Behavioral Signs & Management

Millions of people in the U.S. are affected by mental illness. Mental wellness matters can impact a person, a family and the entire community. As an educator, help reduce the stigma associated with mental health and show students that they are not alone.

• One in six youth aged 6-17 experience a mental health disorder each year
  16.5% of youth aged 6-17 experienced a mental health disorder in 2016 (7.7 million people)
• 50.6% of youth aged 6-17 received treatment for their mental health disorder in 2016
• High school students with increased symptoms of depression are two times as likely to drop out of school
• 70.4% of youth in the juvenile system have a diagnosed mental illness
• LGBTQ youth are four times more likely to make a suicide attempt
• 17.2% of high school students have serious thoughts of suicide each year

Consider these key guidelines when approaching the serious topic of mental health with a student:

Know what to look for. Be aware of worrisome student behaviors and take the appropriate steps towards getting students help who may need it. Click here to familiarize yourself with common suicide warning signs and click here to view teen depression symptoms that can be a cause for concern.

Know how to respond to a student in need. You may have noticed a student that might be having a problem, now what do you do? Click here to learn do’s and don’ts when talking with a suicidal student.

1. To start a conversation with an at-risk student, try the following steps:
2. Ask if they are OK
3. Express your concern about what you are observing in their behavior
4. Listen attentively and non-judgmentally
5. Reflect what they share and let them know they have been heard
6. Tell them that they are not alone
7. Let them know there are treatments available that can help
8. If you are or they are concerned, guide them to additional professional help

 

Know who to turn to with concerns. Be knowledgeable about the processes in your school that are in place for helping a student who is experiencing a mental health challenge. Make sure students have access to the appropriate school-based mental health supports.

If observable behaviors do not pose an immediate threat(s), please take the following step(s):

• Contact school counselor with concerns regarding observable behaviors
• Refer to Student Assistance Program (SAP)
• Always err on the side of caution

Please know that the student’s counselor will most likely speak with the student privately to assess his or her risk factors and contact parents if necessary. You may decide or be asked to contact the student’s parents about the behaviors you have observed in your classroom (for reference see Tips for Talking with Parent/Caregiver Communication about Mental Health Concerns). Please continue to report any ongoing behaviors of concern that you observe and maintain communication with the school counselor.

Educate yourself. Complete trainings (for reference see Mental Health: +20 Student-Led Programs and Professional Development Trainings), read articles and stay up-to-date on resources that can help you to when approaching this difficult topic.

Advocate at your school. Band together with other teachers, staff and administrators to develop programming and teams (for reference see Mental Health: +20 Student-Led Programs and Professional Development Trainings) that can help improve the mental and emotional climate of your school.

Promote healthful behaviors. Promoting positive physical and mental health behaviors in the classroom can have many benefits for student mental health and wellness.

• Be a positive role model
• Encourage reflection and mindful activity in the classroom
• Get students moving
• Allow access to drinking water (bottles in classroom, water fountain breaks, etc.)

Click here to learn more tips about promoting mindfulness and self-care in the classroom.

Original Sources:

• http://bit.ly/MentalHealthEducators
• https://save.org/youthsuicide/
• http://bit.ly/CDCHealthySchoolsTeacherTips
• http://bit.ly/NAMIMentalHealthByTheNumbers

Externalizing behaviors are problem behaviors that are directed toward the external environment, which cause impairment or interference in life functioning. This is not to be used as a diagnostic tool.

Common types of externalizing behaviors observed in students are attention deficits, hyperactivity, opposition, defiance, bully-like behaviors and social inappropriateness.

What you can do with students showing these types of externalizing behaviors:

• Build and maintain appropriate and positive relationships. Find common interests, engage with students other than just academics, join students for lunch or down time, and/or attend extracurricular activities.
• Be aware of your tone, rate, volume and body language when addressing a situation or specific student.
• Maintain composure and be willing to remove yourself or be asked to remove yourself from a situation if needed.
• Provide students the opportunity to feel needed or give them a purposeful, specific task to complete.
• Actively engage all students.
• Consider why the student is doing what (s)he is doing.
• Consider your own emotional state (avoid over-reacting based on your own personal status).
• Check in with students at first sign of concern (on individual basis). Click here to reference tips for tough conversations.
• Use I statements when talking with students (i.e “I feel”…, “I noticed”..).
• Be aware of classroom and building setting and events.
• Be honest and open with students. Be willing to admit mistakes, let them know you are human.
• Always maintain confidentiality.

