Follow Up: Mandatory Mental Health

A couple of notes here: I’ve noticed that I’ve been posting a lot and then having more thoughts come to me immediately afterward I put something up. I think that what this means is that I need to spend more time with each post before I hit the publish button. I probably flood this blog anyway, so I’m going to cut down how much I’m posting so that I can devote more time and energy to editing and putting up quality rather than quantity. I will be posting a fair amount on Teen Skepchick this week, and I should have posts going up at The Fementalists and CFI On Campus as well, so never fear you will have your overdose of my writing. With that explanation, here is my single post for the day.

I recently posted that I thought it could be beneficial to institute mandatory mental health education in schools. In my initial post, I didn’t flesh out some of the serious benefits that we could see from instituting this kind of policy, and I didn’t really explore how we could implement it either, but rather focused on the first flash of an idea. In order for this idea to have any kind of impact, it needs to have some feet under it. I need to identify who it will benefit, how it will show benefits, and what might stand in its way. That’s what I intend to do here.

There are many practical benefits to adding a new . The first chunk of these benefits falls under the heading of “preventative treatments”. As it stands today, it is extremely difficult to get any kind of mental health treatment unless you are already overwhelmed or in a non-functioning state. We don’t hand out diagnoses to people who are showing signs of something and want help to keep those signs under control: we hand them out to people whose symptoms have gotten out of control. Unfortunately, a DSM diagnosis is the only way for many people to get help. By the time they get to this point, they’re often already in a state of crisis.

To take a stark contrast, we spend a great deal of time thinking about preventative measures in our physical health: we tell our children to wash their hands, to stay home if they’re contagious, to eat healthy and exercise, and to get vaccines. For some reason this logic isn’t extended to mental health even though there is a great deal of evidence for the biosocial theory of mental illness: we start with some predisposition that makes us vulnerable to mental illness, but our environment can either tip us into it or help us away from it. The messages that we are sent about our emotions and our worth make a huge difference in determining the severity of our emotional difficulties. Adding education to schools can help send positive messages to kids about accepting their emotions and about how to handle emotions. It reduces the stress level of the environment, or at the very least provides kids with some tools to diminish the stress levels in their personal environments.

There are many people who could benefit from this kind of preventative care. First, those people who are vulnerable to mental illness need all the help they can get to build a healthy and safe environment for themselves. This NEEDS to start as a child. Much of the evidence about mental illness suggests that childhood is one of our most vulnerable times and it’s when we begin to develop our patterns and understandings of emotions. Providing some extra help to children could mean significantly fewer individuals who fall into diagnosable states as they grow older. While we can only do so much to provide kids with safe and happy family environments, schools do provide an ideal location to teach the skills to help handle less than ideal environments. Giving a vulnerable child the skills to not fall into the place of crisis that a diagnosis requires would be a huge improvement in quality of life.

In addition to those children who may at some point gain a diagnosis, or who need help to not fall into a diagnosis, there are also individuals who have serious struggles with their emotions and mental health but who will never have a DSM diagnosis. They’re hovering in the uncertain place where they’re not destroying themselves, but they’re certainly not healthy or happy. People with subclinical symptoms, or who might have a bad environment but higher tolerance. Oftentimes these individuals can’t afford therapy or simply don’t have very many resources to help them learn about emotional regulation. With some regular education and practice at emotional regulation, these kids could grow into much happier adults. They deserve help to flourish just as much as anyone else.

Finally, the general population of kids (and the adults that they become) could benefit from learning emotional skills. Obviously we all feel better when we can regulate our emotions and tolerate distress. But the most important section in my mind is learning about interpersonal relationships. If the bullying epidemic in this country tells us anything, it’s that we haven’t been stellar at teaching our kids about interpersonal relationships. We’re constantly talking about how to decrease bullying, and asking all children to learn how to get what they want and need in a more appropriate fashion can only help. In addition, as a recent college grad, I can promise you that 99% of the jobs that I’ve been looking at list “work well in a group” as one of their requirements. Our world is very much about connection right now: technology seems to be thriving on the concept of connecting. So giving our kids the skills to navigate the world of constant connection would be extremely helpful, both for their future work lives, and for their current personal lives.

So beyond helping our kids and future citizens be happier and healthier, what else do we get out of adding mental health education to our schools? I know that politics right now is about money, money, money, pragmatics, the economy…we can’t just go throwing money at things without some guarantee of a return on our dollar. But I have news: this will likely save us money. I don’t know if you’ve noticed, but mental healthcare is EXPENSIVE. My experience is primarily with eating disorder treatment, and I know that it’s come near to bankrupting a fair number of families. Most of the money for treatments is coming from insurers, and thus drives up the cost of insurance for everyone. Therapists are damn expensive, and once a mental illness becomes thoroughly entrenched it can take many, many years of therapy and work to get it under control. That’s a huge amount of expense both for individuals and for the community. If we can prevent some mental illnesses from ever occurring, we can save a great deal of money.

In addition to the cost of treatment, mental illness itself can be expensive, both individually and societally: individuals who are struggling can have a harder time getting and keeping work, or may spend money on things they don’t want (BPD can lead to excess shopping, addiction leads to money spend on substance of choice, BED means money on huge quantities of food). If someone is desperately fighting for their own mind, they’re likely not contributing as much to society as they could be (this is in no way meant to shame individuals with mental illness. Your job is to bring yourself back to health, not to contribute to society on a monetary level. If someone had a debilitating physical illness you wouldn’t shame them because they can’t work as many days. This is simply to say that when we’re very ill we’re not at our best). But if society wants its members to be as productive as possible, holding down jobs and putting money back into the economy, preventing mental illness is a really good way to do this.

