1. Prevalence of Mental Health Issues in Adolescents

According to the National Institute of Mental Health, approximately 46% of American adolescents aged 13–18 will suffer from some form of mental disorder. About 21% will suffer from a disorder that is categorized as “severe,” meaning that the disorder impairs their daily functioning,^[1] but almost two-thirds of these adolescents will not receive formal mental health support.^[2] The most common types of disorders among adolescents as reported by the NIMH is anxiety disorders (including generalized anxiety disorder, phobias, post-traumatic stress disorder, obsessive-compulsive disorder, and others), with a lifetime prevalence of about 25% in youth aged 13–18 and 6% of those cases being categorized as severe.^[3] Next is mood disorders (major depressive disorder, dysthymic disorder, and/or bipolar disorder), with a lifetime prevalence of 14% and 4.7% for severe cases in adolescents.^[4] An effect of this high prevalence is high suicide rates among adolescents. Suicide in the United States is the second leading cause of death for adolescents aged 10 to 24. More teenagers and young adults die from suicide than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. There are an average of over 3,470 attempts by students in grades 9–12.^[5] Some of these suicides are because of, or in part due to the stress they are under during school. A similarly common disorder is Attention deficit hyperactivity disorder (ADHD), which is categorized as a childhood disorder but oftentimes carries through into adolescence and adulthood. The prevalence for ADHD in American adolescents is 9%, and 1.8% for severe cases.^[6]

According to APA, the percentage of students going for college mental health counselling has been rising in recent years, which by report for anxiety as the most common factor, depression as the second, stress as the third, family issues as the forth, and academic performance and relationship problems as the fifth and sixth most.^[7]

2. Effects on Academics and School Life

Mental disorders can lead to many academic problems, such as poor attendance, difficulties with academic, poor social integration, trouble adjusting to school, problems with behavior regulation, and attention and concentration issues. High school students who screen positive for psychosocial dysfunction report three times as many absent and tardy days as students who do not identify dysfunction, and students with high levels of psychosocial stress are much more likely to view themselves as academically incompetent. This leads to much higher dropout rates and lower overall academic achievement,^[2] as well as specific academic and social problems associated with various disorders.

2.1. Anxiety

Students with anxiety disorders are statistically less likely to attend college than those without, and those with social phobias are twice as likely to fail a grade or not finish high school as students who have never had the condition.^[2] Anxiety manifests in many of the same ways as ADHD, and so students with anxiety disorders often experience problems concentrating, filtering out distracting external stimuli, and completing multi-step or complicated tasks. Additionally, anxiety disorders can prevent students from seeking or forming social connections, which negatively affects students' sense of belonging and in turn impacts their school experience and academic performance.^[8] Students may suffer from Social Anxiety, preventing them from going out and creating new relationships with new people or any social reaction one might come across.

2.2. Alcoholism

Continuous alcohol consumption can affect student's mental health. Too much and drinking too often can lead to alcoholism. People who consume alcohol before the age of fourteen are more likely to drink more often without thinking about the consequences later on. ^[9] Alcoholism can affect ones’ mental health by being dependent on it, putting drinking before their own classwork.^[10] Students who drink alcohol can also experience consequences such as higher risk of suicide, memory problems, and misuse of other drugs. A 2017 survey found that 30% of high school students have drank alcohol and 14% of high schoolers have binge drank.^[11]

2.3. Depression

In 2020, approximately 13% of youth aged 12 to 17 years old have had one major depressive episode (MDE) in the past year, with an overwhelming 70% left untreated.^[12] According to the National Center for Mental Health Checkups at Columbia University, "High depression scores have been associated with low academic achievement, high scholastic anxiety, increased school suspensions, and decreased ability or desire to complete homework, concentrate, and attend classes."^[2] Depression symptoms can make it challenging for students to keep up with course loads, or even find the energy to make it through the full school day.^[8] Students in college face everyday challenges that cause them to feel overwhelmed. Whether it be drowning in homework, homesickness, or even relationships, college is definitely a wild ride of emotions. Depression in can cause them to have problems in class, from completing their work, to even attending the class at all.^[13]

Suicide

The U.S. Bureau of Vital Statistics indicates that suicide in the United States exceeds 600 children aged 10 to 19 per year. Some researches estimate that for every suicide in adolescence, there are between 50 and 100 non-fatal suicide attempts. Most suicides reported in Ohio from 1963 to 1965 revealed that they tended to be social outcasts (played no sports, had no hobbies, and were not part of any clubs). They also suggested that half of these students were failing or near-failing at the time of their deaths. These periods of failure and frustration lower the individual's self-concept to a point where they have little sense of self-worth.^[14] In fact, students who perceive their academic performance as "failing" are three times more likely to attempt suicide than those who perceive their performance to be acceptable.^[2]

