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U.S. Department of Health and Human Services Department of Health and Human Services
Substance Abuse and Mental Health Services Administration

Substance Abuse & Mental Health Services Administration

Last Updated: 10/29/2009

SAMHSA’s Resource Center to Promote Acceptance,
Dignity and Social Inclusion Associated with
Mental Health (ADS Center)

The Elimination of Barriers Initiative: Businesses

School Materials for a Mental Health Friendly Classroom: Eliminating Barriers for Learning: An Administrator's Guide

Dear School Administrator:

This booklet introduces a new continuing education package for secondary school teachers, developed by the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the U.S. Department of Health and Human Services (DHHS), in conjunction with your State's mental health department. I invite you, as a leader in your school system, to consider this training for your teachers and staff.

Mental illnesses are surprisingly common. They affect almost every American family at some point, according to a recent report from the President's New Freedom Commission on Mental Health.

The impact of children's mental health on schools can be significant. Schools that promote mental health report significant benefits, including higher academic achievement, lower absenteeism, and fewer behavior problems.

The training package described in the following pages is part of a broad initiative to remove barriers to treatment and recovery for people with mental illnesses, including teens. The Elimination of Barriers Initiative (EBI) includes outreach to schools, businesses, and the general public in eight pilot States: California, Florida, Massachusetts, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin. Following an evaluation of this effort, the Initiative will broaden to include all States.

To evaluate the EBI's school component, SAMHSA will track the use of the materials. In addition, each State's mental health department will follow up with schools that implement the training to help assess its usefulness.

Please read the following pages and consider implementing this training in your own school. Helping teachers become alert to children's mental health issues can have far-reaching benefits for students, classrooms, and the school as a whole.

Sincerely yours,

Charles G. Curie, M.A., A.C.S.W.
Administrator, Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

"My children have benefited from school-based mental health supports. My daughter, Sheena, was able to attend and graduate from high school because a nurturing classroom with teachers who understood mental health issues could give the support she needed to learn and be academically successful. An individualized educational plan, coupled with an environment where all students felt accepted, gave her the opportunity to achieve her potential. She is a wonderful parent and is a good employee. She is making plans to attend nursing school."

Karen Hocker,
Testifying at the Ohio Legislative Forum on Mental Health and School Success: Creating a Shared Agenda, October 2003

Promoting Healthy Learning Environments

Mental illnesses affect 5 to 9 percent of American children and adolescents each year. That means, on average, that one or more students in every high school classroom could be affected.

Obviously, the impact of children's mental health on schools-teachers, classrooms, students, staff-can be significant. But so can the impact of school practices that promote mental health. Across the Nation, schools that promote mental health report:

  • Higher academic achievement;
  • Lower absenteeism; and
  • Fewer behavior problems.1

Students who once might have been expected to drop out and fail have graduated and gone on to lead active, productive lives.

To achieve these benefits, schools must empower the classroom teachers and other staff who interact daily with students. With proper training, teachers can recognize risk factors and warning signs early and take appropriate steps. They can also create the kind of positive climate that enhances social and emotional development and promotes a healthy learning environment.

1 Jennings, J., Pearson, G., & Harris, M. "Implementing and Maintaining School-based Mental Health Services in a Large Urban School District." Journal of School Health, 70(2000): 201-205.

Mental Health and Learning

Mental health and mental illness can be pictured as two points on a continuum with a range of conditions in between. When these conditions are more serious, they are referred to as mental illnesses and include depression, schizophrenia, anxiety, and others that may require treatment and support. The preferred term for mental illness in children and adolescents, up to age 18, is serious emotional disturbance (SED).

SEDs are defined as diagnosable disorders in children or adolescents that severely disrupt their daily functioning in the home, school, or community. SEDs include:

  • Depression and other mood disorders;
  • Anxiety disorders;
  • Conduct disorders;
  • Eating disorders; and
  • Attention-deficit/hyperactivity disorder.

The impact of SEDs on learning is well documented. Children with SEDs have the highest rate of school failure; only about 42 percent of these students graduate from high school, compared with 57 percent of all students with disabilities.2

SEDs can affect important components of classroom learning, particularly attentiveness, concentration, and opportunities to rehearse and demonstrate new knowledge or skills. Mastery of a skill, the prize of learning, is difficult to obtain when any or all of these components are affected by a mental health problem.

