“There are no words.” Those words of grief echoed throughout the world as yet another mass shooter ripped apart a community, this time in Chicago on our nation’s birthday, July 4, 2022. Just six weeks prior — on May 24 — our country suffered another elementary school shooting in Texas that echoed the Sandy Hook tragedy in 2012.
Once the immediate shock gives way, we must find words — and we can start with four life-saving ones: prevention, screening, early intervention.
Better mental health screening is possible and we know it from our years of experience in the field.
Connecticut and Texas, seemingly opposite states in many respects, now share a new macabre bond: the highest K-12 death tolls from U.S. school shootings since 1970 with active shooters. Connecticut Gov. Ned Lamont, a Democrat (D), and Gov. Greg Abbott, a Republican (R), both claim that we need more mental health services and more access to those services. We echo that claim and heartily endorse a bipartisan effort to not only increase such services, but to shift their current emphasis on treatment to a focus on prevention, screening and early intervention.
Such solutions would not only help to reduce mass shootings but suicides as well, which sadly have increased by almost 30 percent over the last 20 years. Our youth are especially at risk: In 2020 suicide was the second leading cause of death for people ages 10-14 and 25-34. Also, nearly 20 percent of high school students report serious thoughts of suicide and 9 percent have made an attempt to take their lives. The Chicago shooter had attempted suicide in 2019.
Enough is enough.
Prevention first
Unfortunately, most current mental healthcare interventions focus on treatment, rather than prevention, and typically begin only after behaviors such as substance use, addiction problems, suicidal thoughts and criminal activity are identified.
Research shows, however, that earlier intervention, before more serious behaviors emerge, is better. Innovative interventions in mass screening for health risks have a long history globally of reversing death rates and promoting healthier outcomes. Decades of research show that monitoring for health issues, such as heart disease or cancer, before they are a concern, is the best way to inform early, de-stigmatize, and prevent illness, even warding off illness as soon as it is detected.
Likewise, in mental healthcare, the science now shows that viable, effective solutions must start at the earliest possible age. Monitoring emotional well-being establishes a baseline, and therefore provides more information before clear signs and symptoms of illness arise. It is the only way to accurately know what is triggering an individual to respond in unhealthy ways. It identifies the need for more intensive assessment and intervention and alleviates the acute tension on the lack of providers.
Imagine a world with a prevention, screening and early intervention approach to mental health that is the DNA of school systems and communities in America.
Start with our schools
To initiate preventative mental healthcare for children and youth, we recommend three related techniques that can be easily integrated into schools and aligned with specific developmental milestones in students:
- Social and emotional integration. This begins with evidenced-based social and emotional lessons integrated during a typical school day, such as within reading, English and social studies classes. Since the COVID-19 pandemic, this promising change is increasingly being implemented in most U.S. states, including Texas and Connecticut, from pre-K through 12. It’s an instructional approach that helps children learn content in a way that invites discussion about how they relate to that content in a fluid and real life way. It explores how the content affects them emotionally. For example, a discussion of World War II would ask students if the content makes them mad or sad or both. Improved understanding of well-being, healthier relationships, and more responsible decision-making result in fewer behavioral infractions and higher academic achievement. One of the most important outcomes, however, is that children have access to adults who understand their unique internal emotional state better, which is also one of the leading indicators of successful development into adulthood.
- Mental health supports. Mental health support is health support. As described in the 1999 Surgeon General’s Report on Mental Health, it is the “springboard of thinking and communication skills, learning, emotional growth, resilience and self-esteem.” We aim to protect our physical health but typically ignore mental health until behavioral responses stop our daily functioning. Imagine a world where schools are filled with trained adults who can help to identify if a child needs mental health supports. Well-informed referrals to a mental health professional would streamline early intervention. School systems all over America already have the infrastructure in place for these referrals called Multi-Tiered Systems of Support primarily used for learning differences. And now, in Texas and Connecticut this infrastructure is used for mental health referrals as well, and is a promising immediate resource.
- 21st century screening. Mental health assessments have not been updated since the late 1980s and early 1990s. Since that time millions of research dollars have revealed nuances in tween and teen development that were previously unknown. The kids of the 21st century are NOT children of the ‘80s. Their lives are filled with access to information right in their pockets. They’re evolving at a rapid pace. It’s time we meet kids where they are and screen their mental health in creative ways that resonate with them and provide accurate and insightful data that trained healthcare professionals can use to track changes and support early interventions. Such screening can be implemented in schools regularly or even at annual well-child visits with pediatricians, primary care physicians or mental health professionals.
This approach can be streamlined cost effectively and seamlessly into the regular school day. Schools are not just a delivery vehicle for academic content. We must encourage education of the whole child.
Teaching both cognitive and non-cognitive content simultaneously encourages a more open dialogue with students, so they can learn how to have healthier relationships, make better decisions and understand the importance of self-care. With early digital screening, a protocol can be established for the small percentage of students who may need more mental health supports. Often, these students may need limited interventions, such as a conversation with a caring adult. Yet those who have more serious concerns can be referred to mental health providers. Exemplars in Texas and Connecticut show that this preventative approach does work but it is not yet mainstream.
By implementing these three related concepts in schools, transformation to preventative mental healthcare is ours to have. To make it happen, school administrators, teachers and parents must adopt a mindset of prevention which in turn will reduce costs. As youth mental health is a national priority with promises of increased funding, the opportunity to resolve these challenges earlier rather than later is right before our eyes.
With preventative mental healthcare, we won’t need to guess or wonder if our children are emotionally okay; we can monitor their mental health just like we do for hearing, vision, height, weight, and blood pressure. We can thrive, living in a world where mental health is the fabric of overall health, just as science tells us it is. The U.S. can become the global leader in children’s mental health instead of mass shootings.
We can start today by implementing what we already know works: prevention, screening and early intervention.
Wendy Ward is the founder of futuresTHRIVE, the Darien-based developer of a technology-driven mental health screening tool for ages 4-24. Patricia Gail Bray, Ph.D., is the founding director of the David and Helen Gurley Brown BridgeUp at Menninger Center at the Menninger Clinic in Houston, TX.