Sherrill Scott will never forget an emotional conversation with an Edmond mom whose 15-year-old son had committed suicide.
“At the funeral, she discovered that 12 people knew he’d been having those kinds of thoughts and no one did anything,” Scott said. “That goes to show that the subject is taboo and students don’t know what to do.”
A licensed counselor and the coordinator for a Mental Health Association Oklahoma (MHAO) program called TeenScreen, Scott helped confidentially screen more than 900 middle and high school students in the Tulsa area for general and mental health concerns last year. Students individually answer a series of questions about their thoughts, feelings and behaviors on laptops. On average, 30 percent of the students screened are flagged as showing symptoms of a mental health condition.
“This screening doesn’t specifically diagnose but looks for symptoms of certain conditions, like depression, anxiety and suicidal thoughts,” Scott said. “We’re trying to identify things before they become really serious.”
TeenScreen was developed at Columbia University and the evidence-based questionnaire has been in use for about 15 years. Parents must sign consent forms for students to be tested and when students have completed the questions, mental health professionals review results immediately. If the screening indicates cause for concern, a more in-depth clinical interview is conducted on-site, parents are notified and arrangements are made for the student to be evaluated further by a counselor. If students indicate they have had suicidal thoughts in the past 24 to 48 hours, they’re referred immediately for an evaluation and sometimes inpatient treatment.
“A lot of times, students who have had suicidal thoughts, this is the first time they have actually talked with someone about it,” Scott said. “The safety of the student is our first priority.”
Recognizing the need for their services outside of the Tulsa metro, the organization is expanding its screening and education services to Oklahoma City and across the state. But they need more funding to keep up with the demand. According to Mental Health Association Oklahoma (MHAO), suicide is the second leading cause of death among Oklahoma youth and 90 percent of lives lost to suicide nationally were impacted by mental health conditions. One in 15 youth in Oklahoma has attempted suicide.
Scott finds her work to identify signs and symptoms of mental health conditions in adolescents fulfilling and rewarding, but the lack of awareness and understanding can be frustrating and overwhelming. Mental health professionals with TeenScreen also educate students in the classroom about depression and suicide. Scott said one in four students will experience an episode of depression in their teenage years and she wants students to understand those thoughts and feelings don’t make them crazy. Professionals also stress that students should tell an adult immediately if someone they know expresses suicidal thoughts.
“The brain is an organ in the body just like any other,” said Scott. “There are times that it might not work exactly like it’s supposed to. We need to feel like we can go to someone and tell them, just like if we were having headaches or stomachaches all the time.”
Dr. Naveena Boindala, child and adolescent psychiatrist with INTEGRIS Mental Health-Spencer, said Oklahoma students need this type of instruction in the classroom because acquiring the skills to recognize mental health concerns in themselves and others is “just as important as learning to add up numbers.”
“I would like to see children being taught skills to cope with stress and what to do with tough feelings like sadness and anger,” said Boindala. “Mental health and its problems are messy, and we often find people not wanting to deal with them or even pretending these problems don’t exist … until we are forced to sit up and take notice when a friend or loved one [is] affected. Then you open up your eyes and see that it really is all around.”
Cultivating mental wellness at home
While organizations like TeenScreen are making an effort to educate Oklahoma youth about mental health conditions, experts say prioritizing mental health starts at home with open communication. Scott often screens students whose parents were completely unaware of their feelings.
“Lots of times children either don’t feel like their parents hear them, so they quit telling them things, or they want to protect their parents,” said Scott. “I speak to a lot of students who say, ‘I didn’t want to worry my mom or for my mom to feel bad about my feelings.’”
Aundria Goree, community health administrator with the Oklahoma City-County Health Department and a certified Mental Health First Aid Curriculum instructor, said practicing non-judgmental listening and watching for signs and symptoms of mental health conditions should start when children are very young.
“We don’t take what our children say seriously,” Goree said. “Stop and listen to your children. Ask how they’re feeling, who they played with today, what friends were nice to them and what friends made them sad. How they are handling these types of situations lets you know if your child is coping with what they are going through and if they know how to handle it.”
