Student mental health crisis spurs Oregon to try in-school programs
March 2, 2018 | By Natalie Pate
For Salem school psychologist Chris Moore, it isn’t uncommon to see a student come to school, settle into a routine and then, without warning, go into crisis.
Maybe the student punches another kid in the face, flips over a desk and curses at the teacher, Moore said. Then they run out of the school. And the teacher has to chase after them.
“In their mind, they are trying to survive,” he said.
Severe depression and anxiety, schizophrenia, bipolar disorder and obsessive-compulsive personality disorder are some of the increasingly prevalent and least-understood mental health disorders among K-12 students.
About one in five — 20 percent — youth nationwide are affected by some type of mental disorder to such an extent they have difficulty functioning, according to the National Institute of Mental Health.
Salem-Keizer Public School’s rate is even higher — closer to one in four of the district’s nearly 42,000.
The pervasiveness of mental health issues and child suicide rates leads Oregon to rank as the worst state in the country for mental illness. And the state’s lack of child psychiatrists and school counselors leaves families waiting for months to get help.
This significantly reduces students’ odds of completing their education, ending up unemployed and adding long-term financial impact on the communities where they live.
But more subtle effects are felt, too, such as the persistent stigma associated with asking for help with mental health.
Though schools aren’t fully equipped to handle intense, mental health issues, some Oregon districts are starting to develop ways to bring services to students.
Salem-Keizer has partnered with Marion and Polk counties and Trillium Family Services, one of the largest mental and behavioral health care providers for families in Oregon,to fill part of the gap in services and lower the waiting time for families.
In its pilot year, on-site outpatient programs have been established at Washington and Brush College elementary schools, Crossler Middle School and McKay High School.
District officials and school counselors say the change has delivered substantial progress, but it’s not enough.
The district plans to expand into seven more schools before the end of this school year — Hoover, Hallman, Battle Creek and Myers elementary schools and Judson, Waldo and Walker middle schools.
“This is about the mental health of our country and whether people feel a sense of belonging to their community,” Moore said.
Too scared to learn
Students respond to mental health crises differently. But Moore has seen attacks involving punching, hitting, kicking and spitting on a regular basis.
Some have destroyed property or choked peers and staff.
Moore said about 5 percent, or 2,000 students, in the district engage in that extreme behavior.
“The priority for a kid is to feel safe in school,” he said. “Our teachers really want to know what to do.”
Of Medicaid recipients in Marion and Polk counties alone, more than 9,180 children who are 17 years old or younger have a mental health condition, according to the Oregon Health Authority.
Moore said only 20 percent of those who have been diagnosed are receiving services. And it’s not always the right care.
“Step one is just awareness,” he said.
It’s important for educators to understand how trauma — emotional and physical — affects the brain, Moore said, that there may not be an environmental trigger that sets the brain off and that there are things a person can do to reduce the impact of the trauma students have experienced.
But there are still students whose needs “far exceed even that level of intervention,” Moore said, explaining mental illness and trauma often go hand-in-hand.
Some students go home to physical abuse, emotional trauma or neglect from a family member, and it “erases all the work they’ve done that day.”
“We definitely have kids who have complex needs,” said David Fender, the coordinator of Salem-Keizer’s Office of Behavioral Learning. “Staff are doing the best that they can.”
Wraparound services, which connect school staff and medical professionals with families on a frequent basis, are among recommended practices.
Additionally, services offered in Salem-Keizer include providing paraprofessionals, coordinating with outside providers, Positive Behavioral Interventions & Supports curriculum and managing follow-up care, Fender said.
Each school in Salem-Keizer has a student support team that meets weekly.
“We don’t look at mental and physical health as separate,” Moore said.
“When our line of inquiry moves from ‘What’s wrong with you?’ to ‘What happened to you?’ or ‘What is happening to you?’ an important shift begins to take place not only in the way we think about trauma and mental health,” he said, “but also in how we feel (about) the lived experience of our most vulnerable populations and … of ourselves.”
The school’s responsibility
Traditionally, a school’s responsibility is to provide the environment and support needed for 12 grades of instruction.
Typical markers of success are graduation, dropout and attendance rates because they get to the core requirement of a school — to get the students through the primary and secondary education systems.
