presentation on mental health in schools

Transforming the understanding and treatment of mental illnesses.

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Resources for Students and Educators

The National Institute of Mental Health (NIMH) offers a variety of learning resources for students and teachers about mental health and the brain. Whether you want to understand mental health challenges, promote emotional well-being in the classroom, or simply learn how to take care of your own mental health, our resources cover a wide range of topics to foster a supportive and informed learning environment. Explore videos, coloring books, and hands-on quizzes and activities to empower yourself and others on the journey to mental well-being.

You can also find additional educational resources about mental health and other topics on NIH’s STEM Teaching Resources website  .

Childhood Irritability : Learn about symptoms of irritability, why it's important to study irritability, NIMH-supported research in this area, and new treatments for severe irritability in youth.

Get to Know Your Brain: Your brain is an incredible and complex organ! It helps you think, learn, create, and feel emotions, and it controls every blink, breath, and heartbeat. Learn more about the parts of the brain and what each area helps control.

NIMH Deputy Director Dr. Shelli Avenevoli Discusses the Youth Mental Health Crisis: Learn about youth suicide, the effects of technology and the pandemic on the developing brain, and tips for supporting the mental health of youth.

Getting to Know Your Brain: Dealing with Stress: Test your knowledge about stress and the brain. Also learn how to create and use a “ stress catcher ” to practice strategies to deal with stress.

Coloring and activity books

Print or order these coloring and activity books to help teach kids about mental health, stress, and the brain. These are available in English and Spanish. 

Get Excited About Mental Health Research!

This free coloring and activity book introduces kids to the exciting world of mental health research.

Stand Up to Stress!

This free coloring and activity book teaches children about stress and anxiety and offers tips for coping in a healthy way.

Get Excited About the Brain!

This free coloring and activity book for children ages 8-12 features exciting facts about the human brain and mental health.

Quizzes and activities

Use these fun, hands-on activities in the classroom or at home to teach kids about mental health.

Teen Depression Kahoot! Quiz  

Engage students in fun and interactive competition as they learn about depression, stress and anxiety, self-care, and how to get help for themselves or others.

Stress Catcher

Life can get challenging sometimes, and it’s important for kids (and adults!) to develop strategies for coping with stress or anxiety. This printable stress catcher “fortune teller” offers some strategies children can practice and use to help manage stress and other difficult emotions.

Brochures and fact sheets

Below is a selection of NIMH brochures and fact sheets to help teach kids and parents about mental health and the brain. Additional publications are available for download or ordering in English and Spanish.

Children and Mental Health: Is This Just a Stage?

This fact sheet presents information on children’s mental health including assessing your child’s behavior, when to seek help, first steps for parents, treatment options, and factors to consider when choosing a mental health professional.

The Teen Brain: 7 Things to Know

Learn about how the teen brain grows, matures, and adapts to the world.

Mental Health in Schools

Know the warning signs.

Learn the common signs of mental illness in adults and adolescents.

Mental health conditions

Learn more about common mental health conditions that affect millions.

Find Your Local NAMI

Call the NAMI Helpline at

800-950-6264

Or text "HelpLine" to 62640

Where We Stand

NAMI believes that public policies and practices should promote greater awareness and early identification of mental health conditions. NAMI supports public policies and laws that enable all schools, public and private, to increase access to appropriate mental health services.

Why We Care

One in six U.S. youth aged 6-17 experience a mental health disorder each year, and half of all mental health conditions begin by age 14. Attention-deficit/hyperactivity disorder (ADHD), behavior problems, anxiety, and depression are the most commonly diagnosed mental disorders in children. Yet, about half of youth with mental health conditions received any kind of treatment in the past year.

Undiagnosed, untreated or inadequately treated mental illnesses can significantly interfere with a student’s ability to learn, grow and develop. Since children spend much of their productive time in educational settings, schools offer a unique opportunity for early identification, prevention, and interventions that serve students where they already are. Youth are almost as likely to receive mental health services in an education setting as they are to receive treatment from a specialty mental health provider — in 2019, 15% of adolescents aged 12-17 reported receiving mental health services at school, compared to 17% who saw a specialty provider.

School-based mental health services are delivered by trained mental health professionals who are employed by schools, such as school psychologists, school counselors, school social workers, and school nurses. By removing barriers such as transportation, scheduling conflicts and stigma, school-based mental health services can help students access needed services during the school-day. Children and youth with more serious mental health needs may require school-linked mental health services that connect youth and families to more intensive resources in the community.

Early identification and effective treatment for children and their families can make a difference in the lives of children with mental health conditions. We must take steps that enable all schools to increase access to appropriate mental health services. Policies should also consider reducing barriers to delivering mental health services in schools including difficulty with reimbursement, scaling effective treatments, and equitable access.

How We Talk About It

• Many mental health conditions first appear in youth and young adults, with 50% of all conditions beginning by age 14 and 75% by age 24.
• One in six youth have a mental health condition, like anxiety or depression, but only half receive any mental health services.
• Early treatment is effective and can help young people stay in school and on track to achieving their life goals. In fact, the earlier the treatment, the better the outcomes and lower the costs.
• Unfortunately, far too often, there are long delays before they children and youth get the help they need.
• Delays in treatment lead to worsened conditions that are harder — and costlier — to treat.
• For people between the ages of 15-40 years experiencing symptoms of psychosis, there is an average delay of 74 weeks (nearly 1.5 years) before getting treatment.
• Untreated or inadequately treated mental illness can lead to high rates of school dropout, unemployment, substance use, arrest, incarceration and early death.
• In fact, suicide is the second leading cause of death for youth ages 10-34.
• Schools can play an important role in helping children and youth get help early. School staff — and students — can learn to identify the warning signs of an emerging mental health condition and how to connect someone to care.
• Schools also play a vital role in providing or connecting children, youth, and families to services. School-based mental health services bring trained mental health professionals into schools and school-linked mental health services connect youth and families to more intensive resources in the community.
• School-based and school-linked mental health services reduce barriers to youth and families getting needed treatment and supports, especially for communities of color and other underserved communities.
• When we invest in children’s mental health to make sure they can get the right care at the right time, we improve the lives of children, youth and families — and our communities.

What We’ve Done

• NAMI letter of support for the Mental Health Services for Students Act (H.R. 1109), introduced by Reps. Napolitano and Katko
• NAMI letter of support for Mental Health Services for Students Act of 2019 (S. 1122) introduced by Senator Tina Smith
• NAMI Ending the Silence Presentation Program

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Reducing Mental Health Stigma in Schools

Reducing mental health stigma in schools presentation, free google slides theme and powerpoint template.

Mental health issues can affect anyone regardless of age, gender, or socio-economic status. Unfortunately, the stigma surrounding mental health problems can prevent many students from seeking the help they need. In order to reduce this stigma in schools, it is important to educate students, teachers, and staff about mental health and create a safe and supportive environment. Download our template and prepare a speech and its complementary slideshow. Be informative and thorough, and be sure to have nice slides so that everyone can follow everything that is being explained!

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From evidence to impact: Joining our best school mental health practices with our best implementation strategies

There is substantial research evidence for the effectiveness of school mental health strategies across problem areas, developmental levels, and the prevention-intervention spectrum. At the same time, it is clear that the education and mental health fields continue to struggle to apply this evidence at any level of scale. This commentary reflects on ways in which education-specific applications of implementation science principles – and explicit consideration of determinants of implementation success – may guide more consistent use of evidence in school mental health. After reviewing implementation determinants and strategies across multiple levels of effect (i.e., the outer setting, inner setting, individual, and intervention levels), the commentary goes on to recommend specific areas of needed attention in school mental health implementation efforts and research. These include a need to adapt interventions to better fit the context of schools, streamlining school mental health programs and practices to make them more implementable, and recognizing the critical role of assessment and selection of evidence-based interventions by school leaders. The commentary concludes by reflecting on the substantial opportunity provided by the education sector to both apply and advance implementation science.

We live in an era in which mental health disorders in children are at historically high rates and rising (Houtrow et al., 2015; National Academies of Science, 2015), and yet only a small minority of youth who would benefit from mental health supports actually receive them (Costello, 2009; Costello et al., 2014 ). Given the opportunity presented by schools to identify and address youths’ social, emotional, and behavioral needs across tiers of prevention, early intervention, and targeted treatment, the field will benefit greatly from rigorous reviews of evidence about “what works.”

As such, this excellent special issue comes at a critical juncture. All the papers in this compendium make strong and compelling arguments about the importance of their respective problems, their relevance to public health and education, and the opportunities that exist for schools to address them. Moreover, each provides research-based, actionable information for the education and mental health sectors. As detailed in this special issue, evidence around effective strategies varies across problem areas, developmental levels, and the prevention-intervention spectrum. Nonetheless, it is clear that we have plenty of evidence for programs that are effective at addressing problems as diverse as aggression, anxiety, attention problems, and bullying.

