Running head: MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 1

Mental Health Awareness and Suicide Prevention in Schools

Ashleigh Larkin

Central Michigan University

 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 2

Abstract

Student mental health issues and suicides are growing at an alarming rate. The research proves

that it is time for politicians and educational leaders to act in order to create policy that will work

towards solving the issue. Three main solutions are presented within this paper, including suicide

prevention training for school personnel, connecting schools to outside mental health agencies,

and implementing small group counseling techniques in schools. While all solutions are viable

options, the main solution advocated for is mandating mental health awareness trainings and

suicide prevention programs for all school personnel. These types of programs are most

cost-effective and provide the greatest impact. By establishing a mandate and hortatory policy

implementation approach, school leaders and politicians will ensure that the needs of students

suffering from mental health issues are met. Once a mandate is created, schools will follow the

mobilizing, adopting, and institutionalizing steps of policy implementation in order to meet the

needs of all students. Politicians and educational leaders can no longer sit idly watching students

struggle with these issues- it is time to act, and the time is now.
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 3

Introduction

Despite the fact that mental health issues have grown in recent years, the stigma that

surrounds these problems still remains. Mental health issues have been at the forefront of many

tragic events that have occurred in our recent history. In addition to the rise of mental health

problems, suicide rates in the United States have also increased. According to the American

Foundation for Suicide Prevention (2015), suicide is the 10th leading cause of death in the

United States and each year 44,193 individuals die by suicide (p. 1). This national problem has

trickled down into our nations schools and has recently been referred to as a silent epidemic

(Anderson & Cardoza, 2016). Teen mental health issues and suicide is a growing health concern.

The American Psychological Association (2017) states that suicide is the third-leading cause of

death for young people ages 15 to 24, surpassed only by homicide and accidents. Coupled with

the fact that mental illness is the leading risk factor for suicide, it is clear to see how the

connection between these two issues is prominent and is dramatically affecting our youth.

Despite the idea of the rise in student mental health issues being a silent epidemic, it is

no secret to many in education that student mental health issues and the number of teen suicides

due to these issues are growing. The CDC has reported that one in five children living in the

United States show signs or symptoms of mental health disorders in a given year (Anderson and

Cardoza, 2016). Many school social workers, psychologists, and counselors at the high school

level have reported an increase in student mental health issues in the last five years. Sommer

Yono, school social worker at West Bloomfield High School agrees by stating, student mental
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 4

health has become a problem and we need to address it. Many students are feeling overwhelmed,

hopeless and anxious due to the pressures that society has placed on them in regards to their

post-high school plans, social media and technology, as well as peer interactions (S. Yono,

personal communication, March 28, 2017).

Despite the fact that these issues are becoming well-known, approximately 80 percent of

these children will not get the help that they need. Anderson and Cardoza (2016), explain that

this is a role that schools are not prepared for (p.1). Many schools lack the resources necessary in

getting these students the help that they need and deserve. The reality is that the stigma

associated with mental health is wide, the idea that students can just get over it is present, our

teachers, counselors, and administrators have a great deal on their plates in relation to managing

the day to day operations within a school. With more research being done and the findings

clearly showing that student mental health problems and suicide are an increasing problem, it is

time for political leaders and leaders in education to step up and challenge the status quo.

Policy Research and Politics

Student Mental Health Research

Throughout the past ten years, the research on mental health issues and related suicides

has increased. This research has the ability to provide political leaders and educators with the

understanding of how prominent the issues have become. When looking at the research, it is

evident that the mental wellbeing of our students has been impacted by a variety of issues.

According to Schrobsdorff (2016), anxiety and depression in high school students have been on

the rise since 2012 after several years of stability. This is a phenomenon that cuts across all

demographics--suburban, urban and rural; those who are college bound and those who are not.
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 5

Teens in our present day have grown up in a world riddled with fear based on economic

recession, mass gun violence, and high stakes. In particular, research shows that student mental

health has been impacted by the following issues:

1. 6.2 million teens have an anxiety disorder. These anxiety disorders and mental health

issues often go undiagnosed, which can lead to self-harm or suicide.

2. Many statistics that are currently available may not be accurate due to the fact that many

individuals do not report or seek help for mental health related issues.

