Introduction – What is mental health? (And what’s my role in supporting it?)

Michael Hass, a school psychologist and psychotherapist, visited the class of Amy Ardell, a teacher educator, and the discussion that day planted the seed that would grow into this book. Amy’s students (pre-service teachers) were full of questions about how to meet the mental health needs of their students. They had students whose parents were incarcerated, students who threatened self-harm, students who had been rejected by their parents after coming out as gay…and the list went on.

Teachers come face to face with their students’ social, emotional, and mental health needs daily, yet few teachers have the training to deal with these issues in the way a counselor or psychologist would. The statistics support educators’ day-to-day experience: 12- 22% of children under 18 have a diagnosable mental health condition, and many more have “sub-clinical” conditions that still create difficulties in coping with the demands of school.

Though it may never have been a part of their training, teachers function as “gateway providers” of mental health services. They are uniquely positioned to recognize students with mental health needs, provide those students with initial supports (such as listening), and connect those students with needed resources (like counseling). One research study suggests that as many as 70% of students receive mental health services in schools, and it is often teachers who direct them there.

In order to feel confident in meeting these demands, teachers need:

1. an understanding of the nature of mental health
2. the ability to recognize signs of mental health challenges
3. knowledge of how to respond effectively to students with mental health needs
4. a network of other resources in their schools and communities to which they can refer students and their families

Ways of Understanding Mental Health

What does it mean to be mentally healthy? What does it mean to have a mental health problem? There are multiple perspectives and frameworks for thinking about these questions. As leaders and educators broach the topic of mental health in their schools and communities, it is important to think about how you and others around you may already understand these concepts.

You should also think about the frameworks you want to intentionally choose and share with others to best support mental health in school and community. The traditional clinical model for thinking about mental health focuses on finding a diagnosis, but it is not the most helpful model for teachers, who likely don’t have the training and should not make a diagnosis but should try to support students regardless of their diagnosis, including students with no diagnosis.

The following list provides some of the models that authors Hass and Ardell advocate, though these models should not be taken as a complete list, nor are they exclusive of one another.

Ecological Model – Looks at mental health through the lens of multi-layered systems such as the family, the school community, and then more broadly community and social organizations, government agencies and regulations, as well as the interactions between all of these. For example, a child’s family life and emotional well-being will be impacted by government policy if a parent is deported. This perspective helps educators move away from only focusing on within-the-person symptoms that rarely point to how educators can effectively help students.

Public Health Model – Advises that mental health care not be limited to those with the most extreme problems, and shifts the focus to providing mental health services to all. This perspective has influenced several school approaches such as PBIS, RTI, and MTSS with its tiered approach in which Tier 1 is preventative care for everyone, Tier 2 is early intervention, Tier 3 is specialized care, and Tier 4 is crisis response.

Strengths-Based Model – Asks what does work in children’s lives, rather than focusing on what is not working. What resources are available? Which relationships are strong? What competencies such as intelligence, ingenuity, motivation, agency, faith, or hope does the person possess? These strengths provide the foundation for resiliency which can help a person overcome mental health challenges. Some schools have employed Restorative Justice as one type of strengths-based model.

In this book the authors set forth to provide teachers with the knowledge and skills, supported by research, to feel confident in their role as “gateway providers.” They organize the teachers’ toolkit into “4 Rs”:

• Relate – Build strong relationships with students and their families
• Recognize – Know how to spot signs of mental health problems and how to determine whether further help is needed
• Respond – Interact with students appropriately and effectively when they come to you, or you approach them to discuss a problem
• Refer – Maintain awareness of school and community resources to which you might direct a student or family in need

1^st R: Relate to Students and their Families

Most teachers know well the importance of building positive relationships with their students. Supportive relationships are key to helping individuals recover from adversity, but teachers have the unique opportunity to go beyond this individual benefit and build a whole web of community. A relationship-centered classroom, also provides a safe environment to all, promotes social connections, involves student choice, and is culturally responsive. Many teachers make careful choices like greeting students at the door, or modeling how to talk about feelings in order to intentionally build their classroom communities.

