Illinois School Board Journal
September/October 2007

Ginger Wheeler is a freelance writer from Glen Ellyn, Illinois, whose work has appeared regularly in The Illinois School Board Journal.

Brows furrow. Heads shake slowly back and forth in concern. Stories spread through a community like a flood — like a feeling something bad was coming, but not knowing how to stop it:

Classroom misbehavior in elementary school … inappropriate actions in junior high … risky, dangerous activities in high school including drinking, drug use, cutting, arson, gang association, violence and suicide.

For the students involved, the results can be devastating: social isolation, involvement with juvenile justice, truancy, dropping out of school and even expulsion. But these outcomes could be considered preferable to being labeled with a diagnosis that carries a stigma: mental illness.

Experts say one in 10 Illinois children suffer from a mental disorder. Yet 80 percent of these sufferers go untreated, forced to navigate life with few tools to combat complex psychiatric issues ranging from bipolar disorder to depression and schizophrenia. Often they turn to drugs and alcohol — possibly in an unknowing attempt to self-medicate — which, in turn, can derail their education, leading to little income potential, lost wages, homelessness and, in many cases, run-ins with the justice system or prison.

More than 2 million Americans are currently incarcerated. Of those, an estimated 30 to 80 percent suffer from mental illness. The percentages hold true for children being held in the juvenile justice system as well.

The good news is Illinois leads the nation in looking for ways and means to address the mental health needs of children. The bad news is a sick child still needs a savvy adult as an ally to navigate the challenging rapids of a fragmented system for dealing with not only mental illness, but also educational needs that often can cost more than $100,000 per year.

The reality of mental illness

Ryan P.* was an honor student … a sociable boy of 14 … when he entered a large suburban high school. It was the same year his older sister left for college.

A physics whiz and baseball player, Ryan was too small to make the high school team, but he still excelled in physics and other academic subjects. A little younger than his classmates, Ryan found himself the butt of jokes about his size and physical maturation. Many kids would shrug off such teasing. But a daily dose of it, coupled with his sister leaving for college, sent Ryan into a depth of despair that is hard to imagine.

Depression can be difficult at any age, but for children it can manifest itself in so many different ways and with so many different symptoms that it's often left untreated for lack of realization as to what's actually happening.

"The madness of depression is the antithesis of violence," is a famous quote about the symptoms from novelist William Styron, who himself suffered from depression. "It is a storm indeed, but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero. Ultimately, the body is affected and feels sapped, drained."

Styron, who died in November 2006, often wrote of mental illness and depression, including his first novel, Lie Down in Darkness, published in 1951. It was the story of a dysfunctional Virginia family and included a young woman's suicide.

In his 1990 memoir, Darkness Visible: A Memoir of Madness, Styron added to the description with this: "In depression ... faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come, not in a day, an hour, a month, or a minute. It is hopelessness even more than pain that crushes the soul."

For Ryan, the first sign of depression was failing grades. During the next two years, his well-educated stay-at-home mother struggled to get her son out of bed long enough to attend school. As his grades and GPA slid, so did Ryan's options for his educational future. Not being a "trouble maker" did not serve Ryan well. He was ignored and misunderstood. His diagnosis of severe depression was slow in coming, making his failure to complete academic work on time all the more serious for his future educational prospects.

So many 'Ryans'

Ryan isn't alone. In "The Relationship of Self Esteem and Depression in Adolescence," Kathie F. Nunley, a former classroom teacher and now author and researcher, writes: "Major depression affects one in 50 school children. Countless others are affected by milder cases of depression, which may also affect school performance. The peak age of depression correlates with the peak years of low self-esteem."

But only in recent years has the medical community acknowledged childhood depression and viewed it as a condition requiring intervention, according to Nunley.