NEXT STEPS: If behaviors do not improve, or continue at a level of concern, please take the following step(s): Communicate with appropriate staff members (counselors, principal, etc.) in regard to your concerns or observations. Always err on the side of caution. If you think of it as a concern, it is a concern.

Externalizing behaviors typically observed in the classroom include the following:

Attention Difficulties

Staring off into space frequently, making simple/silly mistakes, talking to peers, playing with materials/in desk, missing directions (asking for repetition), missing assignments, not following through with homework struggling to follow classroom rules, disorganization.

Hyperactivity

Constantly fidgeting and moving, talking when not supposed to, messing with other people’s stuff (desk, locker), excessive talking, shouting out, roaming around the room and frequent requests to leave to room or go to the restroom.

Click here to view the do’s and don’ts when managing a student who exhibits Attention Difficulties/Hyperactivity.

Opposition/Defiance

Arguing, not following rules, refusal to follow rules/shutting down, doing opposite of what asked to do, quick to anger/short temper, easily annoyed, vengeful, lack of caring/apathy (to consequences, other people’s feelings), blame others for mistakes or misbehaviors, mean or disrespectful to staff.

Click here to view the do’s and don’ts when managing a student who exhibits Opposition/Defiance.

Bully-like Behaviors

Initiates physical aggression, mean/disrespectful to peers (not all bullies suffer from an externalizing condition, but many with externalizing conditions engage in bully-like behaviors, at least from time-to-time).

Social Inappropriateness

Lack of awareness or struggles to follow social norms (rules of behavior that are considered acceptable in a group), in other people’s personal space/belongings, struggles to read others, lack of awareness or care as to how behavior impacts others (including inappropriate ways to gain peer or staff attention).

Click here to view the do’s and don’ts when managing a student who exhibits Bully-like Behaviors and/or Social Inappropriateness.

Internalizing behaviors are behaviors that result from negativity that is focused inward. People with internalizing behaviors have difficulty coping with negative emotions or stressful situations so they direct their feelings inside. This is not to be used as a diagnostic tool.

Common types of internalizing behaviors observed in students are anxiety/worry, depression/grief, and trauma/attachment. Internalizing behaviors share many of the same behaviors.

Behaviors typically observed in the classroom include the following:

Anxiety/Worry

Irritable or agitated, restless and/or fidgety, forgetfulness/lack of concentration, excessive tiredness, excessive worry or fear, increased/new complaints of headaches or stomach aches, attendance concerns, physical fidgets (pulling hair, nail biting, head banging, etc.).

Depression/Grief

Depressed mood or irritable, decreased interest for pleasure or activities, change in weight or appetite, change in sleep, restless, fatigue, guilt or feeling worthless, poor concentration, thoughts of suicide, observed lack of emotion, hopelessness, loss of interest in activities, attendance concerns.

Trauma/Attachment

Crying, shutting down, argumentative/angry, startles easily (0verreacts to stimuli), verbally aggressive, observed lack of emotion, hopelessness or guilt, mood swings and/or erratic behavior, withdrawn, change from the norm, socially, wetting pants, loss of interest in activities, rumors or talk of student engaging in risky behaviors outside of school (rugs & alcohol, danger-seeking), cutting and self-harm behaviors, increased behavioral referrals, new attendance concerns

Click here to view the do’s and don’ts when managing a student who exhibits internalized behaviors.

NEXT STEPS: If behaviors do not improve, or continue at a level of concern, please take the following step(s): Communicate with appropriate staff members (counselors, principal, etc.) in regard to your concerns or observations. Always err on the side of caution. If you think of it as a concern, it is a concern.

According to New Freedom Commission on Mental Health, which was established by U.S. President George W. Bush through Executive Order 13263 on April 29, 2002, mental health is essential to learning. Because of this important interplay between emotional health and school success, schools must be champions in the mental health care of our children.

Schools are a critically important source of information for families about their children, including information about their emotional and mental wellbeing. With children in the classroom for the majority of their day, teachers and school professionals are in a key position to be aware of any learning, functioning and behavioral problems that should be communicated to parents.

Teachers, school administrators and school health professionals may be the first to notice changes in a student’s attendance, behavior and achievement. Good communication between schools and parents/caregivers can be the first defense in identifying when referrals, interventions and/or services are warranted. Although, communication about concerns is essential, teachers, school administrators, and school health professionals should avoid diagnosing a mental health concern. When there are major concerns, parents want to know how best to address these challenges — this may include information/resources regarding a comprehensive health care evaluation and/or a mental health evaluation.