The Brain Science Behind Teacher-Student Relationships

Teachers, whether they’re aware of it or not, are engaged with shaping the brain processes of their students. As students learn academic content as well as connect socially, teachers are like neuroscientists, tinkering to enhance the students’ ability to think, learn, and act in considerate ways. Healthy relationships, developed through intentional daily practices, unite the teacher and students in their common work, and help to avoid triggering the students’ stress responses unnecessarily.

Teachers engage students’ trust and positive emotions (connecting with their limbic brains) by demonstrating reliable warmth and care. Engagement with the limbic brain enables better functioning of the logical, abstract, and language-using parts of the brain (the neocortex), which is needed for academic learning. Additionally, positive engagement with the limbic brain can in some cases help a student overcome some of the impacts of stressful early experience in which they did not feel safe and cared for. If a child’s caregiver hadn’t consistently listened and communicated that the child’s needs are important, then the child may never have been “limbically known.” A teacher can provide this missing “limbic knowing,” thereby helping the child’s brain begin to rewire.

Whether you usually view it from this brain science perspective or not, the teacher’s warmth, caring, consistency, and trustworthiness are part of the preventative mental health care provided to all students. The preventative or foundational tier of mental health care also begins when teachers initially connect with families. It is common practice among teachers to reach out to families early in the year to establish positive communication and plant the seed of relationship. Later, if there are difficulties to be faced, bad news to be delivered, or areas where support or resources are needed, then the teacher-family relationship will make that easier.

Teachers can build mental-health supportive classrooms that center healthy relationships through intentional planning for the class environment, pedagogy, and curriculum. Below are just a few examples:

Physical and Social Environment of the Classroom

Class meetings that engage students in storytelling, singing, and celebrating together are one way many teachers intentionally build the social environment of the classroom. The physical surroundings, too, might be made to look home-like or incorporate calming colors, natural objects, and student work. Here, students can feel understood and learn to trust their teacher and one another. Teachers invite students’ emotions and self-reflection through creative endeavors and practices like journaling. Dialogues, collaborative problem solving, and restorative approaches to conflict resolution can all help to center relationships and elevate vulnerability over perfectionism.

Pedagogy and Curriculum

Constructivist teaching practices give students the space to develop their understanding in a supportive space. Philosophies such as Culturally Responsive Pedagogy and Reggio Emilia place relationships at the center of pedagogy. Meaningful work that extends outside the classroom, collaborative activities that get students working together, a focus on dialogue and sense of purpose all serve the greater goal of supportive relationships in the classroom. Teachers offer thoughtful feedback with a focus on strengths and student voice. Approaches like Responsive Classroom or the Warm Demander (expecting great things from students while believing in the students’ own brilliance) also represent mental-health supportive styles.

2^nd R: Recognize Mental Health Needs

Even in a healthy classroom community, there will be individuals with mental health struggles, and teachers are often the first adults to notice the signs. Any teacher can relate to this moment of uncertainty: a student in your classroom seems “off” in some way. You suspect something may be wrong, but what? Is it a serious “something” or a normal “something?” Is it just a phase that will pass or the beginning of mental illness that will worsen without help? Should you talk to the child? The parents? The guidance counselor? Will they be upset, offended, or amused that you think this is a big deal?

While you probably can’t answer these questions definitively for a given case, you should trust your gut because all signs (and statistics) point to yes.  If you’ve noticed something “off” it is worth looking into. Almost half of students suffer from some mental health disorder—though many go undiagnosed. And even among students with a diagnosis of a mental health disorder, only about    20 – 40 % receive treatment, mostly at school, often because a teacher recognized what was going on and referred them for help.

In other words, the teacher’s role in recognizing possible mental health signs is crucial. Teachers are right to think of themselves as gateway providers, and having the tools and confidence to recognize a possible need for help is essential to that role. Remember, your job is not to discover a diagnosis – that’s not appropriate without the relevant training. Your job is to analyze what you see and determine whether and how to move forward. Below is a set of questions to help you recognize mental health issues when you see them, articulate your concerns to other professionals (such as the school counselor), and determine how (or whether) to move forward.

Questions to Assist with the Recognition of Mental Health Problems

#1. What, specifically, is the student doing or not doing that troubles you?

Answering this question may feel overwhelming in some circumstances, but when a student displays many worrisome behaviors it is all the more important that you attempt to answer succinctly. If needed, select the top three behaviors or patterns you find most worrisome. This will help you clearly communicate your concerns to other professionals.