"A lot of brilliant people have a mental illness," said Pat Doyle, Educational program director for the DuPage County chapter of National Alliance on Mental Illness (NAMI/ DuPage). "It is very important to get diagnosed within the first three years of an episode. And if we can catch kids early, there's a better chance of recovery. After age 18, HIPPA laws kick-in and prevent parents from stepping in to help."

Acknowledging the devastating societal effects of mental illness, the federal government and many states are stepping up to prevent, catch, and treat children and teens before it's too late.

Last winter, the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (www.samhsa.gov) unveiled a national advertising campaign to try to reduce the stigma of mental illness and encourage teens to help their peers through diagnosis and treatment.

Minnesota, along with more than 40 other states, has implemented a screening system through its public school system. TeenScreen, a program designed by Columbia University, uses a short, voluntary survey to screen for possible risk factors that help detect a potential mental illness. While not a formal diagnosis, results can be used to refer students to local mental health agencies for a complete evaluation. The goal is to catch mental illness before it gives way to a public tragedy like Columbine or Virginia Tech, or the personal tragedy of one in 40 children who attempt suicide each year, an estimate Nunley attributes to research by J. Kahn in Adolescent Depression: An overview.

According to the frequently asked questions on the TeenScreen Web site, a number of studies show that such screening can be effective in identifying potential, yet previously unknown problems.

Yet TeenScreen has been vilified by opponents, including religious groups, anti-tax proponents, and right wing conservatives as everything from a tool of pharmaceutical companies to push unneeded medications to a liberal government plot to "control" the country's youth. Many people seem unable to equate the screening of mental health along the same lines as the screening of vision and hearing. As a result, many states are reluctant to implement such programs in schools.

In Illinois, proponents of a comprehensive children's mental health program are making headway. Barbara Shaw, executive director of the Illinois Violence Prevention Authority (IPVA) chaired the Illinois Children's Mental Health Task Force beginning in 2001. More than 100 people representing dozens of organizations, including many involved with public schools, collaborated to research how Illinois deals with mental health issues. The task force was able to issue a report in 2003 with recommendations that would make Illinois the national leader in the delivery of mental health care services to children.

"Mental health care is a very big issue," Shaw said. "But the delivery of services varies from school district to district, depending on each district's interest and ability. We know schools suffer from a lot of financial challenges. But we also know schools are an important place for children (who might have mental health problems) to be identified and for parental involvement to happen."

The task force's report was instrumental in the 2003 passage of the Children's Mental Health Act, which requires every school district to develop a policy for incorporating social and emotional development into their educational program. Shaw said Illinois had 100 percent compliance with this requirement by 2004.

The Children's Mental Health Act also was instrumental in the development of Illinois' Social and Emotional Learning Standards. (See "Setting a standard for social, emotional behavior," opposite page.)

"Our current system is fragmented," she said. "We have a long way to go to build a comprehensive system that will serve as a safety net to help kids be mentally well. We put a lot of resources into children's academic and physical needs. We've put a lot of resources into our punitive system. We've not put a lot of resources into our mental health care.

"Children's mental health care is the stepchild of adult mental health, which is the stepchild of physical health care," she added. "But without good mental health, children have big challenges to progress academically."

Faltering academically

Ryan P.'s case illustrates how a child's academic career can falter due to mental illness. After spring break of his freshman year, Ryan spiraled downward into a deeper depression and was hospitalized for a short time. He required more than 30 extra days to finish his freshman coursework. Still unable to deal with severe depression, Ryan missed most of his sophomore year of school.

Finally, after an accurate diagnosis, his parents requested an individualized educational plan (IEP) from his school district. Under Illinois' special education laws, the school district has 60 days to comply with such a request. During that time, the school's health care workers, administrators and teachers meet with the student and the parents to decide whether to grant the request.

Ryan was admitted to an accredited therapeutic day school, but found that the majority of the school population was placed there due to behavior disorders. The atmosphere and curriculum weren't ideal for this bright, but depressed, student. He dropped out. The cost of his stay per year would have been more than $40,000, or about $145 per day … a cost that would have been borne by the local school district.

