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How schools can help prevent student suicide and substance abuse

SALT LAKE CITY — The rising number of deaths from suicide and substance abuse is creating secondhand suffering among children who might be helped if schools were able to take a more active role in students' mental health, a new report says.

If this happens, it would be a marked change in how schools have traditionally dealt with behavioral-health issues, which has often been through discipline.

In a paper issued Thursday, the Well Being Trust and the Trust for America's Health call for routine screenings to detect mental-health problems in students, increased staffing and a more flexible approach to the use of federal grants that could help troubled children.

The report also calls for specialized training for teachers to help them identify students who have suffered traumatic events and those at risk for suicide. And it advocates for special schools for students recovering from substance abuse disorders.

Such changes would help alleviate the nation's growing problem of "despair deaths" — those from suicide, and drug or alcohol abuse — which are affecting children as well as adults, according to the report of the two nonprofits.

Their recommendations, however, challenge a long-standing reluctance for educators to get involved in students' mental health, in part because of federal health privacy laws.

In Salt Lake City, for example, because of the Family Educational Rights and Privacy Act, "our staff cannot ask mental-health questions to students, unless it is a crisis situation," said Yándary Chatwin, executive director of communications and community relations for the Salt Lake City School District.

"In addition, school counselors are not trained as mental health therapists," she said.

Deaths from alcohol, drugs and suicide in the U.S.

Heather Tuttle

Deaths from alcohol, drugs and suicide in the U.S.

The nonprofits advocate for more training for school personnel, arguing that the opioid crisis, along with steep rises in alcohol abuse and suicide, requires intervention at the places where American children spend about a third of their time.

"There is a growing body of evidence that this is a serious enough problem that it deserves additional attention and prioritization," said John Auerbach, president and CEO of the Trust for America's Health, based in Washington, D.C.

How 'despair' deaths affect children

In a report issued in November, the nonprofits called for a national "resiliency" strategy to combat America's "deaths of despair," which totalled 64,591 in 1999 but more than doubled, to 141,963, in 2016.

That report said such deaths will rise 60 percent by 2025 if trends continue. (In Utah, current trends predict a 40 percent spike, or a jump from 50 to 70 deaths per 100,000 people.)

Children suffer secondhand when adults in their lives abuse alcohol or drugs, or have mental-health issues that end with suicide, the report says. The youths may be forced to take on adult responsibilities in the home, such as caring for siblings or worrying about bills, or they may be placed in foster care. (The number of children in foster care has risen for four consecutive years, according to the government's Administration for Children and Families.)

Moreover, these children are more likely to engage in substance abuse and have mental-health issues of their own, the report says.

While children do not die at rates similar to adults, the number of children dying from suicide and substance abuse is also rising in the U.S.

Among children 17 and younger, deaths from suicide jumped 84 percent in the past decade. Suicide is the third leading cause of death for children ages 10 to 14 and the second leading cause of death among ages 15 to 24.

The number of high school students who reported seriously thinking about suicide increased from 13.8 percent in 2009 to 17.7 percent in 2015, the report said.

And in 2016, more than 1 million adolescents (4.3 percent of children ages 12 to 17) had a substance-abuse disorder, and more than 1 in 5 teens reported consuming alcohol within the past month, according to federal statistics.

Schools do not routinely address these issues, in part because the staff is not trained to do so and there isn't sufficient time or money, said Auerbach, a former associate director at the Centers for Disease Control and Prevention who has worked in public health at the local, state and federal level for three decades.

"Schools are under tremendous pressure to focus on teaching and learning. They're evaluated on standardized tests, not on whether they're dealing with behavioral health issues well," Auerbach said.

As such, schools may react to a student's behavioral problem with discipline, such as suspension, instead of looking into the reasons behind the behavior. Routine, age-appropriate screenings designed to detect incidences of childhood trauma or substance abuse could help identify students who might benefit from a counselor's help, either individually or in a group, the report suggests.

If screenings were routine, they would help to reduce the stigma associated with behavioral health concerns, help students "feel cared for" and establish systems to provide help and resources, the report said.

The challenges of screenings

The report calls screenings a "quick and low-cost method of reaching a wide number of children to identify risky behaviors and problems early and implement appropriate interventions."

They are the foundation of a layered approach that the authors of the report advocate. Called Multi-Tiered Systems of Support, or MTSS, the system was originally developed as a way to help special-ed children achieve academic success.

Used to support children's mental health, the first tier would include screenings and positive behavioral support for all children; the second tier is ongoing monitoring and intervention for some who need additional help; the third is "crisis response" which includes counseling and outside referrals for children who need immediate help.

Dr. William Dikel, a Minneapolis psychiatrist and consultant and the author of "The Teacher's Guide to Student Mental Health," believes that schools are an excellent place for screenings, diagnosis and treatment, so long as these services are performed by medical or public-health professionals, not by school employees.

When educators are involved, schools could be legally liable if something goes wrong, and they're also limited by the constraints of the school week and year. "They're not going to say, 'good luck on your suicidal depression, I'll see you in the fall,'" Dikel said.

There's also the challenge of payment. Students covered by Medicaid are entitled to periodic mental-health screenings, "which they rarely get," and even with private insurance, mental health services are traditionally poorly reimbursed, he said.

Confidentiality is also a worry, because any mental-health diagnosis made by school personnel would wind up in the child's educational file — a problem that could be solved by outsourcing the screenings. "Screenings shouldn't be done by the schools, but they can be done in the schools, as long as the information goes into confidential files," Dikel said.

Other programs that could help

The report by the Well Being Trust and the Trust for America's Health also recommends the spread of "recovery schools" designed as an alternative to the justice system for students with substance-abuse disorders. Research has shown that 56 percent of students who attend such schools are not using alcohol at all 90 days after enrolling, up from 20 percent 90 days before enrolling.

According to the Association of Recovery Schools, there are 40 such schools in operation in states that include Colorado, California, Massachusetts, Indiana, Tennessee and Texas.

The report also encourages schools to establish anti-bullying programs, as well as programs that teach children to manage their emotions, known as social-emotional learning programs.

It also recommends a course called Mental Health First Aid, as well as annual suicide prevention and "postvention" training for school personnel.

Utah is not among the 10 states that require annual training for school employees about suicide risk; Utah requires two hours of training, according to the American Foundation for Suicide Prevention.

Although Utah schools are restricted with regard to mental health by federal law, individual screenings can be done in crisis situations or with parental permission, Chatwin said.

"For example, a school counselor could do a suicide risk assessment if needed, but then refer students to Valley Behavioral Health or other community mental health resources for a formal mental health screening," she said.

Albert Lang, with the Trust for America's Health, said that the report's recommendations wouldn't require a change in federal law. Massachusetts, for example, has begun substance-abuse screening for middle and high school students, while allowing parents to opt-out.