A sample answer might sound like:

• • She misses too much school because she is sick.
  • She rarely talks or asks for help.
  • She is currently earning Ds or Fs in all her classes.

#2. How have these behaviors had an impact on the student’s learning? How do they impact the student socially?

As you attempt to answer this question, carefully consider the impact on the student (both academically and socially). Too often, the behaviors that are referred for help are only those behaviors that affect the teacher or the other students—the proverbial squeaky wheel. It may be helpful to think about three categories of mental health problems:

Internalizing Problems – for example, depression, anxiety, sadness, and withdrawal

Externalizing Problems – for example, aggression, impulsivity, defiance, overactivity, ADHD, and ODD

Thought Disorders – for example, delusions, hallucinations, confused or disorganized thinking

Problems in all three categories may cause serious problems for the student, but Externalizing Problems like aggression and defiance often get the quickest response from the school. This is not merely self-centered on the part of teachers. Teachers, not being trained mental health providers, simply may not recognize the signs of internalizing problems like anxiety and depression. In fact, research shows that teachers can only recognize about half of these cases.

Anxiety – About one-quarter to one-third of children and adolescents will experience an anxiety disorder at some point. Anxiety is characterized by excessive worry or fear, but it can present with physical ailments like muscle tension, headaches, and stomachaches. Anxiety can impact students’ willingness and ability to participate, concentrate, and ask for help in school, so it can lead to academic problems.

Depression – Can include many of the same symptoms as anxiety, but also presents as chronic sadness or irritability, and loss of energy and motivation. In 2004 [before the introduction of smart phones] 6% of youth experienced depression in a given year. [Note from The Main Idea: this rate has risen to about 15% since the Covid19 Pandemic].  It is more common among older children than younger children, and more common among girls than boys, but of course younger children and boys can experience depression, too. The long-term consequences of depression are serious – it can lead to lower productivity, lower life quality, and risk of suicide.

For these reasons, early intervention is essential:

#3. Do these behaviors seem typical or atypical?

• Are these behaviors developmentally appropriate?
• What would the consequences be of these behaviors later in the child’s development?
• How intense are these problems?
  • How long?
  • How frequent?
  • Rate on a scale of 1-10

These questions, along with the other questions provided, can serve the purpose of helping the teacher sidestep their biases and make their assessment as objective as possible. Teachers more often refer male students than female students for mental health support. This is possibly because males tend to demonstrate externalizing rather than internalizing problems, but female students are no less in need of mental health support. Likewise, teachers more often refer African American students, possibly due to cultural bias, but the reality is that race and ethnicity are not good predictors of mental health problems. The need can be present in students of any background.

Be wary of the temptation to attribute behavior to “a phase” the child will outgrow. Some developmentally typical behaviors, like a toddler throwing a tantrum, are in fact not typical when frequency is considered. A toddler throwing a tantrum several times a day is not typical behavior. Without support, students with social or emotional problems do not usually outgrow them on their own.

#4. What do you think the student is feeling or thinking about your class, school, or their life in general?

This may seem difficult or even impossible to answer in some cases. The purpose of the question is to orient you to the student’s (possible) perspective, rather than your own perspective on what is happening in the classroom. It is okay not to know. In fact, it would be inappropriate to assume you did know how a student felt. But, make an attempt to see their behavior through their eyes. A sample answer might sound like:

She seems anxious and even fearful. I think she might worry about her future.

#5. What is going on in the student’s life that might contribute to these behaviors?

Of course, as an educator, you are required to report signs of abuse or neglect, and those could factor into your answer to this question. But consider other Adverse Childhood Experiences (ACEs) as well (divorce or illness in the family, for example). You don’t need to research a child’s past, but if you know of something that happened or is happening now, note it in your answer.

#6. Who is the student connected to in a supportive way?

If you can answer this question, it may help determine next steps or relational assets that can help this student going forward. Note family members, teachers, or other staff members you are aware of who might be a positive support for the student.

