The Other 60 Percent

A new tool in schools’ mental health tool box

Using Crayola markers set on each round table, small groups of adults from the Greeley area — school outreach workers, Boys and Girls Club staff and foster parents — created poster-sized pictures of what mental health problems look like. Glum stick figures sat under rain clouds, a face contorted from happy to sad and a placid face showed no outward signs of distress.

The pictures were just one of several hands-on activities sprinkled throughout a recent day-long training that aims to teach lay-people the signs of mental health or substance abuse problems in youth, and give them action steps to follow when they spot trouble.

Called Youth Mental Health First Aid, the training originated in Australia and was unveiled in Colorado last year. There is also an adult version of the training, introduced here in 2008, called Mental Health First Aid or MHFA.

Both are gaining momentum in what mental health advocates say is a welcome development in a state saddled with one of the highest suicide rates in the country and more than its fair share of school tragedies, including a deadly shooting at Centennial’s Arapahoe High School in December and a self-immolation at Westminster’s Standley Lake High School in January.

Olga Gonzalez, a community outreach worker who participated in the recent Greeley training, said she regularly fields questions from parents who are worried about their children but don’ t know where to turn. She recounted how one family she’d worked with discovered their son had started using drugs. Another learned that their son had stolen credit card information from a customer while manning the cash register at the family’s store.

“He has money in a savings account, you know. He just did it,” she said. “I wasn’t sure what kind of support he needs.”

Youth Mental Health First Aid aims to answer such questions for people who are not mental health professionals but who work closely with young people and their families. The target audience includes lay-people like teachers, coaches, guidance counselors, school nurses and even bus drivers.

Advocates for MHFA say Colorado now has one of the largest contingents of certified instructors—around 230 so far. In addition, it’s among only a handful of states to dedicate public funds to the trainings, with $750,000 appropriated for the program next year.

“We have been at the forefront of this since the beginning,” said Brian Turner, director of Mental Health First Aid Colorado at the Colorado Behavioral Healthcare Council.

Preparing first responders

The concept behind both versions of MHFA, much like medical first-aid, is to equip first responders with the know-how to address emerging mental health or addiction problems. The youth version is also meant to help distinguish between true mental health issues and the normal mood swings and behavior changes that characterize the life of a teenager.

But the training is hardly a technical lecture. It’s participant-friendly approach is evident in the hands-on activities, the video clips, the anecdote-peppered instruction and even the pile of bite-sized candy on each table. Originally, conceived as a two-day training, it has since changed to a one-day format.

“I think we try to make it accessible in a very non-threatening way,” said Pamela Collins Vaughn, one of the instructors at the Greeley training and quality assurance program director at North Range Behavioral Health.

The five action steps in Youth Mental Health First Aid.
The five action steps in Youth Mental Health First Aid.

Gonzalez, an outreach worker with Community Care Corps, said she learned about the training at a resource fair that she helped coordinate. Her work with families at two local middle schools, as well as in surrounding neighborhoods, made her want to refresh her knowledge on mental health issues.

While Gonzalez and other MHFA participants are certainly not charged with providing treatment, they do receive a customized local resource guide to help them connect youth with professional help when necessary.

In fact, encouraging youth to seek professional help is one of five action steps—condensed in the acronym ALGEE–outlined in the training. The other four include “Assess for suicide/self harm,” “Listen non-judgmentally,” “Give assurance/information,” and “Encourage self-help/other support.”

Turner said having concrete action steps is important because “there’s a big difference between learning about mental health and substance abuse problems and being able to do something about it.”

During the Greeley training, participants were asked to come up with gestures that would convey each of the five action steps. Soon, in an effort to commit the steps to memory, Vaughn and co-trainer Noelle Hause were leading the group in miming actions like non-judgmental head-nodding and reassuring arm-patting.

Reaching out to schools

While Turner said Youth Mental Health First Aid is not yet widely offered by school districts, there is growing interest. Among the districts that have offered it for at least some staff are Douglas County, Aurora, Thompson, and Weld County District 6.

Barb Becker, division director for community programs at the Arapahoe/Douglas Mental Health Network, said the one-day format make it a very doable training for educators.

One of the pictures made by participants at a recent Youth Mental Health First Aid training.
One of the pictures made by participants at a recent Youth Mental Health First Aid training.

“It just gives a really good overview,” she said, adding, “It takes away some of the stigma associated with mental health.”

While grants to offer Youth Mental Health First Aid are sometimes available and some mental health centers offer it for free, the price of the training can be a barrier for districts. Costs typically run at least $25 per person and can max out at $50 depending on facility and food costs.

While the new $750,000 in state funding will help with expansion, Turner said advocates are also investigating whether Medicaid reimbursements received by schools can help pay for the trainings. Currently, those reimbursements are used for all kinds of school health and wellness efforts, from paying school nurses to buying P.E. equipment.

If Youth Mental Health First Aid is widely adopted by schools, it will join a growing number of tools used to detect and combat mental health problems in students. Many schools already use suicide prevention curriculums, some are adding instruction on social emotional skills and a few conduct universal mental health screenings among students.

