Youth mental health is terrible. Here’s what schools can do.
Originally published December 26th, 2019 (Blogger)
About three years into my teaching career, I got a position in a hospital. Nothing prepared me for it. Nothing in my undergrads, or in my B.Ed year, or in my previous years of work, or of life. I walked in to that hospital at the age of twenty-seven, and walked out four years later feeling as though I had aged a lifetime.
This program was designed for children and youth struggling with mental health issues. For a variety of reasons, they couldn’t be in school — their anxiety or depression kept them out of the building; their delirium made schooling temporarily impossible; or their self-harm made school a much, much lower priority. There are programs just like it all over Toronto. Students are temporarily pulled out of school, placed in these hospitals, get a combination of therapy, medication, and social work, and hopefully can return to their normal lives.
In theory, my role as a teacher was to…well, teach. However I quickly learned that the majority of my labour was in getting schools to take these students back. Many could not understand why these students needed help; some flat-out refused to accept them.
“They’re crazy. We’re not taking them back. How can we even teach them?”
This is a Section 23 program. Hundreds of students are in them, right now. We need to make them better.
Section 23 of the Ontario Education Act stipulates that students have the right to an education even if they aren’t physically present in a school. The first thing that may come to mind is home schooling, but the majority of these programs are for at-risk or in-risk youth. The specific titles for these programs are, like most things in education, acronyms — Children and Youth In Care (CYIC) or Care, Treatment, Custody, and Corrections (CTCC) — but they all fall under the umbrella term of “Section 23”. In Toronto alone there are 63 Section 23 programs with almost 740 spaces, and they operate around 80% capacity. My program was a hospital, but there are others: foster care, youth justice centres, homeless shelters, Children’s Aid programs, eating disorder clinics, extreme behavioural programs, and more.
The purpose of most of these programs is to transition students back into a regular school experience. However, research indicates the recidivism rates in these programs in unacceptably high. A joint research study from Vanderbilt University and the University of Wisconsin School of Medicine shows that the first year of transitioning out of an at-risk program has the highest relapse rate — 47%. Internal reporting from Children’s Aid shows that students re-entering schools found the process “jarring”, hindered by stigma, and ineffective at preparing them for post-secondary education.
In my hospital program, it was impossible to track our success rate. We saw hundreds of youth a year and transferred them back to school, or other programs, but lost track after that. I had to assume that once they left, they were better. I kept this belief until one night, in my third year, I got a call from the unit manager. One of our students had died.
There are so many reasons why students struggle to re-integrate back into their lives, after spending weeks or months in a hospital. Poor mental health is, obviously, a significant factor. The institutional elements, however, cannot be ignored:
- There is little research done on students in Section 23 programs. Most research on at-risk youth is generalized; thus, most policies based on this research are equally generic.
- The overlap between responsible government agencies is frustrating. Section 23 programs alone are overseen by a combination of the Ministry of Education, Ministry of Health & Long-Term Care, and the Ministry of Children & Youth. Program goals are not often aligned, leading to a “silo effect” of miscommunication.
- The eternal refrain of limited resources applies as well. Staff in community schools feel under-trained and under-equipped to handle these complicated cases. Often a student is fully prepared to leave a Section 23 program, but is kept in place for potentially weeks while the receiving school prepares itself.
A lack of research; an unclear leadership structure; a paucity of resources and training. This is the environment into which we are jettisoning our most fragile youth.
Moving students around frequently is obviously not beneficial. A study on 420 foster care students, taken from the National Survey of Child and Adolescent Well-Being (NSCAW), shows that 72% of these students had been in at least 2 homes over a period of 36 months; 46% had been in 3 months. This rapid pace of transitions causes both social and academic anxiety. However, the study also indicates that “if youth removed from home can have the benefit of remaining with familiar teachers, established social networks, and familiar settings, children may have the [ability] to have their emotional needs met.” This shows that a carefully managed transition can result in long-lasting stability.
Students re-entering schools found the process “jarring”, hindered by stigma, and ineffective at preparing them for post-secondary education.
So how do we achieve this? One program out of Massachusetts shows significant promise. The BRYT program (Bridge to Resilient Youth Transition) is a school-within-a-school that works with all transitioning students — be it from an eating disorder, a suicide attempt, a concussion, or a period of bereavement. Out of the 6 BRYT programs across the state, three-quarters of their students are hospitalized on an out-patient basis, while 73% had at one point been in-patients for psychiatric concerns. Over the roughly 10-week transition program, student participation dropped from 75% to 17%. This shows that students were successfully moving out of BRYT and back into the mainstream associated school.
These numbers are fantastic, and more importantly, represent the skill sets that we tried to instill in our hospitalized students — resiliency. Episodes of poor mental health are common amongst youth with previous histories, so the ability to tap into a personal reservoir of support is critical. I got to see many “repeat customers” in the hospital and I never enjoyed it. My parting comment to graduating students was “Don’t take this the wrong way, but I hope I never see you in here again.” Rather than yo-yoing between school and the hospital, the BRYT program provides a logical middle ground for these students.
Students in the BRYT program spoke to researchers out of Northeastern University about their experiences. Most of them reported less stress, and a sense of accomplishment. They felt a personal connection with their teachers that they never experienced before; with their mental health issues destigmatized, “bad behaviour” was now more clearly understood and managed. While the students were still worried about fitting in with friends and catching up with missing work, they felt they could use the skills they learned at BRYT in school. The anxiety they felt could be managed. They could feel good about being in school.
How was this accomplished? BRYT staff are teachers but also have significant clinical and mental health experience. They work in small groups. They are extremely flexible with assignments. Most importantly, BRYT staff have “a caseload and schedule that allows them the flexibility and time necessary to help students navigate the academic, emotional, and social challenges they will inevitably face.”
With their mental health issues destigmatized, “bad behaviour” was now more clearly understood and managed.
After the death of my student, I gave myself one more year in the hospital before I left. Burnout was already claiming my own mental health, and I wasn’t even 30 years old. Once I was back in a community school I tried using the BRYT model in my own classes — flexibility, personal attention, a focus on small success, an understanding of the psychology and pharmacology of mental health. Though I had some success, youth culture had changed. Stress, depression, anxiety, and self-harm were de rigueur amongst teens. The hospital had followed me.
The BRYT model is a ray of hope for high school students. After graduation, however, the daunting independence of post-secondary education looms. Roughly one-third of Canadian universities have a graduation rate of less than 60%. The average graduation rate of an Ontario college program hovers at just over 65%. Canadian post-secondary students report feeling “overwhelmed” on a weekly basis. The University of Toronto found itself embroiled in controversy, and criticism from the Ontario Human Rights Commission, after it enacted a policy that empowered the university to arbitrarily place students on leave if they showed signs of mental distress.
As a high school teacher, I cannot manage the transition into post-secondary. However there are encouraging reports of self-advocacy and community. Frustrated with the lack of mental health support at the University of Waterloo, Tina Chen designed her own “panic attack kits”. They became so successful that the university purchased over 7,000 kits to distribute to first year students. While this is heartening, it is by equal turns disappointing; a student who has given up on the idea that her school will protect her mental health.
I miss working in my Section 23 program. By sheer coincidence, I now work with the spouse of the teacher who replaced me. They love working in the program. I like to think that now, more than 10 years into my career, my own mental health is strong enough that I could thrive in that environment.
The point is not for me to succeed, however. It is, and always has been, for our students to succeed. And if we cannot secure success for the most fragile amongst our students, then we need to reevaluate our policies and prerogatives. We know what to do. We have already waited too long.
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