School Based Mental Health

I continue to consult to schools for mental health programs, although I have changed school districts. Naively, I anticipated fewer mental health problems in the new, more affluent,school district. On my first day at the high school I was warned: "Just because our kids live in nicer houses, don't be fooled. They have the same problems you saw in your previous job, especially drugs." They understated the case. During my first seven weeks I have seen more meltdowns, crises, suicide threats, and psychiatric hospitalizations than I saw in six months at the last school. Is it the recession? I don't know. A check at my ol,\d school revealed no more than the usual frequency of such incidents.

I see a large number of kids with panic disorders. It is a diagnosis I enjoy working with, using cognitive behavioral approaches and resilience techniques. The school counselors appear to be exceptionally caring and knowledgeable--more than willing to work with a clinical psychologist. One is particular has sent the largest proportion of referrals to me. I took exception, however, to how she was dealing with the fourteen year old with daily panic attacks related to her history of physical abuse at home and PTSD. She provided the girl with a meditation/relaxation tape, which was fine with me and consistent with what i was doing with her. I was not pleasd, however, when I saw the girl clutching a fluffy, soft, red satin pillow that the counselor uses to comfort stressed out and depressed teenagers. The girl does need nurturing, but from her mother. I did not not make a fuss over it but mentioned that I was trying to toughen up the girl while she was catering to her dependent needs. My resilience training was sandpaper in contrast to her satin The pillow looked and felt (yes, she asked me to squeeze it) like a gigantic breast. I kept my association to myself.

A mother of a very bright but underachiving sixteen yesr old insisted that her child, who had a questionable (to me) diagnosis of ADD also had "exexcutive functioning" disability. Executive functioning problems are associated with
ADD, although not mentioned in DSM-IV-TR. Without revealing details here, I have the following reservations. ADD is a sufficent diagnosis; we don't need a second. School psychs are using the BRIEF, a symptom checklst for parents and teachers is a group of behaviors seemingly reflecting poor impulse control, attention and memory deficits, poor planning abiilty, and distraction by irrlelevant stimuli. Behaviors such as failure to complete assignments, cutting classes, and underachievement meet all these requirements but can have a variety of other determinants. Furthermore labeling a behavior or symptom is not the same as explaining it. This has been called the "nominalistic fallacy." I don't doubt that executive function is real and is a forebrain activity but if it is there we need to demonstrate it by appropriate testing. In this case I did just that. The boy showed extremely high executive functioning by the best tests I could find. Moral--you can't judge a book by its cover.

I am seeing a fair number of kids on the autism spectrum as well as others with social anxieity and social skill deficits. Many of them ask for help in making friends. I am treating these teens in dyads or small groups for socialization in a very structured way dealing with communication, relationships, social mores and niceties. Role playing is a poweful technique. It is an interesting and useful endeavor. One boy who scares people by his angry facial expression is learning to smile with the use of a mirror.

Mental health is sorely needed in schools, especially the high school and middle school. It is still relatively rare. I was fortunate to receive a Pennsylvamnia Department Of Education grant last year to initiate a program, which continue today without special funding. IEPs frequently pecify counseling for emotinal problems but schools psychs and counselors are overloaded with testing or just puttingout fires. Clinical psychologists are a valuable addition to schools to supplement educational psychology approaches. Teachers need to be trained in mental health concepts and strategies.