Monday, October 8, 2012

U.S. Public Schools and the First Line of Defense in the Early Detection and Treatment of Mental Illness

What the Disease Management Care Blog didn't quite appreciate was the potential role of the U.S. public school system in helping people like "Tim." 

It thought the fundamental purpose of teachers was to teach. Yet, when it considers that the hours that a child spends in school is an opportunity to catch problems that may be missed by parents and docs alike, the idea that schools can be a first line of defense in the early detection of mental illness has some merit.

 For your consideration when you're grappling with your local school taxes:

Tim is the son of Paul Gionfriddo, who is a former Connecticut politician and current mental health advocate.  As the parent of a child with schizophrenia, he knows what he's writing about.

When Mr. Gionfriddo was starting out as a legislator, he was only just becoming aware of Tim's difficulties in school. What followed was heartbreaking tale of inflexible school officials arranging for the wrong evaluations, wrong diagnoses, inadequate care and wasted attempts to help a deeply troubled child. Teachers were unable to cope, the parents were often blamed and Tim got shuffled around an unresponsive school system.  Despite "good" insurance, coverage fell short and many services involved onerous co-pays and limitations. And once he reached adulthood, an unwillingness to accept services moved Tim to the margins of society, leading to repeated hospitalizations and incarcerations. He now lives in squalor somewhere in San Francisco.

Tim's story is not unique. According to Mr. Gionfriddo, a well meaning policy that moved hundreds of thousands of mentally ill out of decaying inpatient psychiatric hospitals in the 1980s was followed by

1) schools being unable to handle children with mental illness,

2) underfunding of community agencies, and

3) the siloing of the resources that did exist, resulting in little collaboration among physicians, law enforcement, community services or the mental health community.

Among Mr. Gionfriddo's recommendations?  In addition to better screening by pediatricians during the well child visit, insurance reform and better housing options, state legislators should support the following:
1. The U.S. public school system should be prepared to offer mental health services in addition to basic education;

2. Every teacher should receive training in recognizing mental illness and how to handle it;

4. Once mental illness is  discovered, meaningful support should be included in a child's individualized education planning.

Image from Wikipedia

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