One by one, Tucson teens are stepping up and sharing their stories of depression, anxiety, suicidal thoughts and other mental health concerns.
They’re sharing deeply personal stories in roomfuls of strangers in an effort to get local school leaders to listen and take action to change a system that they feel has failed to support them and their friends.
But how Pima County school districts handle student mental health crises is, in some cases, somewhat imprecise and, in most cases, far from universal. A lack of funding doesn’t help the situation.
A group of student activists from March for Our Lives Arizona has been making the rounds at local school districts, most recently at a Governing Board meeting of Tucson’s largest school district, TUSD, in January.
One student organizer, Mina Hicks, described an encounter where a school counselor told one of her friends to “figure out” her feelings — which suggested she had depression and an eating disorder — on her own.
“When adults did very little, I didn’t know what to do, and I was left to pick up the pieces of my friend, who tried to kill herself on multiple occasions,” Hicks told the Tucson Unified Governing Board and its superintendent, Gabriel Trujillo.
Halle Bauer-Bedrick, a Tucson High freshman affiliated with March for Our Lives, chastised TUSD’s approach to addressing mental health concerns.
“Our district treats (mental health) in a way that isn’t helpful or beneficial or progressive, but in a way that leaves kids to their own devices,” Bauer-Bedrick said. “How should we be expected to do well in school or want to continue our education if we’re shown time and time again our schools don’t care enough to help us?”
A LOCAL APPROACH
The processes used to identify and respond to students deemed at-risk of suicide and other mental health issues vary from district to district and, sometimes, from school to school within a given district.
The protocols and procedures employed can vary because the Arizona Department of Education does not require districts to go about mental health education, prevention, identification and response in any particular way, according to ADE spokesman Stefan Swiat.
The lack of universalization at the state level is a testament to Arizona’s local-control approach to government, Swiat said.
“Decisions are left to governing boards and localities to determine what’s best for them,” he said. “The state’s role is to issue guidance and assist in any way it can.”
ADE partners with other state organizations, like the Arizona Health Care Cost Containment System, to offer “high-level” support and guidance for mental health prevention and intervention methods but, again, it doesn’t require schools to take their suggestions.
The main difference between Tucson’s major school districts is their processes for identifying students in crisis.
Some districts take a more proactive approach, actively seeking to identify students who might be struggling with their mental health before it becomes a worst-case scenario: harming oneself or others. The Marana School District, for example, administers student wellness assessments and can make interventions based on the results.
Other districts tend to intervene after a student is already in the throes of that worst-case scenario. For example, while some Tucson-area school districts utilize data to identify concerning behaviors or patterns indicative of other issues, at least two reported relying more so on students and teachers noticing students in distress.
HELPING KIDS IN CRISIS
Though their prevention methods differ, the nine Tucson districts that discussed their mental health intervention methods with the Arizona Daily Star appear to follow similar student response protocols.
The response process generally resembles connecting with the at-risk student, determining if they are a higher or lower suicide risk, informing their family and getting them help.
To gauge risk levels for suicide, counselors will seek to determine how long a student has been thinking of harming themselves and whether they have a plan and the means to do it.
Depending on the student’s answers, a school could respond in a number of ways.
Most local districts said that when a student presents with a high degree of suicidal ideation — thoughts of suicide and a plan for how to do it — they call a parent and recommend they take their child to a county Crisis Resource Center.
Providers at these centers, unlike most school-based mental health professionals, can diagnose and determine a course of clinical treatment for students with mental illnesses. Schools can also call a mobile crisis unit to come and clinically evaluate the student, if the situation warrants it.
After the student has been evaluated by medical professionals, district crisis response teams and schools administrations work with families to transition the student back into the most normal school schedule possible.
Every district said they handle every student’s reintroduction on a case-by-case basis. Some kids might need special accommodations to get back into the swing of things, while others may not.
When students do return, school counselors, principals, teachers or a team comprised of all of the above keep an eye on the student. Most districts mandate kids have weekly check-ins with a school counselor or other “trusted adult,” like a coach or teacher.
Some districts, including TUSD, Flowing Wells and Sunnyside, have agreements with community health agencies that allow mental health professionals to treat students while they’re at school, if their parents approve it. Marana has an internship program for educational psychologystudents at the University of Arizona and Northern Arizona University, which allows them to provide mental health counseling to students and families at Roadrunner Elementary.
Other districts, like Tanque Verde and Flowing Wells, don’t offer in-school services, but refer kids to out-of-school treatment for their mental health struggles. The district referrals and community partnerships can often expedite wait times to see therapists, counselors and psychiatrists, according to Marana School District student services director Cindy Ruich.
Preventing crises is a different ballgame.
