Josée DesLauriers of the Champlain East CMHA leads students in a social network exercise at Le Sommet in Hawkesbury.

In a class of 30 students, six may be struggling with a mental-health problem or disorder. Most likely, only one of those six students will be receiving treatment.

What’s a teacher to do?

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A few years ago in Campbellford, southeast of Peterborough, 22-year-old Mike took his own life. The tragic event spurred family, friends and local mental-health workers, with the help of his former high school, to fight back against youth mental illness.

The Campbellford and District Community Mental Health Centre organized a one-day blitz aimed at Campbellford District High School’s 700 students, classroom by classroom and grade by grade. Mental-health workers and young people who had experienced mental illness spoke about depression, mental-health awareness and suicide prevention.

The event was a huge success. Many referrals of students to the local mental-health centre followed immediately, and referrals continued long after. Case workers were accepted into the school, allowing for early and regular intervention.

“The press covered it, and everyone was talking about mental health, depression and Mike,” says Jennifer Robertson, a family education and support worker with the early intervention program at the Canadian Mental Health Association (CMHA), Peterborough.

“The student response was incredible,” says Robertson. “And it has led to a continuous open door between the school and the mental-health agency in the community.”

“According to studies, most of the kids who have mental-health problems are not diagnosed at all,” says Judith Wiener, a professor in the Department of Human Development and Applied Psychology at OISE/UT. “Yet they all go to school.”

Gordon Floyd, President and CEO of Children’s Mental Health Ontario, agrees. “The number-one issue we need to confront in the schools,” says Floyd, “is how we can do a better job of identifying the children with mental-health problems who are overlooked because they withdraw or suffer in silence.”

Mental illness versus success

Darcy Santor, a professor at the University of Ottawa and a child and youth mental-health senior scientist at the Provincial Centre of Excellence for Child and Youth Mental Health of the Children’s Hospital of Eastern Ontario (CHEO), says that mental illness can seriously impair a child’s success at school and the child’s interaction with peers.

Santor, co-author of Taking Mental Health to School, a report the centre released last year, says that 14 per cent of school dropouts can be attributed to psychiatric disorders, that kids with mental illness miss 40 per cent more school days than students without mental illness and that, depending on the disorder, 30 to 50 per cent underachieve.

Mental-health problems can show up as disruptive behaviour, bullying, mood swings, non-compliance and distraction. But, says Santor, you may not be aware of the distress of a student who is withdrawn or depressed.

Schools are ideal settings for prevention and early-intervention programs as well as treatment services, says Santor. His report notes there is broad acknowledgment that student mental-health needs outstrip the current capacity of schools to respond adequately. The report also notes the need for a cohesive, consistent approach to replace the current piecemeal programs. His research shows that teachers generally have low levels of mental-health knowledge and that mental-health education has not been a priority in professional development.

Role to play

“Most teachers have not been trained in mental-illness issues, but they’re being asked to deal with them on a day-to-day basis,” says Santor. “The teacher’s role is absolutely fundamental.”

While he is clear that no one is suggesting that teachers should know how to treat mental illness, he asserts that teachers should understand it and know when to ask for help from Special Education colleagues, guidance counsellors or school psychologists. He also stresses that teachers should receive help in providing accommodations and extra support for these children in the classroom.

Mental-health issues are currently addressed in the Health and Physical Education (HPE) curriculum, explains Gary Wheeler, spokesperson for the Ontario Ministry of Education. In the 2010 revised HPE curriculum, students learn more about mental health, mental illness, stereotypes and stigma. Other subject areas within the social sciences and humanities curriculum also touch on mental-health issues. But, as with all curriculum, school boards determine how it is delivered, says Wheeler.

École secondaire catholique de Plantagenet, a rural school east of Ottawa with a student population of 600 in Grades 7 to 12, is one secondary school in Prescott-Russell where Josée DesLauriers brings that curriculum to life. Between January and June, DesLauriers, a mental-health promoter with the Champlain East branch of CMHA in Hawkesbury, visited 10 of the 12 secondary schools in Prescott-Russell, 80 per cent of which are French language.

DesLauriers uses the Talking about Mental Illness (TAMI) program developed by the Centre for Addiction and Mental Health, the Canadian Mental Health Association (Ontario) and the Mood Disorders Association of Ontario. She introduces students to mental disorders, causes, warning signs, treatment, recovery, suicide awareness, stress management and where to get help. Testimonials, a key part of the presentations, allow students to hear the stories of young people who have experienced mental illness.