After answering these six questions to the best of your knowledge, you’ve taken the first step toward helping the student. You’ve recognized something amiss and put a bit of time into reflecting on what’s going on. It is not necessary, or even appropriate, for you to attempt to make a diagnosis. Rather, your job at this first stage is simply to recognize a need. In the following section you will learn options for how to respond and move forward to refer a student for help if needed.

3^rd R: Responding with Supportive Communication

Now that you’ve recognized a student with a potential mental health need, the aim of this section is to equip you with basic tools to respond to this need, that is, by having a supportive conversation with the student. In some cases, you might be the one to approach a student to ask about what is going on. In other cases, a student might approach you (maybe even before any other adult!) to talk about something. No matter who initiates the conversation, the strategies in this section can help to make it a positive and productive one.

Take the Stance of a Counselor

While teachers are not trained as counselors (and should not act as them), teachers can borrow a few strategies used by counselors to help make their interactions with students more effective. Counselors approach those they work with from a “stance of not knowing.” The counselor communicates abundant and genuine curiosity. When you approach a conversation with a distressed student from this stance, you do not immediately give advice, but rather listen patiently and respectfully. If the student’s perspective doesn’t make sense to you, you might ask genuine questions to help you understand, but avoid telling them what they ought to think instead. It might surprise you, but simply listening is often enough to help a student. As psychologist Carl Rogers said, “I discovered that simply listening to my client, very attentively, was an important way of being helpful… All I have to do is listen.”

In addition to listening, you can offer empathy (attempting to understand their feelings and what their experiences mean to them) and compassion (wanting to act to alleviate their suffering). In other words, be present, and open to their pain. You should also show respect to the student in the form of unconditional positive regard. This doesn’t mean you approve of everything they do, but it means you allow them space to express themselves and you don’t communicate judgement.

Don’t Duck

When a student approaches you or you otherwise find yourself on the verge of a serious conversation about a student’s problem, don’t duck or dodge the conversation. Remain open to it, even if you are nervous. You can follow these steps to prepare:

Prepare to Engage in a Supportive Conversation

1. 1. Breathe to calm yourself.
   2. Look at the person and give them your attention.
   3. Remind yourself that, “All I have to do is listen.”

Next, you can begin the conversation clearly by saying something like, “So, what’s going on?” or “What did you want to talk about, John?” This simple opening takes the burden of starting the conversation off the student. Even if the student has approached you, they may still be worrying about how they will start or what they will say. Carry a bit of the weight of this task by opening the conversation yourself and demonstrating that you are ready to listen.

What to Say Along the Way

As the student talks and you listen, there are things you can say (and do) to help the conversation along.

Compliments – Find something positive to say to the student about themself. This could sound like: “I’m glad you have the courage to talk about this,” or “You know, you’ve been doing really well on your classwork lately,” or any true and positive observation about the student. Genuine compliments communicate that you see the student as more than their current problem. You see their potential and their positive assets. Complimenting them now demonstrates your genuine interest in them as a person, and may lead them to be more open to help or advice from you in the future.

Waiting, Attending, Encouraging – Just as you use “wait time” as an instructional strategy, you can also use it in supportive conversations with students. Allow there to be moments of silence as they collect their thoughts or process their feelings. Do not feel the need to fill silence with questions and suggestions. Attend to the student as they speak using the body language of active listening: face them with an open and relaxed posture, and maintain an appropriate amount of eye contact. Encourage students to continue speaking by verbally responding without interrupting them. For example, you might say, “hmm,” “wow,” “ok,” or “oh.”

Paraphrase and Summarize – Use another active listening skill to distill the essence of what they are saying to you. That serves the double function of showing them you are listening and giving them a chance to correct you if you have something wrong. For example, “What I got was that things are better than they were before, but you feel tired and cranky with the other students in class,” or “Ok, so you don’t want to hurt yourself anymore…glad to hear that.” 

Express Curiosity – Use questions and conversational prompts to gather more information and to demonstrate that you’re listening carefully. For example, “Please, tell me more about that,” or “How are things better now?” While they are useful, you should tread carefully with questions. Consider whether the questions you ask are open- or closed-ended. Open-ended questions have been shown to elicit more accurate information, particularly from children.

Keep in mind that too many questions can cause a student to feel interrogated and to feel as if they are losing control of the conversation. Requesting permission before asking a question can help the student retain some sense of control. For example, “Can I ask you another question, Aaron?”

