicidal young person, having made several attempts to take my life before the age of 18. When I think about what would have helped me, it would not have been a message that something was wrong with my brain. Or that my intense anger, fear, and sadness were simply “disorders” and not understandable responses to the world I inhabited, the trauma that I had experienced. I already felt bad, wrong, and flawed enough. My mental health diagnoses only served to pathologize my pain instead of helping me to make sense of it and to find ways to heal.
We continue to perpetuate the myth that “mental illness is an illness like any other.” We perpetuate it in well-meaning “anti-stigma campaigns” that actually increase stigma and discrimination against people experiencing emotional distress. We perpetuate it in well-funded programs like Mental Health First Aid that teach people “skills” such as how to identify mental illnesses and rank them in order of seriousness, while excluding any discussion of the social conditions that cause young people to suffer from extreme distress and suicidal thinking in the first place.
The apolitical master narrative largely ignores the fact that trauma and toxic stress are an inescapable part of daily life for many young people in the U.S. The landmark 1997 Adverse Childhood Experiences (ACE) Study, which surveyed 17,000 Californians and has since been replicated in almost every state in the U.S., found that ACEs were remarkably common, with two-thirds of the adult respondents having experienced at least one ACE, and 12.5% experiencing 4 or more ACEs. ACEs are shown to have a causative link with nearly every major public health problem in America, including depression, suicide, substance use, and decreased life expectancy.
When young people are exposed to adversity in regular “doses,” this causes a cascade of neurophysiological stress responses that affect the body, influence health, and shape behavior. And this toxic stress is not distributed equally: youth living in systemic poverty, youth of color, queer and gender non-conforming youth, and youth with psychiatric and/or physical disabilities are more like to suffer the impacts. Impacts that are often punished or pathologized in our educational, health care, child welfare, and juvenile justice systems.
Mandating mental health education for youth without addressing the root causes of their distress, and without naming our deeply problematic collective response, is like slapping a band-aid on a gaping wound. Such initiatives conveniently take the onus off of schools, communities, and states to take concrete actions to promote the well-being of young people and their families.
So how could we really make a difference, beyond lip service and serving up outdated and individual-blaming theories of mental health in our schools?
Acknowledge that available services for students may do more harm than good, and create supports that actually help. In nearly all of our states, available resources and services for young people in distress are inadequate at best and harmful at worst. We are always encouraging young people to ask for help, but what happens when they do? Let’s just say hypothetically that due to receiving mental health education, a teen discloses suicidal thoughts or even a plan to end their lives to a teacher or a school counselor. And let’s say that this young person actually accesses some form of professional help as a result.
What most parents don’t know is that the vast majority of mental health professionals in the U.S. do not receive any training on how to respond compassionately and appropriately to suicidal people of any age, let alone youth. As of 2017, only 10 states mandated any kind of suicide prevention training for mental health or health care professionals. Interestingly, Virginia and New York are not among these states.
So what will happen to this student struggling with suicide? The school counselor or community mental health professional, likely untrained to support the student, and also worried about liability concerns, will encourage inpatient hospitalization — that is, if beds are even available. Yet research shows that psychiatric hospitalization and re-hospitalization can increase feelings of hopelessness in youth and can cause what is called “iatrogenic” harm, or harm caused by the treatment itself. According to a 2016 study published in Psychiatric Services, psychiatric hospitalization and “rapid rehospitalization” exacerbated suicidal thoughts in a significant percentage of young people taking part in the study. Numerous other studies and meta-analyses bear out the same conclusion in adults: psychiatric hospitalization is associated with an increased risk of suicide — even in those who were not admitted for suicidal thinking or behavior.
And the harms perpetrated on kids in distress are sharply divided among racial lines. Youth of color who turn to substances to cope with their pain — at the same rates as their white counterparts — are far more likely to have that distress criminalized, setting them up for a lifetime cycle that fuels the school-to-prison pipeline and benefits the corporations that profit from it. Nationally, Native American youth are “30 percent more likely than Caucasian youth to be referred to juvenile court than have charges dropped,” according to Gabriel Galanda, a Washington-state youth advocate fighting the opening of a new kids’ jail in King County, Washington. While we have rightly focused on how the school to prison pipeline affects boys of color, girls of color who have experienced sexual abuse or are survivors of sex trafficking are also disproportionately “treated” within the juvenile justice system, where they rarely receive the trauma-specific services and supports they need, and are further traumatized by their incarceration.
In the context of teaching mental health in schools, we comfortably avoid talking about the realities of historical trauma, ongoing trauma, and systemic oppression faced by children of color. We never talk about chronically-underfunded schools and lack of support for educators as factors negatively influencing students’ mental health. We never talk about the fact that there seems to be plenty of funding for kids’ prisons, as well as the adult prisons distressed youth of color are often funneled into.
Adults need to get honest about the harm our systems and institutions cause to students every day, often in the name of “help.” If we are really willing to do something to reverse this harm, here are just a few ideas that are worth considering.
