an-onlooker-watches-the-annual-solar-eclipse-in-albuquerque-new-mexicoWhen I wrote the book Invisible Children as a volunteer County guardian ad-Litem in 2005, I interviewed many teachers and have continued these conversations even today.  What has been most striking, and until  today’s candid article in the Minneapolis Star Tribune, most under-reported and single biggest factor in most classrooms, is the “thousands of students afflicted with mental health problems … flooding into schools because they have no where else to go”.

Almost all of the 50 abused and neglected children in my caseload as a volunteer guardian ad-Litem suffered from mental health issues.

About half of my GAL caseload had experienced sexual abuse, and all of them had experienced torture as defined by the  World Health Organization (WHO) “extended exposure to violence and deprivation”.

The majority of these children had been forced to use psychotropic medications, and many of them were made to take a cocktail of multiple mind numbing drugs that have not been deemed safe for children.

I write often about my visit to the suicide ward to visit a suicidal 4 year old girl, and the 7 year old foster boy who hung himself and left note about how he hated Prozac and the judge that provide me with a list of the very young children that had been forced to take these drugs during her courtroom that year.

The complex needs of abused and neglected children are a giant, and I argue, the primary challenge facing America’s education system today.  Different states handle the problem in different ways, but very states make the public aware of the depth and scope of the mental health issues like Minnesota has.  New Jersey  incarcerates youth that act out in school.  Expulsion is common in many other states.

Teachers being forced to become social workers and mental health providers with almost no resources,  is a severe and growing problem in all American schools.  Educators speaking openly about the dangers and fear of recurring outbursts by deeply troubled students injuring themselves or other children is a rarity in today’s media, but the data, including crime, graduation rates, test scores, and international achievement comparisons, would indicate otherwise.

There is little question that this problem is impacting the quality of education in our communities and needs to be addressed with adequate understanding and resources.  The full Star Tribune article appears below, and I encourage you to read it, share your comments, and & make it available to educators you know.

Teachers deserve more support and a better understanding of the issues impacting education in America today.

 

Mentally troubled students overwhelm schools

  • Article by: JEFFREY MEITRODT , Star Tribune
  • Updated: July 21, 2013 – 7:26 AM

One boy’s struggle with “Mr. Angry” highlights a growing dilemma: Thousands of kids with mental problems rely on schools for care.

The cigarette lighter sat on the family computer when Gianni awoke.

He said that a voice in his head, the one he sometimes calls Mr. Angry, told him to bring it to school — and threatened to punish him if he didn’t.

Hours later, after getting angry with his teacher, Gianni set fire to a bulletin board outside a special education classroom. The blaze was quickly doused with water bottles, but school officials had him arrested. He was charged with arson.

Gianni, who has been seeing a psychologist since the age of 3, spent the next 37 days in juvenile detention, five times longer than the typical adolescent accused of a crime in Ramsey County.

“I knew setting a fire was bad, but I didn’t belong in there,” said Gianni, who turned 15 while incarcerated. “Sometimes, my brain thinks of horrible things I don’t want to do.”

Gianni is one of thousands of students afflicted with serious mental health problems who are flooding into Minnesota schools because they have nowhere else to go.

Their complex needs are bringing huge and at times dangerous challenges to special education classrooms that are already struggling to handle increasing numbers of students with other handicaps, including multiple disabilities.

In an era of tight budgets, Minnesota has retreated from more intensive adolescent mental health treatment options, at times leaving schools as a setting of last resort for students with problems ranging from schizophrenia to bipolar disorder. And even as special education teachers and specialists try to help, many are now working forever on edge — fearful that recurring outbursts by deeply troubled students could injure them or other children.

“Schools are in over their heads with mental health,” said Mark Kuppe, CEO of Canvas Health, a nonprofit company that works with schools to provide mental health services. “They think they can hire a few social workers and school psychologists to deal with this, but the reality is those folks aren’t trained in the clinical work.”

Brenda Cassellius, commissioner of the Minnesota Education Department, said she’s hearing a growing chorus of complaints from school districts that feel overwhelmed by students’ mental health needs. Schools need more mental health professionals, she said, but can’t afford to hire them.

“We just can’t meet the demand,” Cassellius said.

