12 Sep CMO Cartu Jonathan Claims – Minneapolis schools lead the way on youth mental wellness
MINNEAPOLIS — On a sweltering July day, mental health practitioners who work with young people in Twin Cities schools and clinics gather at the Washburn Children’s Center Training Institute to share techniques and learn from seasoned experts. They talk about the importance of connecting with patients’ family members and practical ways to engage families who might be struggling as much as their child.
The clinicians, including full-time therapists in local schools, came together during the summer because they work with youth served by one of the nation’s strongest school-based mental health systems — and they want it to grow even stronger.
For years, Minnesota has ranked in the nation’s top five states for addressing youth mental health. And, officials there say, Minneapolis schools have led the way when it comes to school-based mental health care.
Most mental health conditions first manifest during adolescence, and they are most effectively treated when addressed immediately. Studies that tracked teen patients in the 1990s found that school-based care is the most effective way to treat youth mental health at scale.
Minneapolis’ program, which started small 15 years ago, has matured and expanded to reach 70 percent of the city’s public schools. Each of these schools has a full-time mental health therapist who provides direct services to students in greatest need of one-on-one therapy. Those therapists also train teachers and other school employees to address low-level mental health challenges faced by broad swaths of students.
That’s helping to create a culture where students who struggle can get help, not suspensions, said Rochelle Cox, executive director of special education and health services for Minneapolis Public Schools. “Teachers are understanding that traditional discipline is not changing kids’ behavior and that when we exclude kids from instruction, they just fall further and further behind,” Cox said. “We need to have people who have a therapeutic approach.”
Teens who need professional help for depression, anxiety or other mental health challenges can face barriers, including costs, stigma and finding it hard to get to a clinic, mental health advocates and practitioners say.
“We want to eliminate barriers to accessing treatment for children,” said Sue Abderholden, director of the Minnesota chapter of the National Alliance for Mental Illness. With school-based services, parents don’t have to take off work to transport kids to appointments, and kids don’t have to miss more school than necessary to keep them.
Offering free or low-cost appointments in the familiar and convenient school setting means more youth can access these services, Abderholden said.
Minneapolis’ program ensures that all students — whether on private insurance, Medicaid or with no insurance at all — can access mental health care.
The Center for School Mental Health at the University of Maryland has described the school-based mental health program in Hennepin County, home to Minneapolis, as one of the best in the nation.
A model that works
Sarah Washington’s daughter Angelica struggles with depression as well as learning and developmental disabilities. Angelica, who just turned 21, didn’t start receiving school-based mental health treatment in Minneapolis Public Schools until she was in high school.
“It’s life-changing,” Washington said.
She wishes her daughter had known about the resources sooner. “She probably would’ve been better off,” Washington said.
Washington describes herself as “a professional mom,” because she has to constantly work to get her child the care she needs, whether that be advocating for her daughter to receive a proper diagnosis or taking her to appointments. When her daughter was in school, school-based care made that easier for her and her daughter, she said. Washington said the school clinician her daughter worked with went out of her way to support Angelica — from helping coordinate resources to visiting Angelica when she was hospitalized to informing about Washington the types of care available after Angelica graduated.
Washington belongs to a Hennepin County parent leadership group, which engages parents in advocating for better student mental health support.
“It changes people’s lives if you can find someone who can help,” she said.
Part of their work is creating outreach materials so other parents know what resources are available to their kids as early as possible.
“Things are going in the right direction,” she said. “Fifteen years ago, I wouldn’t say that.”
Mark Sander, director of school mental health services for both Hennepin County and Minneapolis Public Schools, has been involved in the creation of the county’s school-based mental health infrastructure since the program began in 2005.
Over time, he said, studies of Minnesota’s system found that school-based mental health resources increase access to care, especially for students with acute needs. In the state, around 50 percent of students who received school-based care were receiving mental health care for the first time. Students who receive school mental health care receive fewer suspensions, increase their attendance and feel more connected to their schools, researchers also found.
According to a survey by the Wilder Research Foundation, based in St. Paul, 63 percent of Hennepin County parents whose students received school-based care reported improvement in their child’s attendance. That survey also found that 91 percent of school staff reported that the students were more connected to the school community after receiving those services.
And while its difficult to statistically correlate mental health care with academic outcomes such as standardized test scores, surveys show that parents and teachers report students who have their mental health needs met perform better in the classroom.
“We’re trying to improve students’ mental health so when they’re in class, they’re able to take in the instruction,” Sander said.
Least bad of the bunch
Minneapolis’s system is not without flaws. For youth with mental health conditions, unmet need remains an issue. The shortage of mental health care for youth is a nationwide problem, and Minnesota experts who look at their state’s best-in-nation ranking say Minnesota is more accurately described as the least-bad of the bunch.
“It’s hard to be ranked at the top because it’s a false sense of security at times,” said Shannah Mulvihill, director of Mental Health Minnesota, the state’s oldest mental health advocacy organization. She noted that the state still has a long way to go before being able to meet the majority of student needs.
Even in an area where Minneapolis shines, school-based mental health care, waitlists are common.
A therapist’s caseload usually maxes out at around 20 students, clinicians say. School counselors, school psychologists and school social workers can help try to fill the gaps, particularly for kids who may need some support aside from outpatient therapy, Minneapolis officials say.
“A lot of times what happens is the school social workers are trying to fill in while the kiddo is on the waitlist and provide support,” said Kim Olson, a Minneapolis-area school therapist.
School counselors, psychologists and other support staff play a crucial role in the system of school-based mental health support. But they can feel too stretched to do it well, given other responsibilities, Minneapolis school staff say. According to state statistics, the average number of students under such employees’ purview, depending on the position, can range from a few hundred students to a few thousand.
“You need all of the pieces of the puzzle for the puzzle to work,” said Marcia Sytsma, a Minneapolis school psychologist. Minneapolis still isn’t where it needs to be in funding all the pieces of the puzzle, Sytsma said, but the school district says it’s working on prioritizing funding for school support staff.
Oregon schools struggle to meet demand
Oregon, by contrast, ranks near the worst in the nation. In 2017, state health surveys found one in five Oregon eighth- and 11th-graders have mental and emotional health care needs that have gone unmet. Staffing shortages in Oregon, as in Minnesota, are an issue; for example, the average student to school social worker ratio in Oregon is 8,831 to one.
Portland Public Schools,…