Mental Health Services in Schools

Mental health programs offered in schools could offer much needed help for our children.

One in five children has a diagnosable mental health problem, but nearly two-thirds get little or no help. An estimated 13% of children and adolescents worldwide have significant mentalmental health programs in schools health problems, such as anxiety or depression. Over 15% of high school students have seriously considered attempting suicide. These statistics, plus the many school shootings make it clear that our children and adolescents have mental health needs. Since most children spend much of their time at school, it offers an excellent opportunity to reach many of them with mental health education, prevention and treatment.


There have been attempts to provide mental health services in the schools. For many years, schools have had school counselors on-site. Unfortunately, they have often been given administrative duties that limited their time to do actual counseling. At times, schools have contracted with clinical mental health professionals so that students with identified diagnoses could be seen on the school campus during the school day. This service does increase the availability of treatment, but many students can slip through the cracks, and insurance or Medicaid has to be billed for the treatment.


There have been several examples of more comprehensive school-based mental health programs. A recent review in the Harvard Review of Psychiatry evaluated the effectiveness of eight such programs. The research linked those programs to benefits such as reducing anxiety, improving reading scores, reducing bullying in school, and lowering rates of substance abuse in young adults. Altogether, the programs reached over 27 million students over the last ten years.


These comprehensive programs provide a combination of mental health education, social skills building, small-group activities and when needed, individual therapy. The education components are sometimes taught by specially trained teachers, and sometimes by mental health professionals. Services are made available to all students, regardless of insurance coverage.


The Harvard Review authors concluded that school-based programs continue to be one of the most promising types of preventive mental health interventions for children. Of course, such programs will cost money, but considering the prevalence of mental health programs in our children and adolescents, and the recent incidents of school violence, we may not have a choice.

The Anatomy of a Bully

Bullying behaviors should not be tolerated at any age.

We’ve always had them with us. Every child in every school has felt the pain of being bullied.bullying behavior Every child has also watched as the bully tortures another victim. About one-in-four students in the US are bullied on a regular basis.


Bullying is a form of aggressive behavior, in which someone repeatedly and intentionally causes another person discomfort or injury. Bullying can take the form of verbal attacks, subtle gestures or physical aggression. The victim usually does nothing to cause the bullying and can do nothing to defend himself or herself.


The bully often performs the aggressive actions in front of others in order to create a “mob” mentality. Others will sometimes join in on the bullying to boost their own social position or at least divert any attacks from themselves. Bullying behaviors can often boost popularity. In fact, research shows that bullies are often perceived as the “cool kids.”


About 77 percent of bullying is verbal. It can take the form of spreading rumors, making derogatory remarks, calling names or teasing. About 14 percent of victims have more severe reactions to being bullied, including lowered self-esteem, depression, anxiety about going to school, and suicidal thoughts. Bullying victims are 2 to 9 times more likely to consider suicide than non-victims. A British study found that at least half of suicides among young people were related to having been bullied.


So, why do some people become bullies? For years, the prevailing belief was that bullies really suffered from a low self-esteem. More recent research concludes that most bullies actually have a high self-esteem, seeing themselves as superior to their victims. They do, however, seem to have a higher vulnerability to feeling shame, or being shame-prone. A person can have problems with shame and still have a high self-esteem, and this is what makes the person act like a bully. These kids disown their own shame and try to place that shame on other kids. These kids are also skilled at triggering the emotion of shame in others.


Research shows that the frequency of bullying behaviors decreases as children grow up, with most bullying incidents occurring between sixth and tenth grades. As we mature, most of us learn more healthy ways to interact, and finally realize the destructive power of bullying.


Unfortunately, not all bullies grow out of the behavior. We see, all too often, bullying behaviors in adults. We see adults spreading rumors, making derogatory remarks, name calling or teasing. We see adults exhibiting aggressive behaviors toward people who have lesser power, and have trouble defending themselves. We see adults exhibiting bullying behaviors in public, apparently trying to generate the mob mentality noted above.


Regardless of age, bullying is wrong. It is destructive and damaging and has no redeeming value. It reflects our most primitive nature. When we ignore, tolerate, or worse, praise the bully, we risk sinking to the same level. When bullying behaviors are recognized for what they are and are no longer tolerated, they lose their power. In schools, as in adult life, we need to demonstrate an attitude of intolerance for all forms of bullying behavior.


Missing Walter Cronkite

I believe our nation's divisions have been worsened by 24-hour news channels.