Superintendent Connie Hayes said the problem has reached “crisis” proportions even at schools such as hers in Intermediate District 916 in the northeast metro that are designed to handle children with the worst behavioral problems. A decade ago, she said, students with mental illness were rare. Now 75 percent of her students have mental health issues.

“It’s like night and day,” she said.

Her district does what it can to provide clinical services with limited resources, Hayes said.“But it simply is not enough.”

 

‘Can’t take responsibility’

Gianni set his first fire at the age of 6.

His mother, Shameka Griffin, remembers her son coming into her bedroom and waking her up about 3 a.m.

“Something really bad is happening,” he told her.

Flames crawled up the wall from his bed. Gianni, who has trouble sleeping, had found leftover sparklers in a closet and a lighter in her purse.

Shameka put out the fire before it spread beyond Gianni’s room. But their landlord evicted them.

“Gianni can’t take responsibility for his actions. He is not mentally stable enough to do that,” said Shameka, who decided to speak out about her son’s mental health history because she believes the state and the school system have failed him. She gave the Star Tribune access to his psychiatric and school records and authorized caregivers and others to discuss his case.

Gianni’s odyssey through Minnesota’s public school system shows how children with mental health issues can be lost in a system geared to help students with obvious physical and cognitive handicaps. Their care comes from a patchwork of services through schools, state and local agencies and private insurance — often with little coordination.

“Who is responsible for what?” asked Curt Haats, chief financial officer for Hennepin County Human Services. “You have a lot of parties that want to do good, but they all have some piece of the accountability. If everyone is accountable, then no one is.”

 

17 different drugs

Gianni looks like a normal teenager, but he is not. Over the years he has been diagnosed with psychotic disorder, bipolar disorder and pervasive development disorder. He and his 4-year-old brother both have autism.

“People think I’m not a right person, and autism is just an excuse for me to get into trouble, but it’s not,” Gianni said. “It is something deep inside of me. It’s been there for 15 years.”

Gianni was repeatedly suspended from kindergarten for outbursts. Doctors began medicating him in first grade, when he was diagnosed with emotional and behavioral disorders and began receiving special education services.

Since then, he’s been on 17 different drugs, including antipsychotic medications and mood stabilizers. Reports show the drugs often helped him do better in school, but some produced frightening side effects.

When he was 9, Gianni spent three weeks in the psych unit at Fairview Riverside Hospital after he began talking on an imaginary phone and “voicing homicidal threats against his family and others,” according to a hospital report. Doctors blamed the hallucinations on a change in medications.

When he returned to Minneapolis schools, he was removed from mainstream classes and put in a room with other students with autism. He received no mental health services at school but was seeing a psychiatrist through Shameka’s insurance plan.

The next year, Mr. Angry became a regular companion.

In April 2009, Gianni wandered up to a neighbor working on a truck in his driveway. Gianni picked up a hammer and hit the man in the back of the head.

“He didn’t say hi, bye or anything,” the man told police. He required seven stitches but sustained no serious injuries.

Gianni could not explain what provoked the attack and cried when an officer pressed him for answers. He later told a therapist that his left hand “just did it” because “Mr. Angry” told him to.

Gianni was charged with assault, but the case was dropped months later when he was found mentally incompetent, county records show.

The incident “scared me to my core,” Shameka said. She decided to pull him from public school and enroll him in a residential treatment center, where he could undergo psychotherapy daily and be monitored 24 hours a day. She wanted her son “somewhere he could be safe.”

She was finalizing arrangements when police came to question Gianni again. They wanted to know whether he was the person seen trying to start a fire in a vacant garage. Once again, he confessed.

Gianni was immediately placed at St. Joseph’s Home for Children, which charged $2,000 a month for his long-term treatment. The costs were covered by Shameka’s insurance from her $30-an-hour job as a hospital X-ray technician.

But Gianni’s yearlong stay at St. Joe’s took a heavy toll. Constant visits with her son made Shameka late for work so often that she was fired. Three years later, she still hasn’t been able to find full-time employment.

She now depends on public programs for Gianni’s treatment.

 

Changing directions

Schools are not equipped to deal with students like Gianni, superintendents say.

Ten years ago, a child with his mental and behavioral history might have been put in a group home with other mentally ill children and attended a day-treatment program for academic instruction and mental health services.

