A call to arms: children's mental health: as old stigmas persist, schools can no longer duck their responsibility for ensuring the well-being of students.

When will we listen? Whose voice do we need to hear for us to pay greater attention to the mental health of our children?

As educators struggle with whether to deal with students' mental health issues, how many more funerals will we cry through following teenagers' suicides? How many more times will we accept the loss of young promise as students try to cope with depression?

What if Andy Rooney were given a "60 Minutes" assignment to ask whether mental health issues are important in our schools? Can't you just picture his face and hear his voice: "Did you ever wonder why something so obvious like the mental health of our children is so much discussed and so little understood? Why can't we just spend some of the money that is going to government's favorite pork-barrel programs on the health of our children? Why is this so difficult to do? Would someone please explain this to me?"

Good questions, Mr. Rooney.

A quick Internet search provides all the information, research and suggestions we need to answer Rooney's question. An electronic request to Susan Gorin, executive director of the National Association of School Psychologists, provided me with enough information and solid position statements to put to rest any question about the direction schools should take. Another quick e-mail to Nancy Etcoff, a psychologist and faculty member at the Harvard Medical School and at Harvard's Mind/Brain/Behavior Initiative, reassures me this question is important, noting there are encouraging answers to why we should be hopeful about the emerging positive mental health models.

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Yet mental health issues continue to linger in every school and facing every educator. Why is this?

In spite of some powerful national reports and the articulate voices of individuals and professional organizations, we haven't given this subject enough air time to raise it to the level of the math wars or reading wars debates. Perhaps we still don't have enough knowledge to have productive local conversations, and perhaps the old stigmas are still around.

Compelling Need

Questions about the mental health of students come to us both on professional and personal levels. There's just no ducking what we hear.

Consider this statement from "Children's Mental Health: Developing a National Action Agenda," a report prepared by the Department of Health and Human Services as an outgrowth of the "Surgeon General's Report on Mental Health" in September 2000: "The nation is facing a public crisis in mental health for infants, children and adolescents.... In the United States, one in 10 children and adolescents suffer from mental illness severe enough to cause some level of impairment. Yet, in any given year, it is estimated that about one in five such children receive mental health services. Unmet need for services remains as high now as it was 20 years ago. Recent evidence compiled by the World Health Organization indicates that by the year 2020, childhood neuropsychiatric disorders will rise proportionately by over 50 percent, internationally, to become one of the five most common causes of morbidity, mortality and disability among children."

As clear and frightening as the facts are, what is even more compelling to me are the stories I hear from friends, neighbors, students, parents and colleagues. In those quiet moments of honest conversation, we hear of those who suffer from depression, who have lost days at work or in school because of anxiety, or who have not performed at the level they would like to.

Balanced Discussion

When our granddaughter, Rebecca, runs squealing and giggling, shoulders hunched ready for the jump into my arms and shouts, "Grandpa," I simply melt. There is nothing else in the world at that moment except her arms around my neck, her kiss on my lips and her head on my shoulder. She is a 4-year-old so this is not a long moment. She presses my nose as a sign that it is time to get down and back to play.

Oh that I could freeze those moments, to protect her in my arms forever.

Sometimes the reality of my professional life creeps home into those Rebecca moments. I look at her and wonder, as do all parents and grandparents, will she learn to read, add and subtract, kick a ball, make friends and be happy in life? Our family talks about what we want in life and about what we want for those we love. Those conversations always include a clear priority to have our health and to be happy.

This sweet image of my granddaughter has not been included here just to get a few oohs and aahs. My purpose is to bring balance to the national discussion. Our discussions and actions should not be just about mental illness and problems. We must also focus on our obligation to create mentally healthy classrooms and schools.

Nancy Etcoff, a psychologist at Harvard and author of Survival of the Prettiest, reminds me that we must "talk about prevention. For example, positive psychology, mindfulness, self-esteem, body image, media deconstruction and other programs that would be very helpful and should be more widely introduced."