I’ve written before about my concerns that the divisions between conservatives and liberals,

Walter Cronkite

Republicans and Democrats have become extreme. I, and others, have noted that we have lost the ability to have civil disagreement and to find middle ground. Unfortunately, my concerns have not lessened, but I do have a theory about one contributing factor. I think our perceptions have been altered by the existence of 24-hour news networks.


When I was growing up, we had three television channels. Each had their own news program, which lasted one hour or less. In that hour, they had time to report the events of the day, but little else. They did occasionally express their views, but commentary was minimal. You heard the facts and formulated your own opinions.


I’ve shared before that on occasion, I will flip channels between CNN and Fox News to compare their coverage of a day’s events. The difference is amazing. In fact, I’ve concluded that they are actually reporting on alternative universes. It couldn’t be the same country.


A 24-hour news network has to fill up, well … 24 hours of programing. There aren’t enough events in a day to do that. Thus, they bring in commentators, analysts and panels of “experts.” They discuss each day’s events at length. They state opinions, and they state them with vigor.


Each 24-hour news network knows its viewer base. They cater to that base in their choice of which stories to cover, which angle to present, and which opinions to express. Every program is carefully crafted to pull their viewers in and say what they want to hear.


We have to remember that news programs, like situation comedies, game and reality shows, are designed to sell advertising. They aren’t donating their resources for free just to keep us informed. They sell advertising minutes, and the more viewers they have, the more they can charge for those minutes. They also know that people pay attention to negative stories more than positive, and that agitated people will stay glued to the screen for longer periods of time.


The more we hear stories that reinforce our pre-existing opinions, the more extreme our opinions become. The opposing side becomes our enemy. We focus on the differences between “us” and “them,” and ignore the similarities. We don’t trust, like or respect the other side. We don’t talk to the other side. We just argue, and we certainly don’t listen. Our divisions deepen. Conservatives become more conservative, and liberals become more liberal.


So, the next time you find yourself ranting about the correctness of your own opinion, and the foolishness or evil of the other side, consider the possibility that you may have been influenced or inflamed by programming actually created simply to sell stuff. Neither side has all the answers. All our perceptions are influenced by our own bias. As Walter Cronkite used to say, “And that’s the way it is.”



Relationship Boundaries

Here's a good technique to establish good relationship boundaries.

People need people. We are hard-wired for relationship. We suffer when we don’t have friends and family. We need romantic relationships. Most of the time, ourrelationship boundaries relationships are positive, but sometimes not.


Often, my counseling focuses on helping my client deal with a difficult relationship. The individual may be suffering because of a relationship, which is hurtful or neglectful. The pain has reached the point where they need assistance.


Sometimes, we find ourselves in a relationship with a person who says or does hurtful things to us. They may be critical or demeaning. Their negative messages can come from their words, facial expressions or body language. Either way, we get the point. We feel inadequate and conclude that we can’t please them.


The hurtful relationship could come in the form of a cold, distance. They become disengaged. They seem to have no interest in spending time with us. They may flirt with others, or even have affairs. We feel alone, even when there is someone else in the house. We conclude that we must be boring or unlovable.


The intensity of negative treatment can reach the point of abuse. The abuse can be emotional, physical or sexual. An abusive relationship severely wounds the self-esteem and creates fear.


All relationships begin positively. We would never voluntarily enter into an abusive, hurtful relationship. At first, the other person treats us well. We enjoy spending time with them, and they seem to enjoy spending time with us. We have all kinds of positive expectations for our future together.


The negative treatment begins subtly, with a slight criticism or a decrease in attention. We shrug it off as the result of a bad day. We assume we deserved it. We don’t notice the slow increase in negativity or distance.


At some point, we are faced with the hurtful nature of the relationship, but still tend to blame ourselves. We wonder what we did wrong to deserve being treated so badly.


When do we say, “enough?” When do we let the other person know that we don’t deserve to be treated badly? Where should we set our boundaries?


You can determine your boundaries by putting a loved one in your shoes. Identify a person that you like very much or love. It could be a same-gender friend or one of your children. Imagine that they were in a relationship with a person, who treated them in exactly the same way you are being treated. Imagine that they had made the same efforts you have made to resolve the situation, but the partner continued to treat them badly. Imagine that their partner said the same negative statements, neglected them to the same degree, or was equally abusive to them.  


How would you feel if your loved one was being treated this way? What would you want them to do? There’s your boundary. Never allow someone to treat you in a way that you would not want someone you love to be treated. It’s a pretty simple guideline, but it works!

