When Salem-Keizer Public Schools (SKPS) conducted a district wide survey of secondary and elementary students, they found something they didn’t expect.
“A high number of kids reported that they did not feel connected to their school,” said David Fender, director of the SKPS Office of Behavioral Learning.
Mental health advocates say school is a natural intervention point when students are struggling because it’s where kids spend the majority of their formative years. In Salem-Keizer Public Schools, for many years, it’s been a missed opportunity.
When kids don’t feel like they have a trusted adult in their lives, they often don’t get the help they need when they’re struggling with mental health concerns.
“We thought we were connecting with kids, when in reality, we weren’t,” Fender said. “There’s a lot of kids who fly under the radar.”
The kids who fly under the radar - Fender calls them “internalizers” - are part of a growing cohort of young people who struggle with their mental health.
The district has been slow to acknowledge a problem that has impacted Oregon youth for decades—according to Center for Disease Control data, suicide has been the second leading cause of death among young people in Oregon since 1981.
“It became an issue before the adults figured out that we have an issue,” said Lillian Govus, SKPS spokesperson. “So it became extremely prevalent, and then we started saying oh, we have to do something. So, we’re working backwards.”
In the past few years, Salem-Keizer has begun taking baby steps toward better in-school mental health supports and services. Salem-Keizer has begun emphasizing training around suicide intervention for an increasing swath of its staff, in the form of suicide risk assessments for counselors and “Question, Persuade, Refer” trainings - a kind of pre-suicide risk screening - for other school staff.
John Van Dreal, the outgoing director of the SKPS office of safety and risk management, oversaw these trainings. He finds a lot of school staff are hesitant to raise the question of suicidal thoughts with students. But, it’s something that’s dearly needed. In 2017, nine people under the age of 24 died by suicide in Marion County. The following year, that number jumped to 18 young people.
“People are afraid to ask the questions and part of it is to say, you can ask the question,” he said. “So it builds a little bit of confidence and people need that. It's almost like people need permission to ask the question, ‘Can I talk to kids about suicide?’ The answer is always, yes, please talk to them, he said.
In addition to staff trainings around mental health and suicide, the district is beginning to roll out outpatient therapy based in the school. The prior superintendent didn’t allow outside mental health services in schools, so it’s only been in the past few years that the district even considered in-school mental health services for students.
The district has partnered with Marion and Polk counties, as well as the community mental health provider Trillium Family Services to begin placing part-time mental health counselors in schools during the past academic year.
It’s a newborn initiative. Twenty-seven out of 65 schools receive some kind of support from a mental health counselor, and the district seeks to expand that number in the coming years. Some schools have been more receptive to the therapists than others.
“The hard part is, Salem-Keizer is a huge district. Some schools value mental health more than others,” said Phil Blea, Marion County’s program supervisor for youth mental health services. “Some schools make space available right next to the counselor, so students know when that’s going. Some people make space available [in a different place] every week so we’re bounced around.”
He continued: “We’ve found that in schools that make a consistent space available, everyone knows the counselor is there and there’s better coordination of care. The one that the counselor has to show up and get bounced around, there’s less continuity of care because students don’t know where that person is.”
Getting the word out about mental health services has been another challenge. McNary is one of the schools being served by an outpatient therapist—but many students and parents at the school don’t know about them.
There’s pitfalls at the institutional level as well. The district leaves communication about district mental health initiatives to the discretion of each building. “Some folks take five minutes in a staff meeting, some folks go in depth and talk for 45 minutes,” Fender said. “That’s an area where we’ve found that the information we’re sharing doesn’t get shared the same across all buildings. So the communication piece is something we’re trying to figure out.”
The problem is, even when students know about services, they’re often limited in scope. Therapists typically serve multiple schools, only working part-time at any given school, and can only serve students on the Oregon Health Plan. While the goal is to serve the “highest need” students, all students - even those on private insurance - struggle to get appropriate care, especially when they can’t be seen by in-school providers.
