Schools struggle to cope with rising mental health needs
MARLBOROUGH — When 16-year-old Jasmin Duarte feels anxiety at Assabet Valley Technical Regional High School — often after lunchtime chaos in the cafeteria — she slips inside a small room, lit dimly with floor lamps and miniature lights, with the sound of trickling water in the background.
It is here that Duarte found solace in the weeks after her hospitalization last fall for depression and an eating disorder, and where she received counseling to help her deal with her anxiety and tutoring to catch up in her classes. The room continues to be a lifeline that could prevent a relapse.
“It’s a safe environment,’’ Jasmin said one recent morning. “Everyone is caring. We are all here for each other.”
Such sanctuaries are becoming necessary as Massachusetts schools confront an alarming rise in the number of students who are hospitalized for mental health disorders. Over the last decade, many schools have seen the number of cases grow from just a few a year to upwards of several dozen, often transforming guidance offices into de facto psychiatric wards, educators say.
But helping students through this journey is complex. They may return to school after receiving treatment fragile, self conscious, and overwhelmed. They’re stressed about being behind in class, confused over how to explain their absences to peers and teachers, and in many cases, tormented by mood swings as their doctors figure out the right dosage of medication.
Sometimes, students and families are so worried about the stigma that they don’t even tell anyone at the school what happened, creating confusion for teachers and administrators when a student acts out, resulting in disciplinary action instead of console, and also increasing the possibility of ridicule by classmates.
And if classmates or teachers hear the reason why a student missed school, they are often reluctant to acknowledge it. The reaction is in sharp contrast to the hoopla that can surround the return of a student who is recovering from cancer or a broken arm.
“There’s no signing of a cast or sending over cookies,” said Nancy Parker, who oversees training programs for teachers and administrators at the National Alliance on Mental Illness Massachusetts. “Usually there is silence.”
In response, more than three dozen schools in such places as Boston, Wellesley, and Amherst have been seeking to transform the experiences for returning students and have found inspiration in a program created more than a decade ago at Brookline High School, which provides both academic and counseling support to students who missed schools for either physical or mental health reasons.
Clinicians in the programs help students navigate everything from negotiating plans with teachers on the pace of making up work to helping seniors notify colleges if the absences results in temporary incompletes on transcripts or missed deadlines in the college admission process.
The Brookline program has achieved some notable successes, such as boosting weekly school attendance rates for these students, from an average of 56 percent a week before joining the program to 84 percent afterward. Getting students to school is a huge success. A return to normalcy reduces their chances of being hospitalized again and increases their chances of making it to graduation.
According to the National Alliance on Mental Illness, about half of students who are 14 years or older with a mental health disorder will drop out of school. In the Brookline program, more than 90 percent of students complete their academic year.
“Staff people on the line taking care of these kids are really looking for solutions so they can support the kids through difficult periods and have them come out on the other side even stronger,” said Henry White, a psychiatrist and program director for the Brookline High program Bridge for Resilient Youth in Transition, which is run in conjunction with the Brookline Community Mental Health Center.
Massachusetts students experiencing at least one “major depressive episode” in a given year has been on the rise, according to the most recent survey data compiled by the Substance Abuse and Mental Health Services Administration, a federal agency. In the 2013-14 school year, 54,000, or 11.1 percent of Massachusetts adolescents had one such event, about the same rate as the national average. The Massachusetts rate increased from 8.8 percent in 2010-11.
Yet only half of them sought treatment, the survey found.
Massachusetts, like the rest of the country, has a shortage of child psychologists and psychiatrists, creating long waiting lists for care. The shortage is particularly severe in the spring when mental health issues among teenagers spike. Mental health experts say it may be linked to sleep deprivation and the mounting pressure students face to excel in school and get into the best colleges.
Sometimes problems emerge as students recover from sports injuries.
Ally Lansbury, 18, of Brookline, tore a knee ligament during a soccer game last fall. She missed about two weeks of school while she recovered from surgery and was eager to make up her school work.
But as her recovery extended into the winter, Lansbury grew depressed. She had to skip out on taking part in a soccer club — a troubling situation given she planned to play in college next fall — and felt she was losing a big part of her identity.
“I didn’t feel like I had anything left,” Lansbury said. “That’s when I stopped having motivation to go to school.”
By February, Lansbury entered an outpatient program for anxiety and depression, teaching her such coping skills as mindfulness. When she returned to Brookline High she entered the Bridge for Resilient Youth in Transition program, enabling her to catch up on schoolwork, receive some extra therapy, and ease back into the daily routine of school. The program is in a two-room suite furnished with couches, lounge chairs, and computers.
Lansbury said the program has taught her a lot about how to advocate for herself and how to create manageable ways to get things done, and that she feels less self-conscious about being in the program.
“In the beginning, I didn’t want anyone to know I was here, but now I couldn’t care less,” she said. “I don’t go around telling people, but if anyone asked me I would be open about it. Being open is sometimes helpful to other people.”
Brookline High, working in partnership with the Brookline Community Health Center, started its program about 12 years ago, after noticing a rise in students with mental health disorders. Of particular concern was 12th-graders who were repeating a grade because of extended absences.
A few years later, Wellesley High School adopted the approach and gradually more than three dozen other schools, including Assabet Valley, followed suit.
The programs aim to get students back into all their classes within two or three months. But many students form such strong bonds with the staff as well as the rooms they have difficulty leaving and often return after their stays wrap up.
The Brookline mental health center is preparing to take the program nationwide. Very few such programs exist nationwide, experts say, as many schools take a “crisis of the moment” approach in helping students with mental health issues.
Like many schools, Assabet Valley used to take a haphazard approach to helping these students. Sometimes the guidance office would receive a phone call from a psychiatric hospital alerting them to a student’s situation. Other times, students would return to school without revealing their hospitalization.
Counselors and teachers were not always sure how best to help returning students, who might turn up at the guidance office waiting area, seeking help after a downward spiral.
“I knew therapeutically it wasn’t the best situation, but we had no place for them to go,” said Alyssia Berghaus, director of student services at Assabet Valley. “We were not good at this.”
And the number of students in distress, she said, was growing. When she first arrived at the school about eight years ago, only one or two students a year were hospitalized, but now she said the numbers range between 20 to 30 students a year.
Assabet Valley, like other high schools, has been grappling with a disturbing number of suicide attempts. A survey conducted at the school in 2014 found that 12 percent of students had attempted suicide in the past 12 months.
“I see a lot of students with these amazing skill sets, but they don’t see the worth in that because they don’t see worth in themselves, and that for me is tragic,” Berghaus said. “They have so much that they could give society.”
Three years ago, Assabet Valley got a $210,000 three-year grant from the Metrowest Health Foundation, which has provided money to many suburban high schools to replicate the Brookline program.
Wellington Vasquez, 16, said if it wasn’t for the program he would be behind in school. Vasquez, who entered the program after going through some family issues, said he gives much credit to Kelly Viera, the program’s clinical coordinator.
“The only thing I would change about this program is that there is only one Ms. Viera,” he said. “She is trying to give us equal attention, but there are so many of us. We need to duplicate her.”