Rural Iowa has a mental health care crisis, and school superintendents want more help

A South Central Calhoun Community School District student with autism spent almost a month in the hospital while their family searched for a facility who would accept the child.

The family’s plight and his rural school district’s need for accessible mental health care has been on Superintendent Brad Anderson’s mind after the Jan. 4 deadly shooting at Perry High School.

And his concerns over the lack of accessible mental health care in Iowa’s rural areas is being echoed by educators and advocates across the state.

"I could tell you right now, we could have all the money in the world,” Anderson said, “but we're not going to combat the fact that we are an hour and a half, two hours away from these facilities, and beds aren't available."

On Jan. 4, authorities say Dylan Butler, a 17-year-old student, shot and killed Ahmir Jolliff, 11, and injured seven others at Perry High School. Principal Dan Marburger, among those shot, died 10 days later. Butler’s motive for the shooting is still being investigated.

But the trauma and mental anguish is caused still continues, and school officials across Iowa, including in South Central Calhoun, worry about how to get students the help they need.

Related: Perry School Board puts off vote to reopen schools after shooting, parents question security

Nationally, nonrural districts average 295 students for every one school counselor or psychologist, according to the National Rural Education Association’s Why Rural Matters 2023 report.

In rural areas, that number grows to an average of one psychologist or school counselor for every 310 students. In rural Iowa, the number climbs to 345 students for every one psychologist or school counselor.

The Iowa Health and Human Services programs, area education agencies or AEAs, contracts with health care providers, Medicaid, telehealth, and other programs have helped school administrators patch together needed services.

Some of these services could change or end after the 2024 legislative session because Gov. Kim Reynolds has called on lawmakers to make changes to how Iowa handles behavioral health and area education agencies.

"We also know that we have to provide services for kids," Anderson said. "And when I say services, we're talking professional services beyond the scope of what school counselors can provide, beyond the scope of what teachers and administrators and others can provide."

Iowa's area education agencies are 'valuable,' superintendent says

In the hours and days following the shooting, state and federal agencies and school districts across the state offered support and resources to Perry schools and Dallas County residents. Students have also walked out of school and rallied at the Capitol to protest what they perceive as the state's lax gun laws.

Students and staff at school districts across the state dressed in blue, Perry's school color; raised money for ongoing fundraisers; held moments of silence; opened up facilities for Perry athletes to practice in and other offers of help.

Related: 'Enough with the prayers.' Students march on Iowa Capitol to demand action on gun violence

The Iowa Department of Education, along with Iowa Department of Health and Human Services, public safety and Iowa Homeland Security and Emergency Management have worked with Perry Superintendent Clark Wicks and his team, Director McKenzie Snow told the Iowa Board of Education during its Jan. 11 meeting.

Gov. Kim Reynolds also signed a disaster proclamation to aid the Perry Community School District and area residents in accessing needed resources.

“We are also working with the U.S. Department of Education on recovery supports, including supports to restore the learning environment,” Snow said. “And I know in conversation with each of you, that the board stands ready to support the Perry community in any way possible now and in the future.”

Administrators and education advocates across the state pointed out Perry also received help from the Heartland Area Education Agency — an agency it contracts services through for everything from special education to various therapies — in the form of a crisis response team. During the first few days the team helped counsel students and staff, reunify students with their families and will likely be on hand when the schools reopen.

"These individuals have been instrumental in not only supporting the district with any issue that comes up including, but not limited to, mental health, but they tend to walk side by side with us through both the good and bad times," Anderson said. His district contracts with the Prairie Lakes AEA.

But Heartland, Prairie Lakes and Iowa's seven other area education agencies have found themselves in the state’s crosshairs as Gov. Kim Reynolds called for their roles to be curbed during her Condition of the State address earlier this month.

State law requires school districts to send state and federal funding for special education to their area agency. Des Moines Public Schools is the only district exempt from this requirement.

The agencies “operate without meaningful oversight,” Reynolds said at the time.

Under the proposal, school districts would be able to choose how those federal and state funds are used. A district could continue to contract with an AEA or choose another option for getting students the services they need. The agencies would also be limited to only offering special education services.

