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Drawing on Young Adult Literature to Facilitate Mental Health Literacy: Reading The Words We Keep with Pre-Service Teachers

6/26/2024

 

Drawing on Young Adult Literature to Facilitate Mental Health Literacy: Reading The Words We Keep with Pre-Service Teacher by Rachel Wolney and Ashley Boyd


Rachael R. Wolney is a fourth year Ph.D. candidate in the Department of English at Washington State University. Her research interests include Disability Studies, Young Adult Literature, and Education. She teaches using disability studies pedagogy in a range of literature and writing courses, but specifically enjoys working with preservice teachers and practicing teachers in learning about disability.​
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Ashley S. Boyd ​is an associate professor of English education at Washington State University where she teaches courses on English Methods and Young Adult Literature and researches practicing teachers’ social justice pedagogies as well as avenues for cultivating students’ critical literacies. She is author of Social Justice Literacies in the English Classroom and co-author (with Janine J. Darragh) of Reading for Justice: Engaging Middle Level Readers in Social Action through Young Adult Literature.
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​In 2020, according to the National Institute of Mental Health, suicide was the second leading cause of death for children ages 10-14, and young adults, ages 18-25, were reported to have the highest rates of serious mental illness and mental health concerns compared to adults (Duszynski-Goodman & Henderson, 2024). In response to the growing numbers of teens facing mental health issues, many school districts have incorporated Mental Health Literacy (MHL) into the curriculum and now require teacher training on mental health awareness and early detection. According to Claire Goodfellow (2022), MHL was first developed in Australia in 1997 and incorporated into the curriculum to destigmatize mental health issues and to enhance youth’s belief in seeking out help as an effective action. Since the early establishment of MHL which was originally designed to inform “knowledge and beliefs about mental disorders,” the scholarship regarding MHL has expanded to incorporate four major components: 1) to maintain positive mental health; 2) to identify and understand disorders and treatment; 3) to reduce the stigma of mental health issues and seek out help; and 4) to supply essential resources for support and seeking help (Eisenback & Frydman, 2003, p. 2). While MHL is often supported with resources, such as the Center for Disease Control and Prevention’s Action Guide for School and District Leaders (2023), there is less literature available that directs teachers’ inclusion of MHL in conversation with curriculum, learning outcomes, and state standards.
​What is clear, however, is that one major element of the success of MHL in schools is the role of a teacher who is committed to incorporating its components (Eisenbach & Frydman, 2023). There is no disagreement that MHL is important and should be included in the curriculum, as education can “open dialogue and break the stigma associated with mental illness” (Eisenbach & Frydman, 2023, p. 2). However, when it comes to MHL, teachers may rightfully feel pressure when incorporating content outside of their area of expertise and/or may cross into unfamiliar territory being placed in the role of a counselor or psychologist. Despite these potential challenges, we follow Esenbach and Frydman (2023), feeling that “excluding such topics is a disservice to student learning” (p. 2) and noting the import of building collaborations with qualified school personnel to broach such topics in the classroom.
Mental health literacy works to help both teachers and students identify mental health issues and promotes the process of seeking out help from professionals in support of mental health wellness. It positions the teacher as facilitator, normalizes conversations about mental health, and provides resources for teachers and students alike. We feel that MHL exists alongside other crucial social justice literacies (Boyd, 2017, Hines & Johnson, 2007) that should be cultivated in classrooms, and thus we offer here our own inclusion of discussions of mental health with English Education pre-service candidates. We detail our experiences teaching the young adult novel, The Words We Keep by Erin Stewart and suggest that young adult literature (YAL) can accompany guided critical conversations that can promote MHL in the English Language Arts (ELA) classroom. Following others in the field (e.g. Monaghan, 2016; Olan & Richmond, 2023; Richmond, 2018), we believe that YAL can be a powerful mechanism for broaching oft-considered sensitive topics, especially mental health, which are often avoided or feared in classrooms. We offer here our successes in implementing this course content and possible ideas and cautions to aid teachers in their own endeavors to destigmatize mental health issues.
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Young Adult Literature as a Facilitator for Mental Health Literacy

As educators of literature, we believe that stories, especially those crafted in YAL, have the power to transform the lives of readers. Outside of our own opinions and love for YAL, research has shown that the inclusion of YAL can promote empathy (Sherr & Beise, 2015) and has the potential to create change or inform social perceptions (Ginsberg & Glenn, 2019). According to Eisenbach and Frydman (2023), narratives have the power to change personal beliefs and attitudes regarding the world, and conversations cultivating MHL can “educate readers on the truths of mental illness while challenging stigma and providing a safe space for exploration and discussion” (p. 2). Literature can facilitate these discussions in a multitude of ways. As a mirror (Bishop, 1990), readers can see themselves reflected in the readings in meaningful ways and even help inform their own feelings or situations when they may not have the understanding or the words to name and discuss their situation on their own. It gives readers agency in discussions of their own well-being. According to Goodfellow (2022), over half of the teens involved in a UK survey expressed “that they did not seek help for poor mental health, because they didn’t understand what it was that they were going through” (para. 6).  Literature as a mirror may also help a reader identify that there is a need to seek out help in relation to character portrayal, diagnosis, or depictions of mental distress presented in the text.
​As a window (Bishop, 1990), depictions can inform readers who do not experience mental health issues about the realities of mental illness. And, as a sliding glass door (Bishop, 1990), students may be able to experience empathy for characters whose lives are different from their own, asking students to walk through a narrative understanding what someone who is different from them may feel. Webber and Agiro (2019) remind us that “inducing empathy toward a person belonging to a stigmatized group not only improves attitudes toward the whole group, but also increases the chance that those positive attitudes will prompt actions to benefit that group” (p. 2). Falter (2022) cautions us to take the idea of empathy with YAL a step further and offers a “critical empathy framework” for reading that “moves beyond mere identification with others and perspective taking, and understands that social, cultural, and historical elements are always at play and complicate our ability to feel and think with another fully” (p. 24).  In what follows, we describe our approaches to inviting students’ mental health literacies into our classrooms through a focal text.  

Our Course and Mental Health

Using YAL to facilitate our discussions of mental health, we incorporate several texts that involve varied storylines. For instance, we read The Serpent King (Zenter, 2017) as well as Darius the Great is Not Okay (Khorram, 2018) and discuss the characters’ struggles with depression, amongst other themes. For this YA Wednesday blog, we focus on one of our weeklong units in our YAL course that occurs approximately in the middle of the semester (of a 15-week course). By week six, students have already been introduced to the field of YAL and to our overarching social justice centered curriculum, which includes discussions of race, class, gender, disability/ability as well as societal oppression, intersectionality, and privilege. At this halfway point, students are familiar with classroom expectations and have engaged in respectful and critical conversations with peers about these social topics. In reference to the assigned readings and critical in-class discussions, students are also required to purposefully complete multiple individual and group related assignments, including a research paper, a multimedia project, and a social action project. These projects are scaffolded by daily activities and teaching opportunities where students lead the day’s class discussion. Our courses aim to promote action, a fundamental part of Megan Boler’s (1999) discussion of the “Pedagogy of Discomfort,” as both a place of inquiry and the call to action at critical moments in learning processes (p. 179). We discuss complicity and ask our students to engage in action-based learning where they think critically about how texts can inform lived experiences and challenge spaces outside of the classroom.
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​The assigned reading for this unit was introduced to students a week in advance with content warnings (Appleman, 2022) and students were given the option of choosing between two texts depicting mental illness so as to offer a space for choice and self-determination. In preparation for the unit, students also received information for seeking help for themselves, both at the institution and state levels. They were offered statistics regarding teens’ mental health, reported by the CDC (2024) which informed them that 1 in 5 young adults have a mental health issue and that many go unreported. They were asked to discuss the content with their peers and determine how they wished to proceed with the unit in terms of text choice. Below we focus on one of the choice texts, The Words We Keep (2022) by Erin Stewart.  
​Focal Text:  The Words We Keep
The Words We Keep (Stewart, 2022) follows two sisters through their intense struggles with mental illness. Lily, the younger sister, has anxiety and desires to live a “normal” life.  Lily’s story begins as her sister Alice returns home from a treatment program where she was diagnosed and medicated for bipolar disorder. Lily remembers Alice’s traumatic suicide attempt and sees the burden of her diagnosis on the family, especially her father, but she sees even more how different Alice is after she returns. Alice doesn’t have her previous flair, and her personality is muted. She no longer dons her brightly colored clothing or has eccentric plans or enthusiasm. Instead, Alice is withdrawn and distant. Under close supervision of their father, Alice is not allowed to be alone; all sharp objects have been hidden; and there is a tension in their home as the family supports and navigates Alice’s diagnosis. In the midst of Alice’s mental health crisis, Lily feels like she has to be perfect. She spends most of her time worried about getting into college and being the model daughter to support her sister and family. This exacerbates her anxiety throughout the text and even though she meets Micah, a new student at her school (who also attended the same treatment center as her sister), she feels alone. Throughout the novel, Lily uses art as a way of expressing the ‘words we keep’ inside, hidden, and private. As her school poetry project unfolds, Lily finds that she is not alone in her experiences. Lily, Alice, and Micah journey through the unknowns of mental health issues and face the stigmas surrounding mental health to find that their journey together is what matters most. This exceptional novel is raw and descriptive of what mental illness can look like in multiple forms–through Lily’s anxiety, Micah’s depression, and Alice’s bipolar disorder.  
​​Reading with Students 
Students’ reading of this novel was divided into two sections, with half the novel assigned per class meeting. During the halfway mark, students reported that: they loved the text and couldn’t put it down, had completed the novel already, or felt that the content was so vividly descriptive that they had to take multiple breaks and were behind schedule. Some students shared that the novel was graphic and brought up their own experiences with trauma, but they felt that the content was accurate in its portrayal. Even though they knew that everyone experiences mental health related issues differently, the students shared that they enjoyed the accuracy of the text based on their own understanding of the elements within the novel. While some expressed that the novel was difficult to read, each student did successfully complete the reading and stated that while it brought up hard issues, they were important topics to discuss in the classroom. They understood that mental health issues impact a large portion of the population and expect that they will encounter people in their lives and in their future classrooms who are in crisis. The students appreciated the additional resources delivered with the unit. Some students, interested in writing a novel themselves, went on to have further discussions of mental health representations and the need for more accuracy to fight against stigmas of mental health. Some students identified with having anxiety and resonated with the depictions of Lily feeling like she needed to be perfect. Others understood the realities of bipolar disorder. Ultimately, students repeatedly expressed that while the text might be difficult to read, it facilitated healthy conversations about mental health, representation, stigma, and access to resources.
​The students’ responses all point to the myriad ways that YAL dealing with mental health can promote honest conversation and connection. Our students experienced the text as a reflection of their own struggles, while others learned more about aspects they had not experienced, such as the effects of medication. Still others noted being transformed by the narrative, especially as it reflected the impact of mental health on family members and how sometimes surrounding a person with love is not enough when they need professional help.  
In the novel, Stewart (2022) expertly depicts the dynamics of friendship, family, and romance.  We drew on several discussion questions to solicit their connections of these themes alongside mental health, reminding students throughout that they were not expected to disclose any personal information unless they chose to, which many did. We prodded them to deeply consider the parents’ roles, asking: How did Lily’s father miss the signs that his daughter was struggling?  And, how was Lily’s stepmom helpful (and not) to her stepdaughters?  To help students see the damaging effects of Lily keeping secrets, we asked:  How did Lily think she was helping Alice?  And, to unpack the stigmas in the text, we asked students to locate microaggressions and aggressions expressed at school as well as how the students at the party reacted to Alice’s episode toward the end of the novel, which resulted in social media postings. Our readers delved into how social media can contribute to declined mental health, especially through cyberbullying.  With our final assigned social action projects (Boyd, 2017; Boyd & Darragh, 2019), we extended the opportunity to students to act on their knowledge gleaned from the text. In almost every semester that students have completed the projects in this course, multiple groups choose to focus on mental health, raising awareness of campus resources, building websites, or hosting movie viewings and critical conversations. Using The Words We Keep as a springboard, a recent group constructed a website to give students quick and easy access to mental health resources on campus. Using flyers to advertise this website, the group focused on preventative mental health and wellness, advocating for the importance of caring for your mental health even when you feel “fine.” The flyers created were bright and colorful, depicting mental health awareness as positive. They heralded the power in knowing oneself and provided resources for improving mental health wellness as well as resources for mental health crises. Using a QR code, the group reported that they advertised in private spaces, such as bathrooms on campus as well as on public information boards and received multiple visitors to their website.
​​Integrating Mental Health Literacy 
As noted above, MHL has expanded to incorporate four major components: 1) to maintain positive mental health; 2) to identify and understand disorders and treatment; 3) to reduce the stigma of mental health issues and seek out help; and 4) to supply essential resources for support and seeking help (Eisenback & Frydman, 2003, p. 2). Our unit attempted to address these elements through reading, research, and discussion. We provided resources at the outset of the unit and offered data on the prevalence of mental health issues, definitions of various types of diagnoses, and practices for establishing mental well-being. As also mentioned above, we focused extensively on the authenticity of the narrative and how Stewart’s (2022) representation revealed and debunked common stigmas. Olan and Richmond (2023) write, “many texts featuring characters with mental illness include authors’ language and descriptions which perpetuate stigma via the readers’ positioning of the characters through a deficit narrative model … In YAL, for example, this could mean characters with mental illness are written as not having effective relationships, not fitting in, experiencing violence/harassment, being positioned as victims, experiencing social isolation, or having negative futures” (p. 22). We asked students how The Words We Keep worked against such tropes.  
​One caution, however, that we ourselves experienced (and our students worried about for their future classrooms) was being placed in the role of a counselor. Because we work with college students, we realize we are uniquely positioned with resources and support at the university. For secondary teachers, we encourage the use of Eisenbach and Frydman’s (2024) model in which middle grades teachers “consulted with the school’s social support staff on content and delivery” (p. 7), collaborating with professionals who can “clarify misconceptions, fill in knowledge gaps for the teacher, and provide resources to deepen teachers’ understandings” (p. 11). We don’t–and shouldn’t–do this work alone. Many resources exist to guide us in selecting texts with authentic depictions of mental health, educating ourselves, and working with those trained to provide mental health instruction (e.g. Anti-Defamation League, 2013; Eisenbach & Frydman, 2024; Olan & Richmond, 2023). A few other points to note are that we did offer student choice in the texts, allowing students to select a mental health related option of interest to them since “MHL interventions need to be developmentally appropriate and applied within the most suitable developmental context” (Kutcher, Wei, & Coniglio, 2016, p. 154). Finally, we embedded the text amongst others and within a focus on ELA curriculum and texts, rather than as an added entity for study solely on mental health. 
​Thus, despite the fears that we, as teachers, may experience surrounding working with mental health, we echo scholars before us who have argued that ignoring sensitive topics only perpetuates suffering in silence or in ignorance surrounding conditions, and we feel it is imperative to incorporate novels like The Words We Keep and MHL into our ELA classrooms. We seek to support our students and to engage them with meaningful literature, and we believe we can accomplish these through units such as that which we have described.  

References

Anti-Defamation League. (2013). Evaluating children’s books that address disability. Education Division. adl.org
Appleman, D. (2022). Literature and the new culture wars: Triggers, cancel culture, and the teacher’s dilemma. Norton
Bishop, R. S. (1990). Mirrors, windows, and sliding glass doors. Perspectives – Gerontological Nursing Association, 6(3), ix–xi.
Boler, M. (1999). Feeling power: Emotions and education. Taylor & Francis Group.
Center for Disease Control and Prevention (CDC). (2023, December). Promoting mental health and well-being in schools: An action guide for school and district leaders. DASH. file:///C:/Users/hrsw4/OneDrive/Documents/DASH_MH_Action_Guide_508.pdf
Center for Disease Control and Prevention (CDC). (2024, May 1). Adolescent and School Health. https://www.cdc.gov/healthyyouth/mental-health/index.htm 
Boyd, A.  (2017).  Social justice literacies in the English classroom:  Teaching practice in
action. Teachers College Press. 
Boyd, A. & Darragh, J.  (2019). Critical literacies on the university campus: Engaging pre-
service teachers with social action projects. English Teaching: Practice & Critique,
19(1), 49-63.    
Duszynski-Goodman, L., & Henderson, L. (2024, February 21). Mental health statistics and facts. Forbes Health. https://www.forbes.com/health/mind/mental-health-statistics/#footnote_5
Eisenback, B. B., & Frydman, J. S. (2023). What are we doing?: Teacher role confusion in mental health literacy education. Teaching and Teacher Education, 132, 1-12. https://doi.org/10.1016/j.tate.2023.104236
Eisenback, B. B., & Frydman, J. S. (2024). Integrating mental health literacy in the English language arts middle school classroom. Middle School Journal, 55(3), 5-15.  
Falter, M. (2022). When the shoe doesn’t fit: A critical empathy framework for young adult literature instruction. The ALAN Review, 50 (1), 18-32.  
Ginsberg, R. & Glenn, W. J. (2019). Moments of pause: Understanding students’ shifting perceptions during a Muslim young adult literature learning experience. Reading Research Quaterly, 55(4), 601-623.
Goodfellow, C. (2022, March 4). Mental health literacy in schools: Let’s talk about how we talk about mental health. Education Today. https://www.educationtoday.com.au/news-detail/Mental-Health-Literacy-in-Schools-5540#:~:text=Mental%20health%20literacy%20was%20first%20defined
Hines, M. B.& Johnson, J.  (2007). Teachers and students as agents of change: Toward a taxonomy of the literacies of social justice.  In D. Row, R. Jimenez, D. Compton, D. Dickinson, Y. Kim, K. Leander, & V. Risko (Eds.), 2007 Yearbook of the National Reading Conference (pp. 281-292).  Oak Creek, WI:  National Reading Conference. 
Khorram, A. (2018). Darius the great is not okay. Penguin Books.
Kutcher, S. Wei, Y. W. & Coniglio, C. (2016). Mental health literacy: Past, present, and future. The Canadian Journal of Psychiatry, 61(3), 154-158.  
Monaghan, A. (2016). Evaluating representations of mental health in young adult fiction: The case of Stephen Chbosky’s The Perks of Being a Wallflower. Enthymema, XVI, 32-42.  
Olan, E. L. & Richmond, K.J. (2023). Narrative of deficit and authentic portrayals of mental illness and cultural sensitivities in young adult literature. Study and Scrutiny: Research in Young Adult Literature, 61(1).  
Richmond, K. J. (2018). Mental illness in young adult literature: Exploring real struggles through fictional characters. Libraries Unlimited.  
Sherr, M., & Beise, B. (2015). Using young adult literature to enhance empathy skills: Preliminary findings in BSW education. Journal of Baccalaureate Social Work, 20(1), 101-110.
Webber, K. & Agiro, C. P. (2019). Not from around these parts: Using young adult literature to promote empathy for the immigrant experience. Talking Points, 30 (2), 2-9.
Zentner, J. (2017). The serpent king. Random House.
 

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    Dr. Steve Bickmore
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    Dr. Bickmore is a Professor of English Education at UNLV. He is a scholar of Young Adult Literature and past editor of The ALAN Review and a past president of ALAN. He is a available for speaking engagements at schools, conferences, book festivals, and parent organizations. More information can be found on the Contact page and the About page.
    Dr. Gretchen Rumohr
    Co-Curator
    Gretchen Rumohr is a professor of English and writing program administrator at Aquinas College, where she teaches writing and language arts methods.   She is also a Co-Director of the UNLV Summit on the Research and Teaching of Young Adult Literature. She lives with her four girls and a five-pound Yorkshire Terrier in west Michigan.

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    Evangile is a native of Kigali, Rwanda. He is a college student that Steve meet while working in Rwanda as a missionary. In fact, Evangile was one of the first people who translated his English into Kinyarwanda. 

    Steve recruited him to help promote Dr. Bickmore's YA Wednesday on Facebook, Twitter, and other social media while Steve is doing his mission work. 

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