At the same time, it is clear that the education and mental health fields continue to struggle to apply this evidence at any level of scale. Fabiano and Pyle (this issue), for example, observe that despite its high prevalence rate and a robust research base on school-based intervention strategies, there remains little in the way of a standardized outline of interventions or supports for students with attention deficit hyperactivity disorder (ADHD). A recent study illuminates the problem starkly: a review of individual education plans for 97 students with ADHD revealed that few included strategies with demonstrated effectiveness ( Spiel, Evans, & Langberg, 2014 ). As Fabiano and Pyle (this issue) conclude, “instead of the provision of effective interventions, children with ADHD are inconsistently supported in schools in a manner influenced by local custom” (p.XX). In sum, as noted by other authors in this special issue (e.g., Waschbush, Breaux, & Babinski), and in papers cited by these authors (e.g., Gottfredson & Gottfredson, 2002 ), failures of implementation are the norm in school-based mental health.

Viewing School Mental Health Interventions through an Implementation Lens

The problem of inadequate implementation support for research-based practices is, of course, not unique to schools. In healthcare, seminal work has documented that it takes 17 years for just 14% of original research to benefit practice ( Balas & Boren, 2000 ). Fortunately, in response to these issues, a transdisciplinary field focused on supporting effective implementation has emerged to address the persistent research-to-practice gap. Having identified and synthesized a range of factors across multiple levels that influence successful implementation ( Damschroder et al., 2009 ) and improve implementation outcomes ( Proctor et al., 2011 ), contemporary implementation science is now focused largely on developing and testing specific implementation strategies ( Cook et al., in press ; Lyon et al., under review ; Powell et al., 2015 ) that may hold promise for improving adherent uptake of research-based strategies, so we can consistently promote positive student outcomes. To do so, however, we must first take stock of the multiple levels of influence that may influence implementation success, and which can be targeted by implementation strategies.

Multilevel Influences on Implementation Success

As referenced in several the articles in this special issue, implementation is inherently a multilevel endeavor. Waschbush et al. (this issue) pay particular attention to the multilevel influences on successful implementation of school-based interventions, referencing four domains proposed by Gottfredson and Gottfredson (2002) in their influential paper on the quality of school-based prevention programs: Organizational capacity (e.g., staff morale, turnover); organizational support (e.g., availability of training and supervision, principal support to making these activities and other resources available); program features (such as curriculum elements and quality control mechanisms built into the intervention), and local integration (defined as the extent to which the program is built into everyday school routines).

In the years since Gottfredson and Gottfredson’s influential work, over 60 implementation frameworks have been described ( Tabak, et al., 2012 ), and mechanisms of action across elements of such frameworks are beginning to be identified ( Lewis et al., 2018 ; Williams, 2016 ). While many early heuristics referenced implementation determinants, implementation strategies, and implementation outcomes somewhat interchangeably, as shown in Figure 1 , implementation scientists now articulate each of these domains separately, as well as relationships across them, in an attempt to specify strategies that may address determinants and support successful implementation of research-based practices ( Lewis, 2017 ).

Causal model for applying implementation strategies to evidence-based programs (based on Lewis, 2017 ).

In another advance, frameworks such as the Consolidated Framework for Implementation Research (CFIR; Damschroeder, 2009) have synthesized many overlapping perspectives about what determines implementation success. As a result, the field now has achieved reasonable consensus about the levels of influence in which implementation determinants operate – and thus, the levels where implementation strategies should be focused. These levels frequently include: (1) The outer setting, (2) the inner setting , (3) the individuals who will implement or enact the strategy, and (4) the intervention itself. Implementation processes often play out across each of these levels. Importantly, evidence suggests that implementation strategies that address more than one of these levels are frequently more effective than those targeting a single level ( Beidas & Kendall, 2010 ). Below, we review each of these levels, drawing examples from the special issue articles, and suggest candidate strategies that may improve implementation success.

Outer setting.

The outer setting reflects the larger political, social, and economic context in which implementation occurs. This includes norms, laws, and broader policies as well as inter-organizational linkages within a larger service system. In school mental health, the outer setting may be best defined at the level of the school district and beyond. Although the outer setting is commonly identified as critically important to implementation, it is notoriously difficult to change. Nevertheless, there are plenty of examples of outer setting strategies being employed to increase the availability of evidence-based practices (EBP) in mental health, often through policy and legislation (e.g., Powell et al., 2016 ; Trupin & Kerns, 2017 ).

Papers in the current special issue provide a number of relevant examples of the influence of the outer setting to school mental health. For example, in their recommendations for implementing anxiety interventions in schools, Jones et al. (this issue) detail the ideal timing of implementation and how it can best fit within the academic calendar, which is typically set at the district level. Singer and colleagues (this issue) discuss how outer setting determinants and strategies can manifest as training or professional development mandates, such as those for suicide-related gatekeeper training. As noted by Thomeer and colleagues (this issue) in their description of the work conducted by Locke et al. (2015) , funding availability – or, more commonly, lack of availability – is another critical state- and/or district-level determinant.

At the level of the outer context, many of the most relevant approaches for increasing the availability of EBP are actually dissemination strategies that involve the targeted distribution of information to specific audiences, such as legislators ( Purtle, Brownson, & Proctor, 2017 ; Purtle et al., 2018 ). Among educators seeking to develop a comprehensive, consistent, and sustainable continuum of supports for students’ social, emotional, and behavioral well-being, the policy and funding context – or outer setting – can be extraordinarily influential. For example, without accompanying funding, legislation focused on addressing one problem can impact implementation of other services – including implementation of school-based EBPs – in a way that is viewed as deleterious by local school officials. One study examined local education association officials’ perspectives on an array of such unfunded or underfunded mandates (New Jersey School Boards Association, 2016), including one aimed at reducing harassment, intimidation, and bullying (HIB). Seventy percent of districts reported needing to shift funds for other programs to comply with the requirements of the HIB legislation. As one superintendent put it, “we reallocated resources [to HIB] and lost time to support students with substance-abuse concerns” (p.7). The first recommendation from this report was to urge local boards of education “to adopt resolutions calling on state and federal officials to provide adequate funding of required programs” (p. 19).

Inner setting.

The inner setting is the immediate organizational context in which implementation occurs. Extensive research has supported the importance or inner setting organizational variables for successful implementation across service contexts ( Aarons et al., 2012 ; Beidas et al., 2013 , 2015 ; Bonham et al., 2014 ; Glisson, 2002). In schools, the inner setting is often defined at the building level, including principals, grade level leaders, and distributed leadership teams ( Lyon et al., 2018 ). Building-level leadership – and the continua of incentives and disincentives that leaders and leadership structures adopt and support – drives school climate and is critical to the adoption and sustainment of new practices.

Research has found that principal support is important to promoting implementation of SEL curricula (e.g., Brackett et al., 2012 ), school-wide positive behavioral interventions and supports (PBIS; e.g., McIntosh et al., 2016 ), and more intensive indicated interventions for mental health concerns (e.g., Forman & Barakat, 2011 ). Research on PBIS has also found that the fidelity with which PBIS is implemented, including composition and activities of school-level PBIS leadership teams, is associated with impacts on outcomes such as rates of student disciplinary actions (e.g., Flannery, Fenning, Kato, McGrath, & McIntosh, 2014 ). Given the high level of influence that “inner setting” variables such as building-level leadership plays in achieving both implementation outcomes and student outcomes, it is noteworthy that little attention in the current special issue is paid to research on the influence of such factors on the success of the various EBPs reviewed, or inner setting strategies for ensuring their successful implementation. Such a dearth of information on these critical implementation determinants may point to a need for further research and development. As research on determinants continues to support the importance of leadership to implementation in the education sector, strategies for promoting facilitative leadership practices are increasingly indicated. Some direction may be taken from research in other service sectors that has developed strategies for influencing inner setting constructs, such as implementation leadership and implementation climate ( Aarons, Ehrhart, Garahnak, & Hurlburt, 2015 ), that are related to the adoption of new interventions.

Individual.

Individual-level implementation factors include, but are not limited to, the characteristics and experiences of front-line service providers responsible for delivering the types of evidence-based programs and practices described in the current special issue. Relative to some other healthcare settings, the school context provides opportunities for the expansion of interventionists to include many different types of personnel with different training backgrounds, ranging from paraprofessionals, to teachers, to dedicated school-based clinicians ( Owens et al., 2014 ). In addition to roles, professional backgrounds, and education status, individual practitioner-level factors such as their attitudes, beliefs, and self-efficacy around applying research-based programs have been found to influence implementation success (e.g., Henggeler et al., 2008 ), giving rise to an array of measures of these individual-level constructs (see Lewis et al., 2015 ). Individual strategies for targeting key individual-level determinants – such as school-based professionals’ motivation to engage in training and implementation – are beginning to emerge. In one example, Cook, Lyon, Kubergovic, Browning Wright, & Zhang (2015) described a brief implementation strategy that leverages existing theory to target the attitudes, self-efficacy, and perceived social norms of front-line practitioners to improve implementation intentions and, ultimately, behaviors.