Ideally, schools also provide students with skills for life after graduation, whether in higher education or the workforce.
But when a student is battling a mental health disorder, focusing and learning can slip out of reach.
And if they don’t get help, they quickly can become just another unfortunate statistic — part of Oregon’s fourth-worst in the nation graduation rate.
Absenteeism also is a serious impediment.
Oregon students with disabilities, which includes students with mental health disorders, are among the most likely student groups to be chronically absent, with only 73 percent of students with disabilities attending school regularly.
This heightens their risk of not earning a diploma.
On average, more than $170 million in tax revenue is lost each year due to the decreased earnings of high school dropouts, according to a report by the Foundation of Educational Choice, also known as EdChoice.
Additionally, more than 40 percent of high school dropouts receive Medicaid benefits, costing the state more than $200 million in annual Medicaid costs.
And they are twice as likely to be incarcerated, a $37 million annual cost to taxpayers.
Federal and statewide laws and programs have been enacted to help students with mental health disorders before they reach the point of dropping out. These include the Individuals with Disabilities Education Act (IDEA), Individual Education Plans (IEP) and 504 plans.
But experts say a lot more has to be done to get students to the finish line and to be successful after the race.
For professionals like Richard Blum with Trillium Family Services, it’s about providing services and support and breaking down the notion that it’s bad to ask for help in the first place.
“The goal,” he said, “is (for) kids to be as comfortable going to get help for mental health as they would be if they fell on the playground, scraped their knee and went to the nurse.”
It takes a village
When asked if schools are equipped to address mental health issues, Crossler Middle School staff said, “In a word, ‘No.’ ”
“We have seen a huge increase in the number of serious mental health issues that we are not equipped (to handle),” said Donna Burnett, a counselor at Crossler.
Statewide, Oregon averages one counselor to 600 students, one of the worst ratios in the country.
In Salem-Keizer, it’s closer to one counselor per 400 students. At Crossler, there are 1.7 full-time counselors for the school’s 850 kids.
That’s one of the reasons the school was selected as the first of Salem-Keizer’s 65 schools to partner with Trillium Family Services.
Staff said the added resource has made a tremendous difference but they still need more help.
In addition to destructive behavior, Burnett and other Crossler counselors are seeing a higher rate of self-harm.
When Burnett started as a school counselor 20 years ago, she would file one or two suicide assessments a year. In the last few years, she’s filed two or three a week.
“When you have a student like that, they need a lot of intense attention and intervention,” she said. “We are not able to do that with so many kids.”
Burnett said the school contacts the parents and suggest, if they have insurance, to get the student into counseling outside of school. But that usually takes two or three months before they can be seen due to the lack of child psychiatrists.
In 2015, Oregon only had 12 child and adolescent psychiatrists for every 100,000 children ages 17 and younger, according to the American Academy of Child & Adolescent Psychiatry. Across the United States, there is an estimated one psychiatrist per 1,807 children who need services.
“When they are in a crisis state, that is unacceptable,” Burnett said.
She said Crossler’s staff does what it can to check in on students, but “it’s not the same as a student getting confidential, intense, personal therapy.”
Burnett’s counseling counterpart at Crossler, Michelle Roos, recently helped a student in crisis when the Trillium specialist wasn’t there.
“You have to take the student under your wing and make a safety plan, and they are with you until you can talk with the parents (and) get (them) in the car safely,” she said. “You’re talking about one or two hours.”
Roos said “school counseling wasn’t really designed to work like” that because counselors are then unavailable for the rest of the student body.
“There are a lot of other things we do,” she said, including collaborating with other agencies, serving as part of leadership teams and offering academic support.
That’s why having a Trillium counselor in the school a couple times a week has made a significant impact.
“All we have to do is contact the parents, let them know … we have this service here. The students are able to be seen on campus usually within two weeks,” Burnett said. “It’s like an outside service; it’s just housed here.”
This also allows the parents to stay at work and not take time off.
Blum of Trillium said the programs provide a free, consistent source of care to the students. “It’s like this anchor they’ve got where they have all their needs met,” he said.
“We need … intensive, mental health crisis counseling on campus at every school in Salem-Keizer,” Roos said.
“It can’t just be on the parents, the school or the police department,” she said. “Everyone across the board has to help raise America’s children.”