King of the Hill

Kids and adults sometimes try to boost their social status by putting others down. It doesn't have to be that way.

In the days before video games, kids spent more time outside. They had to be creative in finding ways to occupy themselves. They sometimes created their own games. One suchchildren teasing another child game was “King of the Hill.”


In this game, kids would gather at the bottom of a hill. Someone would yell “go,” and everyone would race to the top. The goal was to be the one standing at the top of the hill at the end of the game. There were two ways to win the game. You could win by being the fastest one up the hill. Most often, you won by pulling anyone ahead of you backwards.


As you can imagine, the game could get pretty rough. Some kids would be running up the hill, while others were rolling back down. You knew you were in trouble when you felt someone grabbing the back of your shirt.


Unfortunately, this game is still played today, just in a different way. It’s played every day in school. Kids will put other kids down in an attempt to elevate their social standing. They try to look cool or gain popularity by teasing, gossiping, or tearing down another kid.


Kids want to fit in. They are acutely sensitive to their social standing. When they tease another kid, their desire to gain popularity blinds them to the pain felt by the victim. The target of their barb simply becomes collateral damage, at they strive to get further up the social hill.


Of course, not every child plays the game. The child with a good self-esteem doesn’t have to play. In fact, I believe that those children with the deepest self-esteem wounds play the game most viciously.


Some kids avoid the game because of their strong sense of empathy. They imagine the pain of the victim, and refuse to attack, even if their own social standing is compromised. They look for a different way to deal with the social battle.


It would be nice if the game were restricted to childhood. Unfortunately, adults sometimes play their own version. We play through gossip, which serves to make us feel better, through the denigration of another. We also play by comparison. We tend to feel better when our stuff is bigger, newer or more expensive than others. In some settings, people still play through direct teasing, oddly reminiscent of sixth grade dramatics.


It would be nice if the victims of this game could realize that their attackers play out of their own insecurities or self-esteem wounds. It would be great if players could pause the game long enough to feel empathy for their victims, and look for a healthier way to boost their own self-esteem. We would all be better off if we realized that there is room at the top of the hill for everyone.


Stress and Aging

We can't eliminate the losses that come with aging, but we can take steps to lessen the stress.

Stress is defined as an organism’s response to environmental demands or pressures. Negative stress occurs when we perceive our environment as straining or exceeding ourstress and aging adaptive capacities and threatening our well-being. We experience stress when we feel a loss of (a) control over our physical well-being, (b) influence over our circumstances or (c) our social support networks.

As we age, we inevitably experience all these losses. People vary in how early or late the losses occur, but unless we die young, we will all be there. Let’s look at these areas of loss and how they impact stress.

  1. Loss of control of our physical well-being: The loss of physical functioning actually begins in middle age. We may find that we need bifocals. We don’t have the stamina we once had, and we experience new aches and pains. As the aging process progresses, our physical losses increase. We exchange agility and stamina for fatigue and pain. In advanced age, even our day-to-day functioning becomes problematic, such that we need others to take care of our needs. All of this adds to our stress in predictable ways. We lose trust in our bodies. We lose control.


  1. Loss of control over our circumstances: With advanced age, it seems that others begin to make choices for us. We are told that it is no longer safe for us to drive. At some point, we find that we are unable to take care of ourselves and stay in our homes. Even with retirement savings, most of us have to deal with limited income. Many older adults find themselves worrying more about things they would have ignored in their younger years. Uncertainty always leads to increased stress.


  1. Loss of social support networks: Our social support networks consist of our spouse, family members, friends and acquaintances. One disadvantage of living longer than most is that you live longer than most. You experience the deaths of many people you have known and loved. You miss them. Also, as we age, we have fewer opportunities to make new friends. We are more likely to feel alone and lonely. Isolation creates stress.

Unfortunately, we haven’t found a way to eliminate the changes that come with aging. But we can take steps to lessen the stress. First, we can be thankful for the gift of a long life. We could eliminate the stresses of old age by dying young, but I don’t think many would choose that option. Gratitude lessens stress.

When we realize that old age is a gift, we more easily accept the characteristics of an aging body. We find ways to work around our limitations. This attitude also helps us adapt to the realities of our circumstances. We work to maintain independence where we can, but demonstrate a more serene acceptance where we can’t. Finally, we need to do everything we can to maintain our relationships. Call any remaining old friends or acquaintances, stay involved in group activities as long as you can. Look for opportunities to keep your mind active.

