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Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.

Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too.

The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include: Hallucinations, Delusions, Thought disorders (unusual or dysfunctional ways of thinking), and Movement disorders (agitated body movements).

Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include: “flat affect” (reduced expression of emotions via facial expression or voice tone), reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities, and reduced speaking.

Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include: poor “executive functioning” (the ability to understand information and use it to make decisions), trouble focusing or paying attention, and problems with “working memory” (the ability to use information immediately after learning it).

There are several factors that contribute to the risk of developing schizophrenia.

Genes and environment: Scientists have long known that schizophrenia sometimes runs in families. However, there are many people who have schizophrenia who don’t have a family member with the disorder and conversely, many people with one or more family members with the disorder who do not develop it themselves.

Scientists believe that many different genes may increase the risk of schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.

Scientists also think that interactions between genes and aspects of the individual’s environment are necessary for schizophrenia to develop. Environmental factors may involve: exposure to viruses, malnutrition before birth, problems during birth, and psychosocial factors

Different brain chemistry and structure: Scientists think that an imbalance in the complex, interrelated chemical reactions of the brain involving the neurotransmitters (substances that brain cells use to communicate with each other) dopamine and glutamate, and possibly others, plays a role in schizophrenia.

Some experts also think problems during brain development before birth may lead to faulty connections. The brain also undergoes major changes during puberty, and these changes could trigger psychotic symptoms in people who are vulnerable due to genetics or brain differences.



Most people are familiar with the more widely known eating disorders anorexia nervosa, bulimia nervosa and even binge eating disorder, but few recognize the link between type 1 diabetes and eating disorders. The term “diabulimia”  has often been used to refer to this life-threatening combination and the unhealthy practice of withholding insulin to manipulate or lose weight. People suffering from ED-DMT1 may exhibit any number of eating disorder behaviors or they may only manipulate their insulin and otherwise have normal eating patterns.

This risky practice can have catastrophic health consequences. Often these individuals take just enough insulin to function and consistently feel dehydrated, fatigued and irritable. More critically, they face long-term health complications ranging from blindness and nerve disorders to kidney failure and diabetic ketoacidosis (an acidic buildup in the blood resulting from inadequate insulin levels). ED-DMT1 is a relatively new term and the link between type 1 diabetes and eating disorders is not yet recognized as a medical or psychiatric condition. As a result, it is greatly under-diagnosed and left untreated. The first step in treating this dangerous disorder is understanding the causes and symptoms.

Numerous studies conclude that woman with type 1 diabetes are twice as likely to be diagnosed with an eating disorder compared to their non-diabetic peers. Although many of these studies suggest that there is a higher rate of woman engaging in this risky practice, type 1 diabetic men can and do suffer from eating disorders as well.

There are many factors that can contribute to the increased risk of ED-DMT1: the necessary emphasis on food and dietary restraint associated with the management of type 1 diabetes can create an unhealthy focus on food, numbers, and control. The psychological and emotional effects of having to manage a chronic medical condition such as type 1 diabetes, can also play a role. Depression, anxiety and poor body image are common with the dual diagnosis of ED-DMT1. Living with type 1 diabetes is not easy; sometimes insulin omission or other behaviors that could be considered traits of an eating disorder may start out as an act of diabetes rebellion but can manifest over time into an overwhelming cycle of eating disordered thoughts and symptoms.



Depression is a condition that is often overlooked and misdiagnosed. This is partly because the onset can be a bit more subtle than many other psychological disorders. Many times, it’s hard to spot the signs of depression because they appear slowly, over a period of time.

Many times someone will know they are not sick, but will not feel “right,” and wonder what the problem is. If they understood the symptoms of depression they would realize they had a serious problem that needed to be addressed. It’s important to recognize depression because it is a serious medical illness that won’t go away if only you would “snap out of it.” It’s a little more serious than just having a case of the blues.