3. The role of technology and social media has played a part in student mental health issues.

While students are now more connected than ever before, they must also keep up with the

exhaustion of documenting everything online.

4. School pressures play a large role in student mental health. With a difficult college

application process, high expectations, and competition between peers, students can

develop anxiety related mental health issues as a result.

5. There is less time available for school personnel and less financial resources being

allocated towards dealing with mental health issues.

6. Bullying in schools has increased between peers. Bullying can cause mental health problems

and/or young people may experience bullying because of their mental health issues (Fekkes,

Pijpers & Verloove-Vanhorick, 2005).

The research shows that our students are dealing with a variety of issues that impact their

mental wellbeing. Increased anxiety, low reporting, technology, school pressures, less time and

resources in schools, and bullying between peers have all contributed to the rise in mental health

disorders and student suicides. This problem can be directly related to the democratic values of
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 6

our nation. In particular it is related to the idea of common good, which is described as when we

are all "working together for the greater benefit of everyone in our community" (Alvaro &

Vredevoogd, 2001). In order to promote the common good, it is our job as educators to work

with politicians in order to provide our students with equal access to education and services that

will support their needs. This problem impacts a diverse population and it is up to our

government at the national, state, and local level to provide students with the best support

possible.

Approaches to Solving the Problem

While it is evident that educators and politicians must work towards solving the mental

health crisis, there are many different professional opinions on how to tackle this issue and solve

the problem. There are three well known approaches to solving the problem, which include

professional development and suicide prevention program training for school personnel,

developing community relationships between outside mental health agencies and schools, and

establishing small group counseling resources for students. Each of these solutions offer a

strategic way to think about combating the silent epidemic in our schools.

One of the most prominent approaches to solving the mental health crisis is prevention

training for school personnel. This approach is promoted by several mental health organizations,

such as the American Foundation for Suicide Prevention and the National Association of School

Psychologists. School staff must be trained in recognizing mental health issues and intervening

when necessary. A system wide policy increases the chances that students will receive needed

support and assistance. Intervention and prevention training should be taught in schools
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 7

(LivingWorks Education, 2015). This approach to solving the problem is widely regarded as the

best solution by many professional organizations. In order to these types of trainings to occur,

each state should require mandatory professional development for all school personnel in regards

to mental health issues and suicide.

A second approach to solving the problem is to develop better community relationships

between mental health organizations and schools. Being able to build connections with these

organizations in order to provide schools with desperately needed resources is key. At this

present time, many schools have cut counselor and social work positions due to a decrease in

funding. In this case, partnering with community organizations to establish resources for students

is imperative to solving the issue. Schools should start by creating a referral list of licensed

professionals for students and invite members from community organizations to the buildings for

roundtable discussions. Ongoing collaboration will need to occur in order to sustain a program of

this nature (Hamlet & Redekop, 2010).

A final solution to be considered is small group counseling and methods used by school

counseling staff for students. In this solution, students would take charge of their own issues and

would be allowed to participate in small group therapy sessions with other individuals. The

Missouri Department of Education explains that Small group counseling provides students with

assistance to improve skills in the areas of personal/social, academic and career development.

Working with students in small groups is one strategy for helping students become more

successful (Missouri Center for Education, 2015). Small group counseling could provide a

positive solution in regards to the student mental health crisis.

Taking the approach of training school personnel in awareness and suicide prevention
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 8

programs, connecting schools to outside mental health agencies, and small group counseling

strategies for students are all positive approaches towards creating a solution in regards to the

student mental health crisis. There are several major actors and coalitions that have been

advocating for each of the different solutions. Each of these agents have the ability to positively

impact students through their work.

Major Actors and Coalitions Advocating for Different Solutions

When looking at potential solutions for solving the student mental health and suicide

crisis, there are several major agents of change that are advocating for a variety of approaches.

Ninety percent of young people who die by suicide have a mental health condition at the time of

their deaths, although often these conditions are untreated, under-treated, or undiagnosed

(American Foundation for Suicide Prevention, 2016). One of the first steps in preventing suicide

is understanding mental health issues and advocating for solutions.