“There’s only so much we can do as a school district to connect them through their private or commercial insurance,” Fender said. “We can steer parents in the right direction, but I’m going to be completely honest - there’s a six to eight month wait list to receive therapy in this community.”
Other school districts have addressed the gap in service availability in different ways. In Minnesota, a state that has been nationally recognized for its school-based mental health program, all therapists work in each school full time. This maximizes the efficacy of the therapist, who becomes a fixture in the school as much as the school counselors. Working at an individual school full-time allows the therapists not only to see students in treatment, but also to consult with school staff about navigating student mental health concerns. Minnesota’s program has mitigated the struggle with insurance by contracting all services to community providers with county support - which means school therapists can see both kids on the state Medicaid insurance and those on private insurance.
Offering services to a broader swath of Salem-Keizer youth is a goal, Fender said, but it’s further into the future.
Even for students who do qualify for school-based help, mental health needs can go beyond therapy - some students need more intense intervention, others just a bit of preventative support.
When an initiative to address other types of need crops up, it often encounters dead ends. The lack of funding is a constant refrain, and even productive initiatives are short-lived as a result.
For the 2018 calendar year, the mental health provider Trillium received a grant to provide prevention services at Washington and Brush College elementary schools, Crossler Middle School, and McKay High School. According to Chiharu Blatt, director of Trillium’s Willamette Valley community services, the prevention grant created such services as small skills groups for students, education and consultations for school staff and parents, and created a drop-in area for students to get advice and referrals from a clinician.
But after the grant dried up, so did the prevention services.
Another pervasive problem is the ongoing stigma around mental health. Without a school culture that recognizes mental health concerns as real and immediate problems for youth, kids can’t get the support they need. And many of those who work with youth - and the youth themselves - say kids are more and more open to talking about their needs, if they’re given a space to voice them.
“[Students] talking about it isn’t the issue, it’s if they’re being listened to,” Brooklyn Flint, a junior at McNary, said.
Flint discovered how a school’s culture can stifle student’s attempts to reach out. During Flint’s freshman year she tried to start a club to give students a safe space when struggling with mental health concerns. Flint saw the need for the club after coming up short for resources for her own depression.
When she visited a counselor at her middle school, she said, the counselor told her, “‘I’m sorry. That sucks,’” Flint said. “And just gave me a tissue box”
That wasn’t helpful, she added.
So, when Flint got to high school, she tried to address the need through student action. But after several months of trying to get the club off the ground, the effort fizzled out. Students didn’t coalesce behind the club despite what she sees as the glaring need for better mental health support.
Flint attributes the club’s lack of success, in part, to busy students; one promising officer for the club, she said, had to withdraw after getting hired at an after-school job.
But she also sees a culture that doesn’t create spaces for kids to talk about their mental health.
“People are scared to come forward,” she said. “Depression is this thing that makes you want to isolate yourself.”
This means that kids need the adults to reach out to them, Flint said. As the district survey found, that’s often not happening.
Even as the district institutes reforms—including adding mental health resource information to the back of student identification cards for the coming year—it’s clear the response lags far behind the need. Reforms mean little without a school culture that prioritizes student mental wellness.
“The school is barely allowing us in,” Blea said, referring to county mental health services. “They’re getting better.”
Mental health advocates join the kids in saying that all people who work with youth need to take a more proactive approach in reaching out to kids about their mental health. Blea describes mental health as a “hot potato” issue - something that’s passed around because no one wants to deal with it.
That needs to end, he said.
“It would be great to lean into the problem versus leaning out of the problem. So the families, schools, and community need to not be afraid of talking to youth about mental health issues,” Blea said. “If we can get everybody to think about what’s my role, how do I get them help, where do I get the referral, the better it will be.”
Next week, learn how LGBTQ+ youth are disproportionately impacted by mental health concerns.