At last count the program was being offered in 44 French and English school boards across Ontario.

“More and more people are aware of how mental illness is affecting us directly or indirectly,” says DesLauriers. “After the presentation, a lot of kids come forward and talk about themselves or their family members. Quite often the teachers are really surprised.”

At Plantagenet she presented TAMI workshops to eight Grade 11 and 12 classes. Some received the full four-workshop presentation while others received only one or two sessions. She uses fun interactive activities like role-playing, game-show-type quizzes, videos and YouTube clips.

DesLauriers also visited école secondaire publique Le Sommet, a school of 450 students in Hawkesbury, to talk with 90 Grade 7 and 8 students in the class of Jérôme Bercier, OCT.

“It was super. With the Grade 7 and 8 students being in the high school setting, they are more likely to have the stress factor,” says Bercier. “It’s really good to begin early so they have the knowledge and awareness before it gets to the stage of a mental illness.”

School is an ideal place to reach kids, he continues, as they are a captive audience. “The way she explains it, the prejudice disappears. It became, not normal, but okay. She told them it might not be you, but it could be your friend. Don’t keep it a secret. Get help.”

Jason Wagensveld, OCT, teaches Grades 7 and 8 and is the learning resource coach at Russell High School, southeast of Ottawa. He attended a TAMI presentation with his students in June. “It’s a topic kids are typically not willing to talk about. It’s kind of like a secret thing. That, to me, is one of the main goals of having someone come and speak about it. It reduces the stigma and allows them to talk to a guidance counsellor or freely with friends.”

Depression is the major issue he sees at his school, and people who are dealing with it are still embarrassed. “But it’s real,” he says. “I think that was an eye-opener for the students. It got them away from the idea that depression is something you choose or that you’re just feeling sorry for yourself.”

The teacher’s role, he says, is to make students feel comfortable enough to talk about it and then point them in the direction of help. That’s why teacher training in mental health is important. Teachers have the responsibility of knowing the proper steps to follow, even though “it’s not exactly a priority at education faculties.”

The CHEO report and many experts in the field call for greater co-operation and communication among schools, social services and health sectors. That thinking lies behind the government’s introduction of the Student Support Leadership Initiative (SSLI) in 2008, now funded for another three years. Since then, school boards and community agencies have been working together to establish or enhance local partnerships in 29 geographic clusters across the province.

In the Windsor-Essex cluster, the SSLI has taken the form of a partnership comprising the Windsor-Essex Catholic DSB, the Greater Essex County DSB, the Windsor Regional Hospital and the local school authority. They came up with a multi-layered plan to increase awareness and build resources and services.

Initial projects included a survey of school board staff and community services, regular meetings to discuss community needs, the We R Kids mental-health web site, community presentations and a two-day symposium for educators, mental-health workers, parents and students.

Pilot projects under way include after-school outreach clinics for teens in rural areas, a DVD and tool kit, and advocacy to create a teacher-coach liaison position for someone to work in classrooms assisting teachers and support staff.

Cathy Geml, OCT, Superintendent of Education with the Windsor-Essex Catholic DSB, explains how the symposium played a role in helping one particular 17-year-old girl.

“The very next school day, the girl and her mother, unaware of the symposium, showed up at guidance. Because of the pressure she was under, the girl couldn’t bring herself to attend school,” says Geml. “Because of what we had learned at the symposium, the counsellor knew what to do to get her help right away. It was a very compelling reason to move forward with the mental-health SSLI.”

Waiting for help

Students with mental illnesses especially need routines and safe environments.  

Randee Boucher, OCT, teaches Grade 5 at Frank W. Begley School with the Greater Essex County DSB. During the past 10 years, she has taught students with depression, bipolar disorder, obsessive compulsive disorder and oppositional defiant disorder (ODD).

“It’s a little scary when you think about it,” she says. “They’re in Grade 5. They’re young.”

Boucher has come up with effective strategies with the help of her school team of principal, vice-principal, child and youth worker and students’ teachers from previous years.

“Students with mental illnesses especially need routines and safe environments that focus on them as whole children,” she says. She describes a boy diagnosed with ODD who came to her class last year reluctant to complete written tasks and argumentative with adults. His attendance was sporadic, and he refused simple requests.