Perhaps most oft-cited among individual level implementation drivers, however, is workforce development. As pointed out by multiple authors in this issue (e.g., Fabiano & Pyle, this issue; Thomeer et al., this issue), training opportunities for educators are consistently suboptimal, resulting in persistent knowledge gaps among many front-line personnel. In addition to being the subjects of training, Nickerson and colleagues (this issue) also suggest that dedicated school mental health personnel may have a role in conducting schoolwide training efforts, at least in the domain of bullying prevention. This is a worthwhile suggestion to investigate provided that there are also accompanying opportunities for post-training supports. Indeed, it is perhaps the most robust and consistent finding in implementation research that one-time “train and hope” models of professional development are ineffective in producing practitioner behavior change ( Herschell et al., 2010 ; Joyce & Showers, 2002).

Intervention.

Contemporary implementation science tends to focus most on the inner setting and individual levels, despite consistent recognition that implementation outcomes are directly influenced by aspects of the interventions themselves ( Lyon & Bruns, in press ). Indeed, a recent systematic review of implementation science assessment instruments identified relatively few at the intervention level ( Lewis et al., 2015 ). Nevertheless, the characteristics of programs and interventions provide an array of implementation determinants, as well as untapped possibilities for corresponding intervention-level implementation strategies. For example, given that many school-based practices have been transported from other service settings ( Lyon et al., 2014 ), intervention-setting fit is particularly critical when implementing evidence-based practices in school mental health. The current special issue includes a wealth of reflections on the question of “goodness of fit” of the reviewed practices, including (1) questions about when interventions are “ready” to implement, based on evidence, and (2) aspects of intervention design and usability.

Intervention readiness for large scale implementation was referenced in multiple papers. Although the traditional view on intervention development and implementation is of a relatively linear, unidirectional path from developers and testers to eventual delivery in community contexts, this perspective has certainly contributed to the aforementioned “17-year gap” between initial development and broad-based application of research-based practices ( Balas & Boren, 2000 ). On the other hand, the development of evidence for interventions is often uneven, with robust evidence emerging for some applications of specific practices while other (often widespread) applications of the same practices remain unsupported by evidence.

As an example, Chafouleas et al. (this issue) indicate that, although there is strong evidence for some Tier 2 and 3 trauma interventions in schools, there is far less supporting evidence for Tier 1 trauma interventions. This is consistent with the results of a recent Campbell Collaboration systematic review that failed to find any studies of trauma-informed school approaches that were sufficiently rigorous to meet inclusion criteria ( Maynard et al., 2017 ). While we agree that there is a “critical need for rigorous research on implementation processes to identify cost-efficient and effective strategies for the adoption and implementation of trauma-informed approaches by schools” (p. XX), there is simultaneously a clear and present danger of leapfrogging to develop implementation strategies before the core practices are empirically substantiated. Similarly, Fabiano and Pyle (this issue) indicate that some practices such as functional behavioral assessments and daily report cards have good evidence at the elementary school level, but that evidence becomes much more limited when considered in secondary settings.

Other papers in this issue touch on the critically important topic of intervention design, including the complexity of evidence-based programs or practices and their design quality or packaging. For instance, one paper (Waschbusch et al., this issue) discussed reviews demonstrating that single-component interventions can be more effective than multicomponent interventions for aggression. Such evidence is encouraging given that intervention complexity is also a major barrier to evidence-based practice implementation ( Lyon & Koerner, 2016 ). Similarly, Fabiano and Pyle (this issue) point out that many interventions are multicomponent, and that “combining them all together may mask the effectiveness of some treatments and artificially inflate the effectiveness of others” (p. XX). Careful attention to the design quality and packaging of our best evidence-based programs and practices seems overdue if large-scale adoption and sustainment is the goal. User-focused intervention redesign is an underutilized implementation strategy for addressing intervention-level determinants improving design quality and contextual appropriateness ( Lyon & Bruns, in press ). Although relatively few implementation strategies explicitly target the intervention level, considerable direction may be taken from the field of user-centered design, which can supply new strategies geared toward ensuring compelling and usable interventions that demonstrate good fit to purpose ( Dopp, Parisi, Munson, & Lyon, in press ). The benefits of such redesign processes are discussed further below.

In sum, a wealth of evidence from research – as well as observations from authors of the papers in the current special issue – advise that evidence from controlled studies (where researchers are typically the intervention developers and conditions are optimally constructed to find positive effects) should only partially inform decision-making around intervention selection. Equally important, we must pay attention to the usability and feasibility of the interventions and strategies we choose to use in our schools.

In this commentary, we have aimed to complement an outstanding compilation of reviews of school-based interventions for common social, emotional, and behavioral problems with a discussion of factors at multiple levels that are likely to drive implementation success (or failure) of these programs. In reviewing the relative attention paid to the determinants of implementation success – in both the papers in the special issue and the commentary itself – several major themes are worth underscoring.

The first theme is that individuals championing the cause of supporting students’ social, emotional, and behavioral wellness (e.g., intervention developers, purveyors, and school leaders) may have particular control of factors at the intervention level, and as such, intervention-level determinants may warrant particular attention. For example, most psychosocial interventions in mental health are highly complex ( Comer & Barlow, 2014 ) and could benefit from streamlining ( Lyon & Koerner, 2016 ). This may be particularly critical in schools, given the demands on teachers, counselors, and other school helpers, the idiosyncrasies of the school calendar, and the primacy of the education mission over social-emotional wellness ( Bruns et al., in press ; Lyon et al., 2015; Owens et al., 2014 ). As such, we call upon those who develop, select, fund, and use school-based interventions to join into concerted action to ask how these programs – across all tiers of effort – can be simplified and streamlined.

At the intervention level, we also recommend against adhering too closely to mental models that emphasize “leaky pipelines” and/or “voltage drops” in implementation, whereby deviations from adherence to research-based protocols (often developed for settings other than schools) necessarily represent bad outcomes. Instead, we offer that deliberate adaptation in response to the prospective assessment of contextual needs is necessary for successful scale-up as well as beneficial evolution of our school-based strategies ( Chambers et al., 2013 ). Historically, implementation science has tended to see interventions as static protocols that, ideally, can be delivered with perfect reliability ( Lyon & Koerner, 2016 ). In reality, however, “there is no implementation without adaptation” ( Lyon & Bruns, in press ) and substantial improvements may be made to increase the usability and utility of interventions in the school context. Ideally, in addition to more successful local implementation of EBPs, such adaptations will be accompanied by evaluation of the incremental improvements in their usability and effectiveness ( Lyon, Koerner, & Chung, 2018 ), as well as improved iterations of school-based interventions that can be transported to other education settings. In such redesign scenarios, the effectiveness of interventions can be assured through measurement of an intervention’s proximal mechanisms ( Kazdin, 2007 ) (e.g., cognitive changes; skill uptake) that precede changes in symptoms or functioning.

Third, Chafouleas et al. (this issue) implore school mental health providers “to engage in direct and indirect assessment of key intervention usability factors, such as acceptability, feasibility, understanding, home-school collaboration, system climate, and system support.” We could not agree more. Although any such assessment of EBP feasibility, compatibility, and necessary support conditions will require additional efforts by already-overburdened school staff, such systematic assessment efforts hold promise of bearing fruit in the form of better implemented and more effective school mental health programming.

Fortunately, tools exist that can facilitate such assessment and selection. For example, the Hexagon Tool (Metz & Louison, 2018) provides an overarching heuristic framework for use by states, districts, and schools in evaluating the appropriateness of EBPs across six dimensions: Needs (how well the program or practice being implemented might meet identified needs); Fit (with local priorities, structures, support, and context); Resource availability (for training, staffing, data systems, and administration); Evidence (expected outcomes if the EBP is implemented as intended); Readiness for replication (including adequacy of operationalization and expert assistance available); and Capacity to implement on the part of the state, district, or school. In many ways, this tool provides a streamlined method of specifying categories of implementation determinants that may be relevant to schools.

To fully assess the organizational implementation context of schools, our research team has been working to adapt a suite of instruments measuring aspects of school leadership, climate, and employee citizenship behaviors that are most proximal to the implementation of evidence-based practices ( Locke et al., in press ; Lyon et al., 2018 ). Assessment of these constructs may aid in the determination of whether and when a school is ready to implement an EBP, as well as identification of key leverage points for shifting individuals and school systems to be more conducive to the introduction of new practices.

