In 2019 we saw the first decrease in suicide rates since 1998. That’s the good news. But you would probably not be surprised to learn that the story was different in 2020. While it’s too soon to get the data for suicide rates, the CDC reports hospitals saw a significant uptick in the number of children under 18 admitted for mental health emergencies in the past year. Suicide attempts have skyrocketed, more than double the numbers in 2019.
Distance learning during COVID brought plenty of challenges for schools. Not being able to see students in person and interact with them in a way that they are used to has undoubtedly been hard for teachers, counselors, and students. But people who work in schools find creative solutions to problems, and counselors have stayed connected with students.
Districts that use health management software to track mental and behavioral health have an advantage. They can quickly review a student’s health history and take appropriate action when needed. Documenting interactions is one way counselors keep tabs on students who may be struggling.
Know the past to shape the future
This is a story about Maria, a middle school counselor who works for a large district in Texas. She believes that using a mental and behavioral health tracking tool with diligence makes a tremendous difference in how schools can support their students. Maria feels certain that having mental health history available at her fingertips saves lives.
Here’s why. Maria met with a new 6th grader for the first time because the student was experiencing suicidal ideation. The child had hit another student. When the teacher told her she had to go to the office, the girl responded by saying she was going to kill herself.
Maria knew nothing about this child, having never met her before. She logged into the school health tracker and, within minutes, saw the entire health history from the elementary feeder school. This student had a mother who was incarcerated for killing her husband, the girl’s father. The child had a history of depression, anger management issues, had been in and out of foster care, and obviously was unstable as a result of the trauma she had experienced.
During the time it took for the student to calm down in her office, Maria was able to read the student’s entire mental health history. With that background information, she knew how to interact with the child. Maria knew what to do with her, what sets her off, what to say, and what not to say to her.
Health records showed that the elementary school counselor had referred this student for outside counseling. Thanks to having access to that information, Maria knew who to contact to help the child. She also knew not to try calling the mother.
Maria can share story after story about her students and how valuable having their health records is to her as a counselor. A 9th grader she had worked with for three years was known to be at risk for suicide. She had attempted several times, even though she had a psychiatrist and was on medication. Before her first year at the high school started, the counselors had a heads up about her background along with her entire health history. They had a foundation to start building a relationship with her; they knew what worked and what didn’t, who to call, who not to call, and what to expect from her.
Then there’s the girl who was sent to see the counselor because a teacher overheard the child talking about suicide. Maria pulled up her Columbia suicide risk assessment and saw that she had ranked low to moderate the previous week. With that information, Maria knew not only baseline data, but she could see the trajectory the student was on. She also learned that the girl was prone to self-harm, that her home was dysfunctional, and that she’d been bounced back and forth between mom and dad while they were in the middle of an ugly divorce. That background knowledge helped Maria connect with that child because she already knew so much about her.
Mental health tracking is saving kids’ lives because school counselors document so many important details. That includes data about who is at risk for suicide, when they’ve attempted, and whether they have a psychiatrist or an outside counseling agency involved. Suicide Risk Assessment records can be uploaded and kept on file. Any counselor meeting with a student has access to all records.
Overcome barriers with information
That information is also critical during the school closures that happened because of the pandemic. If a student contacts the counseling department through a virtual zoom room, any counselor can read those notes, see the student’s history, and reach out to help.
Think of the teenagers who are home alone all by themselves, hour after hour each day. Working parents come home at night, make dinner, and go right to bed because they’re exhausted. And so the kids are up all night on their phones, texting and using their social media. Fortunately, high school counselors have maintained a connection with their students and can keep a virtual eye on them.
Some students, while they are not suicidal, have severe mental health disorders. Maria talked about a little girl who believed in her mind, heart, body, and spirit, that the angel of death lived on her shoulder. She was on some very serious anti-psychotic medication. She had a psychiatrist and a therapist, but those people are in her life once a week or once a month. As the school counselor, Maria sees her every few days. The mother signed a release so Maria can send reports to the therapist and confer with him to discuss the student’s behavior. The psychiatrists use that information to gauge how well the student’s medication is working and monitor her treatment.
Collaborating with outside mental health agencies provides far more support for those students than schools can offer alone. The documentation system cannot be underestimated because school counselors see those students more than any outside mental health professional will ever see them unless they’re hospitalized.
Mental and behavioral health care
School counselors in Texas are required to have suicide prevention training annually as part of their continuing education. Maria finds value in the training, learning about changes in the field, and current statistics. She was shocked to find out about the increase in suicidal ideation among elementary students at her last seminar. She made connections to the fact that children born with fetal alcohol syndrome are now parents themselves, and some of them have drug-addicted babies. Maria believes that growing up in households with three generations of children who have been affected by addiction and live under a shroud of mental illness may contribute to suicides of children as young as 10.
Lack of affordable mental health care is an urgent problem not only in Texas but across the country. On average, one in four people will experience a mental health condition in a given year. Most of those are not being addressed. Families often lack the financial resources, even if they have insurance, to pay for the cost of having a child treated. Many parents, fearing the stigma of mental illness, are reluctant to seek care for their children.
Even if there are enough providers available in a community, many do not take insurance. That’s not surprising since insurance companies pay mental health professionals only a fraction of their hourly fees, and it often takes months before they receive reimbursement. The less obvious side of that issue is that providers who accept insurance may not be as well trained or have the same level of experience as those paid directly by their patients.
Be the voice
School counselors have become advocates for mental health parity. Deeply concerned about the adolescent and preadolescent mental health