Written by Laura Koran-Swisher, CNN
It is World Mental Health Day on June 20. In some parts of the world, the importance of mental health to the health and wellbeing of everyone involved — from one patient to one’s entire medical team — is often difficult to overstate.
For schools nurses, the gravity of the situation can’t be understated. This is especially the case when working with children and teenagers in the uncertain atmosphere of a school.
“If you think about all of the sleep and stress and anxiety that they go through, just focusing on a problem that could be fully understandable and manageable with great help is incredibly stressful,” said Stacey, from Keene State College Nursing in New Hampshire.
Stacey has worked with community schools in the state for over two decades, and says that each day she feels the weight of an unknown community. “We are dealing with issues that should be as simple as the fact that a child might not be able to reach their bus.
“Parents don’t necessarily know the best way to deal with these types of situations. Even if they do, they don’t always know what, if anything, the school will do to help.”
A snapshot of issues
Mental health is not a new issue for schools nurses; it is a concern that has existed for decades, with schools having to cope with students dealing with stress, anxiety, depression and issues such as ADHD.
That problem is even worse, in some instances, for children living in highly distressed communities, for whom social issues — such as poverty and trauma — are also compounded by their poor education levels.
At the same time, schools have to balance the demands of helping an increasingly mobile population with managing a multifaceted, sometimes intimidating, community.
But stress is only part of the problem. Mental health is also increasingly a victim of clinical status quo, underfunded healthcare systems and a shortage of educational health professionals.
The prevalence of bullying has increased more than 50% in the past two decades, with many kids claiming the issue is more prevalent than their physical ailments.
There is a perception that schools are suitable for mental health initiatives, but the reality is that mental health needs can be assessed for, and treated, within the school environment. However, many agree that prevention is better than cure.
“Going in and talking about a student’s mental health is different than going in and having them sit down with their [school nurse],” said Melissa, from Humboldt State College nursing in California.
“Usually, there are a lot of reasons why something like a depression or anxiety is happening. It’s not like you walk into a child’s office and treat their problem.”
“[Mental health issues] are something you can prevent before they get to crisis state.
“This is one of those things where we talk about kids and mental health and we feel strongly about it, but when you look at the hard facts of what is happening in schools, I think it is still very rare for us to see it.”
Where mental health is required
Improving mental health in schools requires a whole-of-system response to address the need across the community, such as engaging parents, students and other clinicians.
Tracy, from the University of Manitoba in Canada, was talking about the complexity of mental health issues within institutions, including the school environment.
According to Tracy, these social issues also contribute to a lack of resources for schools.
“There is a very real communication problem — that is not always a reflection of our staff in schools, but sometimes our students are more confident sharing issues that are sometimes frightening.”
“Schools are not closed off like single rooms — there are issues where you will have to lock down the school rather than talk to one teacher in one room.”
Early-years stress
According to Casey, from the University of Cincinnati in Ohio, the school environment contributes to mental health problems, particularly in terms of developing behavioral problems in young children.
An example of how this can become a problem was explained by young Laura, a 10-year-old attending preschool in the area.
Her mother, Darryl, said: “One day, they had a ‘power outage’ and my daughter started panicking. She wanted to crawl under the classroom and hide.”
The teacher was able to reduce Laura’s anxieties with realistic scenarios — in an environment where the educator is trained to work with children who have emotional and social issues.
A specialist counselor sat down with the children, answered their questions and listened to their concerns, at the same time reaching out to the kids’ parents to prepare them for the consequences of their child’s behavior.
“Most parents want to help their child and learn about their child’s issues