These variables represent key inner setting determinants of implementation outcomes, which – as discussed above – have increasingly been found to promote implementation. The tools provide one pathway through which to increase the attention paid to those variables in education sector research. Given emerging research that is evaluating how these determinants (e.g., implementation leadership, implementation climate) may also be malleable in response to targeted intervention at the organizational level (e.g., Aarons, Ehrhart, Moullin, Torres, & Green, 2017 ), such constructs also reflect potentially important implementation mechanisms ( Lewis et al,. 2018 ) for organizationally-focused implementation strategies in schools.

As demonstrated by the depth of content of the current special issue of School Mental Health, understanding and mobilizing the evidence base on school-based interventions for emotional and behavioral needs of students is a complex endeavor. To demand that we also apply an implementation lens to this effort may be critiqued as only serving to exponentially increase an already burdensome challenge. Indeed, a skeptic might complain that we are now asking not just that education leaders remodel a house, but to remodel a house that is changing its shape all the time and is also continually occupied by a very large family and all its pets. However, with an estimated two-thirds of EBP implementation efforts ending in failure (Damschroeder et al., 2009), it is incumbent that we seek guidance from sources such as implementation science, which provides a framework for accounting for the multiple and dynamic drivers of success, such as via the mechanisms proposed in Figure 1 .

Fortunately, the school setting provides a particularly hospitable environment for promoting systematic, data-driven approaches to implementing effective school mental health practices. Measurement is inherent to education, with variations of implementation determinants (e.g., school climate), implementation outcomes (e.g., teacher performance), and student outcomes (e.g., disciplinary actions, attendance, and achievement) just a few examples of data points that are regularly collected and used.

Moreover, frameworks such as multi-tiered systems of student supports (MTSS; Lane, Menzies, Ennis, & Bezdek, 2013 ) and positive behavioral interventions and supports (PBIS; Sugai & Horner, 2009 ) have gained widespread adoption, and provide a means to guide selection, organization, implementation, and evaluation of student support strategies and behavioral interventions across multiple tiers of effort. As detailed by authors such as Kincaid and Horner (2017) and Freeman, Miller, and Newcomer (2015), strategies promoted by the PBIS and MTSS frameworks align well with the conceptual framework provided by implementation science. PBIS strategies are also accompanied by well-operationalized procedures and tools that do not only support adherent implementation of PBIS, but that, in and of themselves, represent potentially fruitful enabling strategies that could support implementation of any EBP.

For example, in PBIS and MTSS, district-level leadership teams promote attention to fiscal, policy, and political factors at the outer setting . Meanwhile, district- and school-level teams undertake specific facilitative administration supports and provide leadership training to create hospitable conditions at the inner setting of the school. PBIS also promotes competency at the individual (staff) level via strategies such as staff selection protocols, layered training systems for all school roles, and data-driven coaching. Finally, at the intervention level, PBIS employs tools for strategic EBP selection and consistent data collection on the fidelity and impacts of both the overall PBIS process as well as individual EBPs (Freeman, Miller, & Newcomer, 2015; Sugai & Horner, 2009 ).

Thus, in the form of PBIS and MTSS, the education sector benefits from “operating systems” that are not only informed by implementation science, but that attempt to mobilize implementation science via an organized system of practical strategies. Since research has shown that PBIS can effectively promote a range of positive school climate and student behavioral outcomes (e.g., Bradshaw, Mitchell, & Leaf, 2010 ), that adherence to these strategies is associated with positive outcomes ( Kincaid & Horner, 2017 ), and that many of the core features of PBIS may also function as implementation strategies for carefully selected EBPs, one could argue that school mental health and positive behavioral support provides one of the most comprehensive examples currently available for the potential power of implementation science to promote evidence-based programs.

We look forward to seeing future articles and special issues of School Mental Health focused on efforts to explicate, implement, and evaluate implementation strategies for empirically supported school-based services. By joining our best programs to our best implementation strategies, we can meaningfully advance both the emerging field of implementation science and the social, emotional, and behavioral wellness of our students.

The authors received no funding to support this article.

Conflict of interest:

Aaron Lyon declares he has no conflicts of interest. Eric Bruns declares he has no conflicts of interest.

Ethical approval: This article does not contain any studies with human participants performed by either of the authors.

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More mental health support in schools makes sense – but some children may fall through gaps

Senior Fellow, Health Services Management Centre, School of Social Policy, University of Birmingham

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Jo Ellins receives funding from the National Institute for Health and Care Research.

University of Birmingham provides funding as a founding partner of The Conversation UK.

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Schools and colleges have a crucial role to play in supporting children’s mental health. They are places where young people’s mental health difficulties are identified and help is provided, and they can promote all pupils’ emotional wellbeing.

Most children spend more time in school than anywhere else other than home, and parents who are concerned about their child’s mental health turn to teachers and school staff for advice more than any other professionals. Investing more in schools-based mental health services makes good sense.

This is something the government has been doing in England through the creation of mental health support teams. These are teams of mental health practitioners who work with clusters of schools and colleges. Most are based within the NHS, although some are provided by voluntary sector organisations or local councils.

The first 58 mental health support teams went live in 2020, working in and with more than 1,000 schools and colleges. By 2025, more than 600 teams will have been created, serving around half the schools in England.

I led an early national evaluation of the first 58 teams . This study looked at how they were set up, what support they were providing and how they were progressing. Together with colleagues, I found that increasing mental health support in schools was well received, but that some young people still faced difficulties getting appropriate help.

Mental health support teams are intended to provide support to young people with “mild to moderate” mental health difficulties, such as anxiety and low mood. Their role also includes working with school staff to develop a positive culture focused on wellbeing, and giving schools and parents advice to help them access other types of support. This includes specialist mental health services for young people with more serious or complex problems.

Much of the day-to-day work with young people and schools is delivered by education mental health practitioners . This is a new role in the mental health workforce, created specifically for mental health support teams.

Education mental health practitioners receive one year’s training with a focus on developing the skills to deliver cognitive behavioural therapy (CBT) to young people, either one-to-one or in small groups.

We heard from staff in the teams, schools and colleges, and those working in other local services supporting children’s mental health. We also spoke to young people at schools with mental health support teams.

Our study confirmed the importance of investing in schools-based mental health. School staff told us how valuable it was having ready access to advice when they were concerned about a pupil’s emotional wellbeing, and that they felt more knowledgeable and confident talking to young people about their mental health.

Having access to a team made it easier for some young people to get support at the right time. Timely access is crucial for many reasons, not least because more than half of young people experience a deterioration in their mental health while they are waiting for support.

Through the gaps

However, we also found that not all young people were benefiting from this investment. We heard that some young people were at risk of falling between gaps in provision. They had mental health problems that were neither “mild to moderate”, nor were they judged serious or urgent enough to meet the threshold for specialist NHS help.

There is evidence that thresholds for specialist NHS help are rising in response to growing demand, and so increasing numbers of young people may be falling into this gap between services.

Our early study was not designed to assess the effectiveness of the support that the teams were providing, but people we spoke to were keen to share their views about this. There were concerns from schools and colleges that the teams usually offered only one type of support, and that this was not suitable or beneficial for all young people.

The teams’ early experiences suggested that the CBT approaches that education mental health practitioners were trained to deliver didn’t work well for several groups. These included young people who had special education needs, or were neurodiverse, or whose mental health problems were related to traumatic circumstances or life events, such as poverty or domestic violence.

Wider research shows that CBT can be effective for these groups, but only when it is carefully tailored to their particular needs and circumstances, or is delivered in trauma-informed ways .

These findings offer valuable information about how well mental health support teams are working, but our study only looked at the first wave of teams. We don’t know if these experiences are the same for the teams that were set up later.

I am now co-leading a second, much larger, study of almost 400 mental health support teams, assessing their impact and cost-effectiveness. One of the main aims of our current study is to assess the impact of this support on young people’s mental health outcomes. As the study progresses, we will know more about how well this support works and who it works for.