Just as Rebecca's parents and extended family do all that can be done to treat her allergies and colds, so do we all gladly work together to ensure we are proactive in helping her lead a healthy and happy life.

Beyond Classrooms

I look at their faces carefully. One looks a little tired. (I hope everything is OK at home.) Another child can hardly sit still. (Oh, my--what does all this movement mean?) A third is smiling and singing. (Is this all just an act?)

How beautiful these kindergarten children are.

As with most superintendents, I never miss a chance to visit a kindergarten class. When things are a little tough in the office or I just need a small reminder about why I head off to the office in the first place, there is nothing like visiting schools.

One of my favorite ways to find out about high school kids is to say hello as we pass in the hallway. Some look me right back in the eye, smile and say hello. Others look a little surprised but mumble something back to me anyway. And then there are the ones who pretend not to have heard or seen me.

Which of them, I wonder clinically (and very naively), needs a bit more attention? Who among them might not be feeling well or might need some mental health attention?

One of the major concerns we must address if we are to deal well with intervention and pro-active programming is that of professional development. Classroom teachers are so overburdened with new curriculum, changing pedagogies, increased expectations and new demographics and reduced resources that few have the time to stay up to speed with what has traditionally been expected from them.

We must be careful to respect the limits of public schooling so that we offer intervention and referral services, not therapy. Even with all of these caveats, the evidence is clear that healthy students have a much better chance of succeeding in school. The evidence about the link between health and school success is both for mind and body as Ken Duckworth, who serves as the medical director for the National Alliance on Mental Illness, said several years ago in front of a panel in Washington, D.C.: "It should not be a revelation to us that the head is not detached from the body."

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Harsh Critics

There's something about throwing out mail that just feels good. Sometimes mail that should be treated like junk catches my eye and gets further examination.

The piece of mail that recently never made it to the garbage was a small official-looking white box. It could have been a package from a government agency. However, it was a DVD from the Citizens Commission on Human Rights, an organization affiliated with the Scientology movement.

Inside my package was a DVD with the horrific title, "A Documentary ... PSYCHIATRY: An Industry of Death." The front of the DVD case graphically pictured a roll of money with blood dripping off onto a cemetery filled with crosses. This sure got my attention!

Inside the DVD case was a letter addressed to our high school principal:

"Dear Dr. K:

Are you looking for help to protect youth under your care from being unfairly labeled and stigmatized?

* At least nine million American youth have been put on powerful psychiatric drugs, four million of them on stimulants more potent than cocaine. Young learners have been fraudulently labeled as ADD/ADHD sufferers or as having 'learning disorders' that need to be controlled, not by educational solutions, but by powerful mind-altering drugs.

* Psychiatrists admit that there is no X-ray, blood or other physical test to determine if a child has ADHD or any other 'mental disorder.'

* The New Freedom Commission on Mental Health recommended that all schoolchildren be screened for mental disorders based on a manual that even experts say is unreliable and unscientific. The screening/profiling will lead to more children being forced onto mind-altering drugs."

Treatment Options

The psychiatrists of the world who are attacked by Citizens Commission on Human Rights certainly don't need me to defend them. However, treatment of children with mental health needs must not be limited to the skewed recommendations of this advocacy group.

The Citizens Commission on Human Rights website acknowledges that mental health concerns are real: "No one denies that people can have difficult problems in their lives, that at times they can be mentally unstable. Mental health care is therefore both valid and necessary. However, the emphasis must be on workable mental healing methods that improve and strengthen individuals and thereby society by restoring people to personal strength, ability, competence, confidence, stability, responsibility and spiritual well-being.... [M]ost people can overcome the obstacles of leading satisfying lifestyles through the help of more natural alternatives that treat our whole selves...."

