Adolescent Mental Health: Collaboration among Psychiatric Mental Health Nurses and School Nurses

By Puskar, Kathryn; Lamb, Jacqueline et al. | Journal of School Health, February 1990 | Go to article overview
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Adolescent Mental Health: Collaboration among Psychiatric Mental Health Nurses and School Nurses

Puskar, Kathryn, Lamb, Jacqueline, Norton, Maureen, Journal of School Health

Adolescent Mental Health: Collaboration Among Psychiatric Mental Health Nurses and School Nurses

Schools are assuming an increasing role in intervention with student problems, such as adolescent suicide, which is second only to accidents as a cause of death for teens. (1) School nursing practice provides ample opportunity to become involved in initiating and planning suicide prevention programs. Likewise, psychiatric mental health nurse consultants can assist school nurses plan mental health programs for schools. This application describes the role of psychiatric mental health nurses as respurces to help promote mental health in schools and reviews selected high school suicide prevention programs.


The Community Mental Health Centers Act of 1963 helped move psychiatric nurses out of hospitals and into the community, where psychiatric nursing skills combined with public health skills to produce psychiatric mental health specialists with expertise in psychotherapy and mental health consultation. (2) Clinical specialists with master's degrees in psychiatric mental health nursing often intervene to resolve psychosocial problems and to provide consultation to other health care professionals. The main force of consultation involves problem-solving; (3) primary goals include helping the client and enhancing mental health promotion skills in the consultee.


Schools have a growing need for consultation services from psychiatric mental health nurses. As families face divorce, unemployment, and relocation, often with little support from extended families, school nurses must identify psychopathology and provide crisis intervention to students and families. Extraordinary environmental pressures for students may lead to stress overload with potentially disastrous results. Alarming statistics concerning students ages 15-19 indicate a 72% increase in suicides since 1968, and an estimated ratio of attempted to completed suicides of about 200:1. (4)

Because of daily contact with students, schools offer a highly accessible setting to detect mental health problems. Conversely, mental health agencies often are not chosen for interventions with teens due to limited services, the stigma associated with mental illness, and transportation burdens placed on parents. (5) In contrast, schools offer a natural setting for health assessment and treatment, and hold promise for dealing with mental health problems. Assessment of potential problems occurs as teachers observe decreased attendance and performance or attitude changes. Teens may disply behavior problems, social withdrawal, and somatic complaints.

The psychiatric mental health nurse consultant, whose theoretical base includes normal adolescent development combined with expertise in psychosocial responses, represents a valuable resource to promote mental health in the school-age population. Important aspects of health promotion include education, problem-solving, value clarification, and assessment of family strengths.

A critical area for primary prevention involves adolescent suicide behavior. Literature on suicide prevention stresses the importance of young people learning coping skills necessary for problem-solving, and improving communication skills to increase socialization and to instill hope. [6-8] Psychiatric mental health nurses can assist school nurses to initiate programs to improve coping skills for teen-agers, such as conducting small groups that focus on communication and problem-solving techniques. Nurses can help to educate students, staff, and parents about adolescent stresses, communication skills, and useful coping strategies.

The mental health nurse consultant also provides support and guidance for school nurses and other personnel with concerns about a student. Collaboration of the nurses with school officials can produce programs to address adolescent development, depression, suicide, and coping.

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