Conclude the Conversation

Keep in mind that just because you couldn’t solve the student’s problems in one conversation does not mean the conversation was a failure. In fact, you should consider your conversation a success if you were able to listen well enough for the student to feel understood and supported.

You can conclude the conversation using the following three steps:

1. This is what you said. Summarize what they shared with you.
2. This is who I am going to talk to about getting you the help you need. More on this in the next section.
3. This is what I can do to help. This might be as simple as checking back in with them in a few days. If you don’t know how you could help, you can ask the student, “What do you think would help?”

In addition to talking through day-to-day challenges with individual students, there may come times when children or whole communities are faced with crisis events. At times, a child’s need might be critical and immediate, and there may even be times when something frightening or dangerous occurs and many children are in need all at once. The next section addresses this.

Responding to Students During and After a Crisis – A Teacher’s Role

Everyone says, “kids are resilient,” but the truth is, kids are more vulnerable than adults. Crisis events—events that are uncontrollable, unpredictable, and extremely negative—include natural disasters like floods and human-caused disasters like school shootings. They often produce a dramatic increase in the numbers of students with mental health needs. Many of these do not receive care due to limited resources.

Weathering a crisis without needed mental health care can result in long-term mental health problems. Although teachers are not mental health professionals, they sometimes function as default first responders in crisis events, and with training they can provide effective and needed support during and after a crisis.

Children’s Reactions to Crisis

Recovery from a crisis is the norm for most people. However, there are some short-term reactions, specifically extreme anxiety/panic and dissociation which tend to point to the potential for long-term problems and a more difficult road to recovery. Severe anxiety/panic has intense physical symptoms such as racing heart, sweating, chills, trembling, breathing problems, weakness or dizziness, chest pain, stomach pain, and nausea. The main longer-term reactions to crisis are as follows:

Dissociation can feel like numbness, standing outside yourself, or watching what is happening.

For example: A boy whose father was recently deported will not talk about his father or his feelings about the event. Instead, he withdraws to his room, plays video games, looks at his phone, and talks to no one.

Hyperarousal is the result of a chronically stimulated fight or flight response. The person is always on alert for danger.

For example: A girl who experienced an active shooter alert is afraid to go out on the playground. The alert turned out to be a false alarm, but in the days that follow she stands near the building at recess and cries when told to go out and play.

Intrusion is characterized by uncontrollable recurring thoughts, feelings, or images related to a traumatic event.

For example: A teenager who survived a car crash has nightmares and difficulty concentrating at school. She and the others in the car were not seriously injured, but she still refuses to drive or ride in a car.

What Teachers Can Do

 Immediately

During or in the immediate aftermath of a crisis, a teacher can help by providing Psychological First Aid (PFA). Just as all physical injuries don’t require a surgeon, the same is true of psychological harm. In a large-scale crisis (like a school shooting) there won’t be enough medical professionals or professional counselors available to treat everyone at once.

A non-professional with a bit of training, however, can apply pressure or provide a bandage for a physical wound while EMTs are on their way. Similarly, a non-counselor with a bit of training, such as a teacher, can offer PFA. Here are the steps:

Step 1 – Make psychological contact

Introduce yourself if needed and greet the student by name if you can.

Step 2 – Ask about and meet basic needs

Meet immediate needs by offering water, a snack, a coat, etc., if possible. If you can, protect students from further traumatization by moving them to where they can’t view an ongoing crisis (for example, keep them in an area where they cannot witness EMTs treating injured people). Studies show that both physical and emotional proximity to a crisis increase people’s chance of experiencing difficult recovery in the future.

Step 3 – Provide reassuring information about safety

Share information about the incident to reassure the student, if appropriate.

For example: We’re all going to stay here until the police make sure everyone is safely out of the building, then we’ll walk across the street together to meet your parents.

Step 4 – Stabilize

In the event of an on-going or very recent crisis a student may be dissociated or too upset to talk with you. You can help the student stabilize using a process called co-regulation.

