A Mental Health Crisis Guide for Schools

May 21, 2020 

Mental health is a combination of our emotional, psychological, and social well-being, affecting how we think, feel, and act. Our mental health also plays a factor in how we handle stress, relate to others, and make decisions. People who manage their mental health well are able to cope with the stressors of life, be productive both in and outside of work, and make meaningful contributions to their communities.

Two students embrace in a school hallway while a third stares out a window.

Those who struggle to manage mental health may suffer from a mental illness. A mental illness is a common health condition that involves changes in emotions, thought patterns, and behavior. In fact:

  • About one in five adults in the United States has a mental illness
  • One in 12 has a substance use disorder
  • One in 24 has a serious mental illness

Even though it’s more common in adults, children can develop mental health issues too. Mental health conditions that also affect children and young adults include:

  • Anxiety disorders: Examples of anxiety disorders include generalized anxiety disorder, social anxiety disorder (social phobia), specific phobias, and separation anxiety disorder. It is possible to have more than one anxiety disorder, and some may require medical treatment.
  • Attention-deficit/hyperactivity disorder (ADHD): Adult attention-deficit/hyperactivity disorder (ADHD) is a mental health disorder that includes a combination of persistent problems, such as difficulty paying attention, hyperactivity, and impulsive behavior. Though it’s called adult ADHD, symptoms start in early childhood and continue into adulthood.
  • Autism spectrum disorder (ASD): Autism spectrum disorder is a condition related to brain development that impacts how a person perceives and socializes with others, causing problems in social interaction and communication. The disorder also includes limited and repetitive patterns of behavior. The term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and severity.
  • Eating disorders: Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, emotions, and ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder.
  • Mood disorders: If you have a mood disorder, your general emotional state or mood is distorted or inconsistent with your circumstances and interferes with your ability to function. You may be extremely sad, empty, or irritable (depressed), or you may have periods of depression alternating with being excessively happy (mania).
  • Schizophrenia: Schizophrenia involves a range of problems with thinking (cognitive), behavior, or emotions. It may result in some combination of hallucinations, delusions, and disordered thinking and behavior that impairs your child’s ability to function. Childhood schizophrenia is essentially the same as schizophrenia in adults, but it occurs early in life and has a profound impact on a child’s behavior and development. With childhood schizophrenia, the early age of onset presents special challenges for diagnosis, treatment, education, and emotional and social development.

What Is a Mental Health Crisis?

A mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community. Often, a crisis can involve thoughts of suicide for both adults and children.

Let’s look at data and statistics on children’s mental health.

  • 9.4% of children aged 2-17 years (approximately 6.1 million) have received an ADHD diagnosis
  • 7.4% of children aged 3-17 years (approximately 4.5 million) have a diagnosed behavior problem
  • 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety
  • 3.2% of children aged 3-17 years (approximately 1.9 million) have diagnosed depression
  • 1 in 6 U.S. children aged 2–8 years (17.4%) had a diagnosed mental, behavioral, or developmental disorder
  • Among children aged 2-8 years, boys were more likely than girls to have a mental, behavioral, or developmental disorder
  • Among children living below 100% of the federal poverty level, more than 1 in 5 (22%) had a mental, behavioral, or developmental disorder
  • Age and poverty level affected the likelihood of children receiving treatment for anxiety, depression, or behavior problems

While mental health crises are a major threat to public health and can become fatal, clinical professionals are not always the ones on the front lines of intervening in or preventing such crises. Physicians and nurses sometimes are not aware that a patient is vulnerable to a sudden escalation in mental illness, or even that a mental illness is afflicting their patients. This is a major reason why non-clinical professionals with a background in an area such as general healthcare studies are needed. These individuals are able to help educate the public, develop novel intervention strategies outside of hospitals, and help ensure vulnerable individuals don’t fall through the gaps in a moment of crisis.

However, there is a need for everyone — not just healthcare professionals — to understand the risk factors, warning signs, and interventions that can help others survive a mental health crisis episode.

Warning Signs of Crisis Episode

Signs of a mental health crisis episode may not always be apparent in a child. With the proper education, teachers, principals, and other staff members will know what to look for when the following mental health crisis signs arise.

