Over the past few weeks, we have seen a small number of professionals, researchers and advocates questioning the role of mental health in schools. While we welcome new research, opinions and ways that our work in schools can be improved – we need to ensure the language, vocabulary and spirit of the dialogue are well-intentioned and positive.

In particular, an op-ed was published in the New York Times by Dr. Darby Saxby, dated November 18, 2023, “This Is Not the Way to Help Depressed Teenagers.” While we actually have to agree with the title, the op-ed uses confusing language and conflates different aspects of youth mental health work in schools to lead to false conclusions.

Much of the concern has been sparked from a study completed in Australia relating to a mental health treatment program called WISE Teens. This approach used the mental health treatment modality DBT, dialectical behavior therapy, in a universal format for school communities, in lieu of traditional health education. Essentially, they attempted to leverage advanced mental health treatment as prevention – and it didn’t work.

At Erika’s Lighthouse we believe that schools play a vital role in student mental health. We recognize there is a time and place for mental health literacy, intervention and treatment as a continuum of care to promote student success.

Universal Programs & Interventions

First, there seems to be a continuing misunderstanding of “universal” programs. In school settings, universal programs are considered Tier-1 in the MTSS (Multi-Tiered Systems of Support) model. This means 100% of students should be receiving the program or curriculum. However, any mental health treatment program, if effective, would be leveraged as a Tier-2 or Tier-3 intervention and not as a Tier-1 universal program. 

Second, conflating the concepts of prevention, intervention and treatment is a disservice to prevention-based programs, school professionals and clinicians engaged in treatment.

  • Prevention, or mental health literacy programs, are designed to set a common vocabulary, promote help-seeking and encourage good mental health through exercise, nutrition, sleep and positive coping mechanisms (like deep breathing). Some programs, like ours, may even include a self-referral program where students can ask to speak with a trusted adult if they are concerned about themselves or a friend.
  • Intervention is the process of supporting a student identified as experiencing mental distress or illness. This could be a small group program or a referral to a professional counselor or therapist.
  • Treatment is the actual work of providing mental health therapy to young people. While this may be completed in school environments by mental health professionals, that is not always the case. Regardless, any “treatment” that is being completed would be after a child has been identified as needing additional support through a Tier-2 intervention.

The op-ed equates all mental health programs, even mental health literacy, to those of large-scale treatment programs – which is simply false. Failing to appropriately recognize distinct types of mental health programs (prevention, intervention and treatment) and lumping them all as one is a disservice to addressing the youth mental health crisis.

Prevalence Inflation

Dr. Saxbe discusses that mental health programs may actually be doing more harm than good. That is heavily dependent on the program itself. We can certainly acknowledge that prevalence inflation exists, but that further underscores the importance of evidence-informed mental health literacy programs. 

Using mental health symptoms and diagnosis to describe our emotions has certainly entered our normal lexicon. We regularly hear people using the terms anxiety and depression to describe what are likely everyday feelings or emotions. That mental health vocabulary is now mainstream is a testament to stigma reduction, but using it recklessly diminishes the severity of mental illness. That makes mental health literacy essential to helping anyone, especially young people, improve in identifying the difference between everyday feelings vs overwhelming feelings. It is important that young people know the actual signs and symptoms of anxiety, depression and suicide to parse out their experiences. 

Students are being exposed to mental health information from family, friends and social media. It is absolutely the role of school communities to provide factual mental health literacy.

Literacy, not Treatment

Dr. Saxbe remains focused on treatment for young people experiencing mental distress. We commend that and recognize that treatment is essential; but want to be sure we do not denigrate real, purposeful, meaningful Tier-1 mental health literacy due to misplaced treatment programs. 

Language is important, and lumping different types of programs into a generalized group of “mental health programs” is misleading. We hope that language can be more thoughtful around school-based mental health to ensure school professionals, families and students can recognize the benefits, challenges and potential risks of every approach.

At Erika’s Lighthouse our programs are truly universal. They are focused on mental health literacy, encouraging good mental health, recognizing everyday vs overwhelming feelings, knowing the signs and symptoms of depression, and encouraging help-seeking behaviors. At Erika’s Lighthouse, we believe mental health literacy has the power to empower young people and promote early intervention so they can receive well-designed, evidence-informed treatments that will help them achieve mental wellness.

Brandon Combs, MNA, Executive Director
Katie Conklin, M.Ed., Director of School Culture
Erika’s Lighthouse, Winnetka, IL