2 U.S. Department of Education. Office of Special Education Programs. Twenty-third Annual Report to Congress on the Implementation of the Individuals With Disabilities Education Act: Results.Washington, DC, 2001.

Examples of SED-related functional impairments that affect schoolwork include:
  • An inability to learn that cannot be explained by intellectual, sensory, or health factors;
  • An inability to build or maintain satisfactory interpersonal relationships with peers and teachers;
  • Inappropriate types of behavior or feeling under normal circumstances;
  • A general pervasive mood of unhappiness or depression; and
  • A tendency to develop physical symptoms or fears associated with personal or school problems.

The consequences of not addressing SEDs can be severe. Untreated emotional and behavioral problems are associated with lower high school graduation rates, school absenteeism, below average grades, problems in acquiring academic skills, and poor relationships with peers and adults. Serious emotional disturbances that go untreated can lead to suicide and suicide attempts, acceleration of the course of the illness, damage to brain functioning, an increase in health-risk behaviors, and involvement with the criminal justice system.3

The financial cost of untreated SEDs can also have a major impact on communities, including schools. It is difficult to place a dollar amount on quality of life, family stress, and social isolation. However, it has been estimated that untreated SEDs cost school taxpayers an equivalent of more than 50 teaching positions in a single education district.4

3 Weissman, M. Wolk, S., Goldstein R., et al. "Depressed Adolescents Grown Up." Journal of the Amercian Medical Association, 281 (1999): 1701-13.

4 Wilkerson, B. Notes for remarks. Presented to the Ontario Teachers Insurance Plan Benefits Workshop, Global Business and Economic Roundtable on Addiction and Mental Health, Toronto, Ontario.

"The key to improving academic achievement is to identify mental health problems early and, when needed, provide adequate services and links to services."

President's New Freedom Commission Report on Mental Health, U.S. Department of Health and Human Services, 2003

Eliminating Barriers for Learning

Eliminating Barriers for Learning is a continuing education program for secondary school teachers and staff that focuses on mental health issuesin the classroom. Developed by the U.S. Department of Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA), its goals are to inform teachers about adolescent social-emotional wellness and provide specific skill-based techniques for classroom use. It aims to:

  • Increase knowledge of adolescent mental health, including risks and protective factors;
  • Show teachers and staff how to develop an action plan to help students who need additional support;
  • Suggest ways to promote a mentally healthy learning environment through instructional techniques that take into account individual styles of learning and the classroom climate; and
  • Help staff identify school and community resources and partnerships to promote youth mental health.

"Another new school, my 11th-grade year... I confided in the school nurse, Mrs. Reynolds, about my illness and that I was scared. She contacted my psychiatrist and my mom. The school nurse made the appointment and helped my mom to get me back on meds and therapy... My senior year changed and was somewhat harder ... though I played basketball and did well academically, I struggled mentally. The staff at [my school], having some knowledge about mental health issues and embracing me in the manner they did, helped so much."

Student-Athlete of the Year diagnosed with bipolar disorder, Testifying at the Ohio Legislative Forum on Mental Health and School Success: Creating a Shared Agenda, October 2003

About the Continuing Education Modules

Eliminating Barriers for Learning consists of four modules, each designed for a continuing education or inservice workshop. The modules include extensive instructions and notes for the trainer, who may be a school social worker, psychiatrist, guidance counselor, school nurse, or other staff member.

The modules provide information and tools that staff can use to address teen mental health problems, enhance students' social and emotional development, and create a learning environment that promotes mental health. Based on current education and behavioral science research, the training modules compile practices supported by research and associated with positive outcomes for youth.

Like most forms of inservice education and professional development training, Eliminating Barriers for Learning emphasizes knowledge and skill development.

Eliminating Barriers for Learning is a complete training package. Each module includes a trainer's outline with detailed instructions, trainer's preparation notes for background on the topics, and descriptions of the learning activities; the package also includes PowerPoint slides on a CD and reproducible handouts.

The entire training package should take about four hours to deliver. However, each module has been designed to stand alone, with the exception of Module I, which is a prerequisite for all or any of the following modules. This flexible format allows for training in specific areas or for ongoing training as time permits.