Create trauma-sensitive school cultures — everywhere, and for every child. We know now more than ever about how trauma and toxic stress impact students in a variety of ways, and that the environments in which children live and learn can affect their health — for better, and for worse. The previously-mentioned Pediatrics study that found a sharp increase in suicidal thoughts and behaviors in young people between 2008–2015 also found a seasonal trend that was disturbing and telling. Visits to emergency rooms for suicide rose in midfall and midspring and dropped to their lowest point in the summer, when school was out. The study’s authors themselves note that this trend speaks to “the stress and the strain” that students experience at school.
Schools need to take a look at their cultures and assess whether they are supporting young people or hurting them. This may seem like an impossible task, but with the political will, it is possible and happening right now in handfuls of schools around the country, with dramatic and positive results. Check out the documentary Paper Tigers, which tells the story of Lincoln High School, a school that instituted a trauma-responsive, restorative-justice based culture and saw as a result a significant decrease in dropouts and suspensions.
This intentional change in school culture was not just focused on educational outcomes, but on building relationships of trust and respect between students and their educators. These kinds of relationships can make all the difference in the trajectory of a young person’s life. We know from the latest advances in neuroscience, as well as plain common sense, that connection is a powerful social determinant of health. Neuroscientist Stephen Porges speaks of “connectedness as a biological imperative.” According to the Harvard Center for the Developing Child, “The single most common factor for children who develop resilience is at least one stable and committed relationship with a supportive parent, caregiver, or other adult.” I myself was very lucky to have supportive educators who met me where I was at, who believed in me even when I was trapped in a cycle of distress, suicide, and institutionalization, who saw me beyond the labels I had been given.
Eleanor Longden, a psychologist and advocate who was diagnosed with schizophrenia as a young person, also speaks to the importance of relationships: “Primarily, I was very fortunate to have people who never gave up on me — relationships that really honoured my resilience, my worth and humanity, and my capacity to heal. I used to say that these people saved me, but what I now know is that they did something even more important: they empowered me to save myself.”
Virginia has taken some preliminary steps to create pockets of trauma-informed culture change in a handful of Richmond schools, but why are these changes in school culture not being mandated and implemented in every school and every district in the state? New York State’s Department of Education has developed a plan to improve school climates, but it seems to be in a very preliminary phase. How much longer will it take until every child in America has access to schools that truly support and nurture them?
Educate students, teachers, and families about the effects of toxic stress and adversity on health, as well as the factors that build resilience. I support the kind of health education that is based on the latest findings in neuroscience, including the effects of ACEs, stress, and toxic stress on the body and mind, as well the factors that can increase resilience and healing.
Collective education about ACEs was a cornerstone of the approach taken at Lincoln High School, featured in the Paper Tigers documentary. This kind of education, emphasizing that students’ mental health difficulties are understandable responses to ongoing toxic stress and adversity, fosters the compassion and empathy that young people so desperately need for themselves, each other, and from their educators, families, and communities. We need to stop telling young people what is wrong with them and support them in understanding what has happened and is happening to them.
We also need to teach students that adversity, while affecting us in significant ways, is not destiny. The brain is neuroplastic, or able to heal itself, especially when we are exposed to the right kinds of social support, and learn strategies for regulating our chronically-stressed nervous systems. We need to underscore that healing is always possible, and affirm the many ways in which young people manage to cope and survive in the face of incredible adversities.
Teach students, educators, and families practical mind-body skills to manage stress and intense emotions. In its most recent report on rising suicide rates in the U.S., the Centers for Disease Control and Prevention (CDC) noted that suicide is “more than a mental health concern,” and is often driven by various forms of stress. Therefore, one of the CDC’s recommendations included “teaching people coping and problem-solving skills” to deal with the stressors they face. Currently, there are just a handful of organizations around the country, including the Niroga Institute in Oakland and the Holistic Life Foundation based in Baltimore, that are teaching students these strategies for managing stress. These skills should be as foundational in our schools as STEM competencies.
Niroga Institute has created a Dynamic Mindfulness curriculum, which has been the subject of rigorous research and has led to such outcomes as “lower levels of perceived stress and greater levels of self-control, school engagement, emotional awareness, distress tolerance and altered attitude towards violence.” Similar research conducted on the Holistic Life Foundation’s Stress Reduction and Mindfulness Curriculum found a reduction in “rumination, intrusive thoughts and emotional arousal. A qualitative assessment with middle school students following our intervention showed experiences in improved impulse control and emotional regulation.”
I want to make it clear that these interventions are not designed to teach students to meditate or breathe their pain away, but to help them to feel more in control of their brains and bodies, even in the midst of the very real challenges they face.
Connect young people to in-person and online peer-to-peer support resources. While “mental health education” programs will likely teach young people about how to identify signs of emotional distress in themselves and their peers, it’s unclear if they will be taught anything about peer-to-peer support, a non-clinical approach that is based on the idea that those of us “who have been there” are in an ideal position to support one another. Genuine peer support, as developed over the last several decades, is based on the values of empathy and mutual aid in all of our relationships. Research shows that youth who had access to peer support after significant stressors enjoyed better mental health than those who did not. A 2017 Australian study found that “teens who were with (or were communicating online with) friends in the time immediately following a stressful event reported lower levels of sadness, jealousy, and worry — and higher levels of happiness — than those alone or with adults. Whether they were with friends in-person or online didn’t seem to matter.”
