Download and read articles and papers by forensic psychiatrist and student mental health expert, Dr. William Dikel:
Optimizing the Effectiveness of Mental Health Support Staff in Your District
The COVID-19 pandemic has added a whole new dimension of challenges in addressing students’ mental health needs. Many students who previously had no mental health difficulties are now dealing with COVID-19 adjustment related problems, and students who had previously struggled with mental health disorders are now dealing with the additional stresses that COVID-19 brings.
Addressing the Core Issue in Children’s Mental Health: Early Intervention and Prevention
Research clearly indicates that early intervention (screening, diagnosis and treatment at early stages of a health problem) is the most clinically effective and cost effective intervention. This is well understood in the public health community regarding a wide variety of medical disorders. Unfortunately, this is not the case for mental health disorders. This article makes recommendations for taking the steps necessary to successfully implement a public health model for children’s mental health in Minnesota.
Drugs and Disabilities: Conducting Special Education Evaluations of Students Who Abuse Drugs or Alcohol
Although many health and mental health disorders are potentially considered disabilities under special education law, substance use disorder (previously known as drug or alcohol abuse or dependence) is not. In fact, in some states, a student cannot qualify for the Emotional Disturbance category of special education if drug abuse is the primary cause of emotional or behavioral problems. This article, co-written with school attorney Michael Waldspurger, clarifies the relationship between substance use and special education law.
Slides: Creating Self-Sustaining, Replicable School Mental Health Programs: A User’s Guide
There is a wide variety of school mental health programs across the country. They are based on multiple models.Some have all services provided by school staff, some have colocated diagnostic and treatment services and some have a combination. In this presentation, Dr. Dikel explains the tiers and services models for student mental health in schools, discusses how they're funded, and outlines the choices we face as educators, parents and members of school communities. View Creating Self-Sustaining, Replicable School Mental Health Programs: A User's Guide.
Slides: Nutrition and Psychiatry: Research-Based Prevention and Treatment Approaches
We know that obesity among children is rising and threatens their physical health. But, did you know that obesity is also a student mental health threat? Depression precedes obesity in adolescents and obesity precedes depression in older adults. Psychopathology is most common in the chronic obese group first, suggesting that obesity increases the risk of developing a mental health disorder. Obese pediatric patients have higher rates of anxiety, depression and eating disorders than the general population. Dr. Dikel explains the mental health consequences of nutritional issues in this presentation. View Nutrition and Psychiatry: Research-Based Prevention and Treatment Approaches.
Slides: Student Mental Health: An Essential Guide for School Administrators
Mental health disorders in children are often undetected and therefore remain untreated. Unmet MH care needs can have serious consequences
for children and their families: strained social relationships, poor academic performance, and serious problems in adulthood. Longitudinal studies of
children with mental health disorders have documented an increased risk of dropping out of school, alcohol and drug use, and criminal activity later in life. How does this impact the schools? What is the role of schools in this issue? Dr. Dikel addresses these questions and lays out a framework for school districts to follow in this 224-slide document, originally presented to the Minnesota Association of School Administrators at their 2013 conference. View Student Mental Health: An Essential Guide for School Administrators.
Providing Mental Health Services in Public Schools: What Educators Need to Know
This article provides an overview of different methods of providing mental health services within the school setting, and makes the argument that schools should “stay out of the mental health business” of diagnosis and treatment, but should collaborate with other systems to assure that students have access to services that result in educational gains as well as cost savings to the school districts. Read Providing Mental Health Services in Public Schools: What Educators Need to Know.
Bridges and Firewalls: Contractual Relationships for Mental Health Services Provided in School Settings
When boundaries of clinical, educational, legal and financial responsibility are clearly outlined in contractual agreements between school districts and mental health treatment providers, students can benefit from the “bridge” to mental health services, while the district maintains sturdy firewalls that limit its financial and legal liability. Read Bridges and Firewalls: Contractual Relationships for Mental Health Services Provided in School Settings.