According to the National Institute for Mental Health, in any given one year period, 9.5 percent of the population or approximately 20.9 million adults in the United States suffer from a depressive illness. The condition is often hereditary, running in families, and can be triggered by stressful incidents, such as relationship problems or financial difficulties as well as physiological conditions. Unfortunately, the symptoms of depression are very similar to those caused by other illnesses, which can prevent or delay much-needed medical treatment.

Some of the most commonly known symptoms of depression include feelings of emptiness or sadness, helplessness and hopelessness and feeling tired or fatigued. Other symptoms include difficulty concentrating on the task at hand, trouble making decisions, irritability or a lack of interest in former hobbies. Some of the symptoms can also be confusing or contradictory. For example, the disruption of sleep patterns can result in difficulty falling asleep, difficulty in sleeping through the entire night or waking up too early in the morning. During the depression, it is also common to experience unexplained changes in appetite that can result in either too much weight gain or too much weight loss.

One fact of depression that often surprises people is that symptoms of depression do not solely include mental issues, such as suicidal thoughts, but can also include physical symptoms such as chronic pain, headaches or digestive problems not due to another illness. As different as all these symptoms appear, they could all be a sign that you are depressed.

Because the condition will vary among individuals, not everyone will experience all of the symptoms of depression or the same severity of the symptoms. Depression does seem to run in families, according to many medical studies. Some differences exist, however. Women are twice as likely as men to experience depression, particularly around significant life changes such as pregnancy, the postpartum period and menopause.

Though most people believe that older people are more susceptible to experiencing the symptoms of depression as they age, this is not true. Depression is not a normal part of aging, but certain illnesses that are more common among senior citizens can lead to depression. Among these are heart disease, cancer, stroke, Parkinson’s disease and diabetes. As a result, the symptoms of depression among seniors can be overlooked and untreated. Some of the most common symptoms of depression include: Sadness and Anxiety, lack of energy and interest, physical illness, negative thinking, and fatigue and sleeplessness.

There is no one cause of depression. This illness tends to run in families. Researchers have theorized that it is a combination of a certain vulnerability due to hereditary factors and environmental factors (physical illness or stress). The combination of the two is thought to trigger an imbalance in the brain’s chemistry, which leads to symptoms such as feelings of hopelessness.

It is not clear whether the illness itself is caused by or merely a symptom resulting from certain neurotransmitters being out of balance. The three neurotransmitters involved are as follows: dopamine, serotonin, and norepinephrine. There are several factors that can contribute to a person feeling this way: hormones, heredity, stress and illness, medications and recent child birth.





Recognizing the signs of student Mental Health problems

Adolescence is a difficult time for many teens, but how does a teacher know the difference between typical teen issues and behavior that might signal a more serious problem? Mental health problems in teens are real, painful and, left untreated, can have serious consequences.

For some teens, adolescence can be the period of their lives when mental health problems appear. In fact, according to a study by the National Institute of Mental Health, 90 percent of people who develop a mental health problem show warning signs during their teen years.

These problems can interfere with the way teens think, feel, act, and interact. When left untreated, mental health problems can sometimes lead to school failure, family conflicts, drug and alcohol abuse, trouble with the law and suicide.

Mental health disorders that can affect teenagers include depression, schizophrenia, bipolar disorder, anxiety disorder, ADHD (attention deficit and hyperactivity disorder) and eating disorders.

Sharon (Shari) Sevier, Ph.D., LPC, is the director of guidance and counseling for the Rockwood School District in Eureka, Mo., and she also operates a private practice. She deals with teen mental health issues on a daily basis.

According to Dr. Sevier, there are a wide variety of issues affecting today’s teens. “There are high school kids who are feeling so much pressure to achieve,” she said. “A lot of it is perceived, but nevertheless it is very real to them and it becomes overwhelming.” Other students are “truly dealing with mental health — depression, anxiety. They want to escape the pain that they’re in.” For these students in particular, early intervention can change — or even save — lives.