  • Abusive behavior: Often an individual will show abusive behavior to themselves and others. This may include self-harm, substance abuse, physical abuse, etc.
  • Inability to perform daily tasks: This can include even the most simple tasks such as bathing, teeth brushing, brushing hair, and putting on clean clothes.
  • Increased agitation: When a child shows signs of increased agitation they’ll use verbal threats, are violently out of control, destroy property, and more.
  • Isolation: Children and young adults tend to isolate themselves in school and work, from both family and friends.
  • Loses touch with reality (psychosis): This encompasses the inability to recognize family or friends — showing signs of confusion, strange ideas, thinking they’re someone they’re not, not understanding what people are saying, hearing voices, and seeing things that aren’t there.
  • Paranoia: This is manifested in suspicion and mistrust of people or their actions without evidence or justification.
  • Rapid mood swings: This includes increased energy levels, the inability to stay still, pacing, sudden depression and withdrawal, as well as becoming suddenly happy or calm after a period of depression.

Other warning signs and risk factors include:

  • Eating or sleeping too much or too little
  • Pulling away from people and things
  • Having low or no energy
  • Having unexplained aches and pains, such as constant stomach aches or headaches
  • Feeling helpless or hopeless
  • Excessive smoking, drinking, or using drugs, including prescription medications
  • Worrying a lot of the time — feeling guilty but not sure why
  • Having difficulty readjusting to home or work life

Suicide Warning Signs

Suicide in teens can be prevented if those around them learn to recognize the warning signs and intervene appropriately:

  • Noticeable changes in eating or sleeping habits
  • Unexplained or unusually severe, violent, or rebellious behavior
  • Withdrawal from family or friends
  • Sexual promiscuity, truancy, and vandalism
  • Drastic personality change
  • Agitation, restlessness, distress, or panicky behavior
  • Talking or writing about committing suicide, even jokingly
  • Giving away prized possessions
  • Doing worse in school

It’s important to take any talk of suicide seriously. “Suicide is a very difficult topic to discuss,” says Jeffrey Borenstein, M.D., an associate clinical professor of psychiatry at Columbia University College of Physicians and Surgeons in an article about the importance of speaking out about suicide. “But silence can have tragic results, and knowledge can save lives. The message that things can get better is more important today than ever before.”

Examples of Triggers for a Crisis Episode

Crisis episode triggers are external events or circumstances that may produce very uncomfortable emotional or psychiatric symptoms, such as anxiety, panic, discouragement, despair, or negative self-talk.

Those with a mental illness typically handle triggers differently than other people. According to author Arlin Cuncic writing for Very Well Mind, from a mental health perspective, “being ‘triggered’ more narrowly refers to the experience of people with post-traumatic stress disorder (PTSD) re-experiencing symptoms of a traumatic event (such as exposure to actual or threatened death, serious injury, or sexual violation) after being exposed to a trigger that is a catalyst or reminder.”

There are both internal and external triggers that can remind a person of a past traumatic event.

  • Internal Triggers: 
    • Anger
    • Anxiety
    • Feeling abandoned
    • Feeling lonely
    • Feeling out of control
    • Feeling overwhelmed
    • Frustration
    • Increased heart rate
    • Pain
    • Sadness
    • Stress
    • Tension
  • External Triggers:
    • Anniversary date
    • Being alone too much
    • Crowded places
    • Ending of a relationship
    • Feeling judged
    • Going to a specific location that is a reminder of a traumatic event
    • Loud noises
    • Money problems
    • News stories about bad events
    • Particular interaction (ex: an argument)
    • A particular time of day (ex: sunset)
    • A particular smell (ex: incense)
    • Physical illness
    • Seeing an overly thin celebrity (in the case of anorexia)
    • Seeing someone else use drugs (for substance abuse)
    • Sexual harassment
    • Violent movies

Being aware of someone’s personal triggers is especially helpful because it allows others to recognize sensitive situations, provide an adequate warning to those who may be triggered, and take other steps to prevent known triggers from leading to a crisis situation.

How to Prevent a Mental Health Crisis

Fortunately, mental health crises can be prevented. As such, how teachers, parents, and peers respond to a child’s mental health crisis is crucial. How an authoritative figure should speak to one suffering from a mental illness crisis varies based on their relationship to them.

