Understanding mental health and mental illnesses
Mental health and mental illnesses aren’t the same things, though the terms are sometimes confused and used interchangeably.
Mental health is a positive state of wellness and flourishing. When we are mentally healthy, we enjoy life, explore and take healthy risks, manage adversity, and find ways to contribute to the world around us. It is something we all want for ourselves, our children, and for others who we love and care about.
Although there are many definitions of mental health, a particularly thoughtful and comprehensive understanding is reflected in the First Nations Mental Wellness Continuum Framework (Health Canada & Assembly of First Nations, 2014), which suggests that mental health and well-being is inspired through “a balance of the mental, physical, spiritual, and emotional” and that everyone, even the most vulnerable or mentally ill, has an opportunity to live as a whole and healthy individual.
Balance can be “enriched as individuals have: purpose in their daily lives… hope for their future… a sense of belonging and connectedness within their families, to community, and to culture and … a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history (p. iv).” First Nations Mental Wellness Continuum Framework
Everyone experiences difficulties with their emotions from time to time. It’s good to remember that even when we, or our children, are experiencing more serious mental health problems, recovery and wellness is possible
Mental illnesses include severe and persistent difficulty with thoughts, emotions or behaviours that causes distress and interfere with day-to-day functioning. The brain governs thoughts, emotions, and behaviours. Mental illnesses are therefore often thought of as being a disease of the brain.
While this is true, in part, mental illnesses are also influenced by a range of factors and experiences, including:
- Social determinants of health (e.g., income and social status, physical environments, access to health services)
- Acute or persistent trauma
Extreme forms of mental illness are rare (e.g., one percent of the Canadian population suffers from schizophrenia). Other types of mental health disorders are more common.
Because difficulties with things like anxiety, attention, or mood are experiences we all have from time to time, it can be challenging to determine if the problem is simply a typical reaction or normal fluctuation, or if it’s something more serious requiring treatment.
Distinguishing between a mental illness and the regular ‘ups and downs’ of adolescence is even harder. And for younger children, problems often go undiagnosed because they don’t always express their feelings and thoughts in a way that adults can respond to.
Rule of thumb: If you notice a change in behaviour, emotions, or thoughts that lasts more than two weeks, is distressing, and causes problems in day to day living, it is time to get it checked out.
Mental health is more than the absence of mental illness. Some people think about these two things occurring along a continuum, like in the image below, to illustrate that we all find ourselves somewhere between these two points and that our positioning can vary depending on circumstances.
Others have broadened this idea to highlight that even when experiencing a mental illness, it is possible to feel mentally well. This is sometimes called the dual continuum model, depicted here:
This short video from the Centre for Addiction and Mental Health (CAMH) elaborates on this idea, and adds dimension, through the dual continuum model.
- According to the World Health Organization, mental health disorders will be the world’s leading cause of disability by 2030.
- About 1.2 million children and youth are affected by a mental illness. 18-22% of students in Ontario meet criteria for a mental health illness or concern. 3
- Some problems appear to be decreasing in prevalence (e.g., conduct disorder), while others are increasing (e.g., ADHD, depression, anxiety).
- More students are expressing a need for help with psychological distress, but only 22-34% of children and youth who have a mental health problem receive needed clinical services
- On a positive note, schools are the most common setting for mental health-related contacts with about 40-50% of children and youth with a parent-identified disorder seeking help at school.
- With appropriate care and support, people who are mentally ill can experience positive mental wellness.
The promise of school mental health
Schools are an ideal place to promote mental health, notice concerns early, offer services, and provide ongoing support. Supporting mental health at school encourages wellness, enhances learning, and carries economic benefits.
Every day, in classrooms across Ontario, there are opportunities to inspire purpose, hope, meaning and belonging amongst students. When we start early in life and reinforce skills and habits that promote mental health within caring classroom settings, we can set students up for success, and may help to prevent or minimize the burden of future mental health problems.
Research has shown that school-based mental health interventions, delivered universally or in targeted ways by school staff, can reduce students’ experiences of mental health problems. Embedding programming into daily practice appears to yield the highest benefits.
When students are feeling mentally well, they’re more available for learning. Research has linked participation in high-quality social emotional learning at school with students’ emotional wellness AND their academic achievement.
Students who receive systematic, active, and focused social-emotional skill instruction perform better on standardized academic tests than those who have not. Also, targeted intervention for students at risk can help to prevent or improve some learning problems at school.
Effective school mental health practices make economic sense. Across many jurisdictions, analyses have shown that investing in mental health promotion early yields a strong return.
For example, economic models from the UK show a significant return on investment for social emotional learning (83.73 £ Return/£ Invested) and anti-bullying programming (14.35 £ Return/£ Invested).
Studies in Canada indicate particular value for early years mental health promotion ($6-16 Return/$ Invested). It has also been noted that investments in school mental health yield cost savings in other sectors like health and justice.