But in an attempt to keep children out of pricey treatment centers and hospitals, Minnesota changed directions in the past decade, pouring millions of dollars into early-intervention programs while cutting funding for longer-term care. The state now serves twice as many children as 10 years ago — 55,000 in 2010, but spending per child is down 47 percent.

“The average age of the children we’re serving has been going down,” said Chuck Johnson, deputy commissioner for policy and operations at the state Department of Human Services. “We’re getting ahead of the problems earlier.”

But, some top educators say, the state did not account for the needs of students with more serious mental problems. Those children now sometimes have no place to go for help when they break down, turning schools across Minnesota into de facto treatment centers.

The number of beds at residential treatment centers in the state has fallen 27 percent in the past decade. Counties also have cut funding for day-treatment care by 55 percent since 2007.

“When I came here, Minnesota had a reputation as one of the best places to go if you needed mental health services,” said Dr. Carrie Borchardt, who has been working as a child psychiatrist in Minnesota since 1983 and with Gianni since he was 9. “And I don’t think that’s true anymore. We are providing much less.”

Schools, which once referred difficult cases to expensive day-treatment programs, have also scaled back. Canvas Health stopped getting referrals from six suburban districts in recent years, Kuppe said.

Lifespan, another day-treatment provider, was cut by several of the state’s largest school districts — including Minneapolis, St. Paul and Anoka-Hennepin — after years of treating their students.

Liz Keenan, special education director in St. Paul, acknowledged that her district can’t provide the same treatment children receive at Lifespan, which typically provides three hours of individual and group counseling per day. St. Paul paid Lifespan about $2,500 per month for each student.

“It comes back to funding,” Keenan said. “If the schools have to absorb the costs, it becomes too difficult to sustain it.”

Anne Klein, whose daughter has been diagnosed with bipolar disorder and depression, said public schools don’t do enough to address children’s mental health. One school worker was openly skeptical about her daughter’s condition, remarking in an e-mail: “Do you ever get the feeling that this whole mental health issue is a bunch of baloney???”

“It was just so wrong,” said Klein, whose family paid to send the girl to Lifespan for nine months after the school district refused to cover the bills. Klein said Lifespan “saved her [daughter’s] life.”

 

Threats at school

After a year at St. Joe’s, Gianni started seventh grade in a new school.

He was transferred to District 916, which takes children whose behaviors are too extreme for regular schools. In its evaluation, the district found Gianni was highly maladjusted and was likely to have conduct problems. He was assigned a full-time aide and was to meet with a school psychologist three times a week in 50-minute counseling sessions.

Gianni’s first year at the school was rough. Every day, he threatened to hurt and even kill other students, even though most of his anger was directed at himself, kicking furniture or hitting a wall. In his first five months, he was locked in the seclusion room three times and physically restrained once, school records show.

In a December 2010 e-mail to Gianni’s Anoka County social worker, Shameka pleaded for advice, saying her son “may not be ready for school and that perhaps a more psychiatric setup would be more appropriate for him.”

The social worker questioned the need for an out-of-home placement, suggesting that “maybe there have been too many changes within the last few months.” Instead, the county arranged for more therapeutic services. In July, the social worker noted in her log that the sessions were not going well because Gianni “is fighting it.”

The school district’s response to Gianni’s escalating behavior was to reduce his mental health services. In his second year, he received just 45 minutes of in-school therapy a week from a social worker, school records show. County and school officials declined to comment on Gianni’s care.

Gianni’s behavior grew worse. In December 2011, school workers started searching Gianni daily because he was bringing things to class that could injure others, including a broken CD.

He was suspended the next month after he tried to hit another student with a heavy book and threatened to “blow your frickin’ head off,” school records show.

The school called local police, who charged Gianni with making “terroristic threats” and placed him in juvenile detention overnight. The charges were later dismissed when Gianni was found mentally incompetent.

District 916 officials recommended that he be removed from school and enrolled in a day-treatment program, according to the social worker’s log. The move would have given Gianni three hours of therapy a day.

The county rejected the plan, “due to his aggression,” the social worker wrote.

For the rest of that school year, Gianni attended just a half day of school in his own classroom with his own teacher, isolated from other students because of “his escalating behaviors and concerns regarding his mental health,” school records show. He went home each day at 11:30 a.m.