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Mental Health in Schools

Sep 25, 2014

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Dr. Alan Brown, Chief Department of Psychiatry (HHS and JBMH) Medical Director Child and Adolescent Psychiatric Inpatient Services (HHS). Mental Health in Schools. Overview . 1) Mental Health – Definition 2) Mental Illness – Inseparable from physical illness 3) Prevalence Rates

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Dr. Alan Brown, Chief Department of Psychiatry (HHS and JBMH) Medical Director Child and Adolescent Psychiatric Inpatient Services (HHS) Mental Health in Schools

Overview 1) Mental Health – Definition 2) Mental Illness – Inseparable from physical illness 3) Prevalence Rates 4) Most Common – Anxiety, Depression, ADHD 5) Resilience 6) Treatment Resources

Mental Health Exists on a Continuum

Mental Disorder/Illness Mental Health Problem Mental Distress No Distress, Problem or Disorder The Inter-Relationship of Mental Health States

1 in 5 students will experience a mental health problem…. ONE in FIVE Every School…..Every Classroom

Mental Health is…. The ability to think, feel and act in ways that help us cope with life’s ups and downs, make good decisions and have meaningful relationships Balancing all parts of life is important to maintaining positive mental health and well-being

What are Mental Health Problems? Emotional, behavioural and brain-related disturbances that interfere with development, personal relationships, and functioning Disturbances that are severe and persistent enough to cause significant symptoms, distress, and impairment in one or more areas of daily life are termed mental health disorders/mental illness

Mental Health Problems include a Range of Difficulties Mental Health problems are characterized by many different signs and symptoms and present in various forms Some mental health problems manifest outwardly (externalizing) Students appear aggressive, impulsive, non-compliant Some mental health problems manifest inwardly (internalizing) Students appear withdrawn, lonely, anxious, depressed

Mental Illness is…. A medical condition that impacts functioning over a period of time Not result of a personal failure or weakness, but is caused by a social, psychological, genetic, physical, chemical or biological disturbance (often in combination)

What’s the Difference? Physiological differences in people who struggle with a mental health disorder Brain differences Driven by genetic, epigenetic effect (hereditability components to these disorders) Underlying genetic structure can be changed by environmental impacts suppressing or expressing genes Similar to other disorders i.e. diabetes

Mental Health Disorders are Physical Disorders Research (genetic, imaging, immunological) all show that mental health disorders are inflammatory disorders (redness, swelling, increased fluid secretion and diminished function in the brain) Not a choice or character flaw

The Good News Proven strategies and supports Psychosocial (talk therapy) and pharmacological (medications) treatments are most common, and are often used together While many mental disorders are chronic, we can help with coping Early identification and intervention improves prognosis

But Most Do Not Receive the Help They Need Up to 80% of children and youth who experience a mental health problem will not receive treatment Major barriers include: Lack of, difficulty accessing, or long waitlists for local services Stigma Misidentification or lack of identification of symptoms

Facts and Figures Causes – multiply determined (biological, life experiences, individual factors, early trauma) Onset – In 70% of cases, the onset of problems begins before age 18; with 50% of cases starting before age 14 Co morbidity – If have one disorder, other problems are also likely (75% have more than one mental health problem) Impact – disturbances to academic and social well-being, isolation, despair, anger; heightened risk of suicide Stage 1 versus stage 4 treatment: minimizing secondary impacts (reduce academic impact, social impact, identify formation in adolescence, sense of self)

Safe and Inclusive SchoolsHDSB Mental Health and Addiction Strategy Launched September 2013 Developed based on Resource Mapping and Needs Assessment Data Mental Health is the presence of physical, emotional, intellectual and social well-being. Our Mission: The Halton District School Board is committed to the mental health and well-being of every student. The Halton District School Board will inspire and support learning; create safe, health inclusive and engaging environments, provide opportunities for challenge and choice; and prepare students for success.

When Should I Be Concerned? Notice changes in behaviour See behaviour that are not age-appropriate Behaviours continue over a period of time Then: seek assistance from school supports (Teacher, Administration, SERT, PSSP)

Signs… Emotional/Behavioural Signs Academic Signs Communication/Social Skills Signs

Prevalence of Mental Disorders in Young People: Who is in your Classroom? Population Prevalence • Depression (4-6%) • Psychosis (0.5 – 1.0%) • Anxiety Disorders (6-10%) • ADHD (2-4%) • Anorexia Nervosa (0.1 -0.2 %) • Total (15-20%) • SUICIDE: 4-5/100,000 • ASD (1-4%) • Substance Abuse (10%) Translation to the “average” Classroom • Depression (1-2) • Psychosis (rare) • Anxiety Disorders (1-3) • ADHD (1) • Anorexia Nervosa (rare) • Total (3-5) • SUICIDE: 4-5/100,000 • ASD (1) • Substance Abuse (2-3)

Why Talk About It? Between 15%-25% of children/youth report at least one mental health problem or illness Suicide is the 2nd leading cause of death among Canadian adolescents Untreated youth mental health problems become adult mental health problems, 70% of adults with mental health issues reported problems started in childhood School difficulties may be a sign of emerging or unrecognized mental illness; these can impact a youth’s ability to be successful at school

What is an Anxiety Disorder? Feelings of excessive stress, fear, worry or nervousness over a prolonged period of time during situations where this response is not justified Interferes with daily activities and relationships Signs may include: school or task avoidance, worrying, frequent crying, isolation, easily frustrated, shyness, aggression, perfectionist behaviours

Types of Anxiety Disorders Generalized (over worry) Social (fear of negative judgement of others) Performance (pressure of situations) Anticipatory (too nervous before changes or transitions) Panic Attacks (provoked and unprovoked) Obsessive Compulsive Disorders

Normal Anxiety versus Anxiety Disorder ANXIETY BEHAVIOUR THOUGHTS PHYSICAL FEELINGS Anxiety is a normal emotion, it exists to help us survive, keep safe and perform better… It is time limited!

What is Depression? Normal to have feelings of sadness and disappointment Not simply having “the blues” A mood disorder causing a disruption in the way a person feels and experiences emotion and impacts daily functioning Clinical depression: low mood persists for at least 2 weeks and is accompanied by changes in physical, emotional and cognitive state

DEPRESSION IS A FLAW IN CHEMISTRY NOT CHARACTER

What Anxiety/Depression can look like at School Academic: poor concentration, forgetful, declining motivation, incomplete/late work, declining grades Emotional/Behavioural withdrawn, negative self talk, harmful coping styles, struggling with peers, teacher and family relationships, avoiding tests, school refusal, Day/Night reversal, nothing makes them happy

Attention Deficit/Hyperactivity Disorder Attentional: Difficulty focusing Sitting quietly, off task Hyperactive/Impulsive: Poor social behaviour and can impact peer relationships Impulsivity Taking turns may be challenging Completing tasks or attending to details

Dual Diagnosis Two or more diagnosed disorders ASD, MID, DD: May or may not have mental illness symptoms presenting as part of ASD diagnosis e.g. ASD and OCD, anxiety (social, performance, anticipatory, panic attacks) Students with ASD may have significant psychiatric challenges that can be treated to help these students function

Other Bi-Polar Mood Disorders 4% Schizophrenia 1% Schizo-Affective Disorder 0.5% Psychosis 1-2% Reactive-Attachment Disorder vs. Attachment Disorders Post Traumatic Stress Disorders

Factors Associated with Effective Mental Health Promotion (Resilience) Programs that focus on applying physical social emotional learning skills in daily life Using interactive classroom instruction with frequent opportunities to practice Culture of respectful supportive relationship among students, school staff, and families Multi-year, multi-component approaches Whole school, community-involved approaches Support physical fitness development Greenberg et al., 2003 Stewart-Brown, 2006

What Do All Child/Youth Students Need? A warm welcome A smile A connection to a caring adult, every day A chance to learn A safe place to risk Someone who notices when something is wrong Someone who reaches out when they notice Someone who listens, and tries to find help for them Someone who believes in them, and instils hope

Caring Adults… Know their children students Notice changes Listen attentively Don’t promise to keep secrets Reframe negative thinking and find ways to build hope Use humour Nurture strength as a lever to hope Know where to get help when problems are too big to manage alone

Caring Classrooms Build Skills We can be proactive by teaching students social emotional learning skills so they are prepared for life’s challenges Research suggests that social emotional skill building helps students both emotionally AND academically Five core skill areas have been identified: Self Awareness Social Awareness Self-Regulation Relationships Decision-making

Relationships are Key Empathy Positive Regard Respect Genuineness Specificity of Response Concrete

New release from the Ministry of Education – An Educator’s Guide to Promoting Students’ Mental Health and Well-Being

Resources School teachers, counsellors, social workers, CYC’s, administration Primary physicians and paediatricians ROCK – behavioural difficulties Woodview – behavioural difficulties Nelson Youth Centre – social skills Hospital Outpatient Services, Clinical Day treatment Services (HHS, JBMH) Emergency Department CAPIS (Child/Adolescent Psychiatric Inpatient Services) ADAPT (Alcohol and Drug Assessment Prevention and Treatment Services) Halton Support Services – Autism and Developmental Delay CAS (Children’s Aid Society) Websites e.g. CAMH, moodgym.com Private therapists/psychologist Bibliotherapy

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Act on Student Ideas to Improve Mental Health, Youth Advocate Urges

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As schools confront a youth mental health crisis, they must engage students in finding solutions, said Rick Yang, 17, a senior at Scarsdale High School in New York.

The Jed Foundation (JED), an organization that promotes mental health and suicide prevention for teens and young adults, honored Yang as one of two recipients of its 2024 Student Voice of Mental Health Award in recognition of his state and local advocacy work.