Dr. Lisa Marotta, an Edmond psychologist who treats children with anxiety disorders, depression and behavioral challenges, encourages parents to be open with kids about their own struggles.
“Sharing the highs and lows of everyone’s day gives kids the benefit of learning alternative ways of managing hard times,” said Marotta. “Children should be protected from big adult problems that could make them worry unnecessarily, but the little adult annoyances, hassles and obstacles are great life lessons.”
One-on-one quality time spent with children, especially those who struggle with anxiety, depression or other mental health conditions, is a key focus in “Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress and Anxiety,” by Donna B. Pincus, Ph.D. The parent-child interaction therapy strategy or change involves spending five minutes a day playing or engaging with a child who struggles with anxiety, letting him or her control the interaction. Parents can’t ask questions, criticize or give commands, but instead use the PRIDE method, offering consistent praise, reflecting what the child is saying, imitating what the child is doing, describing what’s happening and expressing enthusiasm.
Though the skills sound fairly easy, it can be tough for parents in practice to hold back from directing a child in how to hold a crayon or tell a child to place a toy horse in a barn rather than the dollhouse. Peppering an older child with questions about his or her day, or even asking seemingly-benign questions like “Do you want to play a different game now?” subtly controls the interaction and actually ramps up a child’s anxiety. When a child can count on the predictability of quality time and gets to experience control over a part of his or her life, self-efficacy, bravery and independence grow.
“You can’t go wrong with being present with your child,” said Boindala. “Giving them your full attention, being in their little world of make believe or their basketball game or math homework or first crush – just letting them know that you are right there for them.”
At Planet Rock (a division of Red Rock Behavioral Health Services) in Oklahoma City, where children benefit from a multidisciplinary group of clinicians providing mental health therapies, Dr. Wana Ellison and the team stress the importance of caring for mind, body and spirit. Good nutrition leads to better health, both physically and mentally, while putting what Ellison calls “toxic agents” in the body, like an excess of sugar, fat or processed foods, can exacerbate mental health challenges.
“We are given one body, one mind and one spirit,” said Ellison. “We need to take care of all three and practice good habits in eating, exercising, regularly challenging our unhealthy thinking and seeking spiritual wellness.”
Because mental health conditions, especially when untreated, can lead to drug and alcohol addiction, Boindala implores parents and schools to offer ongoing, frank education about how these toxic agents will affect the body and mind.
“I think if kids knew they could end up with more brain damage by using drugs than they would if they got knocked in the head by a baseball bat they would be less likely to try it in the first place,” said Boindala.
Lori Wharton, whose 12-year-old daughter’s depression and anxiety led to two suicide attempts, has learned through volunteer efforts with MHAO the importance of talking to pre-teens and teens about normal sadness versus depression, just like you would instruct kids to identify the signs between a common cold and the flu. She also learned how vital it is for parents to listen to their children’s feelings without being dismissive. For her daughter, exercise, discovering a creative outlet through photography and journaling were essential to her recovery.
“She couldn’t verbalize [her feelings], but she could write and then share with me,” said Wharton.
Creating communities that support mental health
Wharton, now a board member for MHAO and a suicide prevention trainer for the organization’s QPR (Question, Persuade and Refer) program, believes if she’d had QPR training earlier she could have prevented her daughter’s suicide attempts. Much like Scott is teaching Oklahoma students how to recognize the signs and symptoms of friends with depression or suicidal thoughts, QPR staffers go to businesses, churches and civic organizations to train community members to help someone in suicide crisis. The first step is asking an individual if they are thinking of harming or killing themselves.
“We’re afraid to ask that question because we think we’re giving them the idea,” said Wharton. “But if they are thinking about it, they are usually pretty honest with you.”
Wharton’s daughter would often say she hated her life, which she realizes now was one of the signs of her being depressed and suicidal. Wharton wishes she would have asked her daughter that simple question and then known how to persuade and refer her to help.
“Just like learning the Heimlich Manuever or CPR, everyone needs to have this training,” said Wharton. “It can save a life.”
QPR is offered free of charge by MHAO to groups of up to 25 per facilitator. The training takes about two hours to complete.