She set clear, high, consistent expectations from the beginning of the year and used the Tribes TLC program, developed in California, which focuses on a caring culture of learning in the classroom, both academically and socially. She has been using it for four years and now trains other teachers in her board.

By the end of the year, the boy had friends, attended consistently, took social risks and completed his tasks with enthusiasm.

“We had our room’s annual poetry reading,” says Boucher. “This student invited his sister, niece and mom to attend and performed with no hesitation.”

Boucher says that communication with parents and outside agencies and help from those agencies for parents makes a big difference. “That connection and that dialogue are just so key. Having community agencies support the home is a huge plus, providing consistency – with the same rules and routines – between home and school.”

Professional development on mental health is excellent within her board, she adds. “If I needed training, it would be available. I feel that we’re taken care of.”

Lack of professional help

Most school-board psychologists spend the majority of their time on assessment, leaving little time to provide actual support, and social workers are spread very thin, reports People for Education in its 2010 report on Ontario’s publicly funded schools. The report says that in 2009 fewer than half of Ontario secondary schools had regularly scheduled access to either psychologists or child and youth workers and that just under two-thirds reported any scheduled access to a social worker.

The system is far worse in the north, the report says, where almost all mental-health and social services are available only on an on-call basis and where about one-third of elementary schools have no access to a psychologist or to a social worker, and almost half have no access to a child and youth worker. These numbers are falling. Six years ago 20 per cent of northern elementary schools reported having regular access to a social worker; now it is eight per cent.

Ontario’s francophone minority has its own set of difficulties getting help for its children in their own language within sometimes small and spread-apart communities, says René-Guy Cantin, Executive Director of Centre psychosocial – a francophone mental-health centre in Ottawa for children, youth and families.

“It is a problem to recruit highly qualified professionals and even more so francophone professionals. But the major problem is always the same. We talk a lot about mental health and intervention, but there’s no money. We have to fight all the time for what we would like to see for francophone services.”

His agency has come up with two school-focused programs. Distance Services sends professional teams into francophone schools in northern Ontario, where they assess students and train teachers and then continue the relationship through long-distance video conferencing. He would like to see the program expanded across the province. The agency’s second project is an early-intervention pilot study. A school that spots a problem with a child calls the agency, which does a prompt consultation, assessment and identification.

“We take over immediately with a multidisciplinary team that meets with the child and family. We realize that many times this child disturbs the rest of the classroom. So we are releasing, in a way, the burden for the school. The teacher can put more energy into teaching, and we are putting all our energy into working with these children.”

Making the difference

Gordon Floyd believes in the power of our schools to make a difference.

“If we realized how fundamentally important it is to a child’s success to have healthy social relationships, a happy emotional life and appropriate behavior, we would be offering programs and courses to support them at a much earlier age and on a much more universal basis.

“Every teacher I know cares about the success of children in the classroom. Teachers are in a uniquely powerful and useful position. They have a vital role to play.”

Some facts

• Half of all lifetime cases of diagnosable mental illness begin before age 14, and three-quarters begin before age 24.

• Suicide is the second leading cause of death among young people age 15 to 24.

• Ninety per cent of those who commit suicide have a diagnosable mental illness.

• Ten per cent of boys and 11 per cent of girls age four to 11 have symptoms of depression.

• Mental-health problems in children are expected to increase by 50 per cent by 2020.

• Seventy per cent of childhood mental-health problems can be solved through prevention, early diagnosis and intervention.

Resources

Canadian Mental Health Association (cmha.ca)

Children’s Mental Health Ontario, resources for teachers (kidsmentalhealth.ca)

FRIENDS for Life (www.friendsrt.com) from Austin Resilience Development, a program developed in Australia and used in British Columbia’s elementary curriculum to help kids build resilience and reduce anxiety and depression

Centre for Addiction and Mental Health (camh.net), resources for teachers and schools and information on TAMI programs

The ABCs of Mental Health – a Teacher Resource from the Hincks-Dellcrest Centre in Toronto (brocku.ca/teacherresource/ABC)

We R Kids (werkidsmentalhealth.ca), partnered by the Greater Essex County DSB, the Windsor-Essex Catholic DSB, the John McGivney Children’s Centre and the Windsor Regional Hospital

When Something’s Wrong: Ideas for Teachers, a handbook from the Canadian Psychiatric Research Foundation (cprf.ca), available in English and French

YooMagazine (yoomagazine.net), a health and mental-health magazine for students and teachers (a French edition is expected within the year)