In addition, many schools regularly convene meetings to discuss and create plans for students who are showing signs of mental health or behavioral problem. Others publicize programs like Safe2Tell that allow students, parents or staff to anonymously report bullying or threats of school violence or suicide.

While Becker noted that middle-aged white men, not teens are actually at the highest risk for suicide in Colorado, she said it is still a problem among young people.

In 2010, Colorado had the seventh-highest  youth suicide rate among states and Washington, DC, with 16.7 deaths by suicide per 100,000 people in the 15-24 age group, according to data from the Centers for Disease Control and Prevention. In general, Colorado’s suicide rates are higher in rural and mountain communities than in urban areas. They are also higher among males than females.

Becker said there are a variety of reasons, including biological changes, peer conflicts and dating strife, that adolescents experience depression, which is a leading cause of suicide.

“It’s a hard time in life,” she said.

Ultimately, Turner hopes both versions of Mental Health First Aid will be widely available in all parts of Colorado. They won’t prevent all violent incidents, he said, but they might help. They can also aid in the healing process for communities that have suffered through fires, floods, droughts and other disasters.

aftermath

‘Emotionally exhausted’ yet inspired by students: A Memphis educator and gun-control advocate reacts to Parkland

Kat McRitchie, at right, appeared with mothers who lost children to gun violence at a rally outside the National Civil Rights Museum. Photo courtesy Kat McRitchie.

By the time America realized the scope of the school shooting that killed 17 people last week in Parkland, Florida, Kat McRitchie was already weary of responding to gun violence.

A Memphis educator and gun-control advocate, McRitchie had spent the evening before at a candlelight vigil for two Memphis teens gunned down near their high school the previous Friday. She’d spent the weekend reeling from that killing.

And as part of a group called Moms Demand Action for Gun Sense in America, she’d spent countless hours lobbying for policies that could stem the shootings that claim dozens of young people in her city every year.

“Honestly, my emotional reaction to Parkland was, ‘Ugh, this is terrible. Another school shooting,’ but I was emotionally exhausted by the weekend,” said McRitchie. “It wasn’t until Friday that I let myself listen to the video that the student in the closet had taken and let myself feel a response to that.”

The response, when it came, was one of familiarity. McRitchie, the daughter of a Memphis trauma surgeon who treated many gunshot victims, helps train teachers through Memphis Teacher Residency after years of working in city classrooms of her own.

“I can imagine what it feels like to be a student in that classroom,” she said. “I can imagine what it feels like to be a teacher in that classroom.”

Now, McRitchie is looking for ways to help Memphis join a national response to the Parkland shooting that appears to be gaining momentum, rather than dropping out of the headlines. We talked to her about those efforts, how her advocacy work intersects with her teacher training, the complexity of race in the gun-control debate, and more.

How teaching opened her eyes to the reality of gun violence in Memphis: “I never had a student who was shot when I had them, but I saw them walk through the deaths of their family and friends. There was this culture of what to do when someone you know gets shot. Here are the people you call. Here’s how you decide what picture goes on the T-shirt. Kids now choose a hashtag. How to pick the funeral colors. There was a process for when a teenager dies in the way that I would have a process for getting ready for prom. This was a big part of me understanding how gun violence is affecting my community.”

On the reawakened debate over whether teachers should carry guns: “Kids deserve for us to think more creatively than just increasing school security. I cannot think of a single public school teacher who thinks arming teachers is a good idea. I don’t know any teachers who would want to have a gun. I don’t know any teachers who think having a gun in this situation would make themselves or their students safer. All of them say the likelihood of an armed person entering their school for the purpose of a mass shooting is terrifying but extremely small. But how many times do teachers get their purses stolen in schools or drop their expensive calculators? If we have teachers with guns in schools, that just creates opportunities for accidents. Most school shootings now are things like that. More guns in schools will only mean more deaths in schools or more guns get stolen and end up on the street. Even the teachers who have a fear of mass shootings, if you ask them, all of the everyday things that can go wrong with guns in schools are scarier.”

On the outpouring after Parkland after seeing Memphis teens’ deaths go unnoticed nationally: “It can feel frustrating when we know that black children are way more likely to die than white children because of guns. But the thing that has surprised me a little bit is that of the survivors that I know in Memphis — who are predominantly women of color who have lost children to gun violence — I would not have been surprised if the response to the Parkland shooting was, ‘That’s sad, but we’ve been out here on the front lines.’ That is absolutely not the response.

“Every single survivor mom I know has posts about praying for Florida families, expressing grief and solidarity for Florida families. We recognize that gun violence affects people differently along race and class lines, just like education, but there’s just this very shared human experience in responding to the toll of gun violence. That’s one of the things that has been most moving in the last week: watching women respond with grief and not resentment.”

How her work as a teacher coach overlaps with gun violence advocacy: “Part of my work last week was to order coffee for teachers at the high school where the [Memphis] students were killed. Coffee and donuts in the teachers lounge seems a little silly, but Memphis Teacher Residency is all about ‘pursuing a vision of restored communities living with dignity and peace.’ Even going to the vigil for the kids last week, there were teachers there, and colleagues and community partners were there as citizens. One of my colleagues went to the funeral of the young man who was shot last week. When going to a funeral is part of our jobs as teachers — we shouldn’t tolerate that in this country.”