Another group in Oklahoma City training community members to recognize signs of mental health conditions in children and adults is the Oklahoma City-County Health Department. OCCHD, INTEGRIS Health and a number of other nonprofit agencies in the organization’s Mental Health Coalition were recently awarded the national Public Health Foundation’s Future of Population Health Award for their mental health improvement strategies and implementation efforts. Using Mental Health First Aid Curriculum, a national public education program that’s trained more than one million people, OCCHD professionals teach local businesses, health professionals, educators, law enforcement and churches, among others, to recognize and direct individuals in mental health distress to resources.
Mental Health First Aid teaches common risk factors and warning signs of conditions like anxiety, depression, substance use, bipolar disorder, eating disorders and schizophrenia. The training is open to the public, offered regularly through OCCHD or can be scheduled by a group, and takes eight hours to complete. Participants learn how to approach an individual who is struggling with depression or suicidal thoughts or actions, listen non-judgmentally and identify if the person needs help and how to help them get it. The day after OCCHD’s initial training, a community health worker was able to use the new skills with a client.
“When you think of Mental Health First Aid, what individuals are doing is offering initial help until professional help arrives,” said Goree. “The same way we offer support or help to those with physical health concerns, we should do the same for mental health.”
Goree became certified to teach the adult curriculum in 2016, and the coalition is primed to make a youth course available soon.
“We see children who need help in the classroom, who may not be doing well academically,” said Goree. “We want to get to the root of the issue the child may be dealing with, like a traumatic event they have not had an outlet to talk about it.”
Goree believes the training will help teachers and administrators better understand the signs and symptoms of mental health conditions in children, talk to them about it and get them connected to the right resources. She’s fueled by the statistic that half of all mental health conditions begin by age 14; three-quarters by 24.
“When we’re looking at how youth are affected [by mental health conditions], we look at how it affects education, movement into adult occupational roles and social relationships,” said Goree.
OCCHD plans to integrate the Mental Health First Aid youth curriculum with its Whole School, Whole Child program, offered at 12 Oklahoma City Public Schools and Millwood to improve health outcomes of students and engage with families. The program was developed in 2010 and provides physical activities and education on nutrition and mental and behavioral health to students and parents with the goal to improve academic success, behavior challenges and attendance rates at these schools.
Making a Change
While Goree and other mental health professionals across the state agree that Oklahoma suffers from a lack of funding and services to adequately help those in our state who need it, she feels hopeful that programs like Mental Health First Aid are moving the needle.
“We’re teaching how to demystify mental health and reduce the stigma,” said Goree. “Everyone needs some type of mental support. Those dealing with mental health conditions often feel like they are the only ones dealing with it and we want them to know they aren’t.”
Boindala believes an important step in improving the state of mental health in Oklahoma is for lawmakers to start thinking of the people affected by mental health conditions as their own children, parents or siblings, and then fund services accordingly.
“I think if mental health is made a priority and lawmakers developed a genuine, scientific curiosity about it and took the time to look at the problem, they would know the importance it has,” said Boindala. “[Oklahomans] need access to physicians, affordable inpatient treatment and access to the right medications at a reasonable price.”
Boindala said it’s critical to determine how mental health services can be protected, both so local hospitals and treatment facilities can focus more on treating patients and less on making payroll each month and to ensure local mental health professionals choose to stay and serve the people of Oklahoma.
At home and in schools, Goree believes helping children—and their parents—understand how the brain and mental health is connected to the physical body is vital to reducing stigma. Boindala said it’s important for parents to remember that all children have some level of struggle, and it’s not the parent’s fault. She also believes it’s critical for parents to educate their children about the impact their own mental health has on their lives and others.
“The mind is an entity that is so powerful that it could change the way the rest of the body feels,” said Boindala. “It could decide if you are someone who is going to be a productive part of society, if you can have stable relationships, if you can start a family and keep it, if you can function and care for yourself on a daily basis, or, alternatively, if you are going to be someone who has to use every ounce of his or her will to wake up and get out of bed every day… it could make or break society.”