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Student needs increasing in face of dwindling outside resources

December 16, 2018

When asked if the mental-health needs of their high school students are being met, Flathead County principals, counselors and school-based therapists answered separately, but unanimously - there is a lot of need, and at times, the needs are overwhelming the available resources.

The sentiment, shared by staff interviewed at Bigfork, Flathead, Glacier, Whitefish and Columbia Falls high schools, is also one shared by many.

According to the National Alliance on Mental Illness, one in five children ages 13 to 18 have, or will have a serious mental illness and nearly 40 percent of students with a mental-health condition age 14 and older drop out of school.

Overall, Mental Health America ranks Montana No. 40 in the nation for mental-health care. The rankings, determined by an evaluation of 15 measures, evaluates a state’s prevalence for mental illness and rates of access to care.

Flathead County is working improve those numbers, and both school and hospital employees agree that tackling mental and behavioral health problems should start with youth.

“When you’re a kid and you learn things at an earlier age, they tend to stick with you throughout your lifetime,” said Leslie Nyman, director of behavioral health at Kalispell Regional Medical Center. “It changes the culture of whatever you want to do, it allows you to be successful.”

The thought is simple: healthy youth will grow into healthy adults and thus, influence healthy communities.

“A school of 1,300 is just a microcosm of the community at large,” Glacier High School Principal Micah Hill said. “These kids will eventually become active adults in our county.”

In 2016, Flathead County health providers, community organizations and other groups created the Community Health Improvement Plan. The No. 1 objective of the plan, which is set to be re-evaluated in 2019, calls for increased psychiatric services countywide, including in schools.

While strides have been made in recent years to accommodate the needs in schools, there are a host of challenges to addressing mental health - the cited lack of psychiatric services being just one.

Others that top the list include a depletion of facilities necessary for those with more serious, immediate medical needs and a lapse in communication between those facilities and schools on reintegration tactics for a child who has had to temporarily leave school.

The Daily Inter Lake interviewed a dozen health-care and education providers across Flathead County. Collectively, those interviewed in schools represented more than 4,000 high-schoolers.

Mental-health care shifts to schools

“It’s really not the hospitals, the clinics, the medical side of it. Schools have become the mental-health providers and in some ways that makes a lot of sense, because schools are obviously a captive audience for children,” said Michele Paine, principal of Flathead High School. “The hard part about that is now you have to train schools and staff members in mental-health supports.”

To the surprise of many, schools are rapidly becoming primary providers of mental-health services for youth.

Teachers are being trained in suicide prevention, counselors are sometimes asked to provide advice beyond their scope of expertise and students-assisting-students programs are now available in every school to help students identify and address problems among their friends.

“It’s not therapy, it’s not counseling. It’s a place where you can go to talk about what’s going on in your life with kids who are going through similar things,” said Solveig Munson, a counselor at Bigfork High School. “The idea is to build relationships and learn to talk about things that are bothering you, that are going on in your life.”

In addition, the five high schools have successfully implemented school-based mental-health experts through the Comprehensive School and Community Treatment program (CSCT). The CSCT teams, typically made up of a licensed clinical social worker and licensed clinical counselor, are coordinated in conjunction with Kalispell Regional Healthcare.

Then CSCT workers are licensed to handle a wide range of mental-health needs. But their services are often pushed to capacity, which is considered about 10 to 15 students per CSCT representative, based on need. If more students require attention, they often challenge themselves to rise to the occasion.

“We’re going to work with the kids and we’re not going to say ‘no, we don’t have time.’ We’re going to do it. But at the expense of our stress levels” said Lindsay Jordan, a CSCT worker at Whitefish High School. ” We’re going to do what we have to do. We’re going to give of ourselves that way.”

Jordan can cite a few times where the number of students who needed her and her teammate, Jenny Profitt, was overwhelming and they believed a second team would benefit the high school that serves around 500 students.

This year, Glacier High became the first to have two CSCT teams under its roof, which was requested based on the “needs of the student population.” Yet, in a high school of more than 1,000, the four CSCT employees at Glacier High can only help about 30 students in need at any given time, according to Hill.

