Our guidance counselor came to the classroom for a brief, and awkward conversation with my English class. One of our schoolmates had committed suicide. It was almost exactly a year after the deaths of two other schoolmates had left my classmates and me reeling. The counselor asked us how we felt, and it felt strange for an adult working in the school to ask us about our emotions.
Many New York City students would like to have someone to whom they can turn. But a large percentage of New York City schools offer no mental health services.
According to the New York State Coalition for School Based Primary Care, one in five children in New York City have a diagnosable mental, emotional or behavioral disorder, and at least one in ten has a serious emotional disturbance that interferes with their ability to function on a daily basis. Seventy percent of teens with a severe diagnosis do not receive any mental health services, and about 100,000 teens are on waiting lists for mental health services in New York City.
BRINGING HELP TO SCHOOLS
To help more young people get the care they need, New York City Councilmember Gale Brewer and representatives of a number of advocacy groups rallied outside City Hall in June to try to convince the city to provide $6 million to fund at least one full-time clinical social worker or psychologist in each school-based health center. The groups also wanted to open school-based health centers, where students can receive medical, mental and dental services, in schools that don’t have them.
Advocates like Adria Cruz-PeĂ±a, school health services manager of the Children's Aid Society, thought that the time was right for this cause. “When we were pushing for this, we had just learned about the killing scene in Virginia,” says Cruz-PeĂ±a, referring to the events at Virginia Tech where a student with a history of psychological problems killed 32 people and himself this spring. “We think this type of thing can be prevented when you have timely mental health services and information.”
But the funding was not included in the city budget adopted in June. “It’s so disappointing because we know the impact that the services have on the mental health of our teenagers,” Cruz-PeĂ±a said.
The Coalition for School Based Primary Care plans to try again next year.
SERVICES IN SCHOOLS
The New York State School-Based Health Centers Program, which Cruz-PeĂ±a calls “the best-kept secret in New York,” started in 1981 to treat children in low-income, high-risk communities, many of whom had no health insurance. The program sought to provide health services to children through teams of school nurses, nurse practitioners, physicians, physician assistants, community health aides, social workers, psychologists, psychiatrists, health educators, nutritionists and dentists. There are now 61 such centers in New York City high schools and middle schools, according to the New York State Coalition for School Based Primary Care, and many other states have introduced similar services.
Advocates of the centers say that providing mental health services can make a profound difference. According to the Children’s Aid Society, students who received mental health services in the centers showed declines in depression and improvement in self-concept. They also determined that adolescents were far more likely to seek help for depression and suicidal thoughts at school-based programs than ones in the larger community.
But not all schools have health centers, and of those that do, not all provide adequate mental health services. One quarter of the school-based centers provide no mental health services, one quarter have only one mental health provider for up to 4,000 students, and only half have one full-time provider.
Children in schools without school-based health centers can have a tough time accessing mental health services. Although the Department of Education must hire a school nurse for every New York City public school, the nurses do not have to be trained in mental health issues.
The school based health centers are funded through grants from the state and city government or agreements with private health centers or nearby hospitals. This almost guarantees that not every school will have a center since not every school is near a hospital or able to get a grant from the government. Few of the centers can bill Medicaid and virtually none can bill private insurance, so most are not reimbursed for the services they provide.
EXPANDING THE CENTER
Advocates for the centers say they provide a valuable service. “Young people have issues,” said Brewer. “Communities are challenged with drugs, incest, housing and there’s nobody to talk to. You need someone to talk to and you need somebody on site because if you tell people to go to a hospital, they’re not going to go.
Teens who do not have access to these centers have few options beyond government health clinics, which Dr. Chris Kjolhede, a member of the steering committee of the Coalition for School Based Primary Care, describes as “understaffed and not necessarily teen friendly.”
Further many teens may be reluctant to go to them. Because mental illness has a ”stigma,” Brewer said, students might be reluctant to go to a clinic in an unfamiliar setting. But, she continued, ”If you’re at a [school based] health clinic, there is no stigma. No one knows who you’re going to see and it’s none of anyone’s business.”
But not everyone sees the need for more mental health facilities. Columnist Mike Males of Youth Today cites numerous studies showing that teens are happier than they have ever been. He also refers to a Kansas State University study that showed that only 5 percent of students use mental health services, a rate that has not changed in 15 years.
Brewer thinks there remains a pressing need. In New York City, she said, 5 percent still means a large number of students. “It’s just someone to talk,” she said. “It doesn’t have to be more than that.”
I can see her point. After the guidance counselor left my classroom, a quick glance around revealed bowed heads and watery eyes. It was clear many of us did need someone to talk to.
This article by April Daley, 17, a writer for New Youth Connections, written by and for New York City teens, is adapted from the pages of our partner, Youth Communication.