2.4. Attention Deficit Hyperactivity Disorder (ADHD)

Attention disorders are the principal predictors of diminished academic achievement.^[2] Students with ADHD tend to have trouble mastering behaviors and practices demanded of them by the public education system in the United States, such as the ability to sit still and quietly or to apply themselves to one focused task for extended durations. Much like anxiety, ADHD can mean that students have problems concentration, filtering out distracting external stimuli, and seeing large tasks through to completion. These students can also struggle with time management and organization.^[8]

There has been a rising concern about the increased misuses of ADHD medicines in recent years, especially among college students. The most frequent misused ADHD medicines is Adderall, but many other stimulant medications such as Ritalin and Methylin have also been found as in most cases these drugs are getting from friends. Based on the drugs' function which can serve as a cognitive enhancer, common reasons of misuses by college students include better academic performance, creating euphoria, being awake and arousal, peer pressure, and also as which happened more in female for weight loss. Side effects such as mood changes and insomnia are shown differently by people but in severe cases, the misuse could even be associated with sudden death.^[15]

2.5. Middle School Malaise

Middle school malaise happens on children during the transition from elementary school to middle school when they encountering a lot of significant biological, psychological and environmental changes. Researches concluded that after moving to middle school, children show less interest in school as well as less confidence in their ability.^[16] These factors contribute to their significant falling grades especially in the first year, and the poorer grades could circularly lead to their decline of motivation and self-confidence.^[17] Compared to elementary school where teachers are usually more task-oriented as simple goal of teaching and for children to learn, middle school values more of children's performance and the goal turns to become achieving a certain grade. Such a goal change might relate to negative effects on children's perception such as lower self-esteem and achievement loss.^[18] Studies also identified a developmental mismatch that as children are developing more cognitive ability neurologically, the increased constraints and discipline in middle school actually provide fewer opportunities for children decision making and with lower cognitive involvement.^[19][20] Besides being more competitive, middle school environment is also more complex and impersonal than elementary school which the social life is another significant challenge for children during the transition.^[21] APA also points out that currently, many psychologists believe children who think their intelligence can change over time importantly adjust better than those who think their intelligence is fixed during the transition.^[22]

3. Policies in Public Schools

3.1. United States

Concerning U.S. state policies as of 2020, three states have approved mandatory mental health curriculums. In July 2018, New York and Virginia passed legislation that made mental health instruction mandatory in public education.^[23] This is correlated with the CDC reporting a 30% increase in US suicide numbers over the last 20 years. New York has made it mandatory for students from Kindergarten to 12th grade to undergo mental health instruction.^[23] After experiencing traumatizing suicidal behavior with his own son, the governor of Virginia thought it necessary to teach warning signs to 9th and 10th graders so they can look out for the safety of their peers and themselves.^[23] The board of education is in charge of deliberating details of the curriculum but the governor is hopeful that teachers will also receive training on warning signs. Even though investment in mental health has never been higher, the state legislature has yet to approve extra funding to implement the curriculum.^[23] In July 2019, Florida’s board of education made 5 hours of mental health education mandatory for grades 6 through 12, making it the third state to approve such instruction.^[23]

The United States has done a lot of data gathering and creating statistics of what can wear away at a student's mental health, but few widely known policies have been put in place at the national level. School systems within the United States, either on the state or city/county level, seem to typically make decisions on what mental health policies should be included. There has been a growing popularity with school-based mental health services in United States public school systems, in which schools have their students covered for mental health care. This concept has the potential to allow students to have access to services that can help them understand and work through any stressors they may face within their schooling, as well as a better chance of intervention for those students who need it.

COVID-19

Outbreaks of disease forecast a rise in mental health policies. This is due to the increased levels of unemployment and emotional distress during the global pandemic of 2020.^[24] There was cases of increased isolation and depression rates of the elderly, xenophobia against people of Asian descent, and resulting mental health effects of large-scale quarantine and business closures.^[25] Not only is an achievement gap projected for students that undergo the COVID-19 pandemic, but significant repercussions are expected for the mental health and well-being of students in low income families, since more than half of students utilize reduced-priced or free mental health resources provided by schools.^[26][27] JAMA Pediatrics expects that the global health crisis will worsen pre-existing mental health disorders in students and the number of childhood mental health disorders will increase with the higher prevalence of social isolation and familial income decline due to economic recession.^[28]The Kaiser Family Foundation reported that 56% of Americans have endured at least one negative mental health effect due to stress related to the outbreak.^[24] This can surface as increased alcohol and drug use, frequent headaches, trouble sleeping and eating, or short tempers. Additionally, in May 2020, Well Being Trust reported that the pandemic could lead to 75,000 additional "deaths of despair" from overusing drugs and alcohol or suicide from unemployment, social isolation, and general anxiety regarding the virus.^[24] Thus, although as of 2020 there are no federal requirements in place, a rise in mental health awareness and approval of policies is expected post-COVID-19.^[24]