Without commenting specifically on Gianni’s case, Superintendent Hayes noted that her district and two others that specialize in high-needs children routinely wind up with students who have been kicked out of residential treatment or day treatment for aggressive behavior.

“It begs the question: If they are too aggressive for a mental health treatment environment, why is a school environment the best place?” Hayes asked in an e-mail to the Star Tribune. “Our state has allowed a system to develop, due to a lack of planning at the policy level, for schools to be the default placement for these seriously mentally ill students — without any planning, preparation, collaboration or resources to do so successfully.”

 

Mr. Angry resurfaces

Worried the school was failing Gianni, Shameka asked the district to move him. At his new school, administrators allowed him back into a classroom with six other disabled students for the 2012-13 school year, despite concerns about his mental health problems. Gianni’s therapeutic sessions were reduced to one 30-minute session weekly with a social worker.

Workers at the Little Canada school no longer searched his pockets and backpack, Shameka said.

Initially, at least, Gianni stayed out of trouble. Even when a classmate insulted him with a racial epithet, he did not become violent, records show. A January report shows that Gianni was making adequate progress on his academic and mental health goals.

Then, on April 16, Mr. Angry spoke up again, demanding that Gianni bring the lighter to school. Gianni admitted he used it to set fire to the bulletin board. The school was evacuated, frightening dozens of disabled kids.

“If they had just checked my pocket, all of this wouldn’t have happened,” he said in an interview with the Star Tribune.

School officials agreed with police that Gianni should be arrested because of the “severe” nature of the incident, police records show.

Gianni spent the next five weeks in juvenile detention. His barren cell had a concrete bed and steel toilet.

Meg Kane, Gianni’s lawyer, tried to move him into a residential treatment center, but nobody had any vacancies and Anoka County social workers refused to help, citing “liability issues,” she said. Anoka County officials declined to comment.

Gianni was denied video games and other items that calm him. His mother could visit only twice a week. He said he was bullied constantly.

“It was pretty scary,” he said. “I felt like I was in there for 50 years.”

Shameka said Ramsey County officials told her Gianni had three psychotic episodes and threatened suicide after an incident on the basketball court. She said her son, who rarely smiles or shows emotion, cried on his 15th birthday.

Gianni’s teachers and therapists wrote letters to the judge pleading for Gianni to be sent to a treatment facility or released to his mother. On May 23, after once again deciding that Gianni was mentally incompetent to face criminal charges, a judge let him go.

“That’s unacceptable,” DHS’s Johnson said of Gianni’s ordeal.. “We shouldn’t have kids going into the juvenile justice system who don’t belong there.”

 

Sent to Utah for help

Children across the state are waiting as long as a year for their first appointment with a psychiatrist. If a young person has a crisis, they may be forced to go out of the state for help because there aren’t enough beds here.

“Our state is not capable of managing the complex mental health problems that we have here,” said Dr. George Realmuto, medical director at the state mental hospital in Willmar.

Realmuto recently had to send a boy from Hennepin County to Utah because he couldn’t find a residential treatment center able to take him anywhere in Minnesota. “How is it that Utah has more services than we do?” he asked.

In an interview, senior DHS officials conceded the move from institutional care has created a service “gap” for at least 100 students with behavioral problems too intense for schools or for existing state facilities. Minnesota may have to create a new type of facility that would provide intensive psychiatric care to such students for as long as three months, as well as offer other services, said Glenace Edwall, the department’s director of children’s mental health services.

“We want to acknowledge that we have a ways to go in creating and funding the children’s mental health system,” Edwall said.

Edwall noted the department recently received legislative approval to double a program that pays for school-based mental health services, but, department officials said, the nearly $10 million in funding for 2015 will still be $22.3 million short of what is needed.

Cassellius, the education commissioner, said she will meet with top officials at other state agencies — including corrections and Human Services — to address the crisis.

“Is this a problem because there are not enough beds on the DHS side, or is this a problem of adjudication (of juvenile criminal charges), or is this a problem of special ed in schools?” asked Cassellius. “How do we get at the root cause instead of coming up with a Band-Aid solution?”

Educators say the state has to rethink its approach to mental health and figure out which students belong in settings other than schools.

“We are teachers. We are counselors,” Hayes said. “We don’t provide medical, clinical therapy. That is not the mission of schools.”