Startling Statistics

The facts are sobering. About four million, nine to 17 year olds have a major mental health disorder that results in significant impairment at home, at school and with peers, according to a report of the Surgeon General’s Conference on Children’s Mental Health. At least one in five children and adolescents has a mental health disorder, and one in 10 has a serious disorder. And most tragically, the National Center for Health Statistics reports that suicide is the third leading cause of death among teens and young adults 15 to 24 years old.

Research supported by the National Institute of Mental Health (NIMH) has found that half of all lifetime cases of mental illness begin by age 14 and that despite effective treatment, there are long delays — sometimes decades — between first onset of symptoms and when people seek and receive treatment. Untreated mental disorders can lead to a more severe, more difficult-to-treat illness, and to the development of co-occurring mental illnesses.

Early Recognition is Key

While the statistics are startling, early recognition of mental illnesses, early diagnosis, and referral to appropriate treatment can greatly improve the lives of adolescents and young adults.

When young people who suffer from emotional or mental health problems get help through counseling and other treatment, it can change the course of their lives.

Research shows that teens with mental health problems who do get appropriate treatment have increased scholastic test scores, and that effective mental health interventions and a positive school climate contribute to improved student achievement.

Mental health intervention can also delay the onset of substance abuse, if intervention occurs before the ages when young people are most likely to begin experimenting with or using drugs and alcohol (research findings, New York Office of Mental Health).

Spotting the Signs

Dr. Sevier credits the American Psychiatric Foundation’s (APF) Typical or Troubled?TM school mental health education program with helping her conduct 59 staff trainings in her district.

As Richard K. Harding, M.D., Board member of APF and child and adolescent psychiatrist explained, “the Typical or Troubled?™ program is designed to educate school staff — counselors, teachers, coaches, custodians and others — about recognizing the warning signs of mental illness in adolescents, and if they notice the warning signs in a student to talk with them and refer them to help within the school or if necessary to a mental health professional.”

Counselors, teachers and other school staff may be the first to notice symptoms. They see students every day and have a unique role in helping troubled teens get help. How do you tell the difference between typical teenage behavior and something more serious?

Some of the signs that there might be a serious problem include:

  • Increased tardiness or absences — one of the earliest signs
  • Angry or aggressive behaviors
  • Poor concentration — student can’t focus, fidgets
  • Student seems withdrawn, silent, lacks friends — especially if this is a change in behavior
  • Student appears overly anxious or worried, even fearful

The Typical or Troubled?™ program includes more detail on all the warning signs and information about mental health problems in adolescents.

The teen years are complex — even normal adolescents may display alterations of mood, distressing thoughts, anxiety and impulsive behavior. So how can you distinguish normal teen behavior from behavior that might signal a more serious mental health problem?

The answers to two questions can provide insight and guidance: The first is, “how frequent?” Are warning signs happening over and over again? Warning signs persist over a couple of weeks, and don’t go away. The second question is “how extreme?” If a warning sign or behavior shows up, even if it is infrequent, the important question to ask is: “is this warning sign extremely different from this student’s usual way of behaving?”

A “yes” answer to either question is a good indicator that there may be a serious problem. If these indicators are present, the counselor or teacher should talk to the student and connect them to the school mental health staff.

Types of Mental Health Problems

There are four major overall categories of mental disorders:

  • Mood disorders (depression, bipolar disorder)
  • Anxiety disorders (Post-traumatic stress disorder, obsessive-compulsive disorder, social phobia)
  • Psychotic disorders (such as schizophrenia)
  • Behavioral and disruptive disorders (oppositional defiant disorder, conduct disorder)

While only mental health professionals can diagnose these disorders, it is helpful to be familiar with the characteristics.

Clinical depression

Individuals experience deep despair, sadness, crying, sleep disturbance, chronic fatigue and other physical symptoms, or thoughts of death or suicide. As many as one in 13 adolescents experience symptoms of depression at some time. Adolescent girls are twice as likely to experience bouts of depression.

In a school setting, it may be evidenced by withdrawal, silence, body/stomachaches and trips to the nurse.

