The Politics of Mental Health

Per my Sunday morning ritual, hubby and I watch Meet the Press and This Week while sipping coffee and eating waffles. In some ways, it’s a relaxing ritual, in other ways it is the opposite of relaxing. Today was one of those not-so-relaxing days. The coverage is all about the tragedy in Tuscon and I have gone between crying (the picture of 9 year old girl who was killed gets me every single time) and being enraged. I have also been encouraged that the pundits are actually talking about mental health issues. Mostly though, like many things in my life, I filter all information through my school psychologist lens.

I see kids all the time that could grow up to be Jared Lee Loughners. I can see them in elementary school. Their problems become more pronounced in middle school. In high school, they are often hidden in the crowd, or check out of attending school altogether. As a school psychologist, I have counseled kids who have witnessed shootings. I have counseled a teacher who was held up at gunpoint out front of our elementary school. I have pleaded with parents to take their child to a psychiatrist because of the danger to themselves or others. I have confiscated guns and knives from the backpacks of children. I even worked with a kid who later ended up murdering someone. And I have involuntarily committed children and adolescents who I knew posed an imminent threat.

Identifying troubled students is easy. Providing them resources and follow up care is hard. So often I sit at support staff meetings and the list of students who need counseling is far greater than our resources. I only have time to counsel about 5-10 students a year with my current case load. Many students are referred out to agencies, but the follow through by the families is often poor. The average ratio of school psychologists to students at last measure in 2000 was 1:1500, with the median being 1:2500. In some cases, it’s 1:5000. What can we do when we have thousands of kids we are responsible for and we are likely on a school site only one or two days a week?

I can’t imagine that Jared wasn’t ever referred for help in secondary school. Even if he had a late onset of mental illness, the community college certainly was aware of his needs. But like K-12 education, community colleges don’t have mental health resources either. Our new California governor’s budget protected K-12 to some degree, but slashed post-secondary education. Schools are the access point for so many students in need. Imagine if we had the resources to serve students with mental health needs. Could adequate mental health services have prevented this shooting? Unknown. Could it have lessened the chances? Probably.

I should note that predicting who will become a violent offender is a difficult business. It is especially hard to predict because of the rareness of the events. Statistically speaking, rare events are harder to predict (earthquakes, anyone?). There are far more students in need of mental health services that are not going to go on to shooting innocent people if they don’t get help. But they will go on to suffer. What matters to me most is preventing suffering. Mental health issues are still thought of as personal weakness in our society, and something to be ashamed to admit. We need to start a national conversation about how it takes personal strength to seek help. We need to recognize the connection between mental health and education. If you are not well emotionally, you are not ready to learn.

As I watch the media coverage in the aftermath of the tragedy, I can only hope it sheds some light on the real issue underlying the tragedy—that our education and mental health systems are in need of support. While I’m only one school psychologist in a big district, big country, big world, I know that if there were more mental health providers helping me reach troubled students, we could make a real difference.

The real challenge is for politicians to stop talking and start acting. Reverend Al Sharpton hit the nail on the head today on Meet the Press. He said that Martin Luther King, Jr. had concrete goals and legislation in addition to his overall civil rights beliefs. Without concrete, tangible goals, he would have only been a dreamer. I’m just left here, with my empty coffee mug and dreams of adequate mental health services in the schools, wondering what I can do next.

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Comments on The Politics of Mental Health

  1. Anonymous says:

    What can an elementary school teacher in an urban school look for to help prevent such horrific violence? What can a mom of 2 boys watch for? As a school psychologist what is your opinion of boys playing "war" with neff and airsoft guns?

  2. Anonymous says:

    Why was a Psychiatrist needed for someone who was a danger to themselves/others? Surely you, as a Psychologist, could administer the correct form of Psychotherapy to get to the route of the persons problems, rather than having a Psychiatrist drug them up. Your thoughts please?

  3. Dr. Tonya says:

    As a fellow school psych in an urban district with far too large of a caseload to do much effective counseling, I feel your pain. I have made so many referrals through the years with little to no follow-up. It is easy to place blame on the schools ("how could 'they' have not known this kiddo had mental health issues") but as you stated, we cannot force follow-through on our referrals. That was my first thought in reading the comments on the tragedy – so many asking why the college did not do more. We, unfortunately, can only do so much.

    My dissertation was on school-based mental health services. I was lucky enough to do my predoc internship down in Dallas where they have school based mental health centers scattered throughout the district. Those centers are a huge start of tackling the paucity of available mental health services for families (especially poorer families), but more funding is definitely needed. I always hope that other districts would do the same – but again, it all comes down to money.

    I have since left Dallas for another large, urban school district without school-based mental health services. I wish they were here – those were instant, easy referrals especially in crisis situations.