But maybe money isn’t your thing. Maybe you’re more interested in the people than in the money. Well first of all go back and read the first few paragraphs about how we could make a lot of people happier and healthier. Still not enough? Ok, I’ve got another. The most immediate and concrete would likely be an improve in grades. Now I don’t know of any studies on the relationship between mental health treatment and grades, but I’m gonna go out on a limb here and say that when you’re fighting a mental illness or fighting to stay out of a mental illness, you’re more likely to struggle in school or at work. Now there are absolutely people who can keep up good grades while struggling. Some mental illnesses tend to push people towards perfectionism, and those individuals appear highly competent while in the throes of a mental illness. I myself managed to keep up above average grades through all of college while dealing with an eating disorder, depression, and generalized anxiety. But the worst grades of my life came at the time when my mental health was at its worst. This is not a coincidence. If we want our children to be well-educated and to be as successful as possible, we have to help them to be able to focus on school when they need to, and to have ways to deal with whatever else might be going on in their lives.

In addition, spending time with one’s own emotions can really help to create more empathy for others. Again, I am speaking from my own experience here, but I find that the more I learn about understanding where my own emotions come from, the more I find myself curious about why others are upset or struggling. If even half of the kids in these classes gained something, we would have a significantly more empathetic and supportive community for others who might still have difficulties. And if every child went through something very like therapy at a young age, we might be able to decrease some of the stigma against mental illness and against therapy.

Now obviously there would be a cost here. It’s not free to get a therapist into the schools, or to further educate our already over-burdened teachers to handle one more thing. But adding a single additional school therapist who did one hour of work per week with each classroom would not break the budget (possibly two for larger schools. Keeping therapy groups small is REALLY important), and it could lead to some serious improvements. Therapists are expensive, but if we get all of the benefits outlined above it seems that it would be well worthwhile.

The ideal way to do this seems to me to have one therapist who is entirely devoted to education and preventative work, who conducts classes with small groups of students to teach them different skills, check in about their week, and assign them a short piece of homework to practice an emotional skill during the week. This would be a highly demanding position for one therapist to build close relationships with a large number of kids, but if schools were capable they could add more therapists for more students. Even if it didn’t exactly mimic a traditional therapist/patient relationship, it could still be a useful way for kids to simply have a time to check in, learn how to talk about emotions, and get some emotional education. It absolutely seems to be a cost effective measure to improve grades across the board (because this seems to be a measure that would benefit all kinds of students, and engage those with some interest in psychology at an early age) and to prepare kids for jobs and life.

Now I am obviously not a school administrator or policy maker. I have never been in the position to create a budget for a school. So I would love to hear input from those people who might have more experience with these sorts of things: do you think it would be a cost effective measure? Could it help to lighten the load of some of the other school counselors to do some preventative measures? How could we try to push for this change to be made?

Mandatory Mental Health Education

Lately I’ve been spending a lot of time talking to people about concrete ways to deal with stress or improve their mental health. It’s been really interesting and kind of exhilarating as I notice how much I’ve learned in the last year or so and how wonderful it is to be able to share with others. However as I do this, I’ve begun to notice that even those people who are supposedly “normal” often don’t have a whole lot of skills around managing their mental health. Many of them have struggled to regulate emotions, to understand interpersonal effectiveness, or to tolerate distress. While they likely don’t feel emotions as strongly or have as few skills as those with diagnoses or who have been medicated, there is almost no one in this world who is an expert in navigating their emotions and mental health. To use the featured pic as an example, while not everyone is hanging out in the burning basement, few people are on the roof and everyone could enjoy being a few steps higher on the ladder.

 

The odd thing about understanding emotions is that it’s something we’re never taught. We are taught how to interact with other people, we are taught how to learn, we are taught how to budget or do our laundry or care for an animal. We’re particularly taught how to take care of our physical health. But for some reason everyone is expected to just pick up how to manage emotions and mental health. Now many of us have things modeled for us by our parents, but they were often just as clueless as we were and have cobbled something together out of their life experiences to get the best version they can. And rarely do they spend a lot of time consciously helping us sort out our emotions. All of that seems a little bit ridiculous to me. If there are two things that are really really useful to be successful anywhere else in life it’s stable mental health and stable physical health. If you don’t have those two things, everything becomes infinitely more difficult. So why don’t we give our children the tools to succeed?

 

Especially as I’ve been participating in DBT, I’ve been noticing that it really would not be all that hard to include education like that in schools. I only go once a week for two and a half hours. And I’m supposed to figure these skills out in a year. If we began implementing some of the knowledge that we have from psychology in schools from the time children start and teach them skills that will actually help them regulate emotions and deal with interpersonal relationships, we wouldn’t have to devote much time each week to it. Think of how helpful it would be to kids to understand what being judgmental is and how to cut down on judgments without feeling ashamed or bad about it. Or how helpful it would be to give them clear strategies for calming themselves. Or to help them recognize and name their emotions. Or to learn that emotions are acceptable and that they can feel emotions and simply sit with them. Holy cow I would have done so much better in life if I had had some of this basic training.

 

I don’t know if there’s any way to make this happen, but if we could adjust education in any way, I would suggest that we should add in a basic curriculum of emotional regulation. Most schools have a school therapist: it could be something they do once a week or once a month, or it could be something that teachers start getting trained on in school. It would include skills like how to make requests, set boundaries, validate, or be generous to and with others as part of interpersonal effectiveness. It would include techniques like breathing, distraction, or self-soothing for tolerating bad situations. And it would include some measure of work on identifying emotions, accepting emotions, fighting judgments, and using mindfulness to accept situations. Does anyone have a suggestion of how to make this into a petition or move it into the broader dialogue? I never hear a question of emotional education being brought up when we talk about improving mental health, but this could be a huge step towards decreasing stigma and increasing access.