Ryan was then admitted to another day school that specializes in educating children with mental illness. The cost: more than $60,000 per year. But because of the difficulty involved with regulating medications, Ryan's depression manifested itself with many physical symptoms. Many days he was unable to get out of bed, unable to eat and unable to function … and unable to attend school. He earned Fs that went on his academic record, resulting in a grade point average hovering just above 2.5.

Then Ryan was referred to the residential Sonia Shankman Orthogenic School at the University of Chicago in Hyde Park. The "O-School," its more informal name, accepts bright third-graders through post-high school graduates with severe emotional disorders, including Asperger syndrome and mental illness. Many of the students were victims of physical or sexual abuse at a young age, an occurrence known to adversely affect brain development and create negative behaviors that manifest themselves as the child grows older.

The O-School blends intense therapy with social learning experiences, while delivering the individualized curriculum each child would have in their home school district, including two foreign languages. More than 30 school districts in Illinois have children placed at the O-School, and 86 percent of those students will eventually attend college.

Ryan, who entered the O-School as a junior with a grade point average of just above 2.5, was finally able to get his depression under control with this therapy and proper medication, and was able to play catch up. He graduated with a 4.2 GPA and earned a perfect writing score on his ACT coupled with 90th percentile scores in the other areas of the test.

Stabilized and healthy, he currently attends a renowned state university where he is doing well. But without his devoted and persistent mother, Ryan may have been just another of Illinois' 34,000 high school dropouts.

The O-School matriculates about six to 10 students each year, out of a total population of 54. But rather than a "degree" from the O-School, the children usually return to their home school, earn a diploma, and then go on to college or vocational school.

The cost to stay at the O-School is about $120,000 per year. Usually, the tab is paid by a combination of the home school district and an Individualized Care Grant (ICG) awarded from the state for residential living expenses. Illinois awards about 400 ICGs each year to students who require a specialized residential education, either at an accredited school or at home.

"We need about three years with each student," said Diana Kon, principal of the O-School. "We'd like to get them as early as possible so we can help them adjust back to life at their home school. By the time they're 16 or 17, our time with them is more limited. But we're seeing schools waiting longer before sending kids to us."

Sarah Sebert is a principal consultant in the Illinois State Board of Education's department of Special Education, Schools and Mental Health Integration, working with non-public special education schools in the state. Illinois, she said, regulates 462 therapeutic schools with a student population of 9,000 to10,000 students. Of these, 300 are residential institutions that serve approximately 3,000 children.

These numbers are not segmented by the type of special education the child receives, so, Sebert said, it could include kids like Ryan, as well as kids with cerebral palsy, brain damage or any number of disorders.

Illinois requires class sizes of one to 10 students for special education. Because schools work hard to remain small enough to help those who do get admitted, Sebert said, "Every school I work with is turning kids away."

A few children who suffer with mental illness are lucky enough to find a program that can help them the way the O-School helped Ryan. The rest are left behind.

Barriers to success

The barriers to success are enormous, especially for those who are poor, have single parents or lack English language skills. Even home school districts can be barriers, as teachers dealing with overcrowded classrooms aren't trained to recognize the warning signs of mental illness. And schools with strained finances are reluctant to place any more children than absolutely necessary into the expensive special education category, which currently handles kids with mental illness, too.

That shouldn't be the case, Sebert said. For the past 20 years, the state has paid 100 percent of the costs of residential treatment for kids with an approved IEP. "If a child enters a residential placement, school districts are supposed to be the payer of last resort. We're working to make this easier for poor parents," she said.

Even so, advocates of those with mental illness are working to differentiate the educational needs of often bright children with a mental illness, from those with a physical, learning or behavioral disability. They reason that special education may not be the right way to administer services.

Darlene Ruscitti, superintendent of the DuPage Regional Office of Education, said the Mental Health Act is a step in the right direction, but much still remains to be known.