Bipolar disorder

Bipolar disorder is a type of mood disorder, with marked changes between extreme elation or happiness, irritability and severe depression. An estimated one in 100 teenagers has bipolar disorder. Those with bipolar disorder may be in a good mood and very productive during the manic phase and in deep despair during the depressive phase. Suicide can be a very real concern for adolescents with bipolar disorder.

Extreme ups and downs in attitude and behavior are signals that someone may be suffering from bipolar disorder.

Anxiety disorders

Anxiety disorders include panic disorder, post traumatic stress disorder, obsessive-compulsive disorder and social phobia. A person with anxiety disorders experiences overwhelming or terrifying fear, or fearful anticipation of danger or problems, often with no apparent cause. Symptoms can be incapacitating, or characterized by mild but incessant anxiety or repetitive rituals.

These disorders frequently run in families, and young people have a nearly one in seven chance of developing some type of anxiety disorder. Obsessive-compulsive disorder frequently arises during teen years, and can be the most disabling of the anxiety disorders.

Signs may include fidgeting or tapping, body/ stomachaches and trips to the nurse.

Eating disorders (anorexia and bulimia)

Eating disorders are characterized by unrealistic, irrational thoughts about weight. Suffers refuse to maintain a body weight at or above a minimal normal weight for their age and height. Some others repeatedly engage in episodes of binge eating and purging. One in 20 adolescents suffers from an eating disorder, and nine in 10 of those are girls. Anorexia is easier to see than bulimia, due to low body weight. Taken to the extreme, eating disorders can affect the heart and result in death.

Warning signs include extreme thinness, signs of throwing up or excessive time in the restroom.


Schizophrenia is the most chronic and debilitating of all psychiatric conditions. It causes strange thinking, strange feelings, unusual behavior or hallucinations. People suffering from schizophrenia may be high functioning and then experience a big decline in performance. They may be distrustful, cease being social or respond to voices only they may be hearing. Early intervention may improve a young person’s prognosis.

Symptoms may include very disturbed and/or paranoid statements.

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD causes problems paying attention and concentrating, with hyperactive and impulsive behaviors. It can seriously impact one’s ability to learn and overall school performance, and can lead to later difficulties or failure in education, job and marriage.

In a school setting, frequent disruptions in the classroom may be a sign of ADHD.

Oppositional Defiant Disorder

In children with oppositional defiant disorder, there is a pattern of persistently negative behavior that can be hostile. This kind of behavior, if it happens in the classroom, can be distracting and disruptive to the classroom.

Consistently being disobedient and disrespectful is a signal.

Conduct Disorder

People with conduct disorder exhibit verbal and physical aggression toward people and even animals.

Without appropriate treatment, most young people with this condition can face a dim future. Studies of juveniles in prison found that approximately nine in 10 had conduct disorder.

Warning signs include aggressive, violent behavior or outbursts.

Take Action to Make a Difference

The process for referring an adolescent to appropriate help within the school when noticing signs of trouble can vary for different schools and school districts. Many times the school or district has set up a referral system and policies which guide action. Oftentimes there is a social worker, psychologist, or other mental health professional on the school staff, or associated with the school district. School counselors have a network of professionals within the school community to whom they can refer students who need help.

Parental involvement is crucial. A school representative should make sure to inform parents about their child’s behavior in school, and discuss resources available to them. It is important to focus on making the first meeting with parents a positive experience. It will help pave the way for future meetings or discussions that may have to address a sensitive issue like a student’s troubling behaviors. Make an effort to maintain frequent and open communication with parents. And it’s also important to communicate the positive — not just the negative. Parents tend to have a hard time listening or discussing issues if all they are hearing about is poor progress or problem behavior.

Only a mental health professional can diagnose a mental health disorder. When talking to parents, it is important for non-mental-health professionals to discuss only those observable behaviors that they believe are warning signs.

If the parent chooses to move forward, he or she would work with a mental health professional such as a child and adolescent psychiatrist who will do an evaluation. The parent may choose to talk to their family physician or pediatrician. Following the evaluation, treatment may include psychotherapy, medications or a combination of both.