The continuum of mental health support at school
As noted above, schools are an excellent place to promote mental health, notice concerns early, offer services, and provide ongoing support. To organize the various supports and services most suited to the school setting, leaders in this area describe a continuum of care, often called a “Multi-Tiered System of Support”. In Ontario, we depict this continuum using the AIM model.
The Aligned and Integrated Model or AIM is a triangle with three equal sides that shows the three levels of student mental health support in Ontario. The bottom of the trangle is the Foundation and includes school and classroom leadership. It’s divided into the following five sections:
Welcome – school and classroom physical environments
Include – student engagement and belonging
Understand – Mental health literacy and knowing your students
Promote – Curriculum, teaching and learning
Partner – Home, school, community partnerships
The second level is Notice and represents early identification. It’s divided into the following three segments:
Prevent – Provide early intervention services
Support – Offer ongoing classroom support
Bolster – Build skills and resiliency
The third level is the top of the triangle. It is Bridge and represents mobilizing board and community supports. It includes one segment:
Intervene – Assessment and treatment services The words equity, engagement and evidence appear around the graphic.
This model helps to organize mental health promotion efforts offered in a universal way for all students (Tier 1), services for students who may be at risk and needing a “higher dose” of targeted skill development (Tier 2), and supports for students who have a diagnosable mental health problem who need treatment and ongoing care (Tier 3).
An essential ingredient in mental health promotion is ensuring a welcoming, inclusive, caring classroom environment where each student knows and feels that they belong. Learn more about creating and sustaining a mentally healthy classroom.
Educators and other school staff can help students learn about mental health and develop healthy habits. Within mentally healthy schools and classrooms, we:
- nurture identity, relationships and a sense of belonging
- help students learn how to manage stress and maintain an optimistic outlook
- teach about mental health in developmentally-appropriate ways
- emphasize critical thinking skills like goal-setting, problem-solving, task focus, and decision-making
- model healthy habits
- reduce stigma
- connect students with additional support when needed
There are many good initiatives, speakers, and programs that can help with mental health promotion, but a thoughtful approach to selection is required.
Mental health programming can be risky, and sometimes well-intentioned approaches can cause harm. If you aren’t sure about an approach, consult with your board Mental Health Leader.
We also offer decision support tools to help with the selection of mental health programming.
School Mental Health Ontario has a growing suite of social emotional learning and mental health literacy tools and resources that you may with to try. All our resources are evidence-based and implementation sensitive.
Have an idea for a new mental health promotion initiative? Contact us and we can consider this for our Innovation and Scale Up Lab where new ideas are tested for Ontario schools
For most students, everyday practices and caring support will be enough to help them flourish. Some students may need more support.
Educators and other staff members may notice small changes in student behaviour and emotions over time. They can recognize the early signs of mental health concerns or mental illness, help students to describe how they’re feeling and connect them with appropriate support. Educators are not mental health professionals, and cannot diagnose a problem in this area, but they can observe and connect.
In addition to ongoing classroom support for students at risk, such as appropriate accommodations and modifications to address associated learning and emotional/behavioural needs, schools are well-positioned to provide prevention and early intervention services for students with mild-to-moderate mental health problems.
Most school boards across Ontario have regulated health professionals, such as school social workers, psychologists, and psychological associates, who are trained to deliver evidence-based preventive interventions.
School Mental Health Ontario is creating a growing suite of structured psychotherapy approaches to help in enhancing the quality and consistency of Tier 2 services. These approaches are evidence-based and implementation-sensitive.
The SMH professionals page outlines upcoming training opportunities for regulated health professionals. In addition, recognizing that there are other professionals who have an important supportive role with students who are at risk or who are showing early signs of difficulty. We are developing resources for child and youth workers, guidance teachers, etc.
In Ontario, schools are the most common place children and youth receive mental health support. And while we are ideally positioned for mental health promotion, prevention and early intervention services, schools are not ideally suited to provide intensive therapeutic intervention.
When students are struggling with mental illness, it’s critical that they receive the types of supports that are offered within a community or healthcare setting.
School staff help to identify when students require more support than can be offered through prevention and early intervention services, and help students and families to access this additional help. Schools staff continue to support students through and from services, reinforcing skills and strategies that clinical settings have established with them.
Some students will not, or cannot, access clinical services, but they still come to school. School-based regulated health professionals, school staff, and parents/families need to coordinate to wrap around supports as best as they can to help the student to be successful and well. School-based crisis support also needs to be available for students who are suffering from a mental illness, in case an emergency situation were to arise.
By creating mentally healthy school environments, introducing high-quality mental health promotion, offering prevention and early intervention services, and ensuring a safety net for students who are struggling with mental health problems, schools can fulfil the promise and play a strong role in keeping young Ontarians mentally well.