City schools confront mental health

Students in Susan Tozier’s Brooklyn high school health class at were having trouble understanding the problems facing seven-year-old Fred, a little boy with a very high IQ.

They were watching the film Little Man Tate, in which the main character, Fred, has savant syndrome—a condition in which one talent or skill is highly developed despite a person’s overall mental or developmental disabilities. “They told me that they didn’t think he had a mental illness because he was really smart,” Tozier explained. “They were astounded.”

It’s this kind of confusion about mental health conditions that shapes curricula and services aimed at addressing adolescent mental illness. In 2005, suicide was the fourth leading cause of death for 11 to 18-year-olds in New York State, according to the Centers for Disease Control and Prevention. According to the 2007 National Survey of Drug Use and Health Promotion, nine percent of New York State youth between the ages of 12 and 17 suffered an episode of major depression within one year. Just two months ago, an eleventh grade student at the Upper East Side’s private Dalton School jumped to his death from a school window.

Students in New York City public high schools take one semester of health before they graduate, usually in their junior or senior year. In addition to mental and emotional health, the curriculum includes topics such as abstinence and sexual health, nutrition and physical activity, and tobacco, alcohol, and other drug prevention.

Tozier, who teaches health as well as chemistry and a biology class called “Living Environment Review” at the High School for Telecommunication, Art, and Technology, reserves three weeks of the semester for mental health education. She said that her students might come into the class already knowing the names of mental disorders, but not truly understanding what it means to have a mental condition.

“They’re not aware of the idea of mental illness as a disease, something that is treatable,” Tozier said. “They think of mental illness as distinct from physical illness.”

For Tozier, building awareness about mental health issues is just as important as memorizing the specific symptoms of a variety of disorders. “My focus is more to get them to understand what it might be like to be a person with mental illness and the challenges that are associated with that,” she explained. The health curriculum is not subject to a Regents exam, so Tozier allows the students to guide the syllabus by choosing research topics and then presenting their projects to their classmates. This way, Tozier said, the class is “about something they found interesting, and that translates, because when they’re presenting they’re excited about it, and their classmates are interested, too.”

One 16-year-old eleventh grader at Frederick Douglass Academy, who was granted anonymity due to her privacy concerns as a minor, learned about depression, bipolar disorder, stress, and schizophrenia in her health class last semester. She knew how to describe significant conditions and their symptoms, but noted that even common stress factors can raise issues for young people trying to cope with every day life. “General stress to me is like schoolwork, family issues, peer pressure and college process—the list can go on forever,” she explained. “I learned that finding ways to cope with stress can enable mental health.”

Currently, NYC public school health teachers receive no health-specific training. Instead, they take on the extra class when they are teaching fewer sections of their own subject. The curriculum uses a textbook called HealthSmart, which is published by non-profit health promotion organization ETR Associates. Paul Thompson, who teaches health and chemistry at the High School for Math, Science, and Engineering at City College, explained that he doesn’t “have enough background” to “sound like a psychiatrist” in his classroom, so instead chooses to stick to the HealthSmart textbook and curriculum.

Thompson also finds that it can be difficult to engage students in candid conversation. “I don’t think kids are too keen opening up in front of the other kids,” he said.

In addition to the mental health curriculum in high school classes, the New York City Department of Education offers school-based mental health programs in 135 schools across the five boroughs. These programs help to identify children with behavioral and emotional health needs, facilitate access to mental health services, and provide training to parents and teachers on pertinent issues. They are typically staffed by licensed social workers, psychologists, and psychiatrists, according to the DOE website. Student participation in these programs is kept confidential, even from the rest of the school staff, and parental consent is required before services begin. Referrals to the school programs can be made by parents, teachers, or the students themselves. The DOE did not respond to inquiries for comment.

Yet finding a way to identify mental health conditions in students so they can begin receiving the treatment and attention that they need can be a difficult task. The TeenScreen National Center for Mental Health Checkups at Columbia University is an organization focused on identifying and treating mental illness in teenagers. Developed in 1991 in response to new research linking mental illness and suicide in teenagers, the Center’s official mission is to “prevent adolescent suicide and reduce disability associated with mental illness through early detection of mental illness.” The program operates 32 screening sites in New York and over 500 sites nationwide.

TeenScreen conducts their ‘mental health checkups’ through a screening questionnaire distributed in middle and high schools, doctors’ offices, and other settings that provide services to youth. Meant to detect potential mental health disabilities or risk-factors for suicide, the questionnaires take five to 10 minutes and require parental consent before being completed. For teens who score positively on their questionnaires, a one-on-one interview is administered, and the program offers referrals to mental illness professionals for students identified as being at risk.
With controversies surrounding teenage mental health, TeenScreen has received much criticism from groups who find the risk of a false-positive identification too costly. Research has raised concerns that teenagers treated with anti-depressants can still sometimes exhibit effects of depression—including suicidal and violent tendencies—especially when incorrectly diagnosed. Many feel that such medications are over-prescribed, particularly for adolescents.

In response to such criticism, the TeenScreen National Center emphasizes that the program is voluntary and that the questionnaire is a tool to evaluate mental health, not diagnose conditions. “These are evidence-based questionnaires that have been studied and researched,” said Susan Craig, a spokesperson for the center.

It is difficult to measure the results of such screenings in terms of effectiveness in identifying mental health conditions and preventing suicide or other harmful behavior. Still, the United States Preventive Services Task Force on Major Depressive Disorder in Children and Adolescents found as of March 2009 that “although the literature on diagnostic screening test accuracy is small and methodologically limited, it indicates that several screening instruments have performed fairly well among adolescents.”

David Mrazek, chair of the American Psychiatric Association’s Council on Children, Adolescents, and Their Families, addressed the difficult issues surrounding mental health for young people in a piece written for the APA.

“Depression can sometimes be difficult to see in children, especially children who are going through puberty,” he wrote. “Teenagers can appear irritable or angry when they are really feeling sad or bored.”

The same Frederick Douglass Academy junior said, “Teens go through a lot today, so it’s important for teens to be informed.”