  • Family members and friends: If a family member or friend is showing signs of a mental health crisis, you can help to prevent the situation from occurring/worsening by:
    • Asking questions, listening to ideas, and being responsive when the topic of mental health problems comes up
    • Educating other people so they understand the facts about mental health problems and do not discriminate
    • Expressing your concern and support
    • Finding out if the person is getting the care they need/want — and, if not, connecting them to help
    • Including your friend or family member in your plans — continue to invite them without being overbearing, even if they resist your invitations
    • Offering to help your friend or family member with everyday tasks
    • Reassuring them that you care
    • Reminding them that help is available and that mental health problems can be treated
    • Treating people with mental health problems with respect, compassion, and empathy
  • Students: When assisting a student who is showing signs of a mental health crisis, educators should:
    • Educate other staff members, parents, and students on symptoms of mental health problems and how they can help
    • Encourage good physical health
    • Encourage helping others
    • Help ensure access to school-based mental health support
    • Help ensure a positive, safe school environment
    • Promote social and emotional competency and build resilience
    • Teach and reinforce positive behaviors and decision-making
  • Your child/other dependents: It’s important for caregivers to pay special attention to their children, especially after the loss of a loved one, separation of parents, and/or any other major transition. This is because children typically have a hard time understanding difficult situations. However, if you are concerned your child is on the verge of a mental health crisis you should:
    • Ask your child’s primary care physician if your child needs further evaluation by a specialist with experience in child behavioral problems.
    • Ask if your child’s specialist is experienced in treating the problems you are observing.
    • Talk to your child’s doctor, school nurse, or another healthcare provider and seek further information about the behaviors or symptoms that worry you.
    • Talk to your medical provider about any medication and treatment plans.

Communication Tips and Talking Points

Starting a conversation about mental health can be uncomfortable, no matter how necessary. Here are a few tips for parents and educators for talking to children about their mental health.

  • Create a sense of belonging
  • Develop competencies
  • Educate staff, parents, and students on symptoms and help for mental health
  • Encourage good physical health
  • Encourage helping others
  • Ensure access to school-based mental health support
  • Ensure a positive and safe school environment
  • Establish a crisis response team
  • Promote resilience
  • Provide a continuum of mental health services
  • Teach and reinforce positive behaviors/decision-making

Seek Help from a Professional

Mental illness can be treated. Here is a list of medical professionals one can utilize when seeking treatment for mental illness.

  • Addiction counselor: Addiction counselors treat people with addictions. While this usually involves substance abuse or gambling problems, it can also include less common addictions such as sexual addictions or hoarding.
  • Art therapist: Art therapy involves using creativity in ways like painting, sculpture, and writing to explore and help with depression, medical illnesses, past traumatic events, and addiction.
  • Family and marriage counselor: A family and marriage counselor specializes in common problems that can come up in families and married couples, from differences to arguments.
  • Mental health counselor: “Mental health counselor” is a broad term used to describe someone who provides counseling. Their titles may also include the terms “licensed” or “professional.” It’s important to ask about a counselor’s education, experience, and the types of services involved since the term is vague. Counselors can specialize in fields like job stress, addiction, marriages, families, and general stress.
  • Psychologist: Psychologists specialize in the science of behaviors, emotions, and thoughts. They work in places like private offices, hospitals, or schools. Psychologists treat a range of issues, from relationship problems to mental illnesses, through counseling. A psychologist usually holds a doctoral degree, such as a Ph.D. Psychologists cannot prescribe medications in most states.
  • Psychiatrist: Psychiatrists mainly diagnose, treat, and help prevent mental, emotional, and behavioral disorders. They use psychiatric medicine, physical exams, and lab tests. Psychiatrists’ specialties can include children and adolescents, forensic psychiatry, and learning disabilities.
  • Psychoanalyst: A psychoanalyst follows the theories and practice of Sigmund Freud by helping someone explore their repressed or unconscious impulses, anxieties, and internal conflicts. This is done through techniques like free association, dream interpretation, analysis of resistance, and transference. However, it is important to be cautious in selecting a psychoanalyst. The title and credential are not protected by federal or state law, which means that anyone can call themselves a psychoanalyst and advertise their services.
  • Psychiatric nurse: Psychiatric nurses are registered nurses who specialize in mental health. They’re known for their therapeutic relationships with the people who seek their help.
  • Psychotherapist: Psychotherapist is a general term for many types of mental health professionals. This can include psychologists and therapists. These professionals all provide psychotherapy — a type of talk therapy designed to improve your mental health and general well-being.
  • Religious counselor: Religious counselors are trained to help people with a variety of problems, including crises of faith, marriage and family counseling, and emotional and mental problems.
  • Social worker: Social workers are public or private employees dedicated to helping people cope with and solve issues in their lives, including personal problems and disabilities. They may also address social problems like substance abuse, housing, and unemployment. They are often involved in family disputes that involve domestic violence or child abuse.