By noticing early warning signs, school counselors, teachers and other school staff can work with mental health professionals and parents to assure that young people get the help they need to remain healthy. A practical piece of advice from Dr. Sevier is to pay attention. In her words, “You have to know your students well enough to notice when their behavior changes.”


Mind/Body Connection How Your Emotions Affect Your Health

People who have good emotional health are aware of their thoughts, feelings, and behaviors. They have learned healthy ways to cope with the stress and problems that are a normal part of life. They feel good about themselves and have healthy relationships.

However, many things that happen in your life can disrupt your emotional health. These can lead to strong feelings of sadness, stress, or anxiety. Even good or wanted changes can be as stressful as unwanted changes. These things include: being laid off from your job, having a child leave or return home, dealing with the death of a loved one, getting divorced or married, suffering an illness or an injury, getting a job promotion, experiencing money problems, moving to a new home, and having or adopting a baby.

How can my emotions affect my health?

Your body responds to the way you think, feel, and act. This is one type of “mind/body connection.” When you are stressed, anxious, or upset, your body reacts in a way that might tell you that something isn’t right. For example, you might develop high blood pressure or a stomach ulcer after a particularly stressful event, such as the death of a loved one.

Path to improved healt

There are ways that you can improve your emotional health. First, try to recognize your emotions and understand why you are having them. Sorting out the causes of sadness, stress, and anxiety in your life can help you manage your emotional health. Following are some other helpful tips.

Express your feelings in appropriate ways

If feelings of stress, sadness, or anxiety are causing physical problems, keeping these feelings inside can make you feel worse. It’s okay to let your loved ones know when something is bothering you. However, keep in mind that your family and friends may not always be able to help you deal with your feelings appropriately. At these times, ask someone outside the situation for help. Try asking your family doctor, a counselor, or a religious advisor for advice and support to help you improve your emotional health.

Live a balanced life

Focus on the things that you are grateful for in your life. Try not to obsess about the problems at work, school, or home that lead to negative feelings. This doesn’t mean you have to pretend to be happy when you feel stressed, anxious, or upset. It’s important to deal with these negative feelings, but try to focus on the positive things in your life, too. You may want to use a journal to keep track of things that make you feel happy or peaceful. Some research has shown that having a positive outlook can improve your quality of life and give your health a boost. You may also need to find ways to let go of some things in your life that make you feel stressed and overwhelmed. Make time for things you enjoy.

Develop resilience

People with resilience are able to cope with stress in a healthy way. Resilience can be learned and strengthened with different strategies. These include having social support, keeping a positive view of yourself, accepting change, and keeping things in perspective. A counselor or therapist can help you achieve this goal with cognitive behavioral therapy (CBT). Ask your doctor if this is a good idea for you.

Calm your mind and body

Relaxation methods, such as meditation, listening to music, listening to guided imagery CDs or mp3s, yoga, and Tai Chi are useful ways to bring your emotions into balance. Free guided imagery videos are also available on YouTube.

Meditation is a form of guided thought. It can take many forms. For example, you may do it by exercising, stretching, or breathing deeply. Ask your family doctor for advice about relaxation methods.

Take care of yourself

To have good emotional health, it’s important to take care of your body by having a regular routine for eating healthy meals, getting enough sleep, and exercising to relieve pent-up tension. Avoid overeating and don’t abuse drugs or alcohol. Using drugs or alcohol just causes other issues, such as family and health problems.

Things to consider

Poor emotional health can weaken your body’s immune system. This makes you more likely to get colds and other infections during emotionally difficult times. Also, when you are feeling stressed, anxious, or upset, you may not take care of your health as well as you should. You may not feel like exercising, eating nutritious foods, or taking medicine that your doctor prescribes. You may abuse  alcohol, tobacco, or other drugs. Other signs of poor emotional health include: back pain, change in appetite, chest pain, constipation or diarrhea, dry mouth, extreme tiredness, general aches and pain, headaches, high blood pressure, insomnia (trouble sleeping), lightheadedness, palpitations (the feeling that your heart is racing), sexual problems, shortness of breath, stiff neck, sweating, upset stomach, and weight gain or loss.