Yang, who is Chinese American, was inspired to action when he saw the barriers a fellow Asian American friend faced in seeking mental health treatment during the COVID-19 pandemic. He attributes some of those barriers to the “model minority myth,” a term that refers to cultural stereotypes of Asian American students as high-achieving and academically gifted—a perception that may cause some adults and peers to overlook their needs.

He later advocated for wellness centers in his school district , and he co-founded “Frontiers of Fulfillment,” a group that provides online coaching for student leaders to advocate for policies like excused school absences for mental health.

This interview has been edited for length and clarity.

How did your experience during the COVID-19 pandemic influence your advocacy?

I was pretty isolated during [the beginning of] the pandemic. As an incoming freshman, I would say that my transition from middle school to high school wasn’t the greatest. I started high school half remote and half in-person, and it was pretty surreal to live in a world where I kind of stuck in my room most of the time.

I was pretty depressed, locked in my room, playing every video game you could possibly imagine. And sometimes I was even unable to eat dinner with my family. And I think it was certainly that experience, coupled with what I went through with my friend, that showed me that student mental health was a real concern that needed to be addressed.

My friend and I would FaceTime every night. She was depressed and wanted to seek help, but her parents wouldn’t let her at first. They eventually did, and she was actually diagnosed with bipolar disorder. Now she’s doing great; she’s thriving now.

My hypothesis is that—coming from a relatively high-achieving community with a lot of Asian Americans—the model minority myth prevented [her family] from seeking help. She’s a good student, and they didn’t want her to be perceived as weak.

How does your cultural identity as a Chinese American inform your work?

Oftentimes, culture and mental health are interconnected. When we approach mental health challenges in a certain community, I think it’s important to understand how the people in that community have grown up.

I try to highlight the diversity among Asian Americans because we are obviously not all the same. But a lot of us have encountered the model minority myth, even through subtle microaggressions in the hallways. I try to promote education among adults, including teachers, to break down some of the barriers that might keep students from seeking care.

How can schools more effectively address student mental health?

Mental health supports need to be comprehensive in order to effectively reach students. That means all students should be considered, supported, and protected. What works for one student may not help another. There is no one-size-fits-all approach.

What I admire about the Jed Foundation is [its] comprehensive approach to mental health promotion and suicide prevention. It recognizes that there are multiple areas of well-being—like learning about life skills, or having a counseling center—that can make a difference in someone’s life.

Ultimately, I think schools need to listen to the students themselves.

How did you advocate for student mental health in your school district?

The main initiative I started is called SchoolSight. In 2021, I realized the stress students faced at Scarsdale High School needed to be addressed. I attended a conference with Congressman Jamal Bowman where I essentially crafted a proposal to implement universal school-based wellness centers in Westchester County, which eventually blossomed into a countywide initiative.

The response was overwhelmingly enthusiastic. I began creating blueprints for introducing these [centers] in schools—universal wellness spaces for all students—starting with a pilot in my high school. So far, I’ve secured over $125,000 in grant funding to develop these spaces. They include things like de-stress zones with beanbags and yoga balls, board games, and places to study privately. Eventually, I’d like to see this scaled up to other districts.

What do you want educators to know about student mental health?

If we genuinely want to make a difference, we must not only allow but actively encourage young people to speak up. We must create environments where young people feel safe to express their thoughts, struggles, and ideas and treat them as equal partners. It fosters a sense of ownership and empowerment among the youth when they see their ideas and feedback being taken seriously.

I think school administrators, policymakers, community leaders must not only try to create platforms for youth to express their views, but they need to actually use that input in decision-making. Co-creation and agency are essential for young people to feel supported.

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The ‘Hidden Curriculum’ of Mental Health in Higher Education

• Posted April 1, 2024
• By Ryan Nagelhout
• Career and Lifelong Learning
• Counseling and Mental Health
• Higher Education Leadership
• Student Achievement and Outcomes

As mental health remains a crucial and evolving aspect of teaching students across all levels of education, Professional Education at HGSE has developed programming to help educators evaluate the institutional supports and programs behind caring for student mental health.

One of those programs, Mental Health in Higher Education: A Theory-to-Practice Approach for Student Well-Being , aims to confront the complex challenge managing student mental health presents in higher education. Led by Lecturer Alexis Redding , the four-week virtual institute features a theory-grounded approach to mental health topics in an effort to provide educators clarity around the wide variety of mental health challenges seen in student populations.

“One of the principles of our program is that there is no one-size-fits-all solution when it comes to the college mental health crisis,” says Redding, faculty co-chair of HGSE’s higher education concentration. “Instead, we will give our participants the opportunity to learn from experts in the field who each offer a set of key questions to consider as they craft a tailored solution to meet the need at their home institution.”

Redding explained one of the goals of the curriculum is to bring “a new approach to thinking about student well-being” by using experts across a variety of educational disciplines. Rather than present a uniform set of solutions, the programming offers “a set of key questions to consider” that will help educators find solutions that match their own culture, existing programming, and resources available.

The program features a long list of education experts, including HGSE faculty such as Senior Lecturer Richard Weissbourd , director of Making Caring Common, and Emily Weinstein , executive director and co-founder of the Center for Digital Thriving. Other guests providing insight for the program include the Jed Foundation Chief Medical Officer Laura Erickson-Schroth, faculty director of Boston University’s Newbury Center Anthony Jack and Ball State professor and author Amanda Latz.

“When you look at our faculty, every person has an entirely different vantage point on student mental health and will help us consider a different aspect of the student journey,” Redding says. “We will follow the arc of what students experience from before they even get to college through the job search and graduation. Along the way, we will think critically about the issue of belonging on campus, basic needs security, and students who have been traditionally underserved.”

The vast perspectives considered, and mental health factors explored, allow participants to go beyond the numbers and data to gain new insights and avoid the “hidden curriculum” — assumptions of common knowledge about mental health that can create barriers between educators and student needs.

“This approach will allow them to create solutions that fit their institutional culture, existing programming, and the availability of resources,” Redding said. “Every participant will leave the program with a concrete set of questions to ask related to each of our topics, resources to use, and models of practice that they can consider for inspiration.”

Registration for Mental Health in Higher Education closes on April 10.

The latest research, perspectives, and highlights from the Harvard Graduate School of Education

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How Exercise Strengthens Your Brain

Physical activity improves cognitive and mental health in all sorts of ways. Here’s why, and how to reap the benefits.

By Dana G. Smith

Growing up in the Netherlands, Henriette van Praag had always been active, playing sports and riding her bike to school every day. Then, in the late-1990s, while working as a staff scientist at the Salk Institute for Biological Studies in San Diego, she discovered that exercise can spur the growth of new brain cells in mature mice. After that, her approach to exercise changed.

“I started to take it more seriously,” said Dr. van Praag, now an associate professor of biomedical science at Florida Atlantic University. Today, that involves doing CrossFit and running five or six miles several days a week.

Whether exercise can cause new neurons to grow in adult humans — a feat previously thought impossible, and a tantalizing prospect to treat neurodegenerative diseases — is still up for debate . But even if it’s not possible, physical activity is excellent for your brain, improving mood and cognition through “a plethora” of cellular changes, Dr. van Praag said.

What are some of the benefits, specifically?

Exercise offers short-term boosts in cognition. Studies show that immediately after a bout of physical activity, people perform better on tests of working memory and other executive functions . This may be in part because movement increases the release of neurotransmitters in the brain, most notably epinephrine and norepinephrine.

“These kinds of molecules are needed for paying attention to information,” said Marc Roig, an associate professor in the School of Physical and Occupational Therapy at McGill University. Attention is essential for working memory and executive functioning, he added.

The neurotransmitters dopamine and serotonin are also released with exercise, which is thought to be a main reason people often feel so good after going for a run or a long bike ride.

The brain benefits really start to emerge, though, when we work out consistently over time. Studies show that people who work out several times a week have higher cognitive test scores, on average, than people who are more sedentary. Other research has found that a person’s cognition tends to improve after participating in a new aerobic exercise program for several months.

Dr. Roig added the caveat that the effects on cognition aren’t huge, and not everyone improves to the same degree. “You cannot acquire a super memory just because you exercised,” he said.

Physical activity also benefits mood . People who work out regularly report having better mental health than people who are sedentary. And exercise programs can be effective at treating people’s depression, leading some psychiatrists and therapists to prescribe physical activity. The Centers for Disease Control and Prevention’s recommendation of 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week is a good benchmark.

Perhaps most remarkable, exercise offers protection against neurodegenerative diseases. “Physical activity is one of the health behaviors that’s shown to be the most beneficial for cognitive function and reducing risk of Alzheimer’s and dementia,” said Michelle Voss, an associate professor of psychological and brain sciences at the University of Iowa.

How does exercise do all that?