  4. Rebecca says:

    @Anon#1: If you have any concerns about a student, and I find teachers have good instincts on this, do consult with your school psychologist. I think the violence in kid's play is a whole new post…

    @Anon#2: Good question. Medication is never the first line of defense for me in treating mental health problems. However, when a child or teen is having a psychotic break, experiencing delusions or hallucinations, psychotherapy alone is often not sufficient to address the issue. I reserve referrals to psychiatrists for these situations.

    @Dr. Tonya: When I win the lotto, we can partner together for school based mental health programs in our districts. Putting the service where the students and families are is much more efficient than asking a family in crisis to navigate the complex mental health referral process.

  5. luckeyfrog says:

    I think plenty of kids play 'war' or something without it being necessarily a sign of mental health issues. I'm not saying I think it's good, or okay, but I would think that no mom should worry based only on seeing that behavior. I'm no psychologist, though! Maybe our blogger could offer some signs of what to look and listen for.

    I agree that even as early as elementary school, you can see students who really struggle with mental health issues. I can already see students with anger who sometimes have uncontrollable outbursts. I can see students who crave attention and will be vulnerable to bad influences. I can see the students for whom criminal activity is "normal." I refer them to our counselor, who luckily works only within our school- but I still worry.

    I think it would surprise a lot of people outside of schools just how well teachers could predict their students' future. It's sad, and we do what we can to help, but if someone made me predict which students might end up with a criminal record, which students might end up in a gang, which students might pursue unhealthy romantic relationships, which students might end up in college… I think I'd, sadly, be fairly accurate.

    I think it's sad, too, that so much blame goes on the schools in situations like these. Like you said, sometimes schools give a referral, thinking their job is done, and parents can't or don't follow up. Everyone looks for someone to blame, but I don't think it can be placed on the school or any other single entity.

  6. Anonymous says:

    School based mental health services have the advantage of not requiring the parent to take off from work and check the student out of school for an appointment, and usually being free or at a much reduced cost. In addition, (if the parent permits) the counselor could check on the student's behavior at school directly. The downside is that the need is so great that it will never be met because of the cost.
    As a proactive step I would like to see schools teach a reworked version of the 10 or 12 errors in thinking and how to refute them taught by Albert Ellis's Rational Emotive Behavior Therapy. (Especially reworked to remove that name from the set of ideas, since the name could freak out some parents.)

  7. Anonymous says:

    I've been a long-time reader of your blog and (hopefully) future school psych and this post was wonderful. This past week I've been watching the news and have just been left wondering how this kid could have slipped through the cracks but then I realized that this happens all too often. Now maybe not every kid who is in need of mental health services is going to go out and commit such a tragic crime but their unresolved personal issues will more than likely follow them for the rest of their lives which is sad enough within itself. One of the few positive results of this tragedy is that it is alerting everyone to the importance of mental health services and how schools are usually the first (and only ones) to identify children, adolescents, and young adults with psychological issues.

    -Brittany

  8. I am a former teacher/counselor/school psychologist. I also worked at and ran a detention home and taught in prisons and colleges. I have only met a couple students who weren't "teachable" (read that to mean – "…have a heart that was, somewhere in there, open to receive love and guidance") Even "bad" people don't like to hurt inside. Perhaps I see poor behavior as a cry for help – physically (how can a 3rd grader not be discovered to be deaf?) Emotionally (the young man Rebecca counseled who said, "Yes" under his breath that finally someone wanted to listen without judgement), Spiritually ("Who is Big enough – out there – to take loving control of me?")

    Over the years I've put a lot of "good thinking" in books used by a lot of young people,parents, teachers, etc. I am leaving this earth soon but my books don't have to. Visit http://dennishooker.com for the cd with all of them on it. If you can't buy it now, that's OK. I'll send the cd of books, MP3's, Programs as my gift to you to use/share freely. I want students to not hunt people and not hurt themselves. Dennis Hooker

  9. John D. Ayer says:

    No offense, but, I think your belief that violent outburst behavior is predictable may in fact be a cause of violent outburst behavior. Quite often treating people a particular way can influence their behavior. Treating people as if they will have a violent outburst can influence that behavior. This has actually been satirized in racial relations. A well educated, well dressed young black male walks into a store and some white person yells "don't hurt me". In real life a fearful person will probably become aggressive or passive aggressive which actually increases the likelihood of a confrontation. In addition the subjective analysis you suggest is based on subjective development of probable behaviors. As an example we could address the theory of multiple intelligences. While multi-modalities probably exist the idea that they can be subjectively determined to develop an objective analysis strikes me as ridiculous. The objective analysis of random behavior such as Internet surfing will probably allow a much more objective model of the multi-modalities of human behavior. If I had listened to my teachers in school I would never have earned six figures and I would not be earning more than the majority of people with advanced degrees. I would have ended uo in the "average" range.

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