Why does my doctor need to know about my emotions?

You may not be used to talking to your doctor about your feelings or problems in your personal life. But remember, he or she can’t always tell that you’re feeling stressed, anxious, or upset just by looking at you. It’s important to be honest with your doctor if you are having these feelings.

First, he or she will need to make sure that other health problems aren’t causing your physical symptoms. If your symptoms aren’t caused by other health problems, you and your doctor can address the emotional causes of your symptoms. Your doctor may suggest ways to treat your physical symptoms while you work together to improve your emotional health.

When to see a doctor

If your negative feelings don’t go away and are so strong that they keep you from enjoying life, it’s especially important for you to talk to your doctor. You may have what doctors call “major depression.” Depression is a medical illness that can be treated with individualized counseling, medicine, or both.


Addressing the Rising Mental Health Crisis in Public Schools

More than 50 million students are enrolled in public schools across the United States. Of those, one in five meet the criteria for a mental health condition. About 70-80% of these students won’t receive any kind of treatment or therapy. Because children and adolescents spend most of their time at school, teachers, administrators, school nurses, and other staff are often in a unique position to be the first to identify any problems or issues in a child’s life. Here are some ways for public schools to better address this rising mental health crisis.

Mental Health Screening in Public Schools

Most schools do not have any type of mental health screening in place for students. The National Association on Mental Illness supports mental health screenings for several reasons. Half or more of chronic mental health issues begin at or before age 14. Early identification and treatment can help prevent more serious problems down the road.

Just as screenings are done for a variety of physical health problems, mental health screenings in public schools could greatly benefit vulnerable students. Conducting mental health screenings in schools allows teachers to recognize the warning signs of various mental health issues, allowing for earlier identification and quicker connections to the treatment resources students might need.

The Role of Public School Nurses in Mental Health

While school nurses are usually the most likely to catch any mental health issues early on, many schools only have one on-staff nurse, and many of these nurses only work part-time. It is not uncommon for entire school districts to share one nurse, meaning that one nurse may see hundreds or even thousands of students (depending upon the size of the district). This makes it more unlikely that a school nurse would be able to spot symptoms of mental health issues, as the nurse may not be available or have enough time with each student to address their needs.

According to the American Association of Pediatrics, schools function as the mental health system for approximately 80% of students. For this reason, school nurses play a critical role in identifying problems so they can be treated as soon as possible. Unfortunately, school nurses typically receive little to no training in mental health.

While nurses aren’t expected to be psychologists or therapists, they should be aware of emotional, physical, and behavioral warning signs for common mental health problems. Awareness and recognition of problems as soon as they arise could prevent a suicide.

Integrated Mental Health Strategy in Public Schools

Researchers suggest the best way to help students with mental health issues may be to have teachers, counselors, administrators, and school nurses work together to spot and handle mental health issues. Saddling this responsibility on one teacher or administrator is not likely to be effective because they typically do not have the necessary training or time. On average, school counselors see around 500 students. School nurses may see even more students, especially if they are the only nurse for an entire district. Teachers also see a significant amount of students, ranging from 20-30 in elementary schools to hundreds of students in middle schools and high schools where students change classes and teachers throughout the day.

Integrating mental health care and strategies in public schools can help all staff who encounter students. They will likely be better able to recognize mental health problems and provide early intervention as well as prevention for many issues, including thoughts of suicide, drug and alcohol use, and relationship abuse. To recognize these potential problems, some degree of training in mental health will likely be necessary.