Provide Support

It’s important to provide loved ones with support when they’re suffering from a mental crisis. This ensures that they are not alone in the process and minimizes the damage that may come along with mental illness. Here is how you can help a loved one with a mental illness:

  • Avoid falling into the role of fixer and savior
  • Check out support groups for family members of those experiencing mental illness
  • Have realistic expectations
  • If a loved one is in acute psychiatric distress (experiencing psychosis or feeling suicidal), getting them into the hospital may be the wisest and best choice
  • Inform yourself as much as possible about the illness being faced
  • Instead of guessing what helps, ask
  • Keep yourself healthy and pace yourself — overextending yourself will only cause further problems in the long run
  • Know that even if your actions may seem to have little impact, they are making a difference
  • Offering objectivity, compassion, and acceptance is valuable beyond measure
  • Seek counseling for yourself
  • Start dialogues, not debates

Immediate Crisis Response and Emergency Intervention

Crisis response refers to all the advance planning and actions taken to address natural and man-made disasters, crises, critical incidents, and tragic events. Of course, in an emergency, you should always call 911. However, in some cases, having a crisis response and intervention plan can be helpful as well.

Crisis intervention is beneficial because it can mitigate adverse reactions, facilitate coping and planning, assist in identifying and accessing available support, normalize reactions to the crisis, and assess capacities and need for further support or referral to the next level of care.

The three main goals of crisis intervention are:

  1. Stabilize
  2. Reduce symptoms
  3. Return to adaptive functioning or to facilitate access to continued care

In regards to a suicidal crisis on school grounds, some key principles to remember are:

  • Be direct
  • Be honest
  • Debrief all teachers and staff of the current situation
  • Ensure that the student in crisis is safe
  • Inform parents (when the time is right)
  • Inform the student of what is happening at all times
  • Keep other students safe
  • Know your limits
  • Listen to the student
  • Monitor your surroundings
  • Send someone for help

Parents and teachers can help prevent mental health crises by helping adolescents and teens develop emotional intelligence and healthy coping skills.

Assess the Situation

Before making any rash decisions, assess the situation and ask yourself: Is the person in danger to themselves or others? Is emergency assistance needed? Can I call someone for guidance? Are there resources to help me and the person at risk? What triggered the crisis? Am I capable of handling this on my own?

It is important to assess the situation because the person you are trying to help may not be able to communicate clearly. If you’re able to figure out what is going on using your own assessment of the scenario, you may find it easier to help control the moment.

Emergency Resources and Suicide Prevention Hotlines

Always call 911 in an active emergency situation, especially if someone is trying to harm themselves or others, or is threatening to. Additional help is also available 24/7 via specialized emergency hotlines. Here is a sample list of national hotlines you can call, text, or online chat when in distress:

AIDS

AIDS Info: Treatment, Prevention and Research

(800) HIV-0440

Alcohol

  • Al-Anon for Families of Alcoholics Automated meeting information: (800) 344-2666
  • Families Anonymous – a 12-step program similar to Al-Anon, meeting information only: (800) 736-9805
  • SAMHSA National Helpline: 800-662-HELP (4357)

Child Abuse

Crisis and Suicide

  • Girls & Boys Town National Hotline: (800) 448-3000
  • International Suicide Hotlines
  • National Suicide Prevention Lifeline – for youth and adults: (800) 273-TALK (8255)

Domestic Violence, Rape and Sexual Assault

Medical

  • American Association of Poison Control Centers: (800) 222-1222

Online Chat

Other

  • Disaster Distress Hotline (SAMHSA): (800) 985-5990
  • National Eating Disorders Center Helpline: (800) 931-2237 — Open M-F, 9-9 p.m.
  • Shoplifters Anonymous: (800) 848-9595 — Open M-F, 9-5 p.m.; otherwise use the website
  • Veteran’s Crisis Line: (800) 273-8255
  • YouthLine: (877) 968-8491 — Text TEEN2TEEN to 839863

Pregnancy

  • Planned Parenthood Hotline: (800) 230-PLAN (7526)

Running Away

  • National Runaway Safeline: 800-RUN-AWAY
  • National Center for Missing & Exploited Children: (800) 843-5678
  • Child Find of America Helpline: (800) 426-5678

Substance Abuse

  • SAMHSA’s National Helpline: (800) 662-4357
  • Poison Control: (800) 222-1222
  • National Institute on Drug Abuse Hotline: (800) 662-4357
  • Cocaine Anonymous: (800) 347-8998

Techniques to De-Escalate a Crisis

Here are 10 tips on de-escalating a crisis. Remember, only do this on your own if you feel comfortable doing so. If not, emergency personnel should be called immediately.

