Published Online: June 20, 2014

Commentary

Including Teachers in the Student Mental-Health Continuum

The location changes, but the story is a familiar one: An angry young man—sometimes a teenager—guns down others in a public place. Whether it's Troutdale, Ore.; Isla Vista, Calif.; or Newtown, Conn., questions soon arise about the mental health of the killer and whether treatment could have prevented a tragedy.

Findings from the most recent National Comorbidity Survey Adolescent Supplement, conducted from 2001 to 2004 and to date the largest nationally representative study of child and adolescent mental disorders, tell a striking story. Almost half the 13- through 18-year-olds studied met criteria for a mental disorder. Yet two-thirds of those with a disorder never received mental-health treatment. Even among those with the most severe disorders, only half reported receiving treatment for their symptoms.

There are many explanations for this gap in treatment. At the intersection of stigma, shame, budget constraints, the distances to doctors' offices, and inadequate insurance coverage stand the parents, teachers, pediatricians, psychologists, counselors, and social workers who provide the best care they can, almost always with limited resources.

Despite their many other professional burdens, teachers remain in one of the best positions to attend to children exhibiting mental distress. Parents, only naturally, are biased and emotionally invested. They surely know their children better than anyone, but have limited knowledge of typical and atypical child development. Pediatricians, on the other hand, are knowledgeable purveyors of information on children, given their experiences with hundreds if not thousands of them, but a physician is unlikely to know an individual child as well as the child's teacher does.

So it is that we turn again to teachers. The essence of school would seem to be about the wellbeing of children, helping them live their lives according to their best lights, as University of Pennsylvania President Amy Gutmann has written. They need to be educated, as well as cared for, in ways that will help them thrive. It is not melodramatic to assert, therefore, that education is a life-or-death enterprise.

Teacher referral of children to mental-health treatment is, however, a complex matter. It requires that teachers first recognize that students need help, and, second, conceptualize that need as a mental or emotional one and not just a medical, disciplinary, or parenting problem. But that is only the beginning. Teachers need to assess risk, know whether and with whom to consult, and then be confident that there are resources available for students.

In a series of interviews that one of us (Jennifer Green) conducted with junior high and high school teachers, they described the challenges they face. A high school math teacher said: "My average student I see for 50 minutes, 55 minutes, and unfortunately based on time and the things that you're trying to get through, … I know that there are things that I missed. … I'm sure that there are people who are suffering from some sort of emotional distress or just some general dissonance and, I don’t know how to address those."

An 8th grade history teacher talked about an all-too-common challenge: "We lost our full-time counselor last year, so when I first started at the beginning of the year, we didn't have a counselor." The school has a new counselor, but the teacher added: "I'm not sure exactly what the procedure is to utilize his services. Or even what days he's exactly in."

“Some teachers welcome the student-support role, but are unsure how to help students or where to find the information they need.”

From a high school math teacher: "I'm always just wishing we could do more to support these kids better. Put them in smaller classes. Have them connected to adults. How do we have every student in the school feel connected to an adult in the building? How do you get to know 1,500 kids and make sure they’re all connected somewhere? I think really, really, really the key—whether we're talking about their emotional health or their academic ability—is that students feel personally cared about, and I don't know how we do that."

Some teachers welcome the student-support role, but are unsure how to help students or where to find the information they need to do this well. Most teachers have little or no training in the complexities of addressing student mental-health issues.

Further, how do teachers balance the needs of individual students with those of an entire class?

From a high school teacher: "Our role in society is pretty vague, and I think for some teachers, they feel more like parents and are willing to accept that added responsibility, and for other teachers, I think myself included, I don’t like that responsibility. I didn't become a teacher to also become a parent. I pursued teaching because of the subject that I love, and I wanted to share that passion with young people.

"I just think if teachers knew more about the resources out there that we could use, just to prepare ourselves. … I can go on the Internet and do a Google search, but how do I know that that’s the right thing?"

It seems essential that teachers possess an understanding of normal and abnormal psychological development. They need not become experts in diagnosis or treatment; no one is suggesting they assume the role of therapist or counselor. But if we insist that regular classroom teachers receive training in special education, then why not instruction in mental health or, at the very least, the signs of potential danger? President Barack Obama actually called for such training in 2013.

A number of programs designed to instruct teachers in identifying and responding to mental-health and behavioral challenges already exist. For example, the American Psychiatric Foundation’s "Typical or Troubled?" program trains school staff members to identify signs of trouble among adolescents. Ought not this training be universal?

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The reality is that many schools and communities are sorely lacking affordable and high-quality mental-health resources for young people. Let us hold in mind that children don’t slip through the cracks; they are overlooked, neglected, or at times simply improperly cared for. The path to understanding remains today as it did for Immanuel Kant: "[T]he human being can only become human through education." But let us add that recognizing, understanding, and treating mental illness are ingredients of that education.

Knowing what we do, how can we not act on these words from a high school English teacher: "We have to be the bridge—we know them the most, we see them the most, we see them consistently every day for however many minutes, and even though we have a lot of support systems, those people aren't going to know about it unless someone refers them."

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