3.2. Canada

In Canada , the Mental Health Strategy highlights the importance of mental health promotion, stigma reduction, and early recognition of mental health problems in schools to be a priority (Mental Health Commission, 2012). Implementing comprehensive school health and post-secondary mental health initiatives that promote mental health and prevention for those at risk was recommended by the Mental Health Commission of Canada. A major focus of school programming is to promote positive mental health to all students instead of just doing so to those already identified as having a mental health problem. This is a preventative measure as it seeks to promote well-being and emotional regulation in all students to avoid mental health problems from further occurring or escalating.

3.3. Bhutan

In Bhutan, efforts toward developing education began in 1961 thanks to Ugyen Wangchuck and the introduction of the First Development Plan, which provided free primary education. By 1998, 400 schools were established. Students' tuition, books, supplies, equipment, and food were all free for boarding schools in the 1980s, and some schools also provided their students with clothing. The assistance of the United Nations Food and Agriculture Organizations' World Food Programme allowed free midday meals in some primary schools. This governmental assistance is important to note in the country's Gross National Happiness (GNH), which is at the forefront of developmental policies and is the responsibility of the government.. Article 9 of the Constitution of Bhutan states that "the state shall strive to promote those conditions that will enable the pursuit of Gross National Happiness."^[29]

Gross national happiness

GNH in Bhutan is based on four principles: sustainable and equitable economic development, conservation of the environment, preservation and promotion of culture, and good governance. Their constitution prescribes that the state will provide free access to public health services through a three-tiered health system which provides preventative, promotive, and curative services. Because of this policy, Bhutan was able to eliminate iodine deficiency disorder in 2003, leprosy in 1997, and achieved childhood immunization for all children in 1991. It became the first country to ban tobacco in 2004, and cases of malaria decreased from 12,591 cases in 1999 to 972 cases in 2009.^[29] The elimination of these diseases and the strong push for GNH allows for all people (including adolescents who are provided with many necessary items and free education) to live happier lives than they otherwise may have had.

3.4. United Kingdom

The Department for Education in United Kingdom is working on developing a whole organizational approach to support mental health and character education. An October 2017 joint report from the Departments for Education and Health outlines this approach with regard to staff training, raising awareness of mental health challenges that children face, and involvement of parents and families in students' mental health.

3.5. Singapore

REACH is a program in Singapore that looks to provide interventions for students struggling with mental illness. A quote from the REACH website reads, "The majority of children and adolescents do not suffer from mental illness. However, when a student has been identified, the school counselor, with consultation from the school’s case management team, will look into managing the care of the student. When necessary, guidance specialists and educational psychologists from the Ministry of Education will render additional support.

In 2010, the Voluntary Welfare Organisations (VWOs), in collaboration with the National Council of Social Service (NCSS), have also been invited to join this network to provide community and clinical support to at-risk children. Students/children with severe emotional and behavioural problems may need more help. The REACH team collaborates with school counselors/VWOs to provide suitable school-based interventions to help these students. Such school/VWO based interventions often provide the requisite, timely help that these students/children need. Further specialised assessment or treatment may be necessary for more severe cases. The student/child may be referred to the Child Guidance Clinic after assessment by the REACH team for further psychiatric evaluation and intervention. These interventions may include medications, psychotherapy, group or family work and further assessments."

3.6. Mexico

Traditionally, mental health was not considered a part of public health in Mexico because of other health priorities, lack of knowledge about the true magnitude of mental health problems, and a complex approach involving the intervention of other sectors in addition to the public health sector. Among the key documents anticipating the policy change was a report presented by the Mexican Health Foundation in 1995, which opened a very constructive debate. It introduced basic tenets for health improvement, elements for an analysis of the health situation related to the burden of disease approach, and a strategic proposal with concurrent recommendations for reforming the system. Mexico has an extensive legal frame of reference dealing with health and mental health. The objectives are to promote a healthy psychosocial development of different population groups, and reduce the effects of behavioural and psychiatric disorders. This should be achieved through graded and complementary interventions, according to the level of care, and with the coordinated participation of the public, social, and private sectors in municipal, state, and national settings. The strategic lines consider training and qualification of human resources, growth, rehabilitation, and regionalization of mental health service networks, formulation of guidelines and evaluation. All age groups as well as specific sub-populations (indigenous groups, women, street children, populations in disaster areas), and other state and regional priorities are considered.

