Mental Health and Our Schools. Terri L. White, MSW Commissioner Oklahoma Department of Mental Health and Substance Abuse Services

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1 Mental Health and Our Schools Terri L. White, MSW Commissioner Oklahoma Department of Mental Health and Substance Abuse Services

2 Both mental illness and addiction are real medical conditions, just like diabetes, cardiovascular disease and heart disease. In terms of addiction, although initial substance use might be voluntary, drugs of abuse have been shown to alter gene expression and brain circuitry, which in turn affect human behavior. Once addiction develops, these brain changes interfere with an individual s ability to make voluntary decisions, leading to compulsive substance abuse, seeking and use. (Natl. Institute on Drug Abuse) 2

3 The brain scan on the left reflects normal activity; the scan on the right shows a person affected with schizophrenia. Source: PBS.org 3

4 4

5 In Oklahoma, mental disorders are the third leading cause of chronic disease behind only pulmonary conditions and hypertension and more prevalent than heart disease, diabetes, cancer and stroke. Oklahoma consistently ranks as having among the highest rates of mental illness when compared to all other states More than 245,000 Oklahomans above the age of 12 abuse or are dependent on alcohol or illicit drugs; and underage drinkers consume just over 20% of all alcohol sold in Oklahoma. Deaths due to suicide are increasing, jumping from 567 in 2009 to 618 in Oklahoma ranks 13 th nationally in terms of suicide rate. Between 1-3% of all Oklahomans are problem or compulsive gamblers and in need of intervention. 5

6 In 2010, Oklahoma had the 4 th -highest unintentional poisoning death rate in the nation (17.9 deaths per 100,000 population). Oklahoma has the 9 th -highest rate of deaths involving prescription painkillers in the nation. (CDC, 2011) Of the nearly 3,200 unintentional poisoning deaths in Oklahoma, from , 81% involved at least one prescription drug. The number of fatal drug overdoses in Oklahoma has more than doubled over the past 10 years, climbing to 739 in The most common prescription drugs involved in overdose deaths were hydrocodone, oxycodone, and alprazolam. In Oklahoma, more overdose deaths involved hydrocodone or oxycodone than all illegal drugs and alcohol combined. 6

7 As with adults, mental health is a key component in a child s healthy development. Kids need to be healthy in order to learn, grow and lead productive lives. As parents, advocates and policy makers, we must be the ones to invest in our children to ensure the future prosperity of our state. Our children are our future, and safeguarding their physical and mental health should be at the forefront of state agency objectives. Even back in 1999, Former Surgeon General Dr. David Satcher said children s mental health care must become a standard part of general health care, as mental health and healthy social/emotional development are integral and inseparable parts of overall health and affect virtually every outcome of a person s life. 7

8 Mental, emotional, and behavioral (MEB) disorders are a major health threat and are as commonplace today among young people as a fractured limb not inevitable, but not at all unusual. One in five young people have one or more MEB disorders at any given time. Half of all mental illnesses occur by age 14 and three-fourths by age 24. The median age of onset for anxiety disorders and/or impulse-control disorders is age 11. Clear windows of opportunity are available to prevent MEB disorders and related problems before they occur. Risk factors are well established, preventive interventions are available, and the first symptoms typically precede a disorder by two to four years. 8

9 Nearly 40% of Oklahoma high school students in grades 9-12 are current drinkers. 74% of 12 th graders have used alcohol. 19% of Oklahoma youth report that they had their first drink of alcohol, other than a few sips, before age 13. Children who drink before age 15 are five times more likely to have problems with alcohol as adults than those who wait until age 21. Of those Oklahomans who sought ODMHSAS treatment services for alcohol addiction in FY13, nearly 85% said they began drinking before their 18 th birthday. Prescription drug abuse is a rising problem among youth, as it is with Oklahomans of all ages. 9

10 A recent study from the University of Michigan reported that found that: One in 10 high school seniors reported consuming 10 or more drinks in a single bout over the previous two weeks. One in 20 (5.6%) consumed 15 or more drinks in a row over the same time period. One in five reported consuming 5 or more alcoholic drinks in a row. Boys (25%) were more likely than girls (15%) to binge drink. Binge drinking was far more common among white students. High school seniors with college-educated parents were more likely to binge drink; but students who did not have college-educated parents were more likely to engage in extreme binge drinking. High school seniors who drank 15 or more drinks at a time were also more likely than those who did not binge drink to use other drugs. Parents are the #1 influence on their teen s decisions about alcohol. On a positive note, in Oklahoma, binge drinking among all high school students fell from 34% in 2003 to 23% in 2011, a significant decrease. However, we must do more to keep children from consuming alcohol in the first place. Why? 10

