Schools’ Role in Mental-Health Care Uneven, Experts Say
A raft of evidence suggests that screening children for mental-health problems as early as the primary school years and providing appropriate support can help alleviate poor school performance, bullying, depression, and suicide—all far more common than school shootings.
Such screening programs could also catch the rare students who might be considering violent action and steer them into appropriate services, school-based mental-health professionals say. But those programs aren’t as widespread as they should be, they add.
The April 16 killings at Virginia Polytechnic Institute and State University in Blacksburg, Va., have renewed calls for schools to help play a role in identifying students in need of mental-health services and in providing help.
Despite some federal support and several examples of success, however, far too few children and youths who need mental-health care are receiving it, experts say. Offering such programs requires support within the school and the district, cooperation with community health services, and backing from parents, who may be wary of schools’ involvement in the sensitive area of mental health. Often, it takes a determined school or community leader to make such programs happen, say mental-health professionals. And when districts do get involved, they can face legal challenges.
Between 75 percent and 80 percent of children who have a mental-health need do not receive treatment, said Olga Acosta Price, the deputy director of The Center for Health and Health Care in Schools, based at George Washington University, in Washington. At the same time, Ms. Acosta said, it is widely considered “best practice” among districts to have early-intervention teams at schools that can work with students when problems appear.
“The problem is that it’s always better on paper,” she said. “What the policy is, and how [groups] function in reality, isn’t always the same.”
The role that schools play, or should play, in student mental health, in fact, has been discussed for years.
In 2000, the federal government spotlighted the issue by holding the Surgeon General’s Conference on Children’s Mental Health. A summary from that meeting presented the stakes: One in 10 children and adolescents suffers from a mental illness severe enough to cause impairment, but only about 20 percent of them receive care.
“There is broad evidence that the nation lacks a unified infrastructure to help these children, many of whom are falling through the cracks,” the summary read. Schools, primary-care providers, the juvenile-justice system, and child-welfare system were all listed as the partners needed to provide a strong system of care for potentially troubled children.
Two years later, President Bush formed the New Freedom Commission on Mental Health to study ways to improve mental-health services nationwide. A subcommittee focused on issues involving children and adolescents, again spelling out how schools should be part of supporting mental health for students.
Children receive more services through schools than any other public agency, so “federal, state, and local agencies should more fully recognize and address the mental-health needs of youth in the education system,” the subcommittee said in its recommendations, released in February 2003. In addition to offering support services within schools, the commission recommended that teachers and other school personnel be trained to screen students for possible problems.
“Our system tends to be one that deals with crises and failures. What we tried to do in the president’s New Freedom Commission is promote health and wellness and well-being, early on,” said Stephen W. Mayberg, the director of the California Department of Mental Health, who co-chaired the subcommittee that examined children’s mental health. “But sometimes it’s hard to change that focus.”
Larke N. Huang, a clinical psychologist and a senior adviser on children and families in the office of the administrator at the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services, said partnerships between schools and agencies are key to addressing children’s mental health. She also co-chaired the presidential subcommittee examining children’s mental health.
Since 1999, HHS and the federal departments of Education and Justice have sponsored a grant program called Safe Schools/Healthy Students, which provides funding to districts to enhance health services for children and adolescents. Schools are a natural place to provide those services because of their importance in the lives of children and adolescents, Ms. Huang noted.
“The existing school-counselors system and the mental-health system have to work together,” she said. “I think we need to do a better job of building on and partnering with what’s already there.”
And, when it comes to supporting the mental health of children and adolescents, experts say it’s important to start early.
In California, for instance, an Early Mental Health Initiative for kindergartners through 3rd graders requires teachers to note the students who are having mild to moderate problems adjusting to school.
Those children are given one-on-one time weekly with a “special friend,” a trained paraprofessional who engages a child in play and works to establish a positive relationship with him or her. At an average cost of $730 per student, schools have seen dramatic results, according to Mr. Mayberg.
The $5 million program has been on the chopping block in lean budget years, but enthusiastic supporters have helped keep it going.
“Being able to provide not only book learning, but an environment that allows kids to adapt appropriately socially and emotionally, makes a huge difference,” Mr. Mayberg said.
New Jersey Case
When schools do take steps to refer students for mental-health evaluations, however, they can face legal challenges.
In a recent case, an 18-year-old student is suing the 5,500-student Monroe, N.J., district for requiring him to undergo a mental-health evaluation after he drew a stick figure shooting another such figure in a graphic-arts class. He is asking to have his school records cleared and to be allowed to return to class, as well as lawyers’ fees.
The student says that he was not suspended or expelled, but told that he might be a threat to the school or himself. He made the drawing April 16, the same day that Seung Hui Cho attacked his classmates and others at Virginia Tech, but his graphic-arts class took place before the shootings were known.
He was told on April 17 to leave until he was cleared to return by a mental-health professional.
“When someone communicates about shooting someone, we have to look at this seriously,” Superintendent Robert E. Terrill told The Gloucester CountyTimes of New Jersey.
“Mental-health evaluations get into your right to privacy. It’s a search,” said Jamie M. Epstein, the lawyer representing the student, known in court papers as D.K. The student is described in the suit as an honor student and a leader in his high school’s Junior Air Force ROTC program
“If you’re saying you want to do a mental-health evaluation, you better have probable cause to give you the right to do that,” Mr. Epstein said.
In addition to legal worries, educators and school psychologists say budget constraints and competing priorities, including stepped-up pressure on schools to produce academic results, make it hard to address mental health.
“There’s been an increased focus on student achievement at the expense of the emotional part of schools,” said Cathy Paine, the special-programs administrator for the 11,000-student Springfield, Ore., school district. She was a school psychologist there in 1998 when a high school student opened fire in his school’s cafeteria, killing two students.
Districts and teachers need some place to turn within the community if they see a child having problems, Ms. Paine pointed out. “It would be great to teach people to recognize signs,” she said, “but then you have to have some place to go with that.”
Stephen E. Brock, an associate professor at California State University-Sacramento and a school psychologist for 18 years, now trains students for the profession. He teaches them that they will likely have to perform some sort of mental-health triage with the many students they will be assigned once they are hired by a district. Nationwide, the ratio is one school psychologist to 1,500 students. In his career, Mr. Brock was once assigned to seven schools at the same time.
“What’s the most pressing concern? How are you going to budget your limited time?” Mr. Brock said he tells his students. “What you end up doing is going around and putting out fires.”
Morton Sherman, the superintendent of the 3,400-student Tenafly, N.J., district, has worked to provide mental-health services both in Tenafly and in his previous job leading New Jersey’s Cherry Hill district.
In Tenafly, the school system is undertaking an evaluation of what student-support services are available—“what are we doing consistently across the board,” Mr. Sherman said.
In Cherry Hill, after nine students committed suicide in seven years, the district undertook several initiatives, including the creation of a task force to address suicide prevention.
“But there was also a backlash,” Mr. Sherman said. There’s a “pejorative folk wisdom” that talking about suicide might prompt it, he said.
Mr. Sherman said his daughter tried to commit suicide in 1999 and now speaks openly about her struggles with depression.
Getting past such a societal stigma is where leadership comes into play, he said. “You win a battle, you lose a battle,” he said, “but you keep up with it, long-term.”
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