Mental health care in a high school based health service

Adolescence, Spring, 1998 by Lisa Jepson, Linda Juszczak, Martin Fisher

An interesting finding was the high percentage (34%) of teens reporting problematic substance use among family members. During the first years of clinic operation, staff were surprised by the low incidence of substance abuse among students. When the problem was redefined to include family members, striking results began to emerge, suggesting a possible link between high-risk behaviors among both youth and family members. The psychosocial stressors among members of the group for children of substance abusers provide some indication of the plausibility of such a link. One of the group members reported that her pregnancy represented an attempt to gain the unconditional love she never felt she received from either of her substance-dependent parents. She worried, however, that becoming pregnant at 16 reenacted what her mother had done at the same age, which made her question her ability to care for her unborn child.

Other links between family substance abuse and high-risk behaviors among youth emerged from group discussions about conflict management and coping skills. When confronted with conflict, violence, or sexually inappropriate behavior on the part of substance-dependent caretakers, many group members reported engaging in physical violence, running away, or making plans to live with others. Given their sense of insecurity, desperation, and low self-esteem, it is not surprising that many of the alternatives these young women sought ultimately perpetuated their experiences of self-defeat. Due perhaps to underlying identification with substance-dependent parents, or to an intense longing for relationships with emotionally unavailable parents, several group members admitted their own increasing use of alcohol and marijuana. For those youth, who often feel responsible for family troubles, the developmental task of emotional separation and differentiation from family members and caretakers is particularly difficult. It is not unusual, for example, for students who have had enormous social and academic success to suddenly begin having difficulties during their senior year while applying to college or making plans to move away from a chaotic home environment.

Some of the challenges of providing school-based health care also warrant examination. Although it is important that all health center staff develop positive relations with school personnel, this may be most important for mental health providers, whose work may require weekly sessions with students. Effective care within secondary schools must meet the unique needs of students without detracting from their education. One relatively successful solution to this dilemma has been the formation of student groups from targeted classes. This method facilitates teacher cooperation while increasing the number of students who can receive regular assistance.

CONCLUSION

School-based health centers represent an effective means of providing health care services to young people. For high-risk youth in particular, the convenience and accessibility of these centers can mean the difference between obtaining timely medical and mental health assistance and going without care altogether. School-based health centers are, moreover, ideally situated for identifying and responding to the needs of specific subpopulations.