11 The Developing Brain Alcohol can cause alterations in the structure and function of the developing brain, which continues to mature into a person s mid 20s, and it may have consequences reaching far beyond adolescence. Alcohol impedes development of the prefrontal cortex, which can result in youth becoming more impulsive, having poor decision-making skills, poor judgment, and not being able to learn as well as others. 11

12 Risk factors such as victimization, bullying, academic failure, association with deviant peers, violence and substance use occur primarily in neighborhood and school settings. Much of youth exposure to violence occurs either at school or on the way to school, research indicates. Exposure to violence is associated with children s development of various mental health problems, particularly post-traumatic stress disorder, anxiety, depression, antisocial behavior, and substance use. A reciprocal relationship exists between academic achievement and mental health outcomes, in which mental health problems adversely affect academic achievement and poor academic achievement is related to the development of multiple problem behaviors. Students relationships with their peers and teachers and the social climate in the classroom have a powerful effect on their development of MEB problems. Programs promoting classroom and school procedures that encourage pro-social behavior, positive classroom management strategies, academic achievement, or increased positive bonding to school have important implications for children s healthy development. 12

13 In 2010, 618 Oklahomans died by suicide, up from 567 in Oklahoma ranks 13 th nationally in terms of suicide rate Suicide continues to be the most common manner of violent death in Oklahoma. Suicide rates among youth years of age remained stable. Yet, for this age group in Oklahoma, it remains the 2 nd leading cause of death. Suicide rates in rural counties were generally higher than rates in urban counties. The rate increased 10% in rural counties and 7% in urban counties from

14 How Can We Help Our Youth?

15 Strengthening families by targeting problems such as substance use or aggressive behavior; teaching effective parenting skills; improving communication; and helping families deal with disruptions (such as divorce) or adversities (such as parental mental illness or poverty). Strengthening individuals by building resilience and skills and improving cognitive processes and behaviors. Preventing specific disorders, such as anxiety or depression, by screening individuals at risk and offering cognitive training or other preventive interventions. Promoting mental health in schools by offering support to children encountering serious stresses; modifying the school environment to promote pro-social behavior; developing students' skills at decision making, self-awareness, and conducting relationships; and targeting violence, aggressive behavior, and substance use. Promoting mental health through health care and community programs by promoting and supporting pro-social behavior, teaching coping skills, and targeting modifiable lifestyle factors that can affect behavior and emotional health, such as sleep, diet, activity and physical fitness. 15

16 MHFA is an evidence-based training program that trains school personnel to recognize signs of mental illness and substance use within the student population so they can intervene early to prevent a crisis or act to de-escalate a crisis once one develops. Course participants gain the skills, resources and knowledge necessary to help an individual in crisis connect with appropriate professional, peer, social, and self-help care. ODMHSAS has started a pilot program that will make an eight-hour training available for K-12 teachers, administrators and staff at school districts across the state upon their request. The youth version of MHFA which isn t limited to public school systems also can help citizens identify mental health problems in young people, connect youth with care, and safely de-escalate crisis situations. The program, focusing on youth ages 12 to 25, provides an ideal forum to engage communities in discussing the signs and symptoms of mental illness, the prevalence of mental health disorders, the effectiveness of treatment and how to engage troubled young people in services. For more information, call Dane Libart at (405)

17 In FY14, the State of Oklahoma provided ODMHSAS with $500,000 for suicide prevention. These funds have been used to implement the Oklahoma State Suicide Prevention Strategic Plan. Goals of the plan are to: Increase the number of Mental Health Clinicians trained in assessing and managing suicide risk. Improve reporting and portrayals of suicidal behavior, mental illness, and substance abuse in entertainment and news media. Promote awareness that suicide is a public health problem and that it is preventable. Promote efforts to reduce access to lethal means and methods of self-harm. 17

18 ODMHSAS has trained nearly 8,000 suicide prevention gatekeepers using Garrett Lee Smith Memorial Act (federal) funds. These trained gatekeepers have identified 6,943 youth as at-risk for suicide. Of those youth identified as at-risk and referred to mental health services, 99.8% of those have received services. More than 130 clinicians have been trained in assessing and managing risk of suicide, with additional trainings planned. 18

19 School based suicide prevention efforts include: Columbia Teen Screen In-school depression and suicide screening provided by mental health professionals. Lifelines Prevention Program Comprehensive prevention programming, faculty/staff gatekeeper training, parent training, and student training in help-seeking behavior. T3 Time To Talk Promotion and awareness campaign using neon green apparel at large scale sporting and arts school events. 19