The National Strategy for Suicide Prevention (NSSP) has created several goals to involve

individuals in suicide prevention. Specifically, Goal 7 of the revised NSSP is to Provide training

to community and clinical service providers on the prevention of suicide and related behaviors

(U.S. Department of Health and Human Services, 2012). The NSSP organization advocates for

the first solution of school personnel being trained on how to address suicidal thoughts and how

to respond to those that have been affected by suicide. The organization also believes that suicide

prevention should be integrated into the values, culture, leadership, and work of educational

institutions. Schools must be able to intervene and must also know how to deal with mental

health issues after they are recognized.

The National Association of School Psychologists also play a key role in advocating for
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 9

student mental health and suicide awareness. Overall, the NASP takes on the second potential

solution that is advocated for in the form of connecting schools to outside mental health

organizations. NASP argues for more informed and effective decision making when dealing with

mental health issues. The NASP has made four recommendations for improvements for school

and community mental health services. The first solution is to offer a continuum of school and

community mental health supports (Brock & Brant, 2015). Schools need to provide multi-tiered

systems of support and should positively promote mental health and wellness. One of the

arguments of the NASP in particular is to offer mental health screenings to students. The second

recommendation is to broaden mental health supports beyond special education. Many students

who experience mental health issues do not meet the criteria for a 504 plan or IEP and in

accordance, schools must find ways to extend these supports to the general education population.

The third recommendation is to improve collaboration efforts by schools and community mental

health organizations. Brock and Brant state that, Steps toward building effective partnerships

include establishing a leadership team composed of school and community mental-health

professionals, conducting an assessment of needs and existing resources, clarifying roles and

responsibilities, providing professional development, and making time for regular

problem-solving and evaluation. Finally, the NASP advocates for empowering families to

manage the decisions and resources they need to meet their students mental health issues.

Involving the parents and respecting their rights, while helping them advocate for their student is

a main role of school personnel.

A final organization that advocates for the third solution, small group counseling, is the

American Foundation for Suicide Prevention (AFSP). AFSP is the national leading nonprofit for
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 10

understanding and preventing suicide through research, advocacy, and to reaching out to people

with mental disorders and those impacted by suicide (American Foundation for Suicide

Prevention, 2011). One of the solutions that this organization advocates for is small group

counseling. The AFSP states, wherever possible, group meetings should follow a structured

outline, keep to a time limit, and provide each student with an opportunity to speak. The

meetings should focus on helping students identify and express their feelings and discuss

practical coping strategies. These group meetings could provide students with a safe place to

speak about mental health issues and thoughts of suicide.

Finally, the Michigan Board of Education has also advocated for student mental health

issues by creating a policy on integrating mental health in schools. In 2003, the state board of

education adopted the Policy on Coordinated School Health Programs to Support Academic

Achievement and Healthy schools (Michigan Department of Education, 2016). This policy

creates a structure to improve classroom environments, school culture and climate, and address

student behavior, including behavior impacted by mental health. The Michigan Department of

Education has also created a mental health toolkit for schools and provides many

recommendations for dealing with mental health issues. While there have been no formal

legislation efforts beyond this in connection to student mental health and suicide in Michigan,

there have been in other states.

In addition to the major coalitions advocating for solutions, there have also been several

policies developed in different states across the country. According to the American Foundation

for Suicide Prevention there are currently ten states that mandate annual suicide prevention

training for school personnel (2016, p. 3). In eight of the ten states, this mandate is titled the
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 11

Jason Flatt Act. Michigan is not currently one of the ten states to mandate this training for school

employees. In addition, there are seventeen states that require mandated training, but do not

require it annually. Again, Michigan is not one of these states. Although it is not currently

mandatory in Michigan, the state does encourage suicide prevention training, meaning that it can

be an option for professional development (p.4). Each of these organizations.

While each of these organizations and created policies have had an impact on student

mental health and wellbeing, the three solutions that are being advocated for have not fully been

implemented. Taking on one of the approaches would ensure that student needs are being

addressed.

Policy Report and Recommendations

Recommended Course of Action

It is clear that student mental health has become a growing concern in education. While

the statistics clearly show that mental health issues and student suicide prevention must be acted

upon, many school systems are still unsure of how to implement these changes to their

environments. The three solutions that have been popularly advocated for are suicide prevention

programs and professional development for school personnel, building connections with outside

community mental health agencies, and small group counseling efforts. Each of the solutions

have been advocated for through mental health organizations and policy adoptions. Although

each solution in itself is beneficial, a combination of these solutions would ensure that schools

are effectively tackling the mental health and suicide crisis within schools. Due to a lack of

funding for many of these programs and difficulty in getting different solutions off the ground,

the recommended course of action for solving this issue at the state and local level is to
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 12

implement mandatory suicide prevention programs and professional development training for

school personnel.

