Earlier this semester I wrote about mental health care on college campuses. But the truth is, college might be too late. Half of all mental health problems begin by age 14.

In public health, we think of disease prevention as having three levels: primary, secondary and tertiary. Helping students manage their mental illness to improve their quality of life is a classic example of tertiary prevention and is a worthy endeavor. However, more needs to be done to prevent mental illness from developing in the first place (primary prevention) and to detect mental illness as soon as possible (secondary prevention). For both these ventures, we should look to schools.

School has gotten more stressful for students. A report from the Counsel of the Great City Schools found that students take approximately 112 standardized tests between pre-K and 12th grade. The same report also found that high school juniors spend as much as 15 percent of the school year taking standardized tests. The pressure to position oneself for college is growing and begins far too early.

Palo Alto, Calif., serves as an example of the worst-case scenario. According to the Centers for Disease Control and Prevention, the city’s youth suicide rate is 14.1 per 100,000 people. That is almost triple the national rate of 5.4 deaths per 100,000. Extreme expectations from parents in Palo Alto are at least partially responsible for this shocking rate. As one parent put it so simply but powerfully: “What are we doing to our kids?”

The mental health risk factors children and teens face extend far beyond academics. Twenty-eight percent of students in sixth through 12th grade report being bullied. At home, children can also be adversely affected by abuse and poverty. In fact, research out of Cornell University identified a host of mental health problems for which childhood poverty lead to increased risk, including reduced short-term memory and antisocial behavior.

It is no surprise that there has been public discourse on an epidemic of mental illness in our schools, a topic that NPR ran an excellent special series on. Child and teen mental illness have real consequences. Thirty-seven percent of students with a mental health problem drop out of high school, a rate higher than for any other disability.

In the wake of the mass shooting at Marjory Stoneman Douglas High School, President Donald Trump and some Republican lawmakers (including ones in Michigan’s state legislature) have proposed arming teachers and other school staff with firearms. Instead, our governments would have a much greater impact on the lives of students by arming schools with knowledge and resources to promote good mental health.

To their credit, the Michigan House of Representatives just passed a bill to create an optional training program for teachers on how to recognize and respond to mental illness in their students. This is a good policy, yet the training is not mandatory, nor does the bill mandate suicide prevention training for teachers as 27 other states have done. This bill needs to be amended to fix these flaws before it reaches the governor’s desk.

Teachers can play a crucial role in both the primary and secondary prevention of mental health problems in students. This can be achieved by taking measures to reduce stress in their classrooms and by being aware of and on the lookout for the warning signs of mental illness. That being said, a teacher’s main focus should be teaching, as they are not mental health professionals. School nurses, social workers and psychologists must also be involved in addressing the epidemic.

Per the American Academy of Pediatrics, an estimated 80 percent of students seeking help turn to schools for mental health care. School nurses can play a vital role by noticing patterns of behavior in students that may indicate a mental health problem. But they often have minimal training in mental health and are in short supply. In fact, Michigan has a severe shortage of school nurses with a school nurse ratio of one nurse per 6,607 students in 2014, according to Parent Action for Healthy Kids. In contrast, the federal government’s Healthy People 2020 goals aim for a ratio of one nurse per 750 students.

The picture is equally troubling for school psychologists. The National Association of School Psychologists estimates a shortage of 15,000 school psychologists by 2020. In Michigan, school psychologists are on the state Department of Education’s critical shortage list, a designation that incentivizes retired professionals to return to work.

If you are considering becoming a school nurse or psychologist: We desperately need you.

It took me four years between my symptoms developing and when I first sought help for my mental health problem. That is short compared to the average of eight to 10 years between symptom onset and intervention. Had a teacher or school nurse noticed my symptoms and referred me to the school social worker then I could have potentially gotten better sooner. I would have given anything to have had that happen.

Students spend 900 to 1000 hours in school every year. Imagine if parents and schools came together to reduce academic pressure and if students were surrounded by a system of teachers, nurses and mental health professionals well-equipped to help them with their problems. We could end the epidemic of mental illness in our schools.

At stake are the minds and futures of our children.

Ali Safawi can be reached at asafawi@umich.edu

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