How are the kids doing?

School nurses have an important role to play when identifying children’s mental health issues

For Anne*, the bullying began in pre-school in Saskatoon. By the age of six, she began purposely bruising herself and tearing away the skin surrounding her cuticles. The bullying continued – and worsened – when she reached grade seven and moved to London, Ont. By 13, Anne began using razors to cut her body. All the while, she was staying up late, overwhelmed with anxiety and unable to sleep. She was binge eating. Sometimes, she felt too depressed to leave the comfort of her bed. Multiple times, she attempted suicide. Anne felt alone, ugly, stupid and worthless. Now 18 and reflecting back on the experience, Anne figures she saw over 20 mental health professionals in a five-year period.

It’s estimated one in five Canadian youth have at least one mental health challenge. Whether it’s anxiety, depression or an eating disorder, a striking 70 per cent of mental health issues begin in either childhood or adolescence. Given these statistics, Ontario’s Comprehensive Mental Health and Addictions Strategy is welcome news. Targeting children and youth for the initial three years, the strategy – announced almost a year ago – sets out to identify mental illness earlier, offering youth faster access to supports. It’s a $257 million investment in future generations. Coupled with provincial anti-bullying legislation and a federal commitment to compile the best research on suicide prevention, there is renewed optimism for youth who may feel overlooked by the health system.

Christine Garinger, a mental health nurse for more than 17 years, met Anne in 2009 at mindyourmind, a mental health program for youth based in London. “Our job as nurses, or caregivers in any way, is to try to uncover hope,” she says. She remembers hearing Anne express dismay at never receiving the support and help she needed during her elementary and high school years. Anne didn’t exhibit behavioural problems, and was getting good grades. It may have been difficult for counsellors and teachers to see her need and perceive it as a cry for help, Garinger says.

Had a nurse been present at her school, Anne thinks her story might be different. Simply put, an RN may have made the hard times easier, she says.

With the new funding announced in June of 2011, the Ontario government has plans to place mental health workers and nurses with mental health expertise in schools. These individuals will not only help people like Anne, they will also provide educators, social workers and other professionals with tools and training to identify mental health issues early on.

Nurses used to have a consistent presence in the school setting, but throughout the 90s, hundreds of public health nurse positions were eliminated, says RN Yvette Laforêt-Fliesser, retired public health manager and long-time advocate for school-based public health nursing and healthy schools. Ontario’s  funding formula for education changed in the mid-90s, which meant nurses began vanishing from the school setting.

Recently, there’s been a shift back, and a growing number of public health nurses have made their way back into schools. “From 1998 to 2004, there was a lot of advocacy going on to get public health and public health nurses back in schools,” Laforêt-Fliesser says. “I think what we saw were public health nurses reclaiming their role.”

RN Carol MacDougall, public health manager of school and sexual health programs with the Perth District Health Unit in Stratford, is co-chair of the Ontario Healthy Schools Coalition, a group that raises awareness and advocates for every student in Ontario to be educated in a healthy school. She says: “Society needs to value children and youth and realize that by investing resources during the childhood and adolescent years, you are building a healthy foundation so you will have fewer profound problems amongst the adult population.”

For 13 years beginning in 1987, MacDougall worked as a public health nurse. She met many troubled young people in schools, and says she’s noticed many of their mental health issues relate to a breakdown in family support because parents are working longer hours, are less available at home, or are experiencing financial or marital troubles. All of these factors can contribute to a student’s mental health. A partnership between the Perth District Health Unit, the Avon Maitland District School Board and the Huron-Perth Catholic District School Board led to the creation of six full-time public health nursing positions. In 2008-2009, these nurses provided counselling, assessments and referrals to over 1,000 students.

“I really believe that nurses are the optimal professionals to be in the schools so that kids can talk about…physical, social, emotional, mental and spiritual (health-related concerns). Whatever it is, a young person can have a first point of access to the health-care system through a school nurse.”

Thanks to the government’s mental health strategy, more Ontario schools may soon follow in Perth County’s footsteps. A number of nurses are expected to be hired through the strategy. Many schools are eager to receive word on the new hires, especially those catering to Aboriginal youth. The government acknowledged this population needs focused attention, and has set aside funding to provide culturally appropriate services to 4,000 more Aboriginal kids. In its strategy, the government said it will also hire new, Aboriginal mental health workers.

Mae Katt is a nurse practitioner at Dennis Franklin Cromarty High School (DFCHS ), a private high school in Thunder Bay. There are roughly 150 students who travel from their remote Ojibway and Cree northern First Nations communities north of Sioux Lookout to receive education that is not available on their reserves. Since opening in 2000, seven students, plus one recent graduate, have died: six drowned, one was allegedly murdered and the other died from aspiration after drinking alcohol. “Every day, (we) try to keep these kids alive,” she says, adding that she sees students as bright lights, and wants to support them in any way she can. Nurses can help youth to succeed, she says, and can remind them – as Garinger did for Anne – that they deserve the same happiness as anyone else.

Anne says her wish is to see future generations access the nursing care she never had. She wants youth to feel encouraged by the open and caring environment an RN provides. “I want students to…know that it’s OK to talk about it,” she says. “That they’re not going to be judged, that they’ll benefit from talking about it, and that they won’t need to hide it anymore.”

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