At least four of the nine major Tucson-area school districts — Sunnyside, Vail, TUSD and Marana — report following a three-tiered approach to schoolwide and individual mental health and behavioral health needs. Sahuarita utilizes this approach at its schools serving grades kindergarten through eighth. Catalina Foothills will begin implementing a multitiered model next school year.
“It’s a prevention and intervention model,” said Celeste Nameth, the Positive Behavioral Interventions and Supports program specialist at ADE. “It is a system-wide change, and it’s a three- to five-year commitment to actually implement, according to research.”
The idea is to establish a positive, connected school climate where mental health issues are destigmatized, prevented as much as possible and handled swiftly and efficiently when they come up, Nameth said.
The first PBIS tier focuses on universal, or districtwide, interventions, like a school counselor giving all middle and high school classes a presentation about mental health issues and how to get help for them. It could also include training for all teachers and staff about suicide prevention.
Second-tier interventions address smaller groups on a more individualized basis. This could take the form of a counselor-led support group for students struggling with specific issues, like poor impulse control or test anxiety.
Third-tier interventions are the most involved and most individualized. Students dealing with serious mental illnesses and/or suicidal ideations are usually the ones getting one-on-one, tier-three treatment.
Districts identify students who might need a tier-three intervention based on staff observation, behavior and office disciplinary referral data and self-reporting.
Schools look at office referrals because an uptick in disciplinary actions with a student doesn’t indicate they are a bad kid — it means they are likely struggling with a number of issues, mental illness included.
A LACK OF PEOPLE POWER
The multitiered approach is the best way to proactively and reactively deal with student mental health needs, according to Sarup Mathur, a special education professor and researcher at Arizona State University.
But evidence-based systems like it require ample support from school counselors, psychologists and social workers to actually be effective.
Currently, most Arizona schools can’t provide that degree of support.
The nationally recommended counselor-to-student ratio is one to 250, according to a report from the American School Counselors Association and the National Association for College Admission Counseling.
In Arizona, the ratio is more than 900 students for every one counselor — one of the worst ratios in the country.
This ratio spreads counselors thin with nearly unworkable caseloads at the elementary, middle and high school levels.
To put it into perspective: Tanque Verde High School is one of the few local public schools with a counselor-to-student ratio near the national recommendation — one to 300 — but it is also one of the smallest public high schools in the Tucson metropolitan area, district Superintendent Scott Hagerman said.
“They (the counselors) do have more time to develop 504s (individualized learning plans), get kids to resources, get them support,” Hagerman said.
Districts struggle to hire more counselors, social workers and other school-based mental health professionals because of a lack of state financial support, Mathur said.
“We have a shortage of resources,” Mathur said. “We have a shortage of training. It gets very difficult for schools to adopt these kinds of (preventative) practices.”
Some Tucson districts, like Catalina Foothills and Sahuarita, are hiring more counselors, despite the financial burden. TUSD, which serves over 47,000 students, could hire up to four full-time counselors as soon as next school year, if the Governing Board approves the expense in June. TUSD also raised the base salary of school social workers by $2,000, at its first board meeting of the year.
Other districts, like Tanque Verde, have said they will explore the possibility of hiring more counselors, social workers and psychologists as they examine their fiscal year 2019-2020 budgets.
Other districts have utilized free mental health education resources from local nonprofits to fill the gap.
TUSD, for example, has mandated all its staff to go through NAMI Southern Arizona’s “Ending the Silence” program, which educates school staff on how to respond to students who disclose they are struggling with their mental health, according to Judi Maikoff, the Ending the Silence coordinator at NAMI.
TUSD, Vail, Catalina Foothills, Marana and Sahuarita also regularly invite NAMI to give 50-minute presentations to students at their middle and high schools, Maikoff said.
WHAT THE KIDS WANT
The students affiliated with March For Our Lives Arizona want the stigma surrounding mental health and illnesses to dissolve.
They want to see statewide improvement in the student-to-counselor ratio and a change in how schools handle students with mental illness in general.
That’s why they spoke at the TUSD meeting last month, and that’s why they successfully petitioned the Governing Board to pass a districtwide mental health resolution. The student group also persuaded Catalina Foothills and Tanque Verde to adopt the resolution.
“Mental health is not a partisan issue,” Bauer-Bedrick, the Tucson High freshman, told the Star after the meeting. “It can affect you in different degrees of intensity, but everyone has a mind.”
In passing the resolution, TUSD acknowledged all students deserve services supporting their their mental and emotional health.
TUSD has also promised to lobby the state Legislature to allocate more funding toward mental health supports like school counselors and social workers in public schools.
It’s too early to tell if local districts will take any other measures in response to the students’ calls for help, and what they can do, given budgetary limitations.
“We do have kids who are struggling and most of the time, they’re at school. I personally think that’s the best opportunity to provide them services of this kind,” Mathur said. “We have to bring in expertise of all kinds of disciplines and become more open-minded of listening to that.”