Module I: Eliminating Barriers for Learning: The Foundation

This module describes the links between teen social-emotional development, mental health, and learning. It also addresses the impact of the stigma surrounding mental health issues. It lays the foundation for the three modules that follow.

Module II: Social-Emotional Development, Mental Health, and Learning

Module II gives an overview of common mental health issues among adolescents and their potential effects on learning and behavior. It trains teachers to recognize risk factors and protective factors of SEDs.

Module III: Making Help Accessible to Students and Families

Module III equips teachers with the tools they need to address specific mental health issues in their classrooms. It shows how to formulate a plan to help students with mental health needs and encourages the creation of sustained school-home-community partnerships to meet the educational and developmental needs of youth.

Module IV: Strategies to Promote a Positive Classroom Climate

Module IV addresses ways to create a classroom climate that promotes learning and mental health for all students.

Next Steps

Implementing the training

While each school has its own procedures for deciding on and implementing continuing education for teachers, the following suggestions refer specifically to Eliminating Barriers for Learning and may be useful in planning.

Review the materials and select one or more modules

Along with the appropriate school, community, and parent teams, preview the materials and discuss how they fit with the school's mission. Consider asking a clinician from a neighboring mental health agency to join your team when looking over the materials. Invite parents and students affected by SEDs as well.

Identify trainers

The modules are designed to be delivered by school staff members, such as social workers, school nurses, or guidance counselors. Consider the use of two- and three-member teams to present the sessions. These members can represent the school, mental health, and parent communities. A triad might consist of a school psychologist, community mental health counselor, and parent or student. The modules were designed to be delivered by people who know the subject matter, the school building, and the school system.

Integrate the training goals with existing professional development activities

Existing professional development activities can build upon or complement the training in each of the modules. Determine how all the pieces fit together to form a whole. This will create a solid vision for how the various learning objectives fit with No Child Left Behind and the school's standards.

Support school staff members who attend training

Collegial support, rehearsal of skills, and feedback will be essential for staff members who implement the strategies taught in the modules. Use district resources, such as volunteers, aides, substitutes, and paraprofessionals who can pitch in during a class to allow teachers to leave the class to observe a colleague. Help staff devote a small section of planning time to coordinate these activities and to regroup for performance appraisal from their peers.

School-Focused Mental Health Initiatives
  • Center for Mental Health Services' Child, Adolescent and Family Branch
    The Child, Adolescent and Family Branch of CMHS promotes and ensures that the mental health needs of children and their families are met within the context of community-based systems of care.
  • 15+ Make Time to Listen...Take Time to Talk
    The 15+ Make Time to Listen...Take Time to Talk campaign's goal is to provide practical guidance to parents and caregivers about how to create time to listen and take time to talk with their children.
  • Safe Schools/Healthy Students Action Center
    The Safe Schools/Healthy Students grant program draws on the education, justice, social service, and mental health systems to promote enhanced resources for prevention programs and prosocial services for youth.
  • Center for School Mental Health Assistance
    CSMHA is a team of mental health professionals supporting schools and communities in the development of school-based mental health programs.
  • Center for Mental Health in Schools
    The Center for Mental Health in Schools is a national training and technical assistance center focused on mental health in schools.

Mental Health Organizations
  • American Academy of Child and Adolescent Psychiatry
    AACAP is a membership-based organization composed of more than 6,500 child and adolescent psychiatrists and other interested physicians.
  • American Psychological Association
    APA is a scientific and professional organization that represents psychology in the United States. With more than 150,000 members, APA is the largest association of psychologists worldwide.
  • National Association of School Psychologists
    NASP represents and supports school psychology through leadership to enhance the mental health and educational competence of all children.
  • School Social Work Association of America
    SSWAA is a professional association of school social workers that influences educational issues and policy, and offers opportunities for professional development.

For additional copies of this booklet, or to obtain a copy of Eliminating Barriers for Learning, please call the National Mental Health Information Center at 1-800-789-2647 (English/Spanish)or 1-866-889-2647 (TDD). Or visit

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This Web site was developed under contract with the Office of Consumer Affairs in SAMHSA’s Center for Mental Health Services. The views, opinions, and content provided on this Web site do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. The resources listed in this Web site are not all-inclusive and inclusion on this Web site does not constitute an endorsement by SAMHSA or HHS.