Co-Regulating Strategies

• • • Model calm behavior.
    • Provide reassurance of safety. Ask their permission to place a protective arm around their shoulders.
    • Engage students in stabilizing activities such as drawing, coloring, or playing with toys.
    • Help them ground themselves in the present by asking them to look at you and engage in mindfulness and calm breathing.
    • Simple mindfulness exercise: Ask the student to name three things they can hear, two things they can see, and one thing they can feel with their sense of touch.

Simple breathing exercise: Breathe in through the nostrils for a count of four and out for a count of four. Repeat a few times.

In the Short-Term

Shortly after a crisis, whether it is community-wide or individual, teachers can help students through supportive conversations and listening. Here, you can use the conversation strategies presented earlier in this section (waiting, attending, encouraging, paraphrasing, etc.) as well as the “immediate” supportive steps if applicable. After making contact, inquiring about basic needs, and providing reassuring information about safety, you can…

1. Ask the student about their crisis experience and listen actively.

For example: “What has it been like for you since you found out what happened?”

2. Identify specific crisis-related problems.

For example: “I agree, it can be hard to fall asleep when you keep thinking about something like that. Were you able to finally get to sleep?”

3. Problem solve and, if possible, set a small goal.

For example: “Let’s try some deep breathing together…What do you think of trying out the breathing strategy for a couple of days and see if it helps?”

4. Bring the conversation to a close, explain next steps, including potential referrals to mental health providers.

For example: “So, Manuel, if you don’t feel better in a couple of days, I may want to see about you talking to a counselor. Her name is Ms. Ruiz. Do you know who she is?”

In the Longer-Term

Relationships are key to healing from trauma, and teachers, especially those with relationship-centered classrooms, are uniquely suited to provide trauma-informed care. Teachers can support trauma-impacted students in their classes using a range of trauma-informed practices. For example, teachers can try to prevent retraumatizing students by avoiding coercive or exclusionary punishments, overwhelming or too-challenging academic material, and having a chaotic and unpredictable environment. Staying away from media coverage of the crisis is also a good idea to avoid re-traumatization.

Create calm and predictable environments by using easily understood routines and teaching self-calming and self-regulation strategies. Opening and ending rituals, visual schedules, and peaceful background music can all contribute to a calming classroom environment. Include mindfulness exercises or breathing exercises like those described above in daily routines. Teach students to name their emotions as well as rate the intensity of those emotions using numerical or color scales. Collaborative work and an emphasis on kindness and helping the community can also contribute to students’ healing.

While it might seem strange to arrange your whole classroom around the needs of a few, the reality is that one-third to one-half of students have experienced trauma and a trauma-sensitive way of being in school is good for them and everyone. Finally, while it is helpful to understand maladaptive behavior as an expression of trauma, it’s not helpful to view traumatized students only through a lens of deficit. Look for their strengths and resources and believe in their ability to heal and grow.

Responding to the Threat of Suicide

It’s the kind of thing you hope will never happen, but chances are, it will: one of your students considers suicide. They write about death or make an off-hand comment that tips you off. It can feel like a gut-punch and send you into a decision-making panic. Is this their cry for help or are you over-reacting? What should you say? Will you accidentally make things worse? What is your legal responsibility? And why didn’t anyone train you for this?

Every teacher deserves to be prepared for this situation because the number of youth considering suicide vastly out-numbers trained mental health providers on school campuses. Teachers will end up functioning as frontline providers, whether they’re trained or not. Statistically speaking, in a high school of 2,000 students, 350 students may be thinking of suicide. 300 of those may have made specific plans, and about 170 have tried to kill themselves. And it’s getting worse. Between 2007 and 2017, the rate of youth suicide increased 76%.

It is true that certain students are considered at greater risk of suicide than others. Being male, being LGBTQ+, and living in a rural area are all considered risk factors. But of course, these factors on their own do not indicate immediate risk, and protective factors, such as social support, play a role in reducing risk. Regardless or risk factors or protective factors, what teachers should focus on is recognizing observable behaviors and statements. Below are the Warning Signs of Suicidality.

• • Talking or writing about death, dying, or suicide
  • Making plans to kill oneself
  • Taking action to obtain the means to kill oneself

You can think of these warning signs like a continuum that students may proceed along as they come closer to the act of attempting to kill themselves. Beyond knowing the warning signs, teachers also need the skills to respond effectively to students who exhibit warning signs. Following common sense is not always the best course. For example, comments like, “You have so much to live for,” or “Have you thought of how this would impact those you leave behind?” are not helpful.