And for those of you in the younger years, call or visit an older adult. Let them know you love them. Think of someone who may feel that they are alone, and let the know that they’re not. You just might reduce their stress.

Self-Esteem and Aging

Some losses are inevitable with age. Self-esteem doesn't have to be one of them.

Life is like a conveyor belt. We get on at birth, and ride it until we die. The belt takes us through many rooms, often filled with wonderful adventures, and sometimes with Aging with a positive self-esteemheartache. As we move forward, we have many opportunities for purpose, relationship and meaning. Hopefully, we use those opportunities to enrich life for others and for ourselves.


But one thing is certain for every person. Regardless of who you are, the belt keeps moving.  Try as we may, we cannot stop the belt, or even slow it down. Before we know it, we find ourselves further down the path than we ever imagined, and wonder how we got here. We gradually move from youth to old age. The only way to avoid growing old is to die young.


As we grow older, we encounter many changes which can negatively impact self-esteem or self-worth. We’ll examine two potential factors.


  1. Changes in physical appearance: Wouldn’t it be nice to have the money spent each year by people trying to look younger? From anti-aging creams to hair dye to Botox and face lifts, we try to buy back time. If our self-esteem is too closely tied to a youthful appearance, we’re in trouble. Wrinkles form, skin sags and hair turns gray. To maintain self-esteem, we have to accept that such changes are inevitable. More importantly, these outward signs are the badge of honor of successfully living a long time.


  1. Changes in physical functioning: Try as we may, we just can’t do the things we used to do. With aging, we have to adjust to changes in vision, hearing, physical strength and stamina. We have more aches and pains, and less energy. If our self-esteem or self-worth is too closely tied to our physical functioning, we’re also in trouble. Who you are is not defined by what you can do. Think of an older adult you have loved. Was their worth defined by what they could do physically? Did their poor vision impact how you saw them? Did their decreased energy make you grow tired of them? No. You loved them for who they were, not for what they could do. You valued them because they had added value to your life.


To maintain a healthy self-esteem as we age, we have to remember that our worth is defined by who we are, not by what our bodies can do or how they look. Old age means you survived more years. You are more experienced. Because of those years of experience, you have a richer perspective. Wrinkles can bring wisdom. You know things now that you didn’t know in youth. Try to find ways to use that experience, perspective and wisdom to add value to someone’s life. That just may be your purpose on this end of the conveyor belt.

How Much Do You Want It?

There is a big difference between wishing for something, and deciding to make it happen.

I like to collect psychologist jokes. They help me to not take myself too seriously. Here ismotivation to reach your goals. my favorite psychologist joke. Question: “How many psychologists does it take to change a light bulb?” Answer: “Only one, but the light bulb has to really want to change.”


I like the joke because it is so true. I learned a long time ago that I can’t help someone change unless they really want to change. Even with the right motivation, it is hard, but without it, it is impossible.


A new year brings thoughts of change, starting over, and resolutions. We may want to stop some bad habit, or start some new one. We may want to change our job, our house or our relationships. We may want it, but is that enough?


There is a huge difference between wishing or wanting something, and deciding to make it happen. Many people wish for a better job, more education, better health habits or improved relationships, but a smaller number are determined enough or motivated enough to put in the hard work to make it happen.


After all these years, I can still hear my high school football coach asserting that the game would be won by the team that wanted it the most. He was usually right. High school athletic talent is usually fairly evenly distributed, so performance differences can usually be attributed to the player’s motivation and willingness to work.


The research is now fairly well-known that showed that mastery of any task or skill takes about 10,000 hours of practice. That’s a lot of hours. That’s also a lot of dedication, determination and motivation.


I recently heard the following from a business consultant. “If you want to make something happen, you figure out the necessary cost, and then you pay it.” You do what needs to be done. You don’t have to do it all at one time. You will often take baby steps, and sometimes you may not be able to see progress, but with absolute determination and persistence, you will get there.


A student once asked Socrates how to get to Mount Olympus. The question was more spiritual than geographic, since the ancient Greeks believed that Mount Olympus was the home of the gods. Socrates’ response was simple, “Make sure every step you take is in that direction.”


Every step we take either takes us toward or away from our goals. The steps can be small, but if taken in the right direction, they will get us to our goals.


So, in this new year, remember the importance of proper motivation and dedication in the pursuit of your goals. If the goal is good, right and worthwhile, it is worth the effort to make it happen. Change can happen, if you really want it.

