The Doctor is in: Taking the wait out of student support services 

The two signs above Berkeley School Board Member Shirley Issel’s desk spell out the dilemma faced by school board members looking for ways to fund mental health services for troubled students and establish programs to strengthen the coping skills of their classmates.

“Get schools to the table!” commands the first sign emphatically. “Where’s the table?” asks a second sign below.

After spending more than a year building a comprehensive mental health and wellness program for Berkeley students and their families, Issel thinks she finally knows where the table is and how school boards can get there.

There’s a table at every county mental health department in the state, courtesy of California voters who passed Proposition 63 last November to raise hundreds of millions of dollars a year for new and expanded mental health services.

But school districts have to show up if they want a voice, and now is the time.

“Schools need to get on the ball,” says Berkeley school board member Issel, who recently closed down her own clinical social work practice to focus on improving services to all Berkeley students who need help. “They need to find out what the planning process is in their respective counties. It’s so much better to have local schools at the table when services are planned. We know our own needs better than anyone else. Schools traditionally have not been at the table when deals are cut, when decisions are made about which providers qualify for reimbursement and how schools can recover funds for services they provide.”

Proposition 63, which established the new Mental Health Services Act in California’s Welfare and Institutions Code, sets up a statewide commission to write broad guidelines and principles for allocating Proposition 63 tax revenues generated by a new tax on California millionaires.

But it will be up to county mental health departments to allocate these new mental health services funds and draw up local plans for improving mental health services. The new law requires county mental health planners to consult with educators and everyone else with an interest in the mental health and emotional well being of California children, adults and seniors. The first funds will be available in July.

Like many members of the education community, Issel was intrigued by Proposition 63’s tax on California’s millionaires to raise as much as $600 million a year for mental health services. But she knew little about it.

The Campaign for Mental Health, which sponsored Proposition 63 and is chaired by former Sacramento Democratic Assembly Member Darrell Steinberg, promised the measure would expand opportunities for children to get care and emphasized that much of the money would go toward prevention. Initiative co-author Rusty Selix, executive director of the California Council of Community Mental Health Agencies, says he and other Proposition 63 proponents expected that much of the money earmarked for prevention and children’s services would go to school-based programs.

“We do see schools at the heart of this effort,” he says. “That’s one reason we specified that the state commission that oversees implementation of the act would include the state superintendent and a local superintendent.”

Although Issel worked in the mental health field and was busy designing new services for her school district, she didn’t begin to realize the law’s potential implications for schools until after the election. She became increasingly excited, both about the potential revenue available for children’s services and about the revolutionary proposals for spending it.

“This money is not earmarked exclusively for symptomatic kids or seriously ill children, although there is money for these children too,” Issel says. “But 20 percent is earmarked for prevention and early intervention programs. That’s brilliant. It’s money for the kinds of comprehensive, integrated programs that folks like UCLA’s Mental Health in the Schools Project have been recommending for years.”

The money to treat severe and moderately mentally ill children is crucial, she says. But what’s virtually unprecedented in the crisis-oriented universe of public mental health services, is the law’s emphasis on providing money for prevention and early intervention. Funding wellness programs, screening and early treatment for relatively minor problems represents a radical departure from the present system that, critics say, waits until a child is in crisis to attempt an intervention.

David Kopperud, a consultant in the California Department of Education’s Learning Support and Partnerships Division, recognized the measure’s implications for schools from the start.

“The Mental Health Services Act is a unique opportunity to transform how mental health services are delivered to California schoolchildren with serious mental health disorders and their families,” he says. “I believe there is an opportunity for more meaningful collaboration with [state and county] mental health [departments] in providing services designed to enable youth to attend and succeed in school. California’s education representatives will need to be involved in building the long-term transformation of the mental health system that is the promise of the Mental Health Services Act. California’s schoolchildren will greatly benefit by an increased focus on prevention and expanded access.”

Kopperud and a number of colleagues at CDE were so excited about the measure’s potential to help children that they campaigned for the initiative on their own time — as private citizens, not state employees. His tenure as chair of West Sacramento’s Washington Unified School District’s Student Attendance Review Board, he says, gave him a heartbreaking first-hand perspective on the need for more mental health services for students.