Beyond CSCT, two high schools, Columbia Falls and Whitefish, now also have a school-based mental health clinic that was established through North Valley Hospital. Every week, medical professionals from NVH are available to help those with more acute or chronic needs.

According to Scott Gaiser, principal of Columbia Falls, said been an instrumental resource for the school. The statement is echoed by Kirke Steadmon with North Valley Hospital, who oversees the school-based programs.

“We’ve had instances where this [clinic program] has saved lives,” Steadmon said. “It’s so very impactful to hear that and that’s really the reason why these kind of programs exist.”

There’s no doubt the team efforts between school and hospital employees have helped foster a backbone for basic and intermediate-level mental healthcare needs in the schools. However, the bulk of the county’s educational system still lacks the ability to provide immediate care to students that may be considering harming themselves or others.

But referring a student to a clinic or group home - often referred to as “inpatient facilities” - is no easy feat. Sweeping budget cuts have depleted the facilities available, especially those that cater to youth, and the referral often leads to communication gaps between the facilities and schools on how to reintegrate that student into school post treatment.

Lack of cash and communication

Glacier High Counselor Chris Weaks compares communication issues to the Hawaiian Islands.

“So you can get to Hawaii, but you have to plane-jump to the next island, so the service has to leapfrog to the next agency. So in other words, we might have a student who’s in crisis and then we might refer them to a service, but then that service might have to refer them to another service. We all live on these islands and we’re trying to coordinate these services, but it’s a challenge,” Weaks said.

Lapses, brought on partially by confidentiality agreements between hospitals, parents and students, was the most common concern among high schools.

In recent years the issue has become more challenging after sizable statewide budget cuts delivered fatal financial blows to mental-health facilities statewide. Many transitional housing units, group homes and organizations able to bring in youth with mental or behavioral issues outside of schools were forced to close their doors.

In 2018, Sinopah House, an all-girls home in Kalispell, closed after more than two decades of operation. Around the same time, Aware, another provider, shut down both of its Kalispell homes.

The closures displaced many youth and adults in need and brought a sense of financial uncertainty for facilities, including the Sunburst Foundation, a nonprofit organization that offers inpatient group-home care throughout the area, and Turtle Bay, a mental-health clinic that provides more intensive therapeutic services.

“When you think of the programs that have closed, it puts more stress on the other ones trying to survive and make it through budget cuts,” said Mandy Winegardner, administrative supervisor for the Sunburst Foundation. “There are people that still have needs and we can’t just shut our doors and say ‘good luck.’”

Many of those left to bear the brunt of displaced patients on top of regular patient loads had to lay off dozens of employees, many of whom helped students re-adjust to life in school.

Perhaps the most devastating budget slash was the $18 million cut to case-management services - a leg of mental health care that is vital for maintaining services.

When asked if Winegardner believes mental health is receiving the attention necessary from the state and county, she answered “absolutely not.”

According to Winegardner, the cuts left behind only a handful of case managers to care for the increasing load of patients. Where case managers normally average a caseload of about 20, Sunburst Foundation’s load per case manager typically averages more than 30, which impedes on the foundation’s ability to deliver a high level of care to each patient.

“The needs are not diminishing, the needs are continuing to increase, but the services are becoming more limited,” Weaks said. “Some of these places are doing amazing work, but again, the needs are outweighing the resource availability.”

However, Leslie Nyman with KRH said the quantity of need is nothing new and that there has always been a lot of need, but now it is becoming more apparent.

“I think that’s twofold,” Nyman said. “I think, one, our population is growing, and it isn’t that everything’s just much worse than it was 20 years ago, but I think there’s more of an awareness of what’s going on.”

Addressing a long-standing stigma

Many agree that one of the largest obstacles facing mental-health care in high schools is adjusting the outdated stigma that “mental-health problems are embarrassing” and “mental-health problems are bad.”

It’s one that can be addressed as the discussion topic of mental health becomes more commonplace in school hallways and beyond.

“There is such an important piece of being part of a sort of tribe,” said Scott Gaiser, principal of Columbia Falls High School. “If they [students] have a sense of belonging and place to be I think we can address some of these mental-health issues.”

Reporter Kianna Gardner may be reached at 758-4439 or kgardner@dailyinterlake.com.

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