20 School-based screening can help prevent the development of psychological and behavioral problems, which interfere with school performance. The Institute of Medicine recommends universal screening procedures be targeted for the purpose of: Improving school success with struggling students Preventing bullying and student harassment Improving teacher and peer relationships Increasing school safety and security, or Learning to regulate and control behavior 20

21 AlcoholEdu is an evidence-based alcohol prevention program available to all Oklahoma high schools at no cost through a partnership between the ODMHSAS and the Oklahoma Department of Education. 19% of Oklahoma youth report that they had their first drink of alcohol, other than a few sips, before the age of 13. (YRBS, 2011) 74% of 12 th graders have used alcohol. (OPNA, 2010) AlcoholEdu has been shown to increase alcoholrelated knowledge, undermine acceptance of underage drinking, reduce underage drinking, and reduce riding with an intoxicated driver. 21

22 Enforcing Underage Drinking Laws (2M2L) Targeting communities throughout the state, this project aims to decrease underage drinking and related social problems, decrease youth access to alcohol, increase community-level support for environmental change, and increase youth-driven prevention activities. The project's comprehensive plan includes law enforcement training and technical assistance, community mobilization, strategic partnership development, youth leadership development, interagency collaboration, and media advocacy. This project is also known as 2 Much 2 Lose (2M2L) RBSS Training Responsible Beverage Service and Sales Training provides clerks, servers, and managers with the knowledge and skills to sell and serve alcoholic beverages safely, responsibly and legally. The goal of the training is to ensure that expectations, liabilities and legal responsibilities are communicated to all licensees and their employees. Training is offered free through Regional Prevention Coordinators. Social Host Law Also known as Cody s Law, this statewide law imposes fines or jail time for adults or minors who provide a location for kids under age 21 to drink alcohol. 22

23 Children s Mental Health: Systems of Care Systems of Care is the core of our children s behavioral health care program and impacts our most at-risk children and their families. It is a nationally recognized program that provides critical services and hope for the people it serves. SOC impacts children, ages 6-18 years, with serious emotional and behavioral problems at home, school and in the community; and, it has been proven as a model system with successful outcomes. What started out as a program with only a handful of sites now encompasses 58 of Oklahoma s 77 counties. 23

24 Oklahoma: A National Leader Oklahoma is the national leader in Systems of Care, and our program is used as a model for other states. It is a program that pulls local services under a single umbrella, greatly increasing efficiency and effectiveness for all service providers and has resulted in tremendous documented success. Significant achievements in a child s behavior when measuring outcomes have been reported. After just six months of SOC Wraparound Services, data confirms outstanding results: Out of Home Placements A documented 30% reduction Self-Harm Attempts A documented 39% reduction School Detentions A documented 53% reduction Arrests A documented 48% reduction This program absolutely is delivering a return on investment, and is federal money matched by state funding that has been leveraged by the department to meet a critical need. It is a program that has been championed by our participating partner agencies, and by our state leaders including the Governor. 24

25 Treatment Works The good news is this: TREATMENT WORKS! Mental illness and addiction can be diagnosed and effectively treated. In some instances they are preventable. The sooner a mental or addictive disorder is diagnosed and treated, the better the outcome is for all involved, just as is the case with diabetes, cancer or heart disease when diagnosed early. Success rates for heart disease treatments range from 41-52%. The treatment success rate for schizophrenia is 60%. More than 80% of people with depression can be treated successfully with medications, psychotherapy or both. Substance abuse treatment has similar positive outcomes if people can access appropriate treatment and follow-up care. 25

26 Treatment Works In FY13, ODMHSAS provided services to approximately 80,000 individuals. Nearly 64,000 received mental health services and 19,000 received substance abuse treatment services, with some overlap. ODMHSAS programs have been proven to help people: Reunite with their families Increase employment prospects and monthly income Stay out of jail/reduce involvement with the criminal justice system Reduce homelessness Break the cycle of addiction Achieve numerous other successful outcomes, such as obtaining higher educations, increasing productivity on the job, stopping tobacco use, etc. 26

27 In Conclusion To be successful, any discussion about increasing school safety must address the issue of mental health. As nearly half of all lifetime mental illnesses start by age 14, the importance of prevention and early intervention cannot be overstated. Just as we screen our young people for asthma and other physical illnesses, we also must screen them for such illnesses as depression, anxiety or other behavioral health issues. The sooner a mental or addictive disorder is diagnosed and treated, the better the outcome is for all involved, just as is the case with diabetes, cancer or heart disease when diagnosed early. The good news is that help and there is hope. Website: Facebook: 27

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