by Mikaeel Valli.
An average of ten Canadians die of suicide every day.1 Across the globe in high income countries, suicide is the second leading cause of death in youths aged 15 to 24 following accidental injury.2 In most western countries, youth suicide is often linked to mental illness, especially depression. More sobering still is that an upwards of 80% of youth do not have access to treatment to address their mental health needs when and where they need it.3
School boards have been doing their best to foster a healthy and supportive learning environment for children and youth. However, the school mental health support system is overloaded with long wait lists and with fewer psychologists providing direct service in public systems. Within the context of ever-increasing needs, it is not surprising that educational facilities can become “more reactive, rather than proactive as a result” explained Paula Conforti. She has been a licensed Member of the College of Psychologists of Ontario for the past 20 years and works with school boards to help assist children and youth with mental health challenges. In an effort to address these increasing needs, Conforti additionally sought Registration with the College of Regulated Psychotherapists to supervise those in the school system who are seeking this registration path. The IMS Magazine had the pleasure of interviewing Conforti about her perspective on this pressing topic.
“There is a need for more scalable and rigorous research that can prove the value of early interventions that will effectively decrease suicidal ideation and attempts among youth,” Conforti explained. Early intervention is key to improving the course of various mental health disorders. Additionally, population-evidence based interventions set the stage for stakeholders within the community to better support, proactively respond to, and understand underlying mental health challenges. Conforti expressed that she’s “always been very open to helping others to not only realize their potential and build on their successes, but to assist them in understanding how their core beliefs shape their decisions and reactions.” Given her passion and the gaps she observed in the school board system, she decided to go back to school to pursue her PhD with the University of Toronto’s Institute of Medical Science (IMS) graduate program. With her intention to do translatable research that directly benefits the needs of children and youth within the school boards, she had the pleasure of joining Dr. Mark Sinyor’s lab. Dr. Sinyor is a psychiatrist and associate scientist at Sunnybrook Health Science Centre.
Dr. Sinyor’s lab is focused on suicide prevention and mental health literacy in youth, which is aligned with Conforti’s goals. It is increasingly clear that youths need novel, innovative, and experiential ways to learn about mental distress and to develop a sense of resilience to overcome this distress. Together with Dr. Sinyor, Conforti and many other colleagues established a project that aims to increase mental health literacy and coping skills to grades seven and eight in schools within the GTA that elegantly fuses Cognitive Behavioural Therapy and the novel Harry Potter & the Prisoner of Azkaban.
“We chose middle schoolers because this is an age group where you start to see a rise in depression, anxiety and youth who die by suicide,” Conforti explained. “We are anticipating that our intervention will improve student wellbeing, decrease depression and anxiety ratings, and have an overall effect on decreasing suicidal ideations and attempts. The intervention is accomplishing this rather eloquently without ever directly mentioning suicide. Hence, if results show an improvement in student wellbeing, we are interested in seeing if these gains can be maintained at the high school level, ultimately resulting in an overall significant decrease in suicidality.”
Many do not know that J.K. Rowling—the author of the Harry Potter series—suffered from depression and was seeking treatment for it while writing the third novel—the Prisoner of Azkaban. Rowling channeled her experience with depression into the story by manifesting it as creatures called “Dementors” which serve as an allegory for depression. “Dementors” are described as figures that suck out all the happiness from the victims, causing sadness, hopelessness and despair. The author also infused many coping strategies that she learned in her life that helped combat the Dementors in the story. “There are many comparisons used in the novel that lends itself to the mental health literacy concepts that we are trying to teach” said Conforti. This project is integrated into the English curriculum and taught by teachers who follow a protocolized manual that describes the main concepts that need to be imparted for each chapter. However, teachers are given latitude to customize and tailor the curriculum to the needs of their classroom.
Through this project, “students are given tools to recognize and normalize distress in themselves and others along with tips to facilitate help seeking. They can employ some of the strategies such as stress-busters or identifying errors in thinking and basic cognitive restructuring to help them,” Conforti explained. “The lessons afford students the opportunity to self-express in very safe ways, or if they are a little more reserved, they can perhaps creatively identify and share their thoughts through discussion of the characters in the novel” Conforti added enthusiastically. To quantitively assess the effectiveness of this mental health literacy program, self-report questionnaires have been distributed to roughly 525 students whose parents have consented to date, at various time points, to assess changes in emotional functioning. On a qualitative level, the research team will communicate with the students and teachers about their experience and feedback regarding the program through semi-structured interviews and focus groups.
Viewing this literacy project from a school psychology perspective, Conforti expressed, “This is brilliant because it is teacher delivered within the classroom, lends itself to transcending language and culture, and normalizes the conversation about stressors affecting youth. I think this will have a profound effect as the kids will realize they are not alone with regards to how they are thinking and feeling.” The entire research team aspires to scale the intervention across the globe, which in turn has the potential to reduce the overall cost of mental health services, reduce suicide ideations and attempts, and improve youth resilience and positive coping.
When Conforti returned to school to do this research project with the IMS, we asked her what she has learned in her research that she would like to convey to practicing mental health professionals. “There are many professions and disciplines that are aware of the rise in mental health needs. However, I think we should all be afforded time to self-reflect so we can determine how we might collectively continue to make an impactful difference in meeting the needs of the many vulnerable groups who are in our schools and universities including aboriginals, LGBTQ2, multicultural, low socioeconomic status, and youth transitioning to young adults. With the prevalence rates that we are seeing, some as high as 25%, that’s potentially 250 students in a class of 1000 with mental health needs. With 200 students not accessing outside community support because of barriers to care and/or preference to be seen within the educational system, there is a need to find better and novel frameworks to intervene.”
Conforti believes that multidisciplinary professionals and funding agencies should make it a priority to find creative ways to alleviate these barriers and encourage, support, and fund research to shed light on this. “Data speaks volumes. Research and data will prompt ministries and government agencies to realize responsible allocation of provincial mental health funds ear marked by the federal government should flow to school systems as well as health agencies,” she explained.
Going forward, Conforti envisions that schools and post-secondary institutions should create a school health hub embedded in the school system and research this framework to improve access to holistic services to those students in need. Ontario health and education systems often have what can be perceived as conflicting (and complimentary) mandates. It is counterintuitive to separate mental health and education because academic success depends on accessing “the whole student” which sets the stage for flourishing. However, the complex care medical environment is starting to recognize the need for integrated service. She also would like to see the “mandate for a credited mental health and wellness course that emphasizes the importance of self-care, goal setting, self-reflection, and mental and physical awareness.”
- Public Health Agency of Canada. Government of Canada [Internet]. Canada.ca. Government of Canada; 2019 [cited 2020 Mar 15]. Available from: https://www.canada.ca/en/public-health/services/suicide-prevention/suicide-canada.html
- Patton GC, Coffey C, Sawyer SM, et al. Global patterns of mortality in young people: a systematic analysis of population health data. The Lancet. 2009;374(9693):881–92.
- Children and Youth [Internet]. Mental Health Commission of Canada. [cited 2020 Mar 15]. Available from: https://www.mentalhealthcommission.ca/English/what-we-do/children-and-youth