Creating mandatory prevention programs in schools is the most logical solution for

solving the mental health and suicide crisis that is currently plaguing our schools. Critics of

implementing these types of programs in schools suggest that suicide prevention programs may

be too costly. Leenaars and Wenckstern (2007) state that prevention was chosen because it is

generally agreed that this is the most cost-efficient and potentially constructive avenue (although

prevention efforts should be part of a comprehensive prevention-intervention-postvention plan)

(p. 299). With school funding being a challenge for many school districts, prevention plans offer

the most feasible method to combat the problem. This is due to the fact that there are several free

prevention and training programs in existence and schools would be able to have a choice in

which programs they use. For example, Michigan currently has free resources for school

personnel in developing suicide prevention programs. In addition, establishing prevention

programs could be the most effective route for schools in terms of autonomy and ease of

implementation. Schools would be able to choose their preferred method of prevention programs

that can fit the mold of their school setting.

Prevention programs equip individuals with information necessary to understand the

problem and to advocate for those affected. A number of suicidologists have outlined additional

goals for such programs that include (p. 300):

1. educating the entire school community (beginning with administration, followed by

teachers, other staff, parents and students)

 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 13

2. building a working relationship between mental health experts and school personnel and

students

3. detoxifying the anxiety regarding suicide (without normalizing the event

4. demonstrating that mental health experts are approachable, caring, and professional

5. reducing the reluctance to seek therapy

The reason that prevention programs are the best choice for schools is due to the

all-encompassing nature, as described above. Mandating prevention programs for all schools

would ensure that the above goals are met.

In establishing prevention programs, teachers and school personnel, must be at the front

lines of the fight. Hazel (1995) explains that schools should be cautious when implementing

suicide prevention programs due to the fact that there is research to suggest that some individuals

exposed to programs will show a deterioration in attitudes. Much of the research on this topic

describes implementing these types of training with students. Furthermore, there is no major

research to suggest that talking about suicide will increase the amount of suicides in schools

(suicide prevention policies, p. 10). In this case, the solution being advocated for is training for

all school personnel in the building. School personnel must be trained in suicide prevention

training, so that they are able to identify the issues before they occur. Lillian M. Range supports

this argument in Suicide Prevention: Guidelines for Schools (Range, 1993). Range (1993)

describes the importance of prevention programs for teachers and administrators and how to

effectively implement the programs. Suicide prevention programs will train school personnel to

identify students that are at risk, to ask those students pertinent questions in order to gain an

understanding of their mental state, as well as provide them with a course of action in next steps
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 14

to intervening in order to help the student (p. 146).

In addition the importance of establishing prevention programs, the ease at implementing

these programs and the reduced financial burden should allow schools to build these programs

into their systems. Many suicide prevention programs already exist that can provide schools with

the necessary resources needed to combat the problem. One program in particular is the

Adolescent Suicide Awareness Program. The ASAP offers a curriculum based approach to

suicide prevention for schools. The key areas of information provided in the curriculum focus on

the following: the warning signs, the facts of adolescent suicide, what depression looks like in

teens, the causes of self-destructive behavior in adolescents, what educators can do the help, and

where professional help can be provided within the community (Ryerson, 1990, p. 375). In

addition to the curriculum, the ASAP training provides an educator's seminar, a student

workshop, and a parent workshop.

Overall, schools should adopt yearly prevention program training for all school personnel

in regards to mental health issues and suicide. This training is the most cost-effective and

informative. It will allow staff members to recognize the warning signs and save the lives of

students within their buildings.

Current Prevention Programs

While many states are getting on board and implementing prevention programs of their

own, it is not mandated across the country. Currently, the Michigan Department of Education has

created the Integrating Mental Health in Schools Toolkit, a free resource that provides no-cost

techniques for schools. In addition the state board of education recommends that each Michigan

school develop socially and emotionally healthy schools by implementing universal prevention
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 15

programs (Michigan Department of Education, 2016, p. 3). Although it is promising that the

state board of education in Michigan recommends that schools implement these policies, it is not

mandated. Prevention programs must be mandated in Michigan schools as required programs for

school personnel in order to tackle student mental health issues and the increase in suicides that

currently exist.