Mental Health Related Services on IEPs
This paper provides an overview of the topic of mental health related services on IEPs and presents guidelines to assist school districts in establishing appropriate decision making processes to address this difficult topic. Read Mental Health Related Services on IEPs.
The Behavioral/Clinical Spectrum
In order for educators to effectively target their interventions to have maximum success, it is important for them to recognize where a student is on the behavioral/clinical spectrum, and to intervene accordingly. Read The Behavioral/Clinical Spectrum.
Emotional/Behavioral Disorders and Special Education: Recommendations for System Redesign of a Failed Category
Students who are determined eligible for special education services because of their emotional or behavioral disabilities present a broad and complex range of disabilities, needs, behaviors, and challenges to the public schools that serve them. Unfortunately, even with special education, these students tend to have very poor school and post-school outcomes. This concept paper explores the implications of the category on school placement and programming decisions as well as the implications of having a category essentially based on behavior and not on a specific, recognized disability. After explaining the concerns, this paper offers recommendations to effectively address these issues, with the goal of improving both behavioral and academic outcomes for students. Read Emotional/Behavioral Disorders and Special Education: Recommendations for System Redesign of a Failed Category.
Mental Health and Public Health
The recently released U.S. Surgeon General's report on mental health outlines the scope and nature of mental health problems in the U.S.. It notes that these problems, in addition to causing immense human suffering and family disruption, are financially costly to society. In fact, mental health disorders are the second most disabling conditions, second only to cardiovascular disease. The report clearly defines these disorders as public health issues, requiring public health approaches to prevention, early identification and coordinated treatment. Read Mental Health and Public Health.
Mental Health and Healthy Nutrition
Schools play a vital role in students’ nutrition by providing snacks and refreshments, breakfast and lunch programs, and in teaching nutritional information as part of the Health curriculum. Nutrition is a key element in students’ mental health. Schools can support students’ physical and mental well-being by promoting system-wide healthy nutrition policies. Read Mental Health and Healthy Nutrition.
Slides: When Advocacy Isn’t Enough – Successful Mental Health Class Action Lawsuits
Unfortunately, mental health services are not always available even when they are mandated in federal and state laws. This presentation, co-authored with Dan Stewart, supervising attorney at the Minnesota Disability Law Center, reviews cases across the U.S. in which plaintiffs engaged in class action lawsuits in order to obtain appropriate mental health services. Stewart and Dikel explain the concept of EPSDT or Early, Periodic Screening, Diagnosis, and Treatment, and provide examples of EPSDT in legal cases regarding the provision of mental health services to children and teens.
Creating a School District Mental Health Plan that Meets the Needs of Students who have Psychiatric Disorders
Special education students in the emotional disturbance category have the worst outcomes of all disability categories. This paper, written by an attorney and a child psychiatrist, explores the reasons for these poor outcomes, and makes recommendations for redesign of this outdated and ineffective special education category.
Slides: Adopting Evidence-Based Teaching Methods for Students Who Have Emotional/Behavioral Problems
Teachers need two kinds of information about children's mental health issues. First, they need to have an understanding of the different mental health disorders that affect children and adolescents and to understand how these disorders manifest within the classroom environment. Secondly, they need to know and utilize teaching methods that have been shown to be effective for individuals who have emotional and/or behavioral problems. This is a PDF of a talk, first presented at the Education Minnesota 2014 conference, that provides an overview of teaching methods that result in improved academic performance and reduced behavioral difficulties.
School Shootings and Student Mental Health: What Lies Beneath the Tip of the Iceberg
Mental health disorders are pervasive in the student population. It is essential for school districts to have appropriate procedures and guidelines that identify both what they should be doing, as well as clarifying services that need to be provided by other systems. With effective procedures and guidelines in place, schools can get a handle on this complex topic, and be a successful collaborative partner in the provision of services to vulnerable students. Read School Shootings and Student Mental Health: What Lies Beneath the Tip of the Iceberg.