How Memphis Teacher Residency prepares teachers for violence in their communities: “We do have a counselor on staff. That’s one of the greatest services that MTR provides that our teachers and alumni are able to use. Lockdowns are fairly common — actual lockdowns — because of shootings in the area. I know he has walked teachers through, how does it feel going through your first lockdown, going through the death of students. We as coaches would like training about how to do that better when a school is touched by gun violence.”

On “red flag laws,” which would allow law enforcement to seize guns from people who haven’t actually broken any laws: “Moms Demand Action works really hard to promote common-sense gun policies. The thing that I’ve learned in this movement is that me complaining to my like-minded friends about something doesn’t change anything and just makes us angrier and doesn’t make us safer. But we all want our kids to grow up safe; we all want American schools to be safe places — we can actually agree about these things. By having solutions-minded conversations and pushing for evidence-based gun policy, we can reduce the number of Americans that die of gun violence.

One of the most common conversations that I had with teachers in the last week was, ‘Oh, I know who that kid would be.’ I could tell you from my own teaching experience that if something like that happened, it wouldn’t shock me. Teachers know kids. One option that would empower teachers with their specific knowledge is ‘red flag laws.’ We also know that they reduce suicide by guns.

“I would love for people to know that when the response is, ‘We knew that that person was dangerous,’ we can actually have more potential to stop mass shootings. This would be a great thing for teachers to know about and advocate for.”

What comes next: “Having kids leading the response to this particular moment is incredibly powerful. When kids are leading change, the sky’s the limit. Young people are more engaged and more creative than their elders. and I’m incredibly excited to follow the leadership of young people and to support them.

“And to listen to educators about how to respond to school shootings is imperative. Overwhelmingly, what educators are telling us is not what policymakers are telling us. And we should listen to educators.”

First Responder

Jeffco’s superintendent has some ideas about preventing school shootings — and none of them involve gun control or armed teachers

Jeffco superintendent Jason Glass at the Boys & Girls in Lakewood (Marissa Page, Chalkbeat).

Superintendent Jason Glass of the Jefferson County school district isn’t interested in talking about gun control in the wake of yet another deadly school shooting.

Home of Columbine High School, Jefferson County is no stranger to these tragedies or their aftermath, and Glass doesn’t think calls for restricting firearms will get any more traction this time than they have before. Nor is he interested in talking about arming teachers, a proposal he considers just as much of a political dead end.

“A solution is only a solution if we can actually enact it,” Glass wrote in a blog post published Monday. “We are not able to get either of these solutions passed into law so they have no impact.”

That doesn’t mean there’s nothing to talk about, he wrote. Glass lays out four ideas that he sees as more politically feasible and that might make a difference:

  • Put trained, armed law enforcement officials in every school
  • Increase funding and support for school mental health services
  • Create a federally funded center to study school safety and security
  • Change the layout of and access to school buildings to make them safer, much the way we’ve renovated airports, stadiums, and other public facilities

Glass describes these measures as “proactive, preventative, and reactive steps that would make a big impact in making our schools much safer than they are today.”

Some schools and districts already have an armed police presence on campus or offer mental health services, but Glass argues these efforts need more money, more support, and more cohesion.

“These solutions need to come from the federal level to create the scale and impact we really need,” he wrote. “Congress and the President need to act and now. … Flexibility and deference can be built into these solutions to accommodate differences across states and communities – but we have a national crisis on our hands and we have to start acting like it.”

Of course, even studying something, as Glass envisions this new center on school safety doing, can be political. Since 1996, the federal government, at the urging of the National Rifle Association, has placed tight restrictions on the ability of the Centers for Disease Control to study gun violence as a public health issue.

The blog post provoked a vigorous debate in the comments. Some called on Glass to join the national movement demanding more restrictions on firearms. This is not a time for “half measures,” one woman wrote.

Others said that turning schools into “fortresses” would work against their educational mission and questioned how well school resource officers could be trained to respond appropriately to students with special needs – or how fair the district-level threat assessment process is.

In the wake of another school shooting at Arapahoe High School in 2013, one largely forgotten outside the state, Colorado legislators passed a law that holds schools liable for missing warning signs in troubled students.

In an interview with Colorado Public Radio, Bill Woodward, a former police officer who trains schools in how to prevent violence, said more schools are doing threat assessments. But their success may require schools to take even more seriously the idea that their own students might be dangerous.

“I think the biggest barrier is the climate of the school, because I think sometimes schools are just thinking in terms of working with students, helping students out,” Woodward told CPR. “And sometimes when you’re looking at someone who’s made a threat, you have to change to the Secret Service model.”

Woodward said a more comprehensive solution may involve gun control. Schools can’t afford to wait, though.

“There is no silver bullet, speaking metaphorically, but I think gun law changes may well be needed,” he said. “I just think we have to do what we can do now, and we can do things now.”