3.7. Japan and China

In Japan and China, the approach to mental health is focused on the collective of students, much like the national aims of these Asian countries. Much like in the US, there is much research done in the realm of student mental health, but not many national policies in place to prevent and aid mental health problems students face. Japanese students face considerable academic pressure as imposed by society and school systems. In 2006, Japanese police gathered notes left from students who had committed suicide that year and noted overarching school pressures as the primary source of their problems.^[30] Additionally, the dynamic of collective thinking—the centripetal force of Japan's society, wherein individual identity is sacrificed for the functioning benefit of a greater collective—results in the stigmatization of uniqueness. As child psychiatrist Dr. Ken Takaoka explained to CNN, schools prioritize this collectivism, and “children who do not get along in a group will suffer.”

3.8. South Korea

South Korea has traditionally placed much value on education. As a nation that has a degree of enthusiasm like no other for education has created an environment where children are pressured to study more than ever. When mental health issues affect students there are very few resources available to help students cope. The nation's general view of mental health problems, such as anxiety, depression or thoughts of suicide, is that they are believed to be a sign of personal weakness that could bring shame upon a family if a member would be discovered to have such an illness. This is true if the problem arises in a social, educational or family setting. Rather than perceiving mental health issues as a medical condition and concern requiring treatment especially in students, a majority of Korea’s population has perceived them as a cultural stigma. A study conducted by Yuri Yang,^[31] a professor at the University of Florida and a member of the Department of Aging and Mental Health, found when surveying over 600 Korean citizens from the age of 20-60+ years in 2008, most of the older people, many of whom are parents, shared similar and negative views on mental health issues such as depression. The older adults generally were also found to have a negative view of mental health services, including those offered through the educational system, as they are deeply influenced by the cultural stigma around the topic. This negative view of mental health services in education has provided implications for students who are struggling emotionally, as many do not know what, if any, help might be available in the facilities of education. However, this does not mean no mental health services exist in the world or in the educational setting. The World Health Organization (WHO) in 2006 collected data ^[32] regarding Korea’s mental health system. The goal of collecting this information was to attempt to improve the mental health system and to provide a baseline for monitoring the change. Despite Korea having a low budget for mental health services compared to other developed countries, it has taken steps to create long term mental health plans to advance its national health system such as raising more awareness for mental health, creating communities for students, and removing the cultural stigma around mental health.

4. Alleviation and Fostering Adjustment

4.1. Prevention

Some schools may need to recognize that they are not just an institution, but are intended to help shape the lives of students and allow them to participate meaningfully in a social aspect of this environment. Psychologically, this can overshadow the academic aspect, yet often little heed is given. Athletics, faculty-student relationships, clubs, and other social activities are important so that no student is left in a "social limbo year after year." The pressures of school, extracurricular activities, work and relationships with friends and family can be a lot for an individual to manage and at times can be overwhelming. In order to prevent these overwhelming feelings from turning into a mental health problem, taking measures to prevent these emotions from escalating is essential. School-based programs that help students with emotional-regulation, stress management, conflict resolution, and active coping and cognitive restructuring are a few suggested ways that give students resources that can promote their mental health (Mental Health Commission, 2012). Educators need to pay as much attention to the well-being of their students as they do on the academic aspect to ensure they are setting their students up for success in the future.

If teachers are aware of a student who is struggling with their mental health, they can assist in helping that individual receive the necessary help. According to the research Students who receive social-emotional and mental health will have a higher chance of more academic achievements. Since most children spend a large portion of the day at school, about 6 hours, schools are the ideal place for students to receive the services they need. When mental health is not addressed, this can cause issues with causing distractions to fellow students and teachers. This takes away from the opportunity for all students to get a complete opportunity to get the education they deserve. ^[33]

According to a 2019 article regarding school social workers, the field of social workers in schools is continuing to grow. In 1996, there were only about 9,000 social workers in schools. This had increased to be between 20,000 to 22,000 social workers. According to the United States Department of Labor, Bureau of Labor Statistics, it is estimated the field will continue to grow from 2016-2026 due to the increase of mental health services that are being demanded in schools.^[34]

4.2. Belonging

Belonging in the school environment may be the most important and relevant factors affecting students' performance in an academic setting. School-related stress and an increase in academic expectations may increase school-related stress and in turn negatively affect their academic performance. The absence of social acceptance has been shown to lead lowered interest and engagement because students have difficulty sustaining engagement in environments where they do not feel valued and welcome.^[35]

An issue that is faced in our society today is bullying which can happen at school or even in class. Bullying can cause issues for students such as chemical dependency, physical harm, and a decrease in performance academically. According to the NASP, a large percentage, about 70%-80%, of people have experienced bullying in their school years in which the student could have been the bully, victim, or even the bystander. In order for staff at schools to understand how to notice this as an issue and what to do to resolve it, NASP advocates for guiding principals in how to resolve these issues as well as providing information on available programs. ^[36]

The content is sourced from: https://handwiki.org/wiki/Social:Mental_health_in_education