Related: Kim Reynolds proposes in annual speech to boost Iowa teacher pay, overhaul AEAs, cut taxes

The governor also asked lawmakers to combine Iowa’s 32 separate behavioral health services regions — 13 focus on mental health and 19 on substance use — into seven “unified districts.”

“Through Behavioral Health System Alignment, we are building a robust system that ensures that services are delivered consistently to all Iowa communities, including a stronger connection to our schools throughout the state,” Iowa Health and Human Services Spokesperson Sarah Ekstrand told the Des Moines Register in an email.

Over the years, Woodward-Granger Superintendent Mark Lane has seen rural districts use AEAs to contract for shared social workers and counselors and utilize the crisis teams. His current school district is rural but is close enough to Des Moines that families have access to more resources.

"That mechanism of being able to share a resource like that through the AEA system, I think is really valuable," said Lane.

Agency services like the ones Perry officials used after the shooting would cease if Reynolds’ proposals were to pass as presented, said Cindy Yelick, Heartland’s chief at administrator at Heartland.

“There is no funding for this kind of crisis response team,” Yelick said.

The cost of covering care is often a barrier

All the state programs and contracted services cannot help when there is a lack of nearby facilities able to take in more patients and a national shortage of mental health care providers.

"What do you do to take care of the student when you're waiting for that residential placement, when there's not a continuum of care?" said Margaret Buckton, a lobbyist for the Urban Education Network of Iowa and the Rural School Advocates of Iowa. "There's nothing in the middle. I think it is part of the issue too."

Cost is also a barrier to care, said Buckton.

Related: Mothers whose sons were severely wounded in Perry shootings ask for support of victims

"The other piece of intersection of the puzzle is who pays for the counseling?" Buckton said. "And in some cases, if a child is Medicaid eligible, then Medicaid pays for it or if they have private insurance that may or may not pay for it, depending on if it's covered. But there really isn't a funding stream for schools to pay for it."

The one exception is if a student's individualized educational plan or IEP calls for specific services, Buckton said. Then the district must pick up the cost.

At South Central Calhoun, officials' contract with the Seasons Center for social workers and therapists to provide in-house services for students.

"That means parents don't have to take their child to a facility that is 60 miles or (more)," Anderson said. "We try to eliminate that barrier as much as we can provide that service right in the district."

The contract runs costs between $45,000 and $60,000 a year to provide this care.

"That's a teacher and a half, just to provide professional (mental health) services for kids," he said.

Even with in-house help, there is a waiting list of 35 to 40 students.

There are bright spots in the midst of provider shortages, funding issues and possible changes to how statewide agencies operate.

The Spencer Community School District works with Classroom Clinic to bring mental health services to the school via telehealth.

Approximately 5% of Spencer's students are receiving these services, said Superintendent Terry Hemann. Feedback from students, staff and parents have all be positive.

"Currently, there is not direct funding to support mental health services," Hemann said. "A weighted funding approach is one way that the state could provide a funding stream for mental health services. There will continue to be the need for growing mental health needs of children in Iowa."

The state recently launched a pilot program similar to Spencer schools Classroom Clinic.

The state’s Mental Health and Disability Services is piloting delivery of behavioral health services in schools, said Ekstrand. This includes offering assessments, counseling and referrals via both in person and telehealth appointments,

"Regions also have established and funded mobile crisis services and participate in HHS’ disaster behavioral health response teams to help respond to crisis and emergency mental health needs in Iowa communities," she said.

Additionally, this school year middle and high school students' IDs have contact information for Your Life Iowa on the back, Ekstrand said. The group provides free and confidential, 24/7 support by trained professionals for people experiencing mental health, suicide or a related concerns.

Rural school officials and advocates still feel more can be done.

“It's no different than a kid that comes to school hungry,” Anderson said of offering mental health care. “If they're hungry, and don't have some basic needs met, how do we expect them to learn math or expect them to read?”

Samantha Hernandez covers education for the Register. Reach her at (515) 851-0982 or svhernandez@gannett.com. Follow her on Twitter at @svhernandez or Facebook at facebook.com/svhernandezreporter.

This article originally appeared on Des Moines Register: Perry HS shooting shines light on rural schools' mental health needs