Young people are informally providing peer support to one another all the time. I remember that when I was locked up in various psych hospitals and facilities as a teen, the connection with other young people who understood firsthand what I was going through helped me more than anything else.
And there are promising new strides being made towards formally implementing more peer-based support in schools. A new organization, The Adolescent Peer Support League (APSL), is starting a “National Conversation” on the need for peer support. APSL advocates for a “peer-based support system for high school students where their peers can assist and counsel them. Our ultimate goal is to see these programs implemented in high schools across the nation, providing easily-accessible, systematic mental health support to teenagers. Through these programs, students will be able to utilize the support of their peers in order to guide themselves towards better mental health.”
And peer support is not just for young people who may struggle with low-level depression or anxiety — it can be also be extremely helpful for people experiencing even the most intense forms of distress, including experiences of voice hearing or visions that are often labeled as “psychosis.” Teachers and schools counselors can avail themselves of information about national and international peer support networks for young people experiencing extreme states, such as the online support groups offered by the Hearing Voices Network USA.
Engage the leadership of young people and youth-led organizations as community partners in developing programs and educational curricula. While three high school students were involved in advocating for the legislation mandating mental health education in Virginia, it’s not clear as to how they or other students will be involved in shaping the curriculum’s content. And I found no information about whether students or youth-led organizations will be involved in either developing or rolling out the mental health curricula in New York State. By “involvement,” I want to be clear that I don’t mean inviting one token young person to a meeting and asking them to “sign off” on something already developed. I mean involving young people in meaningful ways, as leaders and partners in this vital work of health education and consciousness-raising, both in school and in their communities.
All too often, we disregard the lived experience of young people in our efforts to “educate” them. But there are state and national youth-led organizations focusing on the intersection of social justice and health that we should be looking to as leaders and visionaries in this work. One such organization is Youth in Mind, a California-based nonprofit that recently took a diverse group of young people on a civil rights journey across the South to learn from history and to connect with civil rights leaders. They are currently presenting on their experiences and learnings across California, and are working to develop a Bill of Rights for young people living with mental health challenges.
The Bill of Rights idea came out of listening sessions that YIM conducts across California every two years. The most recent listening session uncovered both disturbing and hopeful information. Susan Manzi, executive director of YIM, told me, “What we found as a common theme was that every civil right of young people was being violated. Many had no idea what their rights were, they could not access supports and treatment, and could not access peer-to-peer support. More youth are getting diagnosed, but not being properly informed about their diagnosis. They are being given medications, with no explanation of how to take them safely, such as possible interactions with alcohol and drugs.” Manzi added, “Young people are big thinkers. They haven’t been conditioned as much as adults to self-censor. They were screaming ‘revolution!’ in the rooms.”
We also have a tremendous amount to learn from Native and Indigenous youth organizations in the U.S. and Canada. While Canada’s Native Youth Sexual Health Network (NYSHN) does not focus on mental health specifically, they look at health from a much-needed historical and intersectional perspective. Their principles and values deserve equal attention in mental health, where young people’s brains and bodies are so often blamed and policed in the name of help and safety.
NYSHN’s “What We Believe” statements represent the kinds of values that should guide mental health education in schools and in the community. For example, NYSHN’s “Support Not Stigma, Support Not Shame” statement says: “We address issues from places of support and meeting people where they are at, instead of approaches that may blame/shame people based on what happens with their bodies or for harms that may come to their lives.” They emphasize the importance of youth telling their stories instead of being told what’s wrong with them: “By creating our own stories and expressing ourselves through various forms of multi-media and arts, we are able to not only push back on demeaning and/or stereotyping mainstream narratives, but also collectively create new visions.” It is these stories that we need to center and elevate in education. Stories of truth, of new possibilities for the future.
If we truly cared about the mental and physical health of young people, we would support the development of grassroots, youth-led strategies for education and responses to distress that do not create further harm and that promote healing. Manzi emphasizes that schools should own up to the truth: that they can’t — and shouldn’t — do it all when it comes to mental health education. “There are great educators out there. I want them to have more support and to build capacity through coalition-building and community engagement. They can bring in community members to show other perspectives, and they should engage in ‘move-aside leadership’ sometimes.”
And most importantly, if we really cared about the mental health of young people, we would double down on addressing destructive social forces such as child poverty, white supremacy, structural violence, the ongoing impacts of settler colonialism, and rape culture that harm students and their families intergenerationally. We would create conditions and environments where students feel safe to live, learn, and create. We would foster communities and cultures everywhere where young people are uplifted to love and honor themselves, one another, and the Earth. To explore their unique gifts and callings. To feel empowered as changemakers. And to share their revolutionary passions with a world that so desperately needs them.
*Acknowledgement and gratitude to Suzan Manzi of Youth in Mind for participating in an interview for this essay, as well as Anjali Nath of Liberation Spring for introducing me to the work of the Native Youth Sexual Health Network via the podcast “Decolonizing the Roots of Rape Culture” by Dr. Sarah Hunt.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.