The Relationship Between Physical Health and Mental Health
Schools play a vital role in health promotion, with positive impacts on students’ mental and physical health. In order to optimize these impacts, it is beneficial for school professionals to understand the interplay between physical and mental health factors, and to target programs and services to have the maximum positive effect. Read The Relationship Between Physical Health and Mental Health.
Applying International Human Rights Standards to the Restraint and Seclusion of Students with Disabilities
No federal law in the United States prohibits school administrators from physically restraining or secluding students. State laws diverge widely. Unlike in medical, psychiatric and law enforcement settings, where strict national standards govern the use of physical restraint and seclusion, many schools may have no, or inconsistent, guidelines to follow in deciding when the use of force against students is appropriate. This lack of industry-approved protocol and standardized training of school personnel makes restraints and seclusion susceptible to misapplication and abuse. Read Applying International Human Rights Standards to the Restraint and Seclusion of Students with Disabilities.
Solving Minnesota’s Perpetual Mental Health Crisis
Despite the work of countless government committees, mental health study groups, task forces, action groups and advocacy organizations over the past 25 years, mental health disorders in Minnesota continue to be prevalent and generally go untreated. In this article, Dr. Dikel offers actionable solutions to Minnesota's mental health concerns, particularly in education. Read Solving Minnesota's Perpetual Mental Health Crisis.
Bizarro World: The Many Ways our System Fails the Mentally Ill
When you substitute "meningitis" for "mental illness," the dramatic loss of funding, resources, diagnosis, treatment, and positive outcomes, becomes visible . . . and heartbreaking. In this article, Dr. Dikel shows the obstacles that prevent effective mental health services for Minnesota and all American students and youth. Read Bizarro World: The Many Ways our System Fails the Mentally Ill.
Program Evaluation: Hawaii Department of Education School-Based Behavioral Health Program
This report examines the systemic issues (legal, educational, clinical, administrative), that impact this approach and the strengths and weaknesses of the present model of service provision. It will outline suggestions for system change within DOE, and will describe changes that will be necessary in other systems in order for DOE activities to yield the greatest benefit. Read Program Evaluation: Hawaii Department of Education School-Based Behavioral Health Program.
How to Handle Mental Health Data In School Files
With increasing frequency, school districts are required to address complex issues that arise out of the mental health needs of students. In addressing these issues, school districts are faced with challenges related to gathering, receiving, maintaining, and disclosing mental health data on students. An accurate understanding of FERPA, HIPAA, and applicable state laws will help school districts avoid costly mistakes that could lead to litigation and liability. Read How to Handle Mental Health Data in School Files.
The Case for Elimination of "Payor of Last Resort" from IDEA (Individuals with Disabilities Education Act of 2004)
The Individuals with Disabilities Education Act (IDEA) is a law ensuring services to children with disabilities throughout the nation. IDEA governs how states and public agencies provide early intervention, special education and related services to more than 6.5 million eligible infants, toddlers, children and youth with disabilities. An obstacle to improving mental health services to children and adolescents is the "Payor of Last Resort" provision (Sec. 640 PAYOR OF LAST RESORT). In this article, Dr. Dikel provides nine reasons why this provision prevents effective mental health treatment for students. Read The Case for Elimination of "Payor of Last Resort" from IDEA (Individuals with Disabilities Education Act of 2004).
Psychiatric Aspects of Youth Violence (Presentation in .pdf)
Mass media tends to focus on dramatic, very rare events of youth violence such as mass murder school shootings. In fact, most adolescent homicides are committed in inner cities and outside of school. They most frequently involve an interpersonal dispute and a single victim. On average, seven youths are murdered in this country each day. Most of these are inner city minority youths. This presentation presents the facts about youth violence, including risks, research, testing, and other critical information for parents and educators.