Some signs that a student may be experiencing a mental health condition include:

  • Sudden changes in a student’s mood or behavior
  • Frequent mood swings
  • Behavioral problems such as aggression, temper tantrums, or lashing out in school
  • Poor academic performance
  • Poor hygiene
  • Frequent absences
  • No longer participating in extracurricular activities
  • Isolation from peers
  • Difficulty paying attention in class
  • Excessive worrying or anxiety
  • Hyperactivity
  • Difficulty relating to others
  • Somatic complaints (stomachaches, headaches) with no clear physiological cause

Providing Mental Health Services in Public Schools

According to the 2016 Children’s Mental Health Report, young people with access to mental health treatment and services in school are 10 times more likely to seek help for mental health and substance abuse concerns than those who do not have such programs available. Many schools are choosing to address the rising mental health crisis in the public-school system by hiring a professional psychotherapist, counselor, or psychologist on staff. Other schools have therapists come in from community mental health centers to see students who are struggling with mental health issues beyond the guidance counselor’s scope of expertise.

Congresswoman Grace Napolitano is currently working on implementing the Mental Health in Schools Act, which would provide $200 million in funding through competitive grants of $1 million each to 200 public schools across the country. This funding would help them provide on-site licensed mental health professionals in public schools. Napolitano has been executing these programs since 2001 in 14 public schools in her congressional district. This approach has proven successful and will be expanded nationwide through the funding provided by the Substance Abuse and Mental Health Services Administration.


School Refusal in children

School refusal describes the disorder of a child who refuses to go to school on a regular basis or has problems staying in school.

Children with school refusal may complain of physical symptoms shortly before it is time to leave for school or repeatedly ask to visit the school nurse. If the child is allowed to stay home, the symptoms quickly disappear, only to reappear the next morning. In some cases a child may refuse to leave the house.

Common physical symptoms include headaches, stomachaches, nausea, or diarrhea. But tantrums, inflexibility, separation anxiety, avoidance, and defiance may show up, too.

Starting school, moving, and other stressful life events may trigger the onset of school refusal. Other reasons include the child’s fear that something will happen to a parent after he is in school, fear that she won’t do well in school, or fear of another student.

Often a symptom of a deeper problem, anxiety-based school refusal affects 2 to 5 percent of school-age children. It commonly takes place between the ages of five and six and between ten and eleven, and at times of transition, such as entering middle and high school.

Children who suffer from school refusal tend to have average or above-average intelligence. But they may develop serious educational or social problems if their fears and anxiety keep them away from school and friends for any length of time.

What can parents do?

  • Expose children to the school in small degree, increasing exposing slowing over time. Eventual this will help them realize there is nothing to fear and that nothing bad will happen.
  • Talk with your child about feelings and fears, which helps reduce them.
  • Meet with the school counselor for extra support and direction.
  • Arrange an informal meeting with your child’s teacher away from the classroom.


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Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder (OCD) is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.

People with OCD may have symptoms of obsessions, compulsions, or both. These symptoms can interfere with all aspects of life, such as work, school, and personal relationships.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:

  • Fear of germs or contamination
  • Unwanted forbidden or taboo thoughts involving sex, religion, and harm
  • Aggressive thoughts towards others or self
  • Having things symmetrical or in a perfect order

Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions include:

  • Excessive cleaning and/or hand washing
  • Ordering and arranging things in a particular, precise way
  • Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
  • Compulsive counting

Not all rituals or habits are compulsions. Everyone double checks things sometimes. But a person with OCD generally:

  • Can’t control his or her thoughts or behaviors, even when those thoughts or behaviors are recognized as excessive
  • Spends at least 1 hour a day on these thoughts or behaviors
  • Doesn’t get pleasure when performing the behaviors or rituals, but may feel brief relief from the anxiety the thoughts cause
  • Experiences significant problems in their daily life due to these thoughts or behaviors

Some individuals with OCD also have a tic disorder. Motor tics are sudden, brief, repetitive movements, such as eye blinking and other eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat-clearing, sniffing, or grunting sounds.

Symptoms may come and go, ease over time, or worsen. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves. Although most adults with OCD recognize that what they are doing doesn’t make sense, some adults and most children may not realize that their behavior is out of the ordinary. Parents or teachers typically recognize OCD symptoms in children.