Shortage of mental health care workers for children affects schools, cities across nation

Shortage of Mental Healthcare Workers

The Denver Post reported that while experts agree that school mental health professionals are key to ensuring student safety, some of the largest school districts in the Denver area do not come close to meeting guidelines regarding student-to-counselor ratios.

Three times the recommended guidelines
In Denver Public Schools and Douglas County, for example, the ratio of students to counselors were more than three times the national recommendation of 250 to 1, and counselors working in schools were often expected to handle other duties with no relationship to mental health.

Samantha Haviland, president of the Colorado School Counselor Association, added that a counselor’s duties also include helping students with career and college plans and doing behavioral and crisis intervention. Haviland, who was a student at Columbine High School during a shooting that left 13 people and the two gunmen dead, told a state legislative committee that discussions about school safety often miss a crucial component in preventing violence: mental health support.

“When you are talking impact and where do we prioritize in order to prevent school violence – we have the drills in place, we have the locked doors in place – but we do not have the mental services in place,” she said.

The health policy database for the National Association of State Boards of Education indicated that recommended staffing guidelines are 250 students for one counselor, 1,000 students for one psychologist and 400 students for one social worker.

The reality is quite different, and many schools fall far short: The American School Counselor Association shows that the national average is actually one counselor for every 457 students – nearly twice the recommended ratio.

According to the Washington Post, the ratios in some states are significantly higher than the national average. Arizona, for example, home state of the gunman charged in the 2011 shooting rampage that killed 6 and wounded 14, including Rep. Gabrielle Giffords, averaged 743 students per counselor. Minnesota schools saw an ever greater disparity, with 759 students per counselor, and the largest gap was in California at 814 students per counselor.

In addition, according to a study published in 2010, at least one in five young children in the United States has some mental disorder, but fewer than half of the states require public elementary schools to hire mental health professionals.

David Esquith, director of the U.S. Department of Education’s Office of Safe and Healthy Schools, emphasized that more mental health services are needed, and they’re needed in the schools themselves.

“It’s a resource issue in terms of funding to support the delivery of services,” Esquith commented. “I think we’re finding that traditional outpatient settings are not as effective as school-based mental health services.”

While on-site mental health services will help deter school violence, most experts believe it will also improve the learning environment in general.

Shortages beyond schools
The need for more mental health workers may be highly visible in school settings, but the problem is far more systemic. Psychiatric News reported that a series of high school suicides and a major child-molestation case in southern Delaware has led to extensive to calls for more mental health services, but so far the response has been inadequate.

Between Jan. 11 and March 22, 2012, eight young people ranging in ages committed suicide in the two southern Delaware counties, Kent and Sussex  – twice the average number for an entire year.

After the suicides, the Centers for Disease Control and Prevention (CDC) launched a study and found that over a slightly longer time – Jan. 1 to May 4, 2012 – there were actually 11 deaths by suicide in those counties, and all of the suicide victims had from two to five risk factors, including substance abuse issues, mental health problems, parent-child conflicts and legal issues.

Studies and strategies
The CDC recommended several prevention strategies, including training counselors to identify at-risk youth and reviewing evidence-based suicide prevention strategies and continuing to implement CDC guidelines for reporting suicides.

As for the child molestation case, the state legislature called for a study of mental health needs in Kent and Sussex counties, with resulting recommendations of better training for child mental health professionals in the two counties and improved case-management services.

“There is no one full time at the hospitals in Kent and Sussex and no inpatient units,” said Carol Tavani, M.D., president of the Delaware Psychiatric Society. “That’s a real crying need.”

Tavani sees a number of complicating factors in western Sussex, a rural area, and they may apply to many other rural areas in the country.

“There’s a relative lack of awareness about psychiatric issues and that help exists for [patients seeking it],” she said. “Fewer people have insurance or it’s hard to find someone to take Medicaid. There is also a lot of stigma attached to psychiatric issues, and so we have to educate the public.”


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