The National Institute of Mental Health estimates 20 percent of school-age children and adolescents in the U.S. have a debilitating mental illness. That equates to approximately 48,000 children in Collin County last year, according to the U.S. Census Bureau.

State Rep. Garnet Coleman, D-Houston, was part of that statistic; he said he was hospitalized for depression when he was about 16 years old.

The politician was diagnosed with bipolar disorder—a mental illness that carried on into his adult years. But Coleman, who sponsored a mental health bill, said early intervention helped him learn how to handle his illness.

“I didn’t understand things in high school the way I do now, which is why I know it’s difficult for a teenager who’s having a hard time anyway to grasp what’s going on,” he said.

At the state level, many state legislators have pushed for laws requiring training for school districts on recognizing signs of mental health issues, Coleman said. Following the 2011 Texas legislative session, the state required school district employees to undergo mental health intervention training as described in House Bill 1386, which was written by Coleman.

The 2015 Texas legislative session saw the passage of more bills, including Senate Bill 674 and HB 2186, which require new educators statewide to undergo suicide-prevention training.

“The earlier you can intervene the more successful you’re going to be,” LifePath Systems CEO Randy Routon said.

Though NIMH estimates 20 percent of the youth population has a major mental illness, it estimates only about 5 percent of the adult population has a mental illness.

LifePath Systems Program Administrator Carrie Crutcher said she thinks this may be because children are provided the local services they need to manage mental illnesses as adults, which is why early prevention programs are needed.

“If you didn’t catch it early, now you’re going to have 20 to 25 percent of your adults—your workforce out there—who can’t work,” she said.

Organizations such as LifePath Systems—a nonprofit organization that will soon be Collin County’s authority on mental health—look to address childhood mental health issues at the local level.

LifePath Systems will take over as the county’s mental health authority by 2017, handling state funding and creating policies for mental health services. It will replace Collin County’s current mental health authority NorthSTAR, a state Medicaid behavioral health program that is being phased out.

School district training

McKinney ISD trains its staff to recognize signs and symptoms of mental health issues in students to comply with state law, said P.J. Holland, MISD director of counseling and student support.

Holland said though MISD staff counselors are trained as mental health professionals, that is not their role within the school. She said the purpose is to ensure staffers can identify red flags and assist in getting the student the help he or she may need.

LifePath Systems Program Administrator Carrie Crutcher, who also used to be a teacher, said without training, teachers may not know if their students need help.

“I [could] have four kids who I have to spend extra time with,” Crutcher said. “Do I even know what to look for? As a teacher that’s really kind of scary that that many in one classroom has a special need.”

As part of the training, employees are taught to spot potential signs of mental health issues, including lack of hygiene, anger and poor grades.

“Our teachers really try to develop those relationships with students, so if they overhear a statement, see changes in the student or read something in the student’s writing, they will tell the counselor,” Holland said. “Then the counselor will start visiting with the student to find out what’s going on.”

Students are also encouraged to report any mental health concerns seen in themselves or in a classmate, Holland said. Students concerned about classmates can report any concerns to the teachers, counselors or nurses of MISD.

School counselors may be able to help students work through issues without seeking outside help, Holland said. But if a student needs help outside of school, MISD has a list of outside resources students and their families can utilize.

“If the student makes a threat of suicide, we will bring in the school resource officer because they will be able to decide whether the student needs to be transferred to a mental health facility or be released to parents,” Holland said. “If it is decided that there is an immediate threat, the SRO will call an ambulance or will escort the student to a mental health facility.”

Symptoms and stigma

Recognizing symptoms of mental illness in children can be challenging because the signs can be mistaken for other behavioral or health issues, Routon said.

“Kids don’t [deal with] sadness as well as adults,” he said. “They’re much more likely to strike out or talk about wanting to hurt somebody badly. They really express it more as an outward thing rather than an inward thing.”

The symptoms can also change as a child gets older. Elementary school-age children, for example, may wet the bed if they are anxious, Crutcher said, but high school-age children may turn to substance abuse.

“I think the first sign [of a mental illness] is if you notice a change,” she said, noting that a change in friends, sleep patterns or appetite can indicate a mental health issue.

MISD Superintendent Rick McDaniel said mental health issues are the least-understood issues facing society today.

“I feel like as a society in general we are behind the curve in understanding how [mental illness] impacts not only the kids we are trusted with but staff members—we have 2,500 staff members, and that number suggests that some of them may need some type of support,” he said. “We also have to understand that some of our kids come from households where their parents have mental illness.”

McDaniel said it is incumbent upon the district to look at all facets of mental illness and how MISD is affected. He said it is the district’s job to disseminate information to help the staff identify the problem and address it.

It is imperative that students themselves understand how to deal with mental health issues both inside and outside of the home, McDaniel said.

Despite the district’s best efforts to educate its staff and students, there is still a stigma related to mental health and depression, Holland said.

“It is important to remember depression is an illness, and even though it may seem severe, you can always get better and we have staff in place that care and want to help,” Holland said. “If you suspect something is going on with a friend, it is your duty to let a nurse or counselor know.”

The state laws regarding mental health training in schools are, in part, designed to help overcome the mental illness stigma, Coleman said. The stigma can prevent a child from seeking help, which could have adverse affects on him or her as an adult, he said.

“If a cancer is not treated, it gets worse; it’s the same for mental illness,” Coleman said. “If a person doesn’t know how to manage their illness at an early age and doesn’t have support, then the future is very, very bleak.”