Policy Instruments

McDonnell and Elmore (1987) argue that four alternative policy instruments, or

mechanisms [exist] that translate substantive policy goalsinto concrete actions (p. 134).

The first policy instrument that will be used to implement the suicide prevention programs in

schools and training for school personnel are mandates. Developing a mandate in this case would

develop language that would require schools to implement suicide prevention programs, as well

as a possible penalty for not doing so. The state boards of education, along with state politicians,

must draft legislation that would require school districts to implement annual prevention training.

The second policy instrument is a hortatory policy. A hortatory policy communicates to

the government that these goals and actions need to be considered a high priority. This approach

would appeal to the values to those in educational policy and would allow for individuals to

target the population that is most likely to act on the information (p. 398). In regards to student

mental health and suicide prevention programs, government officials must understand the dire

need of implementation in schools.

Combining a mandate and hortatory policy instrument provides the best approach for

policy implementation. Creating a mandate in which all schools in Michigan, and perhaps across

the nation, have to create mandatory suicide prevention training programs for school personnel
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 16

would be the first step in ensuring steps towards solving the problem. Appealing to the values of

those in educational policy and targeting the individuals most likely to act on this is also key.

Using the hortatory approach will communicate the dire need for policy implementation in

regards to mental health awareness and suicide prevention programs in schools.

Implementation

The time to implement suicide prevention programs and school personnel professional

development is now. The current statistics on suicide in adolescents proves that educational

policy leaders cannot sit idly and must take a course of action in implementing mandatory

programs for schools. Prevention programs are the best possible solution because they are the

most cost-effective and will help school employees in identifying the warning signs of mental

health issues and suicides. There are three major steps to implementation that must occur in order

to successfully implement the policy: mobilization, adopting, and institutionalization.

The mobilization step to policy implementation may be most critical. In this step, data

will be collected, necessary resources will be determined, and the planning will begin. A group

of individuals will develop a firm understanding of the motives behind the adoption of the new

policy, as well as the implications for the school district. Educational leaders and politicians will

ask critical questions, such as whether the mandated policy and selected training program will fit

the values of the community and whether the policy is consistent with the priorities and needs of

the school district (Fowler, 2013, p. 80). In this step, resources will also be gathered.

Following the mobilization stage, policies will be created and tested at the local level in

the adopting stage. This is the early stage of implementation in which the measure of success of

the program will be determined. In this stage, school districts will follow the mandate created by
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 17

local and state governments to implement suicide prevention programs. Each school district will

select the policy that they believe best fits their environment from a provided list of resources. It

is important for school leaders to provide a combination of pressure and support throughout this

stage in order to see the programs carried out at the local level.

Finally, institutionalization is the last key step to implementation. At this point, an

innovation has been incorporated into the organization (Fowler, 2013). Policy advocates are

working to move the necessary components forward. Institutionalizing the policy will mean that

suicide prevention programs become a norm of school culture and are mandatory for positive

school culture. In the institutionalization phase of implementation, leaders will assess the degree

of policy implementation by making sure the policy is included in the school board manual, as

well as the master contract, and that necessary training is described in a handbook and budgetary

requirements of the program are included in the general budget (p. 293). Once the policy has

been fully implemented, it should continue to be evaluated in order to determine the

effectiveness. Educational leaders and politicians must work to implement annual suicide

prevention training programs for school personnel in all schools in order to aggressively address

student mental health concerns.

Conclusion

Suicide prevention programs and professional development for school personnel are

necessary in order to combat the student mental health and suicide crisis currently plaguing our

schools. These programs are the most cost-effective, comprehensive, and easily implemented

solutions available. It is proven that establishing a system-wide policy will allow students to

receive the support that they need. While some may argue that suicide prevention programs have
 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 18

their pitfalls, the absolute urgency in helping our students outweighs the cost. Educational policy

leaders and school officials must follow the mobilizing, adopting, and institutionalized steps to

policy implementation in order to create safe school environments for the youth of America.

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 MENTAL HEALTH AWARENESS AND SUICIDE PREVENTION IN SCHOOLS 19

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