And it is a myth that talking about suicide makes things worse. Talking to someone about suicide is a critical way to reduce suicidality. Teachers can help most by listening carefully to what students have to say and trying to understand how they came to consider ending their lives.

You can begin by using the three steps from the previous section for preparing to enter a supportive conversation: (1) Breathe to calm yourself. (2) Look at the person and give them your attention. (3) Remind yourself that, “All I have to do is listen.”

In this conversation, you should not attempt to solve the underlying problems that led the student to consider suicide, nor should you focus on dissuading them from harming themselves. Your goals at this time are: to listen supportively, to ask specific questions that help estimate risk, and to connect the student to appropriate resources.

Having a Conversation and Screening for Suicide Risk

You or the student might begin the conversation. At first it might sound like the supportive conversations described in the previous section (waiting, attending, encouraging, expressing curiosity, etc.). But you do need to steer the conversation toward the concern of suicide if the student has shown warning signs. After listening for a while, ask the student’s permission to redirect the conversation.

For example, “Can I ask you a couple of questions about your essay?”

And with their permission, address the warning sign directly.

For example, “What did you mean when you wrote, ‘In fact, I don’t see myself in the future.’?”

After spending time listening and exploring, you should shift the conversation to screen for suicide risk. Use questions like these to learn about where they are on the continuum of risk:

Questions about suicidal ideation:

• Have you ever thought about killing yourself or wished you were dead?
• How often do you think about killing yourself?
• For how long have you been having these thoughts?

Questions about plans:

• Have you considered acting on those thoughts?
• Have you considered doing something rather than just thinking about it?
• Have you been thinking about how you might do this?
  • Do you have a plan?
• Have you worked out the details of how you might kill yourself?
• Do you mean to carry out the plan?

Questions about actions taken:

• Do you have access to______? (gun, poison, etc.)
• Have you tried to hurt yourself before?
• Have you ever started to act on your plan but stopped?

Next Steps and Referral to Mental Health Resources

At this point, you should shift the conversation toward next steps and connecting them with help.

For example, “I’m glad you told me about this. You are very brave. Let’s talk about what we’re going to do.”

 It is essential that you know the laws and policies in your state and school district, as these can vary and may dictate what your next steps are. No matter where you live, however, you:

1. should not promise a student confidentiality on this topic, and
2. you should not leave the student alone.

Not telling anyone what you’ve learned, or leaving a potentially suicidal student improperly supervised are two mistakes that could open you up to legal consequences. In addition to knowing the laws, you should also seek out suicide prevention training and knowledge of resources such as suicide hotlines. If you are a school leader, you can help your staff by arranging training for them and providing them with a list of resources.

Communicate to the student whom you plan to tell and what you’ll do next. For example, “Julie, I’m sorry, but when someone tells me that they are thinking of hurting themselves, I have to tell someone else. So, what I would like to do is call Mrs. Anderson, the school psychologist, and then walk with you down to her office.”

If it is after school hours, or for some reason you are not able to connect the student immediately with a school mental health provider, you will need to consider other options such as leaving the student with a school administrator (after apprising them of the full situation), calling the child’s parents to tell them what’s going on and waiting with the child until the parents can pick them up, or contacting a community mental health emergency hotline. Whatever plan you work out, avoid leaving the student alone, and make sure what you have learned is communicated to a mental health provider and/or the child’s parent.

Whether you are facing a potentially suicidal student or a student with milder symptoms that you are not sure how to categorize, you as a teacher can play a tremendously important role by responding to the student’s needs, being present as a listener, and gathering information that can move you forward to the next stage: referring the student for help, if needed.

4^th R: Refer Students and Families to Resources

One of your students is depressed, another is processing trauma, another’s family is coping with food insecurity, and another’s with unmet medical needs. Students and their families may have a wide variety of needs that teachers simply cannot address by themselves.

The good news is that no classroom exists in total isolation. Classrooms function within the microsystems of their schools and communities. It is a good idea for teachers to actively cultivate knowledge of (and relationships with) the many other programs and providers that surround their students. This allows teachers to better support kids and families by referring them to useful resources.

