Mental illness best detected early in schools, doctors say

Schools can play an important role in reaching children and youth with mental illnesses that last into adulthood, say child psychiatrists who suggest ways to implement better access to care. 

In Tuesday’s online issue of The Lancet Psychiatry, Dr. Mina Fazel of the University of Oxford in the U.K. estimated that 10 per cent of those under the age of 18 in high-income countries could benefit from specialist mental health care in their childhood.

"These disorders are therefore very common, but not only that, they're also persistent, so they're likely to affect young people throughout the course of their lives," Fazel said in a journal podcast.

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An estimated 1.2 million Canadian children and youth are affected by mental illness, but less than 20 per cent will receive appropriate treatment, according to the Mental Health Commission of Canada.

Schools are where children spend most of their time, which makes them an important place to reach out to them, Fazel said.

Behavioural disorders such as separation anxiety and oppositional defiant disorder are seen mainly in children aged four to 10 years, while anxiety and depression are more common in students aged 11 to 18, the researchers said.

"There's a basic understanding of mental health, which I think is important for teachers to understand, because many teachers report that disruptive behaviours in classroom, often from children suffering emotional, behavioural disorders, are the things that impact on their capacity to teach the rest of the classroom," Fazel said.

Interventions don’t need to be highly complex, she said, but a basic understanding of how to implement proven measures is often missing.

"We know what works, but where we fall down is implementing this on a large scale in schools. We also need national policies to help education and mental health services work more closely together."

Benefits of mental health screening

Fazel said evidence shows that children prefer to be seen for counselling in school rather than outside, but the health and education systems need to communicate more with each other to help children and young people.

Stigma continues to be a concern, but Fazel said that if there was greater understanding about mental illness and its potential causes and if treatment was more accessible, there would be less concern about labelling young people.

Dr. Marshall Korenblum is chief psychiatrist at the Hincks-Dellcrest Centre in Toronto, where he specializes in adolescent psychiatry.

"We do need a national strategy. Australia has one, the U.K. has one, to a lesser extent the U.S. has one," Korenblum said.

There are isolated jurisdictions that attempt to identify and recognize mental illness in children in school. Until there is a national approach, he said, raising awareness on a province by province basis would be best.

"We know that 70 per cent of mental illness can be identified before the age of 18 or 19. So if we did a better job of recognizing these problems earlier, they'd be easier to treat and the impact on academic success, social adjustment and of course mental health would be huge."

If teachers had better training and preparation to recognize mental illness, it would be a low-cost and effective way to intervene early, he said.

The researchers suggest a multilayered approach that starts with universal screening for problems such as low self-esteem or bullying and moves up to targeted programs for severe problems.

Korenblum pointed to the precedent of universal screening for immunization and sex ed classes in school as one model that could be adapted to weave mental health into the curricula.