  1. Allow silence for reflection
  2. Allow time for decisions
  3. Avoid overreacting
  4. Be empathetic and non-judgmental
  5. Choose wisely what you insist upon
  6. Focus on feelings
  7. Ignore challenging questions
  8. Respect personal space
  9. Set limits
  10. Use non-threatening nonverbals.

The Importance of Mental Health Awareness

To implement preventive measures, we need to deconstruct the stigma associated with mental illness. This will help make communicating about the topic feel more natural and help students realize it is OK to talk about it — and they aren’t alone. Having the proper mental health resources for students ready is just one of the many ways we can take away the stigma and show the importance of mental health awareness.

Mental health awareness is important because with awareness comes more support and care for those who are in need. When the public is educated on everything there is to know about mental health and mental illnesses, it becomes more likely that these topics become less taboo and negative. Mental health can be just as important — if not even more so — as physical health. This is because it can be hard to maintain your physical health without a healthy mental capacity.

Coping Strategies

Students can take action against their mental health issues and should feel empowered to do so. Here is a list of coping strategies and mental health resources for teenagers and college students:

Dealing with Grief

It’s not uncommon to show signs of grief after losing a loved one, decline in health, death of a pet, a miscarriage, divorce, and more. Grief is the emotional suffering you feel when something or someone you love is taken away. If you are not able to handle grief on your own, it’s important to know that you don’t have to — reach out to a parent, teacher, or mental health professional right away.

There are five stages of grief:

  1. Denial: “This can’t be happening to me.”
  2. Anger: “Why is this happening? Who is to blame?”
  3. Bargaining: “Make this not happen, and in return, I will ____.”
  4. Depression: “I’m too sad to do anything.”
  5. Acceptance: “I’m at peace with what happened.”

To experience these feelings after any emotionally heavy life event is normal. Luckily there are ways to cope with grief:

  • Accept that many people feel awkward when trying to comfort someone’s grieving.
  • Draw comfort from your faith.
  • Join a support group.
  • Talk to a therapist or grief counselor.
  • Talk to friends and family members for support.

Mental Health and Self-Care

Investing in self-care enriches coping skills, energy level, sense of well-being, and the ability to create balance. Applying different self-care techniques — like skin and hair care, reading, baths, meditation, etc. — into your daily routine is beneficial because it allows the mind and body to work together for overall wellness.

Prolonged amounts of stress caused by mental illness can weaken the immune system. This can also lead to more serious health issues such as heart disease, obesity, diabetes, strokes, and high blood pressure. Symptoms of elevated stress levels include but are not limited to:

  • Changes in appetite
  • Decreased in activity levels and/or social connections
  • Difficulty concentrating
  • Feeling anxious, worried, or depressed
  • Increased irritability
  • Sleep disruption

We may not be able to control the stressors of life, but we can control how we react to them. Self-care allows us to do so in a way that is beneficial to our overall well being.

Resources for Mental Illness

In case of an immediate emergency (such as suicidal thoughts, potential to harm yourself or others, or any other life-threatening scenarios) you should always call 911. However, there are other mental health resources that can be utilized for those who need both short-term and long-term solutions:

Support for Schools

Mental health may be an underfunded educational staple for some schools. Luckily there are ways that teachers — backed by the support of lawmakers and principals — can provide support for their students. This can include:

  • Continuing education and awareness workshops for recognizing and addressing mental health issues among students
  • Creating relationships with mental health professionals
  • Peer-to-peer learning
  • Trauma-informed schools

Mental Health Facilities and Government Agencies

Here is a list of mental health facilities and agencies that can help:

It’s important to always remember — if you have a mental illness or are on the verge of a mental crisis, you are not alone. With proper education techniques and the right resources, teachers, parents, and other authority figures will be able to properly care for our youth’s mental health, especially in times of crisis.

Recommended Reading:
The Future of Psychology
The Future of Psychiatry
The Future of Public Health

Sources:

Youth Suicide Prevention
Suicide Prevention Resource Center
National Suicide Prevention Lifeline
American Foundation for Suicide
Child Trends – Key Facts About Teen Suicide
How Much Time Do People Spend on Social Media
Federal Trade Commission Children’s Online Privacy Protection Rule
Children in a Digital World

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