Expanding Mental Health Services in Schools to

Address Problems Related to Violence and Youth

 
Mark D. Weist, Ph.D.
Center for School Mental Health Assistance
University of Maryland School of Medicine

May 5, 1999

My name is Mark Weist. I'm an Associate Professor in the Department of Psychiatry at the University of Maryland School of Medicine in Baltimore. Since 1991, I have been providing mental health services to youth in a high school in the city and directing a program that has grown to include 20 schools. Our program provides what I call expanded school mental health (ESMH) services - assessment, treatment, case management and prevention to any youth, in regular or special education who would benefit from them. Exposure to violence is probably the number one stress factor on city youth, and therefore many of our efforts are focused on helping youth to avoid violence involvement and/or cope with its impacts. Baltimore is a national leader in the development of these programs, which helped us to receive a grant from the Maternal and Child Health Bureau of the U.S. Department of Human Services in 1995 to establish the Center for School Mental Health Assistance (CSMHA), which I direct. The center, and its counterpart as UCLA (directed by Howard Adelman and Linda Taylor) aim to provide technical assistance and training to schools and communities in establishing and/or improving mental health and supportive programs for youth in schools.

The growth of our program from 4 schools in 1989 to 20 now, and the establishment of two national centers reflects a trend toward expanded school mental health programs that is gaining momentum in this country. There are many reasons for this growth. Perhaps most prominent is the fact that we are finally waking up to the reality that mental health needs in youth are the most neglected category of health care needs. Finally, we are realizing that youth mental health problems are more common than serious physical health care problems, with around one-fourth of children and adolescents benefiting from some mental health intervention at some point in their lives. Sadly, while around one fourth present needs for services, less than one third receive any services and far fewer receive appropriate and effective services.

Why has there been such a gap between youth mental health needs an effective services? A major reason is that in this country we have really not invested in children's mental health, and the demand for services far outstrips available resources. This is true for community agencies and for schools. There are many barriers that prevent youth from receiving mental health services in community agencies such as community mental health centers. These include barriers that operate in families such as limited knowledge of mental health problems or approaches to the problems, transportation issues, financial concerns, mistrust of mental health professionals, stigma, and stress in families that often precludes a focus on a child's emotional or behavioral difficulties. These barrier also operate in the community centers, with problems including long waiting lists, insurance obstacles, long intake procedures, and heirarchical models of treatment involving "expect" advice from busy and aloof professionals.

Similarly, mental health services in schools are usually quite limited. School counselors often have upwards of 400 students on their caseloads, limiting their involvments to academic advising and brief crisis counseling in may communities. School psychologists and social workers are often part-time staff with significant responsibilities in the special education system, which limits their abilities to be there for the students. While each of these professionals has excellent professional training an skills, their benefit to the students is limited by their relative scarcity.

Clearly, we have a tremendous need for capacity building in children's mental health. As we are realizing this, in increasing numbers of communities around the country, we are witnessing the growth of a national movement toward expanded school mental health. As mentioned, this is what our program in Baltimore is all about - providing comprehensive and effective services to youth in regular and special education, where they are - in school. And programs like ours are developing all around the country - in Albuqureque, Dallas, Denver, Los Angeles, Memphis, New Haven, New York, Pittsburgh, Seattle, and many other places.

Typically, these expanded school mental health programs represent the joining of the school with community mental health, health , and in some case, juvenile justice and social service agencies. As barriers that constrain the use of community mental health ceners are increasingly evident, more and more communities are moving to reapportion some of these services out of the centers and into the schools. As such, community mental health staff are joining with school hired mental helath professionals, teachers, school health staff, school administrators, and with youth and families, in shoulder-to-shoulder efforts that build effective, culturally sensitive and locally responsive programs.

We are increasingly documenting the benefits of these expanded school mental health programs. These benefits include unprecedented access to youth, enabling staff to work with as man as 20 youngster in a day, compared to the 4 or 5 usually seen by staff in community agencies. We are also documenting that these programs are reaching youth who otherwise would be unlikely to receive services such as youth with less observable problems like depression, anxiety and social skills problems. We are reaching troubled youth early, as teachers can identify these children in preschool. But without adequate resources in the school, identifying a student in need can be frustrating when there is nothing to offer except referral into special education or a mental health agency in the community, which in either case can take months, and then offer little.

I must note that a critical advantage of these expanded school mental health programs is that they remove barriers to children's learning and are leading to improved school behavior and performance for countless youth. Children who are contending with abuse, violence, depression, or attention problems have difficulty learning, and we now realize that these problems have to be addressed for schools to achieve the achieve the academic outcomes they are striving for. We are also beginning to document that these programs are leading to improved emotional and behavioral adjustment, school completion, and functioning in society for the many youth they serve. However, we really are in the early phases of this movement; much needs to be done to both develop and expand programs, and to conduct research on ingredients associated with their success.

Importantly, these expanded school mental health programs offer much to efforts that seek to help youth avoid involvement in violence, and if they are exposed to it, to cope with it. In Baltimore, exposure to violence is probably the number one stress factor on youth from disadvantaged areas of the inner-city, and much of our efforts in schools are directed at addressing multifaceted aspects of this problem. Specifically, we are forming teams involving the school psychologist, social workers, counselors, health staff, teachers and youth and families to develop interventions to address every level of violence. We are initiating school-wide efforts to educate children about violence and its impacts, strategies to stay safe, and strategies to cope with witnessing it or being victimized by it. We are helping youth to realized that symptoms of depression, post traumatic stress disorder, and even intense anger may be normal reactions to violence, and we are helping them to address these symptoms through interventions that have been documented to work. We are developing conflict mediation, peer mentoring and peer leadership programs where youth are stepping up and saying they will be part of the solution and not of the problem of violence. We are identifying youth who are at-risk for victimization by or perpetration of violence early, and we are providing focused and proven-to-work treatment services for them. We are offering any array of treatment services to youth including individual, group, and family therapies, and we are helping youth to connect with services in the community. We are establishing partnerships with community organizations and religious institutions to develop mentoring programs where youth at risk can have the chance to develop a relationship with a positive and caring adult from their community. And the list goes on.

I should add that in my role as a member of the American Psychological Association, I am chairing a task force on violence and youth. We are looking at multiple dimensions of youth violence involvement including type of exposure (e.g., as a witness, victim peretrator), setting for violence (e.g., school, home, community) an approach to the problem (e.g., prevention, assessment, treatment). While we are still early in this process, preliminary findings indicate that most of the work related to violence and youth has been at the level of describing the problem. While there has been some work to develop approaches to help youth avoid involvement in violence, this work has not broadly reached schools and communities in the United States. And, efforts to assist youth in coping with exposure to violence have been sorely limited. Clearly, much work needs to be done.

My thoughts and prayers are with students, staff and families from Columbine High School and the Littleton, Colorado community. I have been shaken by this tragedy, as I know that people from all over the country have been. Its time for us to take a stand for children and adolescents in our schools and communities. Joining with them, their families, pastors, teachers, doctors and coaches, we need efforts that offer them the best support that we know how to offer them in school. Expanded school mental health programs are an important part of these efforts, in generally promoting behavioral and school success, and in addressing problems related to violence and youth.

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