Fine Tuning Those Resolutions

Here are six steps you can take to help you reach your goals.

As we approach a new year, we tend to think about new beginnings. For many, Januarygoal setting 1st suggests a time for starting some new habit, starting a new project, or simply starting over. The idea of setting new year’s resolutions has become cliché.

Yet, most of us have things we would like to improve about our lives. We think about changes that could make us happier or more comfortable. Unfortunately, our wishes or dreams don’t seem to be enough to change our reality.

So, what can we do to turn those dreams into reality? How can we most effectively improve our lives? The answer is deceptively simple. We get more done, create positive change, and realize more of our dreams when we start with written, specific, and measurable goals.

In “What They Don’t Teach You at Harvard Business School,” Mark McCormack relates a study in 1979, where graduating students were asked whether they had set clear, written goals for their future, and made plans to accomplish them. Only 3% of the students had written goals and plans, 13% said they had goals, but not in writing, and 84% had no goals at all. Ten years later, the 13%, who said they had unwritten goals, were making twice as much as the 84% who had no goals, while the 3% with written goals were making ten times as much. Other studies have shown that people who set specific, written goals accomplish much more than those who don’t.

But, it’s not quite so simple. Here are a few guidelines if you want to tap into the power of goal-setting to improve your life.

  1. Your goals need to be specific. A goal of “I want to lose weight” is too vague. A specific goal like, “I want to lose 25 lbs.” is much better. The subconscious mind seems to connect to a specific number or amount, in a way that charges our motivation and determination.
  2. You need a deadline. You will be much more motivated by a goal of “I will clean out the closet by 5:00 Saturday,” than you will the goal “I will clean out the closet.” Try to make it a reasonable deadline, but set one.
  3. Make the goal measurable. This may be accomplished by making the goal specific, but it may not. There needs to be no question whether you met the goal. Anyone should be able to tell whether you succeeded.
  4. Determine a strategy to meet the goal. Make a plan. How do you plan to accomplish the goal? What are the intermediate steps you will have to take?
  5. Post the goal where you will see it. To be successful, you will need to be reminded of the goal. I’m sure that this is the reason someone invented refrigerator magnets.
  6. Tell a supportive, encouraging friend. Having an accountability partner can really help. They may be aggravating, but nonetheless helpful.

Give it a try. You have nothing to lose. See if goal-setting can work for you in changing your life for the better. And there’s no better time than the beginning of a new year!

A Love Letter with Tinsel

Christmas is a reminder that we are loved, but we often have trouble accepting it.

At this time of year, we all often see reminders of the real reason for Christmas, and we do need them. The onslaught of holiday events, family gatherings, shopping Loved at Christmasfrenzy and commercialism can be pretty overwhelming. In the midst of the chaos, we need a nudge to center our focus on a simple, humble birth in an ancient, middle-eastern stable.


So, we remember that Christmas is the celebration of Jesus’ birth and that’s good. But then we have to remember that He was born for the specific purpose of dying. He was born as a sacrifice for us. The first Christmas gift was wrapped in swaddling clothes and laid in a manger.   


But why? Why did He do this for us? We certainly didn’t deserve it. We didn’t earn it. We had messed everything up royally. So why?


We’re told that it was because He loved us, and I believe that to be true. But, it’s too easy to let those words slip out without really considering their meaning. I think most of us have trouble letting that idea fully sink in.


We can accept God’s love when we think of others. We have no trouble accepting that God loves our children, our family members and our friends. We can even accept that He loves the world. But, we have a little more trouble accepting that He loves us, individually.


We may intellectually believe that God loves us, but we have trouble feeling it. We have difficulty accepting it, because we often feel so unlovable. We see our faults, failures and mistakes. We know that we don’t deserve that kind of love.


I believe that the biggest stumbling block for many is their inability to fully accept, and feel God’s love. It’s easier to imagine a wrathful, disapproving, punishing God. The idea that we could be completely and unconditionally loved, when we are so inadequate, seems to be too far a stretch.


But then, here it is. That annual reminder that you are loved completely, unconditionally and sacrificially. The reminder that you matter, that you are precious. Try to accept it.


Recall how it feels to sit in the sunshine on a warm, summer day. You can feel the sun’s rays soaking all the way through you. Imagine God’s love doing the same, soaking through every cell of your body. Accept the gift. Hold onto it. Enjoy it. Let every light, ribbon and tinsel remind you that you are loved this Christmas. And when you read the Christmas story, remember that it is actually a love letter to you, wrapped in tinsel.