Oklahoma schools are stepping up to support mental health for students in crisis

Oklahoma children were already dealing with rising rates of mental health challenges before the pandemic hit, upending education and daily life.

Now, even more children are struggling, and schools are seeing a rise in students dealing with anxiety, suicidal ideation, and other mental health struggles.

Some of the top national pediatric health organizations declared children’s mental health a national emergency in 2021, calling for policymakers to take “swift and deliberate action” to address the crisis.

And new data from the Centers for Disease Control and Prevention further illuminate the struggles children are up against: in 2021, more than a third of high school students reported poor mental health during the COVID-19 pandemic.

Forty-four percent said they “persistently felt sad or hopeless during the past year,” nearly 20% had seriously considered suicide, and 9% attempted suicide.

Teens who reported feeling close to people at school also reported lower rates of poor mental health, feelings of persistent sadness, as well as suicide attempts and ideations, compared to students who didn’t feel connected at school.

Schools have long seen themselves as being on the front lines of supporting students’ mental health. Since the pandemic, that role has become even more apparent, and schools across Oklahoma have been working to shore up resources for students.

Rise in ER visits

In Oklahoma and across the country, emergency departments have recorded a significant rise in pediatric mental health emergencies. At Integris Health, there was a 117% increase in inpatient pediatric admissions stemming from suicide-related ER visits in 2021.

Since then, “we’ve seen more of an increase, at least for the kids that are showing up in emergency departments,” said Allie Friesen, director of behavioral health clinical programs for Integris Health.

Over the years, significantly more young people ages 13 through 18 have come to Integris Health ERs across the state expressing suicidal ideation.

The increase has been so significant that in charts showing the number of visits from 2018 through early 2022, the average line has had to shift up three times, Friesen said.

Those visits, Friesen said, are the “tip of the iceberg” — they represent only the most severe cases of children facing mental health struggles.

Mental health challenges in schools

School counselors were already seeing increases in students dealing with depression and anxiety before the pandemic, said Missy Smith, who works at Norman Public Schools and is the president of the Oklahoma School Counselor Association.

“I definitely think that the pandemic has amplified those things and accelerated the progression of those things that we were already seeing,” she said. “But especially in Oklahoma, mental health and wellness was already an issue.”

At Edmond Public Schools, counselors have noticed more students dealing with anxiety and suicidal ideation, said Erica Harris, student support and school counseling facilitator.

“I would hope that some of that is due to they know where to go, and they know when to go to someone to seek help,” she added.

But she agrees: school counselors and staff are seeing the national emergency in kids’ mental health seen across the country play out in their schools, too.

While the state has seen improvements in counselor to student ratios through efforts like the School Counselor Corps, Smith said there are still some schools where one counselor may be charged with working with 600 or 700 students.

The recommended ratio is one school counselor for every 250 students.

When counselors have high case loads, they’re forced to triage and focus on students with the most immediate needs, Smith said.

“The problem with that is that the student who's riddled with anxiety, but maybe too afraid to say it out loud, is not going to have that same level of access, because their level of need would be lower on the triage and that, to me, is very unacceptable,” she said.

Mercy works with Edmond Public Schools, along with several K-12 schools in the Oklahoma City area and some secondary institutions like Oklahoma State University and Langston University through its Call SAM program, short for “Student Assistance by Mercy.” The program has a hotline for students, staff and parents to call for support.

And calls have steadily increased in the past few years, including crisis calls, said Shelly Whiting, manager of Mercy in Schools, of which Call SAM is a component. Compared with 217 calls during the fall semester of 2019, there were 240 in the 2020 fall semester and 282 in fall 2021.

Crisis calls rose from 40 in fall 2019 to 61 in fall of 2021, Whiting said.

The rise in calls may have to do, in part, with decreasing stigma around asking for mental health help, Whiting said. She worries about a dearth of availability for inpatient and outpatient mental health services as the need grows, she said.

“As stigma is reduced, and more people are reaching out, that means more mental health services are getting accessed,” Whiting said. “And we don't have enough.”

What are schools already doing

Oklahoma has seen a number of initiatives to shore up mental health resources in schools, including the Oklahoma School Counselor Corps, a grant program in which the state Department of Education distributed over $35 million in federal relief funds to districts to hire counselors and mental-health professionals.

Several school districts across the state are also participating in grant programs called Project AWARE that aim to increase awareness of students’ mental health concerns, train school personnel to help children struggling with mental health issues, and connect students who need it to mental health services in their community.

Elk City, Weatherford and Woodward school districts were the first to participate, followed by Ada City, Checotah and Atoka. Davis, Lawton and Sulphur schools are the latest participants.

Oklahoma is also the only state in the U.S. to have three concurrent Project AWARE grants, state leaders said.

“We have been told by those schools that this has been a phenomenal change,” state schools Superintendent Joy Hofmeister said. “They are seeing academic scores rise, they're seeing students attend school more often, which means academic gains can be made. It is probably the very best investment we have ever made.”

And the grants benefit the entire state, she said. Through one of them, state leaders are mapping mental health supports across Oklahoma, “so that schools have a way to connect with those community partners to be part of their support to children,” Hofmeister said.

“This is going to truly be something that lasts for a very, very long time,” she said. “If we are going to see our children thrive academically, we first must address those needs with regard to trauma, with food insecurity, with the needs that they have related to safety, as well. All of this works together, ultimately, to see our students’ academic progress move forward.”

Laura Jacobs, the project manager for Project AWARE with the state Department of Mental Health and Substance Abuse Services, said the grants have already helped more students and families access mental health care.

“We are still very much facing a shortage of mental health professionals across the state. Our districts are no exception,” Jacobs said. “But seeing those relationships either being built or being further solidified as part of the grant, has been really beneficial to those students and their families in these districts.”

Possible solutions

Mental health policy experts and advocates have pushed for more programs like Project Aware, called multi-tiered systems of support. In those frameworks, schools connect with resources in the community to better address students’ needs.

“It’s not a way to just make mental health appear in school, it's a way to make sure that the resources you have in the community are being maximized,” said Brittany Hayes, policy director for the Tulsa-based Healthy Minds Policy Initiative.

Adding more school counselors and mental health professionals in schools is another piece of the solution, said Zack Stoycoff, executive director of Healthy Minds Policy Initiative.

“But what really needs to happen is better linking of schools and mental health systems coherently, through data through partnerships and cooperation,” Stoycoff said. “Because the resources exist in our communities. If we can bridge the gap between schools and families and those treatment professionals, when people need them, we will be much better off.”

House Bill 4106 could be a starting point for some districts in connecting with mental health providers in their community. If the bill passes through the legislature this session, it would require every public school district in Oklahoma to work with a local mental health provider to develop a protocol for responding when a student is in a mental health crisis.

“Schools aren’t and can’t be in this alone,” Stoycoff said. “This isn't a problem schools can solve on their own. The solution is a school-community connection so that we are really utilizing all of our resources to help these students and families and provide them opportunities.”

Everyone has a role to play in caring for the mental health of kids, said Friesen, with Integris.

“We have to work together effectively for us to make any forward movement,” she said. “That is everyone from our physicians, to law enforcement, to school boards, to parents, families, psychiatrists, counselors — it has to reach every single stakeholder in these kids’ lives … We have to work together to fully understand how we can prevent these kids from getting to this point of crisis.”

This article originally appeared on Oklahoman: Oklahoma schools are on front lines of addressing kids' mental health