It is important for staff to keep parents informed of any concerns that are seen in the classroom or school. Consider the following tips to assist in handling any parent communication:

• In-person communication and phone calls are much better tools to express concerns to parents. If you use email, remember to keep confidential/sensitive information out of the conversation.
• Maintain privacy. Make sure students and classmates are out of the area. Set aside ample time to complete the conversation. Make sure parents have time to talk (i.e “Is this a good time to talk?” “Do you have time to discuss..?”).
• Convey to parents that you are calling them because you want to work together for the best interest and care of their child. When discussing concerns, focus on observable behaviors only (i.e. “I have observed in class over the past several days…” “Johnny has fallen asleep three times in class in the past week.”).
• Include positive attributes of the student along with your classroom observations/concerns.
• Be ready to offer resources, information and continuing supports or next steps (i.e. “We have a Student Assistance Program at school that I can refer your child to and someone will be in touch with you with more details regarding that program.”)
• Ask if parents have seen the described behavior and how they manage in the home setting (i.e. “Are you seeing any of these behaviors at home?”). Listen first. Talk later.

DO NOT

• Give opinions, diagnoses or labels about the observable behavior (i.e. “I think your child is on drugs.” “Your child needs to be on medications”).

Source

According to National Alliance on Mental Illness, one of the most important ways to be a good friend is to help your friends when you notice something is wrong. This includes helping them get the support they need and deserve if they are experiencing a mental health condition. This might seem like a big task, but it doesn’t have to be.

How Will I Know If Something is Wrong?

Sometimes things don’t go our way or bad and unexpected things happen. It’s normal to get upset or sad at times, but if you feel that your friend isn’t responding normally it might mean that there’s something more serious going on. Here are some signs to look from your friend.

• Withdrawing from social activities or appearing down for more than two weeks. This could mean crying regularly, feeling tired all the time or not wanting to hang out anymore.
• Self-harming actions such as cutting or burning. Some people may begin to wear long sleeves or pants to cover up signs that they are doing this.
• Threatening to kill his- or herself or making plans to do so. Although you may not know whether your friend is serious or not, it’s better to be safe and take things seriously.
• Extreme out-of-control, risk-taking behaviors. Behaviors that can endanger his- or her own life as well as others, such as speeding excessively and not obeying traffic laws, might be a sign that something is wrong.
• Sudden overwhelming fear for no reason. Includes intense worries or fears that get in the way of daily activities.
• Not eating, throwing up or using laxatives to lose weight. Pay attention if your friend isn’t eating much at lunch or going to the bathroom right after meals.
• Severe mood swings. Life is stressful, but if there seem to be outbursts that go beyond how other people would often act, it might mean something more serious.
• Repeated use of drugs or alcohol. Coming to class hung over, showing up to sporting events intoxicated or wanting to bring drugs or alcohol into daily activities is not normal.
• Drastic changes in behavior, personality or sleeping habits. Your friend might be sleeping much more or much less or get agitated more frequently.
• Extreme difficulty in concentrating or staying still.

What Can I Do?

Share your concerns and observations with your friend. Focus on being nonjudgmental, compassionate and understanding. Don’t interrupt, and don’t give advice. Express concern and tell your friend that together you will find help. Use these “I” (instead of “you”) comments to get the conversation started.

• I’ve noticed you’re [sleeping more, eating less, etc.]. Is everything okay?
• I’ve noticed that you haven’t been acting like yourself lately. Is something going on?
• It makes me afraid to hear you talking like this. Let’s talk to someone about it.
• Go ahead and ask. Your friend may hint or joke about suicide, but it is important to take all communications about suicide seriously. It is safe to ask directly “Are you thinking about killing yourself?” Talking about suicide does not cause suicide. If you have difficulty asking your peer his or her thoughts, enlist an adult to help you. Or call the National Suicide Prevention Lifeline 1-800-273-TALK (1-800-273-8255) and the trained counselors there will help you.

Don’t keep secrets. Rather than promising your friend to keep their thoughts of suicide a secret, tell him or her you can help, but you need to involve other people. True friends will remain your friend, even if he or she does not initially agree with your approach or help-seeking. Your efforts to help another will not be overlooked. Keeping secrets about suicide can have devastating consequences that could affect you for a long time.