Perhaps less obviously, this type of connectedness also serves teachers, helping them to feel more supported and confident and better able to meet the demands of their jobs. They can remain in their role as teachers and trust other professionals or organizations to take on the roles of psychologists and social workers. Teachers are already contributing positively to community mental health by teaching effectively and providing positive classroom environments.

Creating a Resource Map

To effectively refer students, the critical thing teachers need is a resource map. This can be time consuming to create and keep up to date but will be enormously beneficial to students, teachers, and families. Find a way to share the load by compiling existing resources or dividing up sections to research among multiple individuals.

The map should include school- and community-based professionals as well as organizations that provide services in the following areas: academic support, behavioral support, mental health support, physical health support, and other student programs. The map should include names contacts, phone numbers, email addresses, and hours, as well as a description of what the program or person does. Below are a few sample entries of people and programs you might include in a resource map:

Make your map as comprehensive as possible. Be sure to include programs outside of your school as well that can serve students and families, such as Boys and Girls Clubs, the YMCA, public libraries, summer enrichment programs, food banks, low-cost medical providers, etc. Some might be people or services for healing or overcoming significant problems (a food bank, a grief counselor, or a domestic violence shelter). Others might be aimed at promoting well-being for all, including those who are not in crisis (library reading programs, youth sports programs, etc.). Once the resource map is created, share it with everyone at your school and make a plan for keeping it updated so it does not need to be created from scratch again.

When connecting a student or family to a resource, it is helpful to think about what barriers to access there might be. While some barriers, like lack of transportation, might feel big and insurmountable, others like discomfort starting a conversation with someone new or uncertainty about finding information online are barriers you might be able to help a student or parent overcome simply by walking together to introduce them to the counselor, or pulling up the library’s website to help them sign up for a library card.

Referring a family to an outside service will work best if a positive relationship already exists between the teacher and family and if the teacher remains respectful of the family’s right to make the decision about whether to pursue the suggestion. Even if a parent turns down the idea, they have learned that the teacher is knowledgeable about community resources and is able and willing to help. This in itself is positive, even if nothing else happens right now.

Renew and Care for Yourself

While putting together resource maps and pursuing suicide prevention training, teachers often forget that they have their own mental health to care for. Teachers’ mental health is a part of the health of the community and teachers are a part of their students’ microsystems. In many ways, this 5^th “R” (renew) is instrumental so teachers can perform the other “Rs” introduced.

Teaching is stressful. It typically involves long hours, relatively low pay, high accountability with little power, and can include other stressors like emotional exhaustion and lack of collegial support. Teachers may long to solve the injustices their students face but feel they have little power to do so, or even find themselves obligated to enforce policies they feel are unjust.

Teachers need to both cultivate and be surrounded by tremendous reserves of resilience to function at their best in their jobs without damaging their own mental health.

The basics of self-care and the social emotional learning skills we would teach to students apply just as much to teachers. Find balance between the physical, emotional, intellectual, and spiritual aspects of your life. Think and talk about your emotions. Pause and take a deep breath when you’re upset. Practice gratitude by naming and appreciating good moments and feelings. Practice mindfulness by being present in the here and now. These practices can help anyone develop their resilience.

Practicing and committing to self-compassion is a skill that can help anyone but is especially applicable to teachers. Instead of falling into the trap of perfectionism and self-criticism, practice extending the same grace to yourself that you would to others. Teachers may also find needed power and agency through participating in professional organizations. Here they may find mentors to learn from, peers they might help, and an organization large enough to influence opinion or policy.

Meaningful work, too, can play an important part in resiliency. Just as you endeavor to help your students connect to the real-world meaning and impact of their learning, you as the teacher can benefit from taking time to reflect, write, and even share with others about the purpose and meaning you derive from your work and what you are learning along the way. Teachers might enjoy joining a committee, a teacher book club, or simply network with others to find connection and meaning in their work.

Teachers often bear an oversized burden in coping with the challenges in our society. In order to sustain themselves productively and joyfully in their profession, self-care, self-compassion, and self-renewal are necessities.

THE MAIN IDEA’s PD suggestions that go along with this book are not included in this html link. To see those ideas, go to www.TheMainIdea.net and download the full book summary.