It starts with the muscles. When we work out, they release molecules that travel through the blood up to the brain. Some, like a hormone called irisin, have “neuroprotective” qualities and have been shown to be linked to the cognitive health benefits of exercise, said Christiane Wrann, an associate professor of medicine at Massachusetts General Hospital and Harvard Medical School who studies irisin . (Dr. Wrann is also a consultant for a pharmaceutical company, Aevum Therapeutics, hoping to harness irisin’s effects into a drug.)

Good blood flow is essential to obtain the benefits of physical activity. And conveniently, exercise improves circulation and stimulates the growth of new blood vessels in the brain. “It’s not just that there’s increased blood flow,” Dr. Voss said. “It’s that there’s a greater chance, then, for signaling molecules that are coming from the muscle to get delivered to the brain.”

Once these signals are in the brain, other chemicals are released locally. The star of the show is a hormone called brain-derived neurotrophic factor, or B.D.N.F., that is essential for neuron health and creating new connections — called synapses — between neurons. “It’s like a fertilizer for brain cells to recover from damage,” Dr. Voss said. “And also for synapses on nerve cells to connect with each other and sustain those connections.”

A greater number of blood vessels and connections between neurons can actually increase the size of different brain areas. This effect is especially noticeable in older adults because it can offset the loss of brain volume that happens with age. The hippocampus, an area important for memory and mood, is particularly affected. “We know that it shrinks with age,” Dr. Roig said. “And we know that if we exercise regularly, we can prevent this decline.”

Exercise’s effect on the hippocampus may be one way it helps protect against Alzheimer’s disease, which is associated with significant changes to that part of the brain. The same goes for depression; the hippocampus is smaller in people who are depressed, and effective treatments for depression , including medications and exercise, increase the size of the region.

What kind of exercise is best for your brain?

The experts emphasized that any exercise is good, and the type of activity doesn’t seem to matter, though most of the research has involved aerobic exercise. But, they added, higher-intensity workouts do appear to confer a bigger benefit for the brain.

Improving your overall cardiovascular fitness level also appears to be key. “It’s dose-dependent,” Dr. Wrann said. “The more you can improve your cardiorespiratory fitness, the better the benefits are.”

Like Dr. van Praag, Dr. Voss has incorporated her research into her life, making a concerted effort to engage in higher intensity exercise. For example, on busy days when she can’t fit in a full workout, she’ll seek out hills to bike up on her commute to work. “Even if it’s a little,” she said, “it’s still better than nothing.”

Dana G. Smith is a Times reporter covering personal health, particularly aging and brain health. More about Dana G. Smith

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SUNY funding to boost mental health services at UB

campus news

UB will use most of its new state funding to hire seven counselors who will be embedded within the academic units. Photo: Onion Studio

Published April 10, 2024

UB is expanding mental health support for students, which includes the hiring of several new “embedded” counselors and broadening virtual or teletherapy services.  

Gov. Kathy Hochul recently announced new state funding for mental health support across SUNY campuses, including $1 million at UB.

“College can be a stressful and overwhelming time and this funding will expand mental health services on college campuses so students can focus on just being students,” the governor said in a statement.

UB will use the bulk of its funding, which is recurring, to hire seven counselors. Each will be embedded within one of seven academic units: the schools of Management, Social Work, Nursing, Public Health and Health Professions, and Architecture and Planning; the Graduate School of Education; and the College of Arts and Sciences.

“Student health and wellness is a significant priority at the University at Buffalo,” says Brian Hamluk, vice president for student life. “Prioritizing embedded counselors and other mental health-related services underscores our continued commitment to the well-being of our students, ensuring they have the resources and support they need to thrive both academically and personally here at UB.”

The seven new hires will start over the summer, bringing the total number of counselors on campus to 31, says Sharon Mitchell, senior director of student wellness and director of counseling services.

“The biggest thing is the accessibility,” Mitchell says of embedded counselors. “It’s just more convenient if you don’t have to add travel time to get to and from your appointment.

“Also, it reduces stigma because it normalizes seeking help,” Mitchell says. “There’s an academic adviser in the building. There’s a success coach in the building. Now, there’s a mental health counselor in the building. These are all resources that could be of help to students.”

The Embedded Counselor Program, which recently won an award at the national conference of student affairs administrators, started at UB in 2017 with an embedded counselor in athletics. Since then, the program has added an embedded counselor in the Jacobs School of Medicine and Biomedical Sciences; the School of Law, Dental Medicine, Engineering and Applied Sciences, and most recently, Pharmacy and Pharmaceutical Sciences.

Now, with these new hirings, a counselor will be embedded within each academic unit.

“They primarily provide individual counseling,” Mitchell says. “However, we also do outreach.

“For example,” she says, “if the medical school has exams, maybe we offer an educational workshop on managing stress. What’s nice is that we can tailor the programming specifically for students of a particular academic community.”

During the five-year period prior to the pandemic, Counseling Services saw a 43% increase in the number of students seeking mental health services and a 29% increase in the number of attended counseling sessions.

Since the COVID-19 pandemic, students have requested more support on campus for their mental health.

To make an appointment with Counseling Services, students can call 716-645-2720.

In addition to the seven new counselors, the new funding will pay for:

• Expanded teletherapy services . Counseling Services will contract with a professionally licensed vendor to provide services online or over the phone. This makes counseling more accessible and convenient for students who need services outside regular business hours.

“Even though we will have more counselors we are only open until 7 p.m. two nights a week,” Mitchell says. “The teletherapy services will allow us to provide services for students whose schedules just can’t fit into that or who might do a round of treatment with us but need additional care.”

• A financial well-being program coordinator . UB students have reported that finances are among their biggest stressors and a primary factor in their academic success and retention. A financial wellness coordinator can help them with financial literacy and developing a financial plan, while guiding them toward available resources.
• A sexual and reproductive health nurse educator . Students have requested more support regarding their reproductive health, contraception and sexually transmitted infections. This position would provide students with both clinical and educational services.
• Four graduate assistants. The four new positions will increase capacity for both clinical and educational programming.
• Trauma, illness and grief training . This training, open to staff and faculty, would help grow the emotional support of the campus beyond what mental health counselors can provide during the aftermath of a traumatic experience.

School behavioral-health provider hopes to help; DelTech launches new path: Education roundup

With most of spring break out of the way, it's time to get back to work.

Delaware students focused on health care know as much, preparing now for a national leadership conference. And Delaware Technical Community College is focused on the same industry, particularly nursing a new career pathway for allied health students, starting in a local high school.

Additionally, as educators continue to battle behavior and mental wellness challenges post-pandemic, one nonprofit provider of behavioral health care announced late last month it was awarded a contract with Delaware schools. It looks to offer education counseling supports.

There's more where that came from. In this weekly roundup, we'll catch you up on these and other education updates you may have missed.

[Did we miss another good education story?  Tell me about it:  [email protected] . ]

New behavioral-health provider hopes to be at Delaware educators' fingertips

One of the nation’s large nonprofit providers in behavioral health care announced late last month it was awarded a contract with Delaware's Department of Education. Now, Devereux Advanced Behavioral Health said it's set to provide education counseling services across 19 school districts, 23 charter schools and early childhood/adult education programs.

The outfit is looking to grow its network in the First State, serve schools and get the word out to educators.

"Let's sit down and have a conversation. We do offer a comprehensive array of services, but they may not be everything that your district needs," said Jackie Auris, VP of educational services with Devereux. "So it's really just asking for the most precious gift they could give us — which is time."

Auris said service areas seeing the most growth nationally have been school-based mental health specialists, alongside support with school anxiety and refusal, as some nearly 6,500 employees work in programs across the country. Delaware has been no stranger to struggles with student mental wellness, as well as behavior challenges .

According to a press release from the organization, services can range from:

• School support consulting: Often focuses on creating and improving programs for students with academic, social-emotional or behavioral challenges.
• Parent, student and community consulting services/resources: Materials, activities, strategies and trainings to promote social-emotional development.
• Professional development (in-person, virtual or hybrid support)
• Research and data analytics
• Curriculum consulting

"The number one, most important thing that school systems can do is to build a culture within a school system that has the ability to serve the most diverse group of students needs," Auris said. "Creating universal supports in a school system that are really informed by trauma-informed care."

Educators were encouraged to reach out to Auris and the team via email — [email protected] and [email protected] — for more information or questions.

Students post-COVID: Teachers are battling poor student behavior. Delaware lawmakers strain for answers

New Castle County leader honored with Delaware education award

New Castle County Councilman Jea P. Street was just honored with the John H. Taylor, Jr. Education Leadership Award, as announced by the state chamber of commerce last week — for "his commitment, leadership, guidance and contributions to the education system in Delaware."

A product of Wilmington High School, the University of Delaware and much more, Street was honored as having dedicated his career to striving for educational equity and community development.

“Jea Street is an icon among Delaware’s education, community and government leaders, and his north star has been to provide equal access to safe and high-quality education opportunities for students who were disadvantaged,” said Rick Deadwyler, a regional director at Corteva Agriscience.