 

Alone at his party

Gianni brandishes a makeshift sword alone in his back yard, battling imaginary enemies.

“The darkness will take hold of you,” he warns in an ominous tone. “No, it won’t,” he shouts in response, his voice spiraling higher.

Inside, his homecoming party is in full swing. Friends and relatives overtake the living room of the family’s modest home in Fridley, as Shameka, amid tears of relief, rushes to feed them some of Gianni’s favorite foods: hot dogs, steak, zucchini and asparagus.

Gianni flits through the party, pausing just long enough to accept an occasional hug or friendly question before retreating to his bedroom and his video games.

“He’s going to get tired of this,” says his grandmother, as Gianni wipes her kiss off his face.

Gianni is free, but the fallout from his jail time remains. His annual state aid of $30,000 of mental health services was terminated because he spent 30 days in juvenile detention, a disqualifying event.

Shameka is worried by her son’s new belief that he might belong in jail. Gianni’s psychiatrist said the extended jail time could permanently damage the boy. “He could develop worse anxiety or obsessions,” Borchardt said.

Shameka is still angry that school officials had her son arrested and that it took so long to free him. She is not sure where to turn or what to do about school come fall, even though she said the principal wants him back.

“To be honest, I don’t think the district is capable of handling Gianni.”

 

Jeffrey Meitrodt • 612-673-4132

2 Comments

  1. Comments to this article from Linked In writers; I have been a school social worker for 24 years. The increase in children with serious mental health issues in public schools is huge. On the flip side the schools have more and more pressure to have students performing on grade level. There has to be a balance between the responsibilities of the schools and the responsibilities of the community agencies. There are days when I feel I work in a mental health facility instead of an educational setting. With the cut backs in special education services including social workers, I am afraid for these students in the future. There just is not enough staffing in a regular public school to meet the needs of so many highly at risk children. I love my job, but I feel like I can not meet all the needs while having the pressure of documenting success, academic growth.
    By Jamie Irwin-Stavropoulos

    It would be good to play the devil’s advocate here and look at the community perspective. Schools are increasingly expected to be responsible for the biopsychosocial needs plus teaching children how to perform academically. Generally, unless there is an IEP that stretches through the summer, they only have 180 days in which to accomplish their primary tasks.. reading, writing, and math competencies. While I agree that schools can be of assistance and need to support children in learning, I think that children who have major mental illnesses should be entitled to services that form wrap-around care inclusive of the parents. Parents/caregivers should be enabled to participate in these care plans. This of course boils down to funding. Does that come from the educational cost pocket, or children’s services, or the state’s department of mental health ? I might suggest that everyone is avoiding responsibility here particularly the parents. One of the roles that social workers’ have is to not just provide services (in an imperfect system) but to empower people (parents in particular) to advocate politically, legislatively for their children’s needs. It is important to remind folks (legislators, policy makers) that these children eventually do leave school and the failure of the total system (not just the schools) ends up costing more. It takes a committed social system (not just schools) to help these children.
    By Elise Beaulieu
    Since the school is the main (and possibly only) environment where a child’s difficulties may be addressed, it would be proactive for monies to be put into schools solely for the purpose of inclusion of Social Workers with the purpose of solely working with the mental health issues in all schools. There are many programs that aim to rehabilitate individuals, however, not enough is spent on prevention.
    It is not only logical, but it is practical to address the issues in this manner and during this period of the child’s life when change can be effected by providing tools and addressing problems that are at the root cause.
    Appearances are that although we have come so far in society, political agents manage to overlook, ignore, or pass the buck on issues of great importance – our children being one of them.
    By Margie D’Arienzo, LSW (pending)

    Schools often wonder why it IS their role to provide treatment to children with mental illness. That is a rather new expectation in the history of schools. It is a problem in which social workers can have a lot of influence, since causes of problems of this magnitude are related to family, society, economics, local politics and expectations,state politics, the increased prevalence of mental health issues and behavioral problems, drug companies, etc. Alongside of direct practitioners we need social workers trained in community organizing to tackle these huge and complex problems.
    By Lauren Cull Norford