Attendance review boards deal with truant students only after schools have exhausted all other strategies for keeping them in class, so they see some of the most troubled children in the system. “We’re the last straw for these kids,” Kopperud says. “We met with the kids and their parents, but we couldn’t get help for them. We had situations where the student would have to wait three months for an appointment, missing school all that time. The isolation and delay just makes mental health problems worse. You’d get a sense that the clock was ticking. Every second lost made it less likely that the student would get help.”

In his work for the state education department, Kopperud continues to field calls from members of attendance review boards who are frustrated by the lack of resources for kids in trouble.

“They call me and say, ‘We’ve identified this kid with terrible problems, but we haven’t been able to identify any resources to help.’”

In the brave new world of high-stakes testing and No Child Left Behind, some critics have argued that schools can’t afford to worry about services like mental health that are not specifically academic. Others object on a philosophical level. In 1999, when the California Legislature passed a bill to expand school-based health clinics, a conservative parents group campaigned against it. Gov. Gray Davis vetoed the bill.

But school reformers at the opposite end of the spectrum are turning up the heat on the issue. They believe that academic performance is inextricably tied to a student’s experiences and circumstances outside the classroom and argue that schools won’t be able to meet state and federal achievement goals unless they start paying attention.

Advocates of student support services make the case that children who are physically or emotionally stressed generally can’t be expected to excel academically, no matter how excellent the curriculum or classroom instruction.

“In my classroom visits, I often see excellent standards-based instruction,” says Kopperud. “That’s part of the solution, but that’s not enough. Schools need to provide psychologists, social workers and guidance counselors. I get excited when I hear education leaders talking about the need to look at classroom support.”

In the last legislative session, San Francisco Democratic Assembly Member Leland Yee introduced a bill that called for establishing a “Comprehensive Pupil Learning Support System” for all California schools. Lauded by health care reformers as a national model, the bill did not make it out of the Appropriations Committee.

Take a look at recent statistics and it’s not difficult to see why educators who embrace this view are so excited about the prospect of getting Proposition 63 funds to bring more support staff to school campuses.

The state is dead last when it comes to student access to school counselors, psychologists, nurses and social workers.

In a recent report on the status of student support services, the state department of education concluded that California’s school social workers, counselors and nurses have the highest caseloads in the nation. Among the 50 states and District of Columbia, California ranks 51st in student-to-counselor ratios, CDE reported, with caseloads of 934 students for every school counselor in California, compared with a national average of 477. Almost 30 percent of the state’s schools have no counseling programs at all.

Other school support staff caseloads are also high. There were 1,645 students for every school psychologist, 2,532 students for every school nurse and 25,803 students for every school social worker.

“Half the schools in California don’t have a school nurse,” says Linda Davis-Alldritt, a CDE school nurse consultant. “School support staff has been decimated since passage of Proposition 13. Schools could play a huge role in helping students overcome barriers to learning by identifying kids who need emotional support. Sometimes it just takes one relationship with a caring adult to turn things around for a child. But we can’t provide even that for most of our kids in trouble.”

Davis-Alldritt, like her colleague Kopperud, is working to spread the word to school districts about the potential benefits of the new law.

Berkeley is ahead of the game when it comes to local planning for ways to take advantage of the new law. Before Proposition 63 qualified for the ballot, the school district and city were at work on a proposal to finance a team of social workers at every elementary school in the district and to institute teen screening programs in the middle and high schools.

Districts would not have to offer on-site services to apply for Proposition 63 funds. By coordinating services with community mental health providers, districts could help outside providers get funds to offer preventive programs in schools or expand services to students referred by schools for further treatment.

California School Boards Association President-elect Luan Rivera, who works in the mental health field as a specialist in suicide prevention, says she absolutely agrees that schools must be “at the table” when county mental health plans are designed for allocating Proposition 63 funds.

