Foundation's School MH Program Seeks Ways to Build on Success

The signature program of the American Psychiatric Foundation (APF), called “Typical or Troubled,” has achieved notable successes in helping to improve student mental health in locations across the country, and plans are under way to expand the program and make it even more effective.

The program was launched eight years ago in response to the Columbine High School shootings. It provides written information and presentations that local school and mental health staff use to educate teachers about the signs of mental illness in students and school and community referrals that provide “scientifically correct interventions” to children who need them, said Richard Harding, M.D., APF president, at an October conference at APA headquarters in Arlington, Va.

The purpose of the conference was to review the effectiveness of the program with mental health and education professionals who have presented it in their school systems.

Since its launch, the Typical or Troubled program has grown quickly as local mental health professionals have presented it in 310 urban, suburban, and rural high schools and middle schools throughout the country. So far, more than 25,000 educators have participated in the program, affecting an estimated 320,000 students.

“We travel the country and see a need for it everywhere,” said APF Executive Director Paul Burke, at the conference.

The Typical or Troubled curriculum instructs teachers and school staff to recognize when mental illness rather than typical youth angst may be present among their students. For example, educators are told to watch for students who have intense fears of becoming obese, with no relationship to their body weight, as a possible sign of an eating disorder. After the presentation about psychiatric disorders, teachers are told about local resources that offer mental health screening and treatment for troubled teens.

After eight years, organizers view the results as encouraging, with nearly 90 percent of educators who participated in a Typical or Troubled program able to discern the difference between typical teen behavior and the warning signs of mental illness, according to surveys that presenters conducted at the end of each session and that were compiled by APF. A similar percentage of educators were able to describe the warning signs of psychiatric illness among students. Approximately 75 percent were able to identify the professional services available to students in their school systems.

Of concern were the lower-than-hoped-for rates of program participants who identified students exhibiting the warning signs of a mental illness and took follow-up action, such as either talking to the students or their parents or referring them to a mental health professional in the school system. For example, in 2009 about 70 percent of the program's educator participants said they would talk to these students or their parents about a possible mental disorder, and about 80 percent said that they would refer the students to a mental health professional.

The program evaluation did not ask educators why they preferred referring students to mental health workers instead of talking to the student or parents, but Linda Bueno, director of industry relations for APF, suggested that the preference stemmed from teachers' belief that mental health professionals are better trained to address psychiatric conditions with students and parents, and the teachers may be uncomfortable in conveying such information. Organizers of the program, which briefly addresses ways to discuss mental illness with students but provides no guidance on talking to parents, are considering adding information about communication with both students and parents.

APF is now conducting a follow-up survey to determine the extent to which participation in the program affected teacher responses to signs of mental illness in the months after the presentation.