    This whole issue troubles me. I once witnessed my state dept of mental health allow a 16 year old to be placed on an adult male forensic unit. Needless to say, while my work with him was somewhat successful, there were behavioral issues that were normal adolescent behaviors which the staff were not willing to give credence. So, when those “normal” behaviors occurred, the majority of the staff felt obliged to correct him with “consequences” often creating a less than therapeutic environment for him. The department’s view was that their professionals and security aides could handle anything. He was 16 years of age and had the physique of a relatively small sumo wrestler. Understandably, what with a psychosis that caused him to displayed dangerous behaviors, his age and size, placement was difficult, at best. The bottom line is that a new milieu needs to be designed for these children. Juvenile detention, in my view, does nothing more than create more profound problems. I don’t mean to be stepping on toes here, but I think it’s high time we forget about possible criticism and keep trying to find answers. There is no room for professional turf wars or jealousy when it comes to problems of this magnitude. And, it goes without saying that mental health social workers should be in the forefront of developing a more successful milieu.
    By Judy Toner Cohn

    The comments I have read from above give me heart and hope for the roles of social workers in the school system. I know I sounded so negative in my comment, but I have no doubt that you can tell I have been so very frustrated in the latter years in my school and school system. I do appreciate the support and positive comments you, my peers have given, I humbly thank you. 🙂
    By Charlene Benton

    I am a LCSW that has worked with middle school and high school students in Mental Health for 15+ years. I then left Social Work for about 5 years and obtained my Special Education Teaching certification and taught in a self-contained classroom at an “alternative school” for about 2 years. After those two years it was decided to try to mainstream these students and send them to regular Ed. classrooms accompanied by me and/or a classroom assistant. The self-contained classroom was never used again, only inclusion. Some of my students were unable to maintain in the regular setting and would then be sent back to the “Self-contained” classroom with me. Then the next day they would again return to the regular Ed. class. Many students have difficulty with adjusting to new environments, but to have it change daily was ridiculous.

    Believe me, they soon figured out if they wanted to leave the regular classroom and go to the self-contained room, for what-ever reason, they would do what they had to in order to leave the regular room. We had a school psychologist, who did testing. We had a behavior specialist, (who had been a Special Education teacher, but with no additional training in mental illness), that would write “Behavior Plans” for the student. She would come to the classroom and watch the student for 15-20 minutes max, and then leave. Then she would present the plan with no input from the teachers or assistants who were with the students for the greatest part of the day. Needless to say, this was not effective.

    The school contracted with an outside agency who would come get a student who was acting out. They would come and pull the student from the classroom and walk around with student for an hour. There was a release of information for the therapist to communicate with the teachers, etc. but they WOULD NOT share anything they had worked on with the student, or learned. They would attended IEP meetings, and they were on the “team”, but the term did not apply here. Imagine working on a behavior goal, but not knowing some of the triggers for the behavior. The therapist would also undermine the teachers. One such example was a student acting out, the therapist coming to the school, and taking the student out of the classroom, and walking with the student down the hallway, patting him on the back and saying, “you know how she is”, talking about the teacher.

    Cooperation needs to occur between the school and the outside agency if that is how the mental health issues in a school system are to be addressed. To me, personally, the ideal situation is a social worker in the school who can specifically deal with mental health issues. No offense to school social workers, but in my experience, they deal with a broader spectrum of things and haven’t had the training through their school emphasis on social work rather that the social worker that has had more mental health emphasis and training.

    I’m certain I will get blasted for these statements, but that is how the school system I worked in addressed these issues. Of course now, in NC, with the cuts in Education, classroom sizes will increase, teachers jobs have been cut and there will be fewer assistants in classrooms. So I don’t see ANY schools hiring a social worker with a mental health emphasis for the school system. Schools aren’t willing to pay the salaries for MSW’s or LCSW’s. By the way,,,,at this point, I am returning to the world of Social Work.
    By Charlene Benton

  2. It is sad that so many of our children are so afflicted. Since Special Education is a federal program, I believe that they should tap into the benefits of The Affordable Care Act. If not for the greedy, these kids would be getting the services and support they need and what I mean by that statement is the public school system was never meant for those within a certain income bracket(s) whose children are using the resources meant for children of the poor. Horace Mann, the starter of public schools, started this program as a way to teach the children of the poor and teach them a trade. Sandra Corder

Leave a Reply

Your email address will not be published. Required fields are marked *

clear formPost comment