Because the measure forbids the use of Proposition 63 money to “supplant” funds from other sources, many analysts have concluded that funds generated by the new tax cannot be used to offset state and federal cuts in special education funding. Rivera is cautiously optimistic. She’s very supportive of the fact that in her region representatives from the San Diego County School Boards Association are participating in their local county planning process.

“These planning committees are critical,” she says, “and it will be interesting to see how it plays out. I do know there are not adequate resources to assist children who are struggling. It’s important that school boards are involved to ensure this money is used to address the needs of children.”

Shirley Abrams, a project director with the Los Angeles County Office of Education works closely with that county’s Student Attendance Review Board. She is just now considering whether Proposition 63 funds could shore up services for chronic truants. “The mental health system is so overloaded with severely disturbed clients,” she says. “Resources are extremely scarce.”

Abrams says it’s taken the isolated but horrific assaults by gun-wielding students to raise awareness about the need for better mental health services.

“People look at districts where there have been school shootings and say ‘Where did that come from?’” she says. “‘What would lead a kid to act out that way? What triggered the breaking point?’”

Most students with mental health problems don’t make headlines. Depression, drinking and drug use are far more common than assault. A 2004 survey of 1400 mental health professionals in U.S. public high schools and middle schools by the Annenberg Public Policy Center at the University of Pennsylvania found that depression was more likely to be a problem for their students than weapons or violence. More than two-thirds of high school professionals identified depression as either a “great” or “moderate” problem at their campuses, and more than 70 percent identified use of alcohol and illegal drugs as major problems for students. By contrast, fighting between students was cited as a major problem by 37 percent of those questioned and weapons by only 6 percent.

Fighting and bullying were bigger problems with younger adolescents, middle schools staff reported, but more than half of these professionals surveyed said depression was a significant concern among their students as well.

The same study found that only 34 percent of high school professionals and 42 percent of middle school staff reported that their schools had a good way to identify students with mental health problems; only 24 percent said their high schools offered drug and alcohol counseling.

In California, black and Hispanic children and those from poor families have the hardest time finding treatment.

A RAND survey of 45,247 parents published in spring 2003 issue of the journal “Pediatrics” concluded that children in California were less likely to have access to mental health services than children in almost any other state in the country. Only Texas and Florida had similarly high rates of “unmet need.” Poor, black and Hispanic children in California were least likely to get care. In states with the lowest rates of unmet need, like Colorado, Massachusetts and Minnesota, children from low-income families were much more likely to get treatment than children from wealthy families.

Some parents are taking desperate measures to get services for their troubled children.

A recent federal report found that in fiscal 2001 more than 12,700 children, mostly teenaged boys but some as young as 7, were placed by their parents in foster care or the juvenile justice system just so they could get access to mental health services. Alarmed by anecdotal reports of such placements, Congress commissioned the General Accounting Office to conduct the 2003 survey of welfare officials in 19 states and county juvenile justice officials in 30 counties by the federal General Accounting Office.

The GAO said its figures represented only a small percentage of the actual numbers partly because officials in 32 states, including five with the highest populations of children, could not provide any data at all.

Given the apparent severity of these mental health care shortages and California’s continuing multi-billion-dollar deficit, it would seem to be in most districts’ best interest to find out more about Proposition 63 funds.

But so far, the new law has not been at the top of most district agendas. That’s partly because many school boards don’t know about it.

Proposition 63 author Selix says that is partly the fault of the Yes on 63 campaign. Although Proposition 63 backers sought and received the endorsement of the PTA and California Teachers Association, Selix says the campaign made a conscious decision not to talk about the potential benefits for local school-based programs or seek other education endorsements. “We feared if we specifically mentioned schools, the opponents might say we were trying to label all kids as mentally ill or that we were going to stigmatize students or medicate them,” he says. “In fact, this law doesn’t call for universal screening, but we feared a backlash. As it turned out, opponents made these arguments anyway. One of the most exciting things about the law is the emphasis on prevention and early intervention, and schools are absolutely key. Now that it’s law, we’ve got to get the word out.”

Carol Brydolf is a writer for California Schools.