Hope for Tomorrow: Mental Health and Substance Abuse Education Evaluation in Utah — Part I
Outreach Partnership Program 2005 Annual Meeting
Sunday April 3, 2005
Vicki Cottrell, Utah Outreach Partner and Executive Director, NAMI Utah
Ms. Cottrell began by describing the history of Hope for Tomorrow, a school-based mental health education program that addresses risk factors for suicide. Shortly after she became Executive Director of NAMI Utah in 1998, the Surgeon General published the National Strategy for Suicide Prevention. Utah had ranked at or above the 90th national percentile for suicide deaths among children 10-19 years of age since 1989. There was a mounting body of research on youth suicide, including preliminary results from the Utah Youth Suicide Study. From experience with a suicide in her immediate family, Ms. Cottrell understood the stigma that surrounds mental illness, as well as the lack of understanding and empathy regarding suicide. She also knew that she wanted NAMI Utah to address this problem. However, Dr. Steven Hyman, then director of NIMH, testified in Congress that very few of the school-based suicide prevention programs in existence had been evaluated properly. He advised community-based organizations to educate the public about risk factors for suicide — specifically untreated mental illness.
In 2000 NAMI Utah initiated the development of Hope for Tomorrow, and enlisted as partners the Utah PTA and the Utah State Office of Education. This partnership was expanded in 2004 to include faculty members of the Department of Pediatrics and Child and Adolescent Psychiatry at the University of Utah, with whom Ms. Cottrell had worked on the Utah Youth Suicide Task Force. The Utah Youth Suicide Study, conducted by these investigators, had identified a number of barriers to appropriate mental health treatment for youth suicide completers, chief among them the stigma of mental illness. The investigators revised the program and developed an evidence-based evaluation that was implemented in the 2004-05 school year.
Hope for Tomorrow is an ongoing school-based mental health education program for adolescents. It is designed to provide mental health information and life skills training to teachers, students and parents, so that students and their families better understand that mental illnesses are brain disorders and thus will seek appropriate treatment. The purpose of the program is to raise awareness of mental health issues, erase the stigma of mental illness, and foster hope among students and their families. The program does not prescribe, treat or attempt to heal. Through education, the program provides an opportunity for adolescents who suffer from undiagnosed, under-treated, or untreated mental illness to learn both when and how to seek appropriate professional help.
With appropriate treatment, adolescents who suffer with mental illness can lead healthy and successful lives. Without treatment, these young people struggle in school and often fail. In the short term, by increasing adolescents’ knowledge and self-awareness of mental illness, the program may increase the number of youth who seek appropriate treatment in Utah. In the long term, the program may result in a reduction in youth suicide in Utah.
In planning how to implement the program, NAMI Utah recognized the importance of community partnerships and strategic planning. Many times, good programs sit on the shelf because school administrators expect teachers to implement the programs, but teachers simply do not have the time. Hope for Tomorrow’s core curriculum materials are available in entirety in VHS format, and each section only requires 30 minutes, thereby protecting teachers’ time. The curriculum covers mood disorders, eating disorders and substance use disorders. Included in each section are interviews with adolescents who have these disorders, commentary from treatment experts, information on signs and symptoms and discussion of potential consequences when the disorders are not treated appropriately.
Supplemental activities include parent education and lunchtime forums for students. Student-designed posters include one conveying the message, “Outside I’m okay and inside I’m not.”; the posters include warning signs and symptoms of mental illness as well as common thoughts teenagers experience related to the signs and symptoms of mental illness. Resource cards include similar thoughts. Scheduled announcements on the school public address system (booster messages) provide students with a “mental health tip of the day”. All of the core curriculum and supplemental materials use a time-tested marketing device — reinforcing messages through repetition.
Research shows that it is important to have consistency between what adolescents learn at school and what they learn at home. Hope for Tomorrow provides a unique opportunity for adolescents to work with their teachers and parents so that they can better understand mental illnesses in the context of their own community.
From the beginning, NAMI Utah realized the need for support from parents. Ms. Cottrell approached the Utah PTA president about a partnership to implement the program. Those conversations continued for some time during program development. Then a local high school PTA asked NAMI Utah for help confronting suicide risk in that school, where a student had died by suicide every year for 12 years. That school became the pilot school for the Hope for Tomorrow program, and three more pilot schools were added the following year. In 2001, the program expanded to 28 schools, and now nearly 60 schools are involved.
At the pilot school, the lunchtime forums started out attracting about 10 students; now, five years later, 150 to 200 students attend the forum every Monday at that school. This pattern is common. NAMI Utah follows up with participating schools and offers help when needed. Adjustments have been made for some schools, but not one school has dropped the program.
On the day of a presentation, the principal makes a particular effort to communicate to students that the counselor’s door is always open. Counselors know that if a child shows signs of being in crisis, parents need to be informed so that they can address the crisis with professional help. The PTA has held community forums for parents, but those have not been well-attended, so other techniques are being used to communicate with parents. For example, at some schools, when parents call to report that a child is unable to attend school, they hear a recording that lists mental health signs and symptoms. Parents are also made aware that NAMI can provide education and support to parents dealing with difficult children and can give them referrals for counseling or treatment.
Coverage by both print and broadcast media has been critical to the success of the program and has generally helped to diminish stigma. Other important elements have been a steering committee in each school, strong relationships with principals, training for teachers, increased numbers of partnerships, a reporting system, and program evaluation. The success of the program also depends heavily on a program coordinator who is experienced in community relations, networking and building relationships; is able to listen to others; is able to assess the strengths and weaknesses of the program; and is willing to make changes and adjustments.
Ms. Cottrell closed with a moving story. Intermountain Health Care (IHC), one of Utah’s largest insurance companies, is conducting a project in which mental health is being integrated into primary care. IHC runs several clinics in the Salt Lake City area where all clients, regardless of their reason for coming to see a primary care provider, are screened for depressive and anxiety disorders. The vast majority of persons who report symptoms on the screening come into the clinic unaware that their symptoms signal a mental disorder. It was surprising, therefore, when a woman called to ask for an appointment for her son, saying, “I think my son is suffering from severe depression.” When she brought him in, he was screened, and found to have symptoms of severe depression. The doctor said, “You know, we rarely get anybody in here who says ’Depression is my problem,’ but you brought your son in here for depression. Why? How did you figure that out?” Out of his pocket, the boy pulled a card. At the top, it said “Hope for Tomorrow Mental Health Education Program,” and the boy had circled how he felt.
Note
Vicki Cottrell died in an automobile accident on April 20, 2005, on her way to a speaking engagement. NIMH joins countless people in Utah and Outreach Partners across the nation in mourning her untimely death.
Disclaimer
* This document is intended to summarize a speaker presentation at the NIMH Outreach Partnership Program’s Annual Meeting and is not an official statement or opinion of the NIMH. This information is in the public domain and may be used or reproduced for educational purposes without additional permission from the NIMH.
