Kids, Schools, and Mental Health

May 01, 2008

In our society, K-12 schools carry a heavy load. In many ways people seem to think they can insert a five-year-old, bake 30 minutes, and then remove a literate, thoughtful, well-adjusted, perfectly socialized young adult. In reality, of course, this happy vision of a flawless recipe comes with its share of mismeasured ingredients.

A recent report from the Washington State Superintendent of Public Instruction, Publicly Funded Mental Health and School Coordination Resource Manual [ Portable Document Format 3MB] , looks at one of the doughy lumps in that cake: the little matter of detecting and addressing mental illness.

"When you look at the range of social, emotional, and behavioral issues that the K-12 system is confronted with, when you look at the continuum of severity, you're really begging a different kind of question," says Roy Harrington, one of the report's authors. "The need is stunning, and I think it's overwhelming."

Two Monolithic Structures, Trying to Dance

The problem is getting today's mental health system and K-12 school system to play nicely together – here in Washington State as elsewhere. Even as the two systems share similar or at least parallel goals, in many significant ways they tend to work against their better instincts.

"The mental health system is an adult-focused system, it's not a child-focused system," says Harrington. "The vast majority of mental health problems begin in adolescence – kids 14, 15, 16 years old. You can see the trajectory. You know where those kids may be headed. But the system isn't organized around responding to them."

Harrington points out that this is actually a well-known issue around both schools and the mental health system. "In terms of the rule structures and overall capacity to act, we don't have a mental health system," he says. "We have a Title XIX mental illness treatment system."

The problem, of course, is that a system that doesn't work to identify mental health problems and intervene early to prevent severe problems from developing in the first place – the system that in many ways we presently have – is one that ends up spending vastly greater amounts of money, effort, and pain on the various cures.

Looking for the Good News

Harrington is understandably pessimistic about the prospects of fixing a system where the problems and the solutions have been known quantities for over 25 years. "The problem with our policy infrastructure in part is that we don't have any institutional memory," he says. "You look at reports that were done in the mid-'80s and they're describing the same precise set of issues. The essential points they make, and the essential ideas about the need to create response, that hasn't changed a bit."

But that doesn't mean he's given up hope – not by a long shot.

"Here's the thing that I'm actually very optimistic about," he says. "People at the local level who are doing this work, who see kids and families, they see the issues. The passion and the commitment and the interest and the level of common cause that exists at the local level is pretty high. The places we found absolutely the most promising approaches were where you had significant local funds purchasing services for kids who don't meet the access-to-care standards."

What's Working

Harrington's report identifies a number of strategies and key factors that contribute to successful relationships between schools and the public mental health system:

A mutual understanding that mental health system resources, as presently constituted, are severely limited.
Various strategic approaches that make mental health services available in public schools via multiple small funding streams. The National Assembly on School-Based Health Centers (SBHC) provides one example of how schools can work with political entities to enhance service delivery for more children.
Wraparound programs and Multi-Disciplinary Teams (MDT) are frequently instrumental in removing barriers to service and increasing communication between all the players.
School counselors and school nurse have both proven themselves critical constituents on the front lines of early detection, prevention, and intervention.
Direct involvement of parents, as always, is essential to success.

What's Next

Based in part on Harrington's report, along with the work of many others, a new move toward building "trauma-informed care" into school systems has begun to gain traction in Washington State. Future articles will look more closely at this unique strategy for closing the gap between schools and the mental health system in delivering services that more successfully meet community mental health needs.

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