Out of all Street’s leadership positions, his achievements, his awards — it has been helping children in his own community that has meant the most to him, writes Delaware State Chamber of Commerce in its announcement.

“All of them didn’t listen. All of them didn’t go the right way. But I love them, and they love me," Street said in a statement. His work will be honored on April 16, at the Navigating Delaware Pathways: An Education Workforce Development Summit.

Aspiring Delaware health care workers headed to nationals

With state awards already in hand, several aspiring health care workers are headed to represent the First State in a national leadership conference this summer.

Late last month, more than 1,000 middle and high school students participated in the 13th annual HOSA State Leadership Conference at Wilmington University. Members who earned a medallion , per DDOE press release, qualified for the International Leadership Conference in Houston, Texas, this June.

Delaware HOSA is a "Career and Technical Student Organization," according to DDOE, dedicated to students interested in health care careers. Membership reaches around 1,300.

A list of awardees can be found online .

Student aid delays: Delaware students can find support amid FAFSA blunders, continued delays

Delaware Tech launches nursing pathway program at William Penn High

Delaware Technical Community College was charged with meeting community needs through programs that address "secondary education, job readiness and workforce development," as it earned a Bank of America Neighborhood Builders Award.

Now, a portion of that funding will look to bolster a pipeline of allied health and nursing students.

That's through a new patient-care technician and nursing pathway program at William Penn High School, DelTech announced at a launch this week. A pilot program will provide up to 15 William Penn High School sophomores the opportunity to earn 12 college credits before they receive their high school diploma, the college explained in a press release.

Upon successful completion and graduation, students will be prepared to enter competitive academic programs in health care. They can also earn workforce credentials, allowing for jobs in the industry as they finish degrees.

DelTech campuses: Delaware Tech catches up on lost time with renovations aimed to support a future workforce

Georgetown Middle School gets a new greenhouse thanks to some help

According to a district spokesperson: "Georgetown Middle School would like to thank Contractors For A Cause and Morning Star Construction for their time, knowledge and willingness to assemble a greenhouse for Ms. Kristina Lowe's agricultural science course."

In late October 2023, teacher George Schwendtner contacted Nick Kypreos hoping for help building something. Quickly, Kypreos connected the middle school educator with Ted Stephens of Morning Star Construction, who heard him out on erecting a new greenhouse. Then, the Morning Star team was able to get it completed within three months — sometimes using their personal time on the weekend to continue the build when weather permitted, the district said.

Now, with final panels installed late last month, it looks like the greenhouse will be functional by the end of the school year. Lowe and Schwendtner told their district they couldn't be more thankful for all the help.

Got a story? Kelly Powers covers race, culture and equity for Delaware Online/The News Journal and USA TODAY Network Northeast, with a focus on education. Contact her at [email protected] or (231) 622-2191, and follow her on X @kpowers01 .

Online Psychiatric-Mental Health Nurse Practitioner Program

Designed for aspiring nurse practitioners who want to make a difference, the online master of science in nursing psychiatric-mental health nurse practitioner (pmhnp) program offers a yale education wherever you are..

Answer the call: Become a Psychiatric-Mental Health Nurse Practitioner.

150 million people in the United States live in communities facing mental health professional shortages. Rural and urban communities alike feel the acute need for mental health care. Psychiatric mental health nurse practitioners can meet that need.  Yale School of Nursing empowers registered nurses with advanced practice nursing experience and training to best serve their communities. Through the online PMHNP program, students graduate ready to provide care for individuals with complex psychiatric needs.

Choose to earn a degree from one of the country's top ranked psychiatric-mental health nursing programs at one of the world's most elite universities. The power of a Yale degree will unlock doors throughout your career and help launch your practice as a psychiatric nurse practitioner. 

Nurse practitioners are now the top recruited providers in the entire health care sector. The online PMHNP program offers a specialized course of study for nurses who want to advance their career with a Yale education. The board certification passage rate for Yale PMHNP graduates is 100%.

Projected employment growth of nurse practitioners from 2022-2032

(U.S. Bureau of Labor Statistics, 2022)

Median total income for full-time PMHNP Nurse Practitioners in the US

Ranked psychiatric nurse practitioner program in the U.S.

(U.S. News & World Report, 2023-2024)

WHO IS ELIGIBLE?

Applicants to the online Master of Science in Nursing, Psychiatric-Mental Health Nurse Practitioner program must have a Bachelor’s degree from an accredited institution, graduation from a school of nursing approved by the licensing board of the state in which it is located, and active Registered Nurse (RN) licensure. The online PMHNP program is currently not being offered to students residing in New York, Tennessee, or foreign countries.

HOW DO I APPLY?

All applicants to the online Master of Science in Nursing, Psychiatric-Mental Health Nurse Practitioner must submit an application via NursingCAS, the centralized application service for nursing schools and programs. You'll need to submit an application, official transcripts from all institutions you've attended, a personal statement, resume/CV, and 3 letters of recommendation. For a complete list of requirements and deadlines, please see our How to Apply page.

HOW MUCH DOES IT COST?

Tuition for the online Master of Science in Nursing Psychiatric-Mental Health Nurse Practitioner specialty is currently $2,001 per credit hour. For a comprehensive breakdown, visit the tuition page .

APPLY FOR FALL 2024 ADMISSION BY MAY 24

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More mental health support in schools makes sense—but some children may fall through gaps

by Jo Ellins, The Conversation

Schools and colleges have a crucial role to play in supporting children's mental health. They are places where young people's mental health difficulties are identified and help is provided, and they can promote all pupils' emotional well-being.

Most children spend more time in school than anywhere else other than home, and parents who are concerned about their child's mental health turn to teachers and school staff for advice more than any other professionals. Investing more in schools-based mental health services makes good sense.

This is something the government has been doing in England through the creation of mental health support teams. These are teams of mental health practitioners who work with clusters of schools and colleges. Most are based within the NHS, although some are provided by voluntary sector organizations or local councils.

The first 58 mental health support teams went live in 2020, working in and with more than 1,000 schools and colleges. By 2025, more than 600 teams will have been created, serving around half the schools in England.

I led an early national evaluation of the first 58 teams . This study, published in Health and Social Care Delivery Research , looked at how they were set up, what support they were providing and how they were progressing. Together with colleagues, I found that increasing mental health support in schools was well received, but that some young people still faced difficulties getting appropriate help.

Mental health support teams are intended to provide support to young people with "mild to moderate" mental health difficulties, such as anxiety and low mood. Their role also includes working with school staff to develop a positive culture focused on well-being, and giving schools and parents advice to help them access other types of support. This includes specialist mental health services for young people with more serious or complex problems .

Much of the day-to-day work with young people and schools is delivered by education mental health practitioners . This is a new role in the mental health workforce, created specifically for mental health support teams.

Education mental health practitioners receive one year's training with a focus on developing the skills to deliver cognitive behavioral therapy (CBT) to young people, either one-to-one or in small groups .

We heard from staff in the teams, schools and colleges, and those working in other local services supporting children's mental health. We also spoke to young people at schools with mental health support teams.

Our study confirmed the importance of investing in schools-based mental health. School staff told us how valuable it was having ready access to advice when they were concerned about a pupil's emotional well-being, and that they felt more knowledgeable and confident talking to young people about their mental health.

Having access to a team made it easier for some young people to get support at the right time. Timely access is crucial for many reasons, not least because more than half of young people experience a deterioration in their mental health while they are waiting for support.

Through the gaps

However, we also found that not all young people were benefiting from this investment. We heard that some young people were at risk of falling between gaps in provision. They had mental health problems that were neither "mild to moderate," nor were they judged serious or urgent enough to meet the threshold for specialist NHS help.

There is evidence that thresholds for specialist NHS help are rising in response to growing demand, and so increasing numbers of young people may be falling into this gap between services.

Our early study was not designed to assess the effectiveness of the support that the teams were providing, but people we spoke to were keen to share their views about this. There were concerns from schools and colleges that the teams usually offered only one type of support, and that this was not suitable or beneficial for all young people.

The teams' early experiences suggested that the CBT approaches that education mental health practitioners were trained to deliver didn't work well for several groups. These included young people who had special education needs, or were neurodiverse, or whose mental health problems were related to traumatic circumstances or life events, such as poverty or domestic violence.

Wider research shows that CBT can be effective for these groups, but only when it is carefully tailored to their particular needs and circumstances, or is delivered in trauma-informed ways .

These findings offer valuable information about how well mental health support teams are working, but our study only looked at the first wave of teams. We don't know if these experiences are the same for the teams that were set up later.

I am now co-leading a second, much larger, study of almost 400 mental health support teams, assessing their impact and cost-effectiveness. One of the main aims of our current study is to assess the impact of this support on young people 's mental health outcomes. As the study progresses, we will know more about how well this support works and who it works for.

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