Medical Foundation doctors issue advice on youth mental health

Following recent teen death by suicide, pediatricians unite to offer recommendations

The Palo Alto Medical Foundation pediatrics department took an unprecedented step into the community debate on teen well-being this week, offering strong recommendations on several factors they see as key to bolstering students' mental health.

This step came in the form of a letter to the editor, submitted to this newspaper and signed by all 20 of the department's pediatricians, with the goal of asking both themselves and the community: What can be done differently to address Palo Alto teens' mental health and well-being?

"Although many teens in the area are doing well, many are not," the letter states. "Each day in the office we see students who are stressed, anxious, and depressed. Depression is a significant factor in teen suicide. But what is causing the depression? What are the factors putting our youth at such high risk?

"I think that there are factors out there that we've come to accept as normal that are very stress-producing and aren't so normal," pediatrician Linda Strain said in an interview with the Weekly.

As medical professionals who see multiple teenagers on a daily basis and are intimately informed about students' lives -- in a different way from the schools, they said -- the group of pediatricians decided to address several of these factors that affect teens and that they are most familiar with: sleep, electronics, academic pressure and home and family.

The letter urges later school-start times, citing the strong correlation between inadequate sleep and mood disorders, poor cognitive retention and increased distractibility. Surveys have shown that Palo Alto teens sleep an average of six and a half hours per night, compared to the nine hours of sleep it has been shown that teenagers need to function well, according to the doctors' letter.

The statement also references a recent American Academy of Pediatrics (AAP) policy that recommends that middle and high school students start school no earlier than 8:30 a.m. At Gunn High School, the day starts at 8:25 a.m., though just under 300 students are enrolled in both physical education and academic classes that meet during a zero period that begins at 7:20 a.m. Palo Alto High School starts at 8:15 a.m., with 102 students currently enrolled in physical education classes that meet at 7:10 a.m., the school's zero period.

Pediatrician Amy Heneghan, also a founding member of mental health professional coalition the HEARD Alliance, said Palo Alto was ahead of a national shift toward later school-start times when both schools moved their days to start at these times -- Paly in 2010 and Gunn the following year -- and should continue to uphold the American Academy of Pediatrics' policy.

"The data are pretty incontrovertible," Heneghan said. "The AAP doesn't endorse policies very often that strongly. This is a national trend."

Electronic devices play a critical and often detrimental role in sleep, time management and focus, the letter states, suggesting that teenagers shut off electronics at least 30 minutes before going to bed or that bedrooms be entirely free of electronics.

And though the pediatricians acknowledge they are not education specialists, they advocate in the letter for several school-based changes that they think could help Palo Alto teens.

The letter urges the Palo Alto school district to extend its homework policy, which limits the amount of homework students at each grade level should have each night, to apply to Advanced Placement (AP) and honors courses. The letter also mentions that many schools limit the number of AP classes a student takes during high school. Other suggestions include offering more nontraditional courses that allow students to pursue their passions, limiting the time commitment for both school and club athletics and integrating mindfulness education into the school curriculum.

"There's just this level of perfection expected in academics and in sports and in so many different areas, which really isn't -- it's not realistic," Strain said.

Stress levels at home as well as at school should be closely examined, the pediatricians wrote, recommending that families "find ways to protect family time and create opportunities for rest and leisure for their teenagers."

"One thing that we notice," pediatrician Rebecca Benton said, "as we watch kids grow up from the time they're toddlers to high schoolers is that within our society -- and it's not just specific to Palo Alto, it's across our country -- kids are so overscheduled.

"From the minute they can kick a ball, they're carted from this lesson to that class, and we strive so much toward trying to help them perfect skills that are going to help them somehow achieve the next goal that it's to the detriment of just down time (and) family time," she said.

The pediatricians in their letter also implore parents to "strive to keep their expectations for their children realistic and healthy.

"Ideally, discussions of plans after high school should include a variety of options. For the college-bound students, the wealth of excellent universities in this country should be emphasized, rather than narrowing the focus to a few of the elite."

The pediatricians said there was no clear tipping point prompting them to write the letter but that it's time for the entire community -- medical professionals, schools, parents, teens -- to start questioning practices that are perceived as the norm but might be contributing to a high-pressure culture driven by achievement and expectations.

"How can we as families, schools and as a community support our teens?" the letter asks. "Clearly, we must listen. We must provide hope, acceptance and encouragement. Overall, we must take a hard look at our goals as a society. Our culture is focused on achievement, but studies have shown that long-term happiness comes from giving, from meaningful relationships, and from purposeful work. Modeling these priorities as adults can help shape our youth's values."

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35 people like this
Posted by Awesome
a resident of Another Palo Alto neighborhood
on Mar 20, 2015 at 8:04 am

I'm so impressed and grateful that our caregivers have taken the time to write this letter. Thank you.

11 people like this
Posted by Gunn Mum
a resident of Greater Miranda
on Mar 20, 2015 at 8:49 am

Please let the PAMF letter stand alone as their opinion. I am sure they chose their wording very carefully and thoughtfully. The weekly is now adding their editorial comments that may alter the message. If you feel the need to editorialize I would suggest waiting at least 24 hours so that people will read the original source first. If they are experts they do not need your assistance in stating their stance.

16 people like this
Posted by Paly Parent
a resident of Palo Alto High School
on Mar 20, 2015 at 8:54 am

Want to say this somewhere, and since other threads are not open, I will say it here.

One thing is very clear to me. We may disagree and have different opinions on the how, but we are all very concerned. The amount of discussion here online and in various venues around town show just how concerned we all are.

This is a caring community. We are all in it together even if we disagree. In fact it can be said that disagreement proves how concerned we are.

If any student feels that we adults don't care, then they should count up the number of comments on these threads and understand that there are a lot of caring adults here and we care for each one of you. We may not agree all the time about everything, but we care for you.

If you can't talk to your parents or someone at school, then find another caring adult in the community. It may be a friend's parent, a neighbor, a youth leader, a coach or a librarian. But find someone and talk away. We are listening, even if we appear to be making a lot of noise.

18 people like this
Posted by why don't this paper get it?
a resident of Adobe-Meadow
on Mar 20, 2015 at 9:18 am

physical education and academic classes that meet during a zero period that begins at 7:20 a.m. Palo Alto High School starts at 8:15 a.m., with 102 students currently enrolled in physical education classes that meet at 7:10 a.m., the school's zero period.

[Portion removed due to incorrect assertion.] This is about sleep, and students not getting enough. It doesn't matter if their not getting enough because of academic or PE. Schools need to stop the practice of zero period [portion removed.]

26 people like this
Posted by Another dad
a resident of Barron Park
on Mar 20, 2015 at 9:37 am

This is dynamite. This is not just about zero period.

What these doctors are recommending is nothing short of a complete overhaul of schools (not just in Palo Alto but all over the bay area) that employ high-pressure tactics to drive kids to be more successful (and in many cases, drive them to suicide, depression, and/or performance-enhancing drug abuse).

This is long overdue. For parents like myself, who have kids less able to handle insane stress levels, we have essentially been forced by the school system to put our kids at risk...or take them out of public schools completely.

Now we have a chance to be heard and to start pushing back at these community-mandated destructive school environments.

Other school systems that are going to be affected: Orinda, Walnut Creek, Menlo Park, Pleasanton, San Ramon, Saratoga, etc etc. All of these cities have jumped on the "rigorous" bandwagon over the years, without considering that this would screw up many kids and many families.

I'm just sad it took so many dead children to get people to stop and consider the consequences.

34 people like this
Posted by Concerned
a resident of Community Center
on Mar 20, 2015 at 9:44 am

I like the frankness of this article. Howeve there will be many who push back on ANYTHING that prevents Susie or Joey from taking more AP's than the next kid because THEIR child CAN handle it.

There are two enormous elephants in the room.

1/A vastly disproportionate (compared to 99% of towns in the entire world) number of parents in our community did go to a "top tier" college. If they dropped out of college it was from an Ivy or Standord and that is considered even "more elite". These parents want their kids to have that feather in their own caps because it is something that nobody will ever be able to take away from them, and they got where they are today with that degree on their resume and think had they NOT had that on their resume they would not have ended up where they did. PERIOD. And there really may be truth to that. This is the mind frame of many. This is where much of the fever begins. At HOME. Because these parents have the experience of having that school on their resume. Those SAME parents work at places like Google (which last I checked requires an IQ test and has a point system associated with college names which must add up to a certain number to even be granted an interview). These parents in our community want their kids to pass that Google entrance exam of professional life.

2/Until the top tier schools stop admitting kids with resumes that clearly reflect that a child did not lead a balanced life, this fever will never end. And until the Googles and Goldmans of the world stop being school snobs
people will want those schools. Parents know about the school "snobbery" that goes on at many companies and so they want their kid to have a school that is accepted in that circle. They fear (and rightly so) that if their child has a less "respected" school on their resume ther theirs will be ignored because of the current process. I know purple on this group will likely blast my thoughts and point out exceptions- but that is what they are, exceptions and that means a gamble and our community of parents don't want to take that gamble.

In my opinion we can talk and talk and talk about making changes to the tune of everything listed above (which I personally want to happen) BUT the reality is families around here are never going to set aside the thoughts that I stated above. Nobody says this stuff outloud. But trust me, this is the concern in their minds and many give only lip service to wanting change. Trust me, many look at it as "hey, maybe if I pretend to want things to clam down around here others actually will and that will give my Susie and Joey a leg up."

I love what these doctors are saying. We need that force and the force of universities and corporations to find other ways to assess candidates or the madness will continue.

And one last thought.. Kids can't get the recommended sleep until PAUSD does some kind of online tracking survey type deal to see how long assigmmts are taking and what time they go to bed. Living here someone should be able to whip up an app for that. What's the delay?

17 people like this
Posted by StopThePush
a resident of Duveneck/St. Francis
on Mar 20, 2015 at 9:55 am

The push for excellence is the problem. This has an affect on the over all well being of our children. I think it starts in the home and what the parents want for their children. People move here for the excellent schools so of course they want their kids to be high achieving. It has become a culture here in Palo Alto that needs to be changed.

I appreciate the doctors at PAMP addressing this problem and sending a letter to the district and community. I think they are spot on and the kids are losing sleep because of the amount of excellence expected. Even if they are tired and yawning they still need to push to get all of the work done. We need to change the tone and stop feeling the need to be the highest performers.

Like this comment
Posted by Palo Alto Online Editor
a resident of another community
on Mar 20, 2015 at 10:01 am

Duplicate threads were created for this article. Please go to Web Link to make comments

Sorry, but further commenting on this topic has been closed.

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