"How well do we keep data on this?" she asked. "Not very well. Do we know how many kids attempt suicide? How many self mutilate? We don't know. The Social Emotional Learning Standards will give us a good start. Working through the K-12 system, we can identify students early and direct them toward the services they need. It's a difficult subject because it's so sensitive and so personal."

And though the subject is difficult and any screening was pulled from the Illinois' Children's Mental Health Act (think TeenScreen controversy), the optimism among those who work with sick children is palpable.

The act transformed the Children's Mental Health task force into Illinois Children's Mental Health Partnership with Barbara Shaw as its chair. Two full-time administrators and one part-time person have been hired by the state to work with Illinois school districts and service providers to facilitate school/community partnerships.

And more is being done. Resources such as trainers are being developed to train teachers about mental health. Grants are available to Illinois schools to help implement the Social Emotional Learning Standards to teach children about the effects of bullying, the symptoms of mental illness and what to do to get help. Grants are available to help schools build their capacity to provide mental health services, often through creative partnerships with community service providers.

Working closely with Sebert is Juana Burchell, one of the people hired to oversee implementation of the Children's Mental Health Act in Illinois.

"We realize that mental health needs a big coordinated effort. Sometimes there's more than one provider," Burchell said. "Now we're trying to develop more of a coordinated system — we're reviewing capacity, evaluating programs, collecting data."

"We know there is a huge need," Shaw said. "We're working to build this in Illinois. We're doing ground-breaking work. We're among the states in the lead."

*Ryan P is a real student in Illinois. His name has been changed to protect his privacy.

References

Illinois Social and Emotional Learning Standards, Illinois State Board of Education, http://www.isbe.state.il.us/ils/social_emotional/standards.htm

J. Kahn, Adolescent Depression: An overview, University of Utah Neuropsychiatric Institute, 1995

Kathie Nunley, "The Relationship of Self Esteem and Depression in Adolescence," http://www.brains.org/depression.htm

Kathie Nunley, Web site, http://help4teachers.com/

William Styron, Darkness Visible: A Memoir of Madness, Random House Inc., 1990

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, www.samhsa.gov

TeenScreen, http://teenscreen.org/

Setting a standard for social, emotional behavior

Adoption of the Children's Mental Health Act in 2003 set in motion development of Illinois' Social and Emotion Learning Standards. Those 10 new standards joined the other Illinois Learning Standards as benchmarks of what students should know and be able to do at different grade levels.

All school districts were required to develop a policy for incorporating these new learning standards into their education program and to submit that policy to the Illinois State Board of Education.

The standards have three broad goals:

• Develop self-awareness and self-management skills to achieve school and life success.
• Use social-awareness and interpersonal skills to establish and maintain positive relationships.
• Demonstrate decision-making skills and responsible behaviors in personal, school and community contexts.

Information on the ISBE Web site details just why each of the goals is important, including: providing a strong foundation for achieving school and life success; learning to manage emotions to better handle stress and control impulses; building and maintaining positive relationships with other people; learning to avoid risky behaviors; and gaining the ability to make decisions, as well as anticipating the consequences of those decisions.

The first and third goal each contains three standards; the second goal has four. Each standard then has benchmarks, or learning targets, deemed appropriate for students at five different grade levels: K-3; grades 4-5; grades 6-8; grades 9-10; and grades 11-12.

As an example, under the first goal, the first learning standard for students is to be able to "identify and manage one's emotions and behavior." The benchmark in Kindergarten would mean a student should be able to "recognize and accurately label emotions and how they are linked to behavior." By the time that student is a junior or senior in high school, he or she should be able to "evaluate how expressing one's emotions in different situations affect others."

"Performance descriptors," which provide more detail on the learning targets, can then be used to develop curriculum and classroom activities, as well as assessments, that align with the standards.

For more information about Illinois Social and Emotional Learning Standards, visit the ISBE Web site at http://www.isbe.state.il.us/ils/social_emotional/standards.htm.

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