Mental Health

[KeeperOfTheIceRN, ADN]

*Admins, please do not post on Facebook*

Hello all. I'm needing some help. I have been approached by one of my SPED teachers regarding one of her students. She has asked me if we have a "mental health protocol" for a student they feel is experiencing depression. This particular student she is asking about has been showing increasing signs of depression and all teachers involved with him are all voicing their concerns with his poor self image, constant state of exhaustion, refusal to do any kind of school work, and his inability to work effectively in groups (he likes to bait the other students with off topic conversations that elicit big reactions from his classmates). Our district does not employ an LPC. We have a counselor, but she is really just an academic advisor and is very quick to let you know that she does not handle behavioral or mental health situations.

What are my options regarding this student? Are we, as school nurses, allowed to make psych referrals? Am I only allowed to provide resources for the parent and leave it up to them to take the steps to have their child evaluated? I will say his mom is very cooperative with trying to help her son overcome his issues. She is very open with the teachers and seems to genuinely want any help she can get. This student does not have a current diagnosis for depression and I realize his teachers are not licensed to make such observations, but I also know they spend the most time with this student. I personally feel if anyone is going to notice drastic changes in a student's mental health, it will be the teachers. I should also say, the teacher who approached me, is unfortunately no stranger to depression as her son took his own life earlier this year after many years of struggling with his own depression.

Any advice you can give will be greatly appreciated. I have already sent this teacher information on local facilities that offer mental health evaluations but they require the student or the parent to make an appointment. I'm just curious to know what else, if anything, I can do to help.

[JenTheSchoolRN, BSN, RN]

This is where the pediatrician can be your friend. I have referred quite a few parents to make an appointment with their pediatrician to voice these concerns. The pediatrician can make the referral and connect student to counseling.

[ruby_jane, BSN, RN]

Has anyone talked with the parent, or have the teachers shared those observations? More importantly, have you done any kind of assessment? My favorite boss used to say "A decision to test is a decision to treat" so you may not want to open that can.

In our district we're discouraged from making any treatment recommendations because the school then *may* have an obligation to pay. However, if a student is suicidal, we get to make all the recommendations we want. Hope it doesn't go there for you. Good luck!

[cooties_are_real]

I have a Little Darling who is recently going through rough time with his parents sudden divorce. His friend brought him in because he just needed a minute and the friend knew this was a safe place (I tell them my office can be a cry zone if they need it) a few weeks ago. He and his mother have talked to our counselor and is now going to be talking to the LPC who comes on campus. I made the call to his counselor once I knew he was struggling with hopeless thoughts.

I too, have recommended the parents start with the pediatrician. We also have a list of local counselors and counseling center we give to parents.

On a personal note, when I noticed my girl struggling, I just told her she was going and took her to a counselor. Sometimes on the HS level is see the parents letting the student call the shots and not doing what they know is best for the LD. With my girl, there was not option but to go.

I hope he gets the help he needs. OH, and what you can do to help, just be there and listen if he talks.

[KeeperOfTheIceRN, ADN]

Has anyone talked with the parent, or have the teachers shared those observations? More importantly, have you done any kind of assessment? My favorite boss used to say "A decision to test is a decision to treat" so you may not want to open that can.

In our district we're discouraged from making any treatment recommendations because the school then *may* have an obligation to pay. However, if a student is suicidal, we get to make all the recommendations we want. Hope it doesn't go there for you. Good luck!

Very good points, Ruby! Yes, his mom and his teachers have been in constant communication about his emotional state. I have recently been added to the email thread they all have going and from what I have read, she is very open to any help she can get. She is a single mom who is quite honestly doing everything she can in her power. She just seems to not have the correct resources (financially as well as knowledge). I have not done a full assessment on him yet, mainly because I wanted to have as much of a game plan as I could before I approached this topic. Our district discourages treatment recommendations as well for the same liability concerns. But, even I have noticed a dramatic change in his demeanor during our brief interactions. He's by no means a FF, however, he is one that I can pick out in a crowd of students. I don't feel he is to a self harm status, however, I also don't want him to escalate to that level.

[KeeperOfTheIceRN, ADN]

This is where the pediatrician can be your friend. I have referred quite a few parents to make an appointment with their pediatrician to voice these concerns. The pediatrician can make the referral and connect student to counseling.

Gah! This is such an obvious answer!! I have no clue why I didn't even think of this Thank you!!!

I have a Little Darling who is recently going through rough time with his parents sudden divorce. His friend brought him in because he just needed a minute and the friend knew this was a safe place (I tell them my office can be a cry zone if they need it) a few weeks ago. He and his mother have talked to our counselor and is now going to be talking to the LPC who comes on campus. I made the call to his counselor once I knew he was struggling with hopeless thoughts.

I too, have recommended the parents start with the pediatrician. We also have a list of local counselors and counseling center we give to parents.

On a personal note, when I noticed my girl struggling, I just told her she was going and took her to a counselor. Sometimes on the HS level is see the parents letting the student call the shots and not doing what they know is best for the LD. With my girl, there was not option but to go.

I hope he gets the help he needs. OH, and what you can do to help, just be there and listen if he talks.

Thank you Ctate! Bless his heart. I hate when they have to process so much emotional stress that they just shut down. Its so hard for them to work it all out! I hope your daughter has succeeded in with her counseling!!