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igh school is increasingly being seen as an important frontline for mental illness - and experts are saying it's way past time. Symptoms for most mental illnesses begin during adolescence and young adulthood. The challenge now is to come up with ways to identify and support students who have a mental illness, so that young lives and futures are not completely derailed.

Many teenagers are too frightened to ask for help when symptoms first appear. They're afraid of what's happening to them, they don't know a lot about mental illness and they're very concerned about stigma or being judged unfairly. Parents, friends and teachers can ignore warning signs, too, thinking that they're just part of typical teen behaviour.

Students these days have to deal with the usual pressures of exams, raging hormones and relationship problems. But, according to the Canadian Psychiatric Association, mental health issues also loom large for many teens. From depression to eating disorders to schizophrenia, youth worldwide are at high risk for mental illness.

			Many Canadian teens at risk
			The Canadian Mental Health Association reports that one in five teenagers have experienced a major mental disorder. Statistics Canada puts the total number of 12-19 year olds in Canada at risk for developing depression at a staggering 3.2 million. The 2002 Report on Mental Illnesses in Canada, produced by the Canadian Alliance on Mental Illness and Mental Health, Health Canada and Statistics Canada, stated that, "the high rates of hospitalization among young adults aged between 15 and 24 years attest to the impact of mental illnesses on young people." The report showed over 10% of hospitalizations in this age group were for a mental illness. Professional treatment reaches only about 1 out of 6 Canadian adolescents, according to the Canadian Psychiatric Association (CPA). The CPA emphasizes that, "It is important to better understand what is going on with our youth, why they are at risk, and how we can try to better address the needs of adolescents with psychiatric disorders."

As an expert in child and adolescent psychiatry, Dr. Stan Kutcher, Professor of Psychiatry at Dalhousie University, has seen first-hand the effects of mental illness on high school students. "Very often, the illness either can be identified within the school setting or it makes a major impact on their ability to be successful in that setting, not just academically, but socially," he says.

Mental health problems and mental illness both affect young people in many ways. They can feel exhausted. They can have problems concentrating and getting along socially. They may have weird or scary thoughts. Their reactions to things can be odd and their behaviour unpredictable.

Students who are on medication for a diagnosed mental illness can suffer side effects such as restlessness, irritability, dry mouth, memory lapses, blurred vision, drowsiness and trembling. They can feel "brain dead", as though their mind is surrounded by a thick, impenetrable fog.

Students coping with a diagnosed mental illness face serious challenges, too. "Many youths need time at home to deal with their illness and treatment and it's difficult for them to return to school," said Catherine Willinsky, Project Manager of the Canadian Mental Health Association's (CMHA) Mental Health and High School Project. "Their confidence has been shattered. If they can have access to treatment, to a continuum of care, their lives won't be so interrupted."

One of the tragic costs of mental illness among youth is suicide. Suicide is among the leading causes of death in 15-24 year old Canadians, second only to accidents. According to the Canadian Psychiatric Association, suicidal thinking and behaviour often go hand in hand with depression in adolescence.

"We totally need help for those of us who are battling with ourselves to finish high school while having a mental illness." The frustration of this student was echoed by other youths when the CMHA researched its Mental Health and High School Project.

The aim of the project was to bring the idea of mental illness in high school out of the closet and provide practical strategies for helping students. "We found that kids felt a complete lack of support and resources - especially people to talk to," said Catherine Willinsky. "They felt they had no recourse when it came to academic supports."

To fill the gap, CMHA produced "A Guide for Students" and a web resource. Both draw on the experiences of students, parents, teachers and counsellors to offer information about mental illness and mental health problems, sensible suggestions and tips for helping kids cope with a mental illness at school.

			Recognizing when there is a problem
			Although the symptoms vary for each mental health problem and from person to person, if there is something serious going on, you are sure to notice changes - whether you are a parent, brother or sister, teacher, or friend. A teen who is experiencing the onset of a mental illness is no longer able to get organized, or take stock of what is happening to them. This is the most obvious sign to those around the person: there is a "breakdown" in their usual behaviour. Because the symptoms of mental illness can come and go, and can be confused with other things, (like normal teenage angst), it can take some time to figure out what's really going on. Be aware of the behaviours, note how long and how often the behaviours have been occurring, and how severe they seem. A pattern that continues for a long period may indicate a serious mental health problem.

Helping students with a mental illness can be as simple as letting them pick their own seats, bring water to class, take breaks when needed and copy a friend's notes.

CMHA's "A Guide for Students" also suggests:

• asking to do written or taped assignments if oral presentations are too stressful,
• negotiating for extra time to complete homework and exams,
• breaking exams up into 2 or 3 sessions,
• requesting essay-style exams if multiple choice is too stressful and
• taking exams in a quiet location.

Often simply reducing their course load can enable students to finish high school, whether it takes one or a few years more.

Teachers and families should also respect teenagers' need to take part in all discussions that concern them. Disclosure, or "telling someone", is a really important issue. Students need to make their own decisions about whether or not to tell anyone about their illness, since, as Dr. Kutcher says, "Stigma is huge for teenagers." Catherine Willinsky agrees that as far as stigma goes, "It certainly isn't any better in high school than it is in the rest of the world."

Mental health professionals view school as a frontline to identify teenagers' mental health problems and illnesses. "The reality is that school professionals come face to face with these issues every day," said Dr. Kutcher. "Schools are increasingly being called upon to undertake a wide variety of social actions, only one of which is education."

			Mental health problems and mental illness defined
			The Canadian Mental Health Association (CMHA) defines mental health problems as the more common struggles and difficulties that affect everybody from time to time. Teens with these problems may not need medical treatment, but can benefit from help and support. Mental illness refers to a diagnosable condition, like bipolar disorder or obsessive compulsive disorder.

The Center for Health and Health Care in Schools, an American policy and program resource center, concurs, describing the school environment as one that is "tailored to learning and development, a natural context for prevention and intervention, connected to community resources, familiar and accessible to students and parents, designed to promote communication between home and school."

Programs and resources are being developed to educate teachers and advisors about mental illness and youth. The Centre for Addiction and Mental Health in Toronto has produced "Talking About Mental Illness" an anti-stigma program for secondary schools. The "My Life - It's cool to talk about it!" has tools to build awareness, links to mental health information and quizzes.

"School professionals can't be expected to be counsellors and diagnosticians," said Dr. Kutcher. "But they can be expected to help with case identification and with accommodations for students."

Growing awareness of the depth of the problem has stimulated programs and resources aimed at transforming Canadian high schools into environments where students with mental illness are identified sooner and supported. The activity is significant, says Dr. Kutcher, "from an education perspective and health treatment perspective, and also very much from a public health perspective."