Natural alternatives may sound fine, but jumping on the couch reactions may shortchange children who need more intensive help. Several years ago in a guest column for this magazine ("Dear Tom Cruise: Meet My Daughter," February 2006), I invited actor Tom Cruise and others who believe that treating mental illness only requires exercise and vitamins to examine the life of my daughter, Rachel. Through cognitive therapy, medication and lots of hard work and tears, Rachel continues on her path toward mental health. As she walks down the aisle on her wedding day this September, she will stand as a symbol of many thousands in our country who are thriving because they did not rely on some simplistic solution.

Sure, alternatives to drugs are available, just as there are alternatives to treating any disease. Although some options work, we also know not all illnesses can be treated the same. We need to understand and use the range of options available to us. Those of us who deal every day with thousands of children want support, help and rational conversations--not alarmist materials in our mailboxes.

The harsh reality is that many children need help. The honest reality is that very good work is being done across our country. While these national distributions of DVDs are stimulating and irritating, they also scare some folks into avoidance. How much better it would be for our children if we focused our collective energy in helping schools create positive mental health programs and environments.

Risk Awareness

Anniversaries are good times to pause to count our blessings and to reflect on what might come next in our lives. Perhaps we can look at this year as an anniversary, maybe as a 25-year memorial to the 1983 White House-commissioned education report that was elegant, stirring and compelling. As with many young school administrators that year, I was deeply moved by the promise of this report. We were inspired with hope, encouraged that our dreams for children might come true and committed to turning against that awful rising tide of mediocrity.

Imagine what might be today if we had actually heeded the warnings of "A Nation at Risk?" Even now, what if we were not just to write about, but to actually act on a call to arms for the mental health of our children? Let's borrow from the language of 25 years ago as we accept the responsibility to take action: "Our Nation is at risk.... We report to the American people that while we can take justifiable pride in what our schools and colleges have historically accomplished and contributed to the United States and the well-being of its people, the educational foundations of our society are presently being eroded by a rising tide of mediocrity that threatens our very future as a Nation and a people."

Our nation is still at risk. This time the risk is not just academic and economic. The enemy is not some foreign country but right here in our own schools. There is a rising tide of social and emotional needs among our children. As this new century is still dawning, we can readily see the needs of our students. Few argue that those needs really do exist. The debate must focus on how best to address students' needs.

Call to Action

I am suggesting that we take at least four steps:

* Acknowledge the existence of mental health needs of our students;

* Provide professional development for all staff in two general areas--creating positive mental health environments and programs and understanding mental illnesses for the purpose of intervention and referral;

* Stop the stigmas and other barriers that keep us from having a candid and honest conversation about children's mental health; and

* Either personally take a leadership role or create systems that encourage positive professional conversations about mental health.

We have so much more to do to for our children's mental health. When I think of the many needs and the slow progress, I am reminded of the good fortune I had quite a while ago to study briefly with John Goodlad. His book A Place Called School had just been published. I asked him how he had the energy over so many years to continue to write what was obvious, yet not largely acted on about school improvement.

Goodlad's advice still works: Be patient, people will listen. Just don't give up; the children need us. And so it goes.

Additional Resources

Morton Sherman suggests these web-based resources on dealing with the mental health issues of students:

* Helping America's Youth, program recommendations from the federal government, www. helpingamericasyouth.gov/programtool-ap.cfm

* Child and adolescent mental health information, prepared by the federal Substance Abuse and Mental Health Services Administration, www.mentalhealth.samhsa.gov/child/childhealth.asp

* Positive behavioral interventions and supports, compiled by the Office of Special Education Programs Technical Assistance Center, www.pbis.org

* Social norming resources, compiled by the independent National Social Norms Resource Center, www.socialnorm.org

* Developmental asset building, from the independent Search Institute, www.search-institute.org/assets

* Promising Practices Network, funded by the RAND Corp., www.promisingpractices.net

* Center for Effective Collaboration and Practice, http://cecp.air.org

* Center for School Mental Health, http://csmha.umaryland.edu

* National Association of School Psychologists, www.nasponline.org/resources

Mort Sherman is superintendent of Tenafly Public Schools in Tenafly, N.J. E-mail: [e-mail]