Reach Out to Someone You Trust. If a friend is in need, you don’t need to go at it alone. Involve others who can provide added support. Try to find someone who might be understanding of your friend’s situation or be able to help. Your friend may feel cornered if you start involving others, so make sure to talk to your friend first. However, if it’s an emergency, you should call 911 and get an authority figure involved. Don’t leave a suicidal friend alone. Go with him or her to a mental health professional, hospital emergency room, or his or her doctor.
Here are some people you may consider reaching out to:

• Friends and family
• School teachers or counselors
• Faith-based leaders
• Coaches

Ways to Get Immediate Help in a Crisis

• Call 911 if you or someone you know is in immediate danger or go to the nearest emergency room.
• National Suicide Prevention Lifeline Call 1-800-273-TALK (8255); En Español 1-888-628-9454
• Crisis Text Line Text “HELLO” to 741741

Move out of harm’s way. If there are firearms, drugs, or other means of suicide in his or her house, ask an adult to remove them until the crisis has passed. Make anything inaccessible that might be used by your friend in an impulsive moment.

Offer Support. Keep in mind that your friend might not be ready to talk about what they’re going through or simply may not want your help right now. You cannot force someone to get help, so just do your best to be there with your friend through their journey and be ready if and when they do finally reach out. It may be helpful to offer specific things that might help, such as:

• How can I best support you right now? Is there something I can do or can we involve others who can help?
• Can I help you find mental health services and supports? Can I help you make an appointment?
• Can I help you with the stuff you need to get done until you’re feeling better?
• Would you like me to go with you to a support group or a meeting? Do you need a ride to any of your appointments?

You can play an important role in helping a friend build a positive, social support network. Here are ways to do that:

• Check-in regularly. Call or text your friend once or twice a week. Check in with them after their therapy appointments to see how things went. Let them know that you are there.
• Include your friend in your plans. Even if your friend doesn’t always come, they will probably appreciate being included.
• Learn more about mental health conditions. Find out more about what your friend is going through so you are better able to help in future situations.
• Avoid using judgmental or dismissive language, such as “you’ll get over it,” “toughen up,” “snap out of it.” Your friend needs to hear that they are not alone and that they can get through this. Reassure them that everything will be okay and that you are there for them.

Being a friend means being there in easy times and more difficult times. If your friend is experiencing a mental health condition, this is a time when he or she needs you the most. Sometimes just talking about it might help your friend feel less alone and more understood. You can be the difference in helping a friend who needs support but is too afraid to seek help. Just a simple conversation can go a long way in helping your friend. You can make a huge difference in someone’s life.

Take care of yourself.

Helping a suicidal friend is stressful. Make sure you get support. Talk to a friend or family member and get good food, rest, exercise and whatever else you need.

Original sources:

• https://www.nami.org/Find-Support/Teens-Young-Adults/How-to-Help-a-Friend
• https://www.preventyouthsuicide.org/resources

According to Penn State Health, one in five teenagers have depression at some point. A teen may be depressed if they are feeling sad, blue, unhappy or down in the dumps. Depression is a serious problem, even more so if these feelings have taken over a teen’s life.

A teen is more at risk for depression if:

• Mood disorders run in the family.
• They experience a stressful life event like a death in the family, divorcing parents, bullying, a break up with a boyfriend or girlfriend, or failing in school.
• They have low self-esteem and are very critical of themselves.
• The teen is a girl. Teen girls are twice as likely as boys to have depression.
• The teen has trouble being social.
• The teen has learning disabilities.
• The teen has a chronic illness.
• There are family problems or problems with their parents.

If the teen is depressed, you may see some of the following common symptoms of depression. If these symptoms persist, talk with the student privately. If you do not feel comfortable talking alone with a student, please refer the student to his or her guidance counselor.

• Frequent irritability with sudden bursts of anger.
• More sensitive to criticism.
• Complaints of headaches, stomach aches or other body problems. The teen may go to the nurse’s office at school a lot.
• Withdrawal from people like parents or some friends.
• Not enjoying activities they usually like.
• Feeling tired for much of the day.
• Sad or blue feelings most of the time.

Notice changes in the teen’s daily routines that can be a sign of depression. You may notice that:

• The teen has trouble sleeping or is sleeping more than normal.
• A change in eating habits, such as not being hungry or eating more than usual.
• The teen fears gaining weight, and exercises excessively.
• They experience a hard time concentrating.
• The teen has problems making decisions.

Changes in the teen’s behavior may also be a sign of depression. They could be having problems at home or school:

• Drop in school grades, attendance, not doing homework
• High-risk behaviors, such as reckless driving, unsafe sex or shoplifting
• Engaging in self-harm behaviors (e.g., cutting or burning their skin)
• Pulling away from family and friends and spending more time alone
• Drinking or using drugs

Teens with depression may also have:

• Anxiety disorders
• Attention deficit hyperactivity disorder (ADHD)
• Bipolar disorder
• Eating disorders (bulimia or anorexia)

Complete the following assessment to see if you or someone you care about may be depressed. When you’re taking the assessment, think about behaviors and moods from at least the past two weeks. The assessment is based on information from Mental Health America. Note: This assessment is not a diagnostic tool and is not intended to be a substitute for a visit with your healthcare provider.

Start Assessment

As an educational professional, it is important familiarize yourself with common warning signs or red flags that can be a cause for concern in students. Red flags can be telling of a larger issue, being able to recognize these potential concerns allows you to help students access the appropriate mental health assistance they may need.

If observable behaviors do not pose an immediate threat(s), please take the following step(s):

• Contact school counselor with concerns regarding observable behaviors.
• Refer to Student Assistance Program (SAP)
• Always err on the side of caution.

Please know that the student’s counselor will most likely speak with the student privately to assess his or her risk factors and contact parents if necessary. You may decide or be asked to contact the student’s parents about the behaviors you have observed in your classroom (for reference see Tips for Communication with Parent/Caregiver about Mental Health Concerns). Please continue to report any ongoing behaviors of concern that you observe and maintain communication with the school counselor.

Click here to learn more about observable behaviors that can be red flags.

Here’s an easy-to-remember mnemonic representing the warning signs of suicide:

IS PATH WARM?

I: Ideation
S: Substance Abuse
P: Purposelessness
A: Anxiety
T: Trapped
H: Hopelessness
W: Withdrawal
A: Anger
R: Recklessness
M: Mood Changes

Increased Risk Factors for Suicide include:

• History of trauma or abuse
• Recent loss of loved one
• Recent loss of relationship
• Recent stressful or traumatic life event
• Family history of suicide
• Previous suicide attempt
• Exposure to other teen suicides
• Lack of adequate health care resources
• Loneliness due to lack of a support network
• Hostile social or school environment
• Substance and alcohol abuse
• Mental disorders
• Impulsive/aggressive tendencies
• Major physical or chronic illness/pain
• Terminal illness
• Easy access to lethal means

Protective Factors

• Effective mental health care
• Easy access to a variety of clinical interventions
• Connectedness to individuals, family, community
• Restricted access to lethal means
• Skills in conflict resolution and handling issues in non-violent ways
• Problem-solving skills
• Contact with caregivers
• Ability to cope with stressful situations

Original Sources:

• https://save.org/about-suicide/warning-signs-risk-factors-protective-factors/
• https://www.mayoclinic.org/diseases-conditions/teen-depression/symptoms-causes/syc-20350985
• https://www.mentalhealth.gov/talk/educators
• http://www.sprc.org/sites/default/files/resource-program/RS_warningsigns.pdf
• https://www.sprc.org/sites/default/files/migrate/library/RiskProtectiveFactorsPrimer.pdf
• https://www.cdc.gov/violenceprevention/pdf/sem_framewrk-a.pdf
• https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/mental-illness-in-children/art-20046577
• https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm

Suicide is the second leading cause of death of those aged 10-34. As an educator, it is important to allow a suicidal person to feel safe and give them an opportunity to express his or her feelings that can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt. Start a meaningful conversation with youth to help reduce the stigma associated with mental health and to show them that they are not alone.

Click here to view recommended guidelines to help during a private conversation with an at-risk student that you are concerned about. Remember; anyone who talks about suicide or shows other warning signs needs immediate help it is not your job to counsel a student, that is the role of a mental health professional. Your role is to identify, ensure safety and refer for help. If you do not feel comfortable talking alone with a student, please refer the student to his or her guidance counselor.

What to do If/When a Student Expresses a Desire to Harm Him or Herself:

Educators play a pivotal role with connecting the student with a school-based intervention. If the student confirms they are suicidal, respond quickly to a crisis by following your school’s protocol for responding to a student at risk of suicide.

If your school does not already have a protocol to adhere too, consider the following suggested guidelines:

• Do not let the student out of the classroom to ensure immediate safety.
• Immediately contact the school counselor.
• Do not leave any messages. Talk to someone directly.
• If the counselor is not available, contact the school nurse.
• If the nurse is unavailable, contact your building administrator(s).
• Please keep in mind that an adult will need to escort the student to where he or she belongs.

Original Sources:

• https://vantagepointrecovery.com/students-with-mental-health-disorders/
• https://classroommentalhealth.org/help-students/how-to-talk/
• https://www.mentalhealth.gov/talk/educators
• https://www.nami.org/Blogs/NAMI-Blog/November-2018/Talking-to-Kids-About-Mental-Illness
• https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm