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Mental Illness Education Does Make a Difference: “Breaking the Silence” Found to be Effective

Students would ask, “What’s wrong with Doug, Mrs. Susin?” Those are the words heard by Janet Susin, then a teacher in the same school where her son was a student, from his high school friends twenty-three years ago when they were searching for an explanation of why he had suddenly disappeared from school. Although Susin says she was comfortable speaking to her own friends and fellow teachers about her son’s hospitalization for schizophrenia, those words from his classmates left her speechless with tears streaming down her face.

Searching for a way to discuss the situation without breaking down, she sought out the school health teacher, reasoning that if she knew what students were learning about mental illness, it would be easier to tackle the subject with Doug’s friends. What she found out was shocking. Although before the age of fourteen half of those who will go on to develop a serious mental illness are already showing symptoms, students in her school learned absolutely nothing about mental illness. It wasn’t part of the curriculum. That was a turning point in Susin’s life, as her heartache became her passion. With the help of three other retired teachers, each a NAMI (National Alliance on Mental Illness) Queens/Nassau member with children living with mental illness, Susin developed “Breaking the Silence” (BTS), innovative teaching packets with lessons, games and posters on mental illness for upper elementary, middle, and high schools.

Although the lessons, in one form or another have received much praise and been available for over 20 years and in use across the United States and internationally, their effectiveness has never been assessed. Thanks to a grant from the National Institute of Mental Health (NIMH), a recent three-year study has found that the BTS middle school lessons are effective in increasing knowledge and changing attitudes and behavior relating to mental illness.

Middle school students in New York, South Carolina, New Mexico and Florida participated in the study. Janet Susin, BTS lead author and BTS Project Director and Lorraine Kaplan, BTS co-author and Director of Educational Outreach collaborated with Otto Wahl, Ph.D., Professor of Psychology, University of Hartford.

“Results of our study show that even brief instruction (2 ½-3 hours) can produce change in how students understand mental illnesses. BTS is a very promising approach to improving the way children perceive and respond to mental illnesses. We can now statistically document that instruction in BTS does result in improvements in knowledge, attitudes, and/or behavior related to mental illnesses,” stated Dr. Wahl.

Susin, and/or Kaplan accompanied Dr. Wahl to the school sites to carry out the research. In an email after their visit, a South Carolina teacher wrote this about her experience, “I just wanted to let you know how much my students enjoyed the stories and the game. They asked thoughtful questions and were intrigued to learn about mental illness. One of my students even felt compelled to share that her sister has obsessive compulsive disorder. I also wanted to let you know how much I learned while teaching the Breaking the Silence lessons. My mom was diagnosed with bipolar disorder last year and these lessons actually taught me a lot about what she is going through. Thank you for sharing this wonderful program with me and my students.”

“Substantial research has established that the public holds inaccurate negative beliefs about those with mental illnesses, seeing them as dangerous, unpredictable, unattractive, unworthy, and unlikely ever to be productive members of society; creating an environment that impedes both treatment seeking and recovery. Children and adolescents are particularly sensitive to public opinion and attitudes. Ostracism, rejection, teasing, and damage to self-esteem, as well as reluctance to seek or accept mental health treatment, are among the possible consequences. The results of this study establish that, by educating children about mental illnesses, we can change attitudes and foster more accurate understanding and acceptance of people with psychiatric disorders,” says Dr. Wahl. Lorraine Kaplan adds “These results will help us with our goal of moving mental illness into the mainstream; we look forward to a time when schizophrenia and depression will be discussed as openly in the classroom as diabetes or cancer.”

NAMI is a nationwide grassroots, self-help, and advocacy not for profit organization dedicated to improving the lives of all those affected by severe mental illness. For more information on BTS and the NIMH study visit For NAMI Queens/Nassau call 516-326-0797or visit The project described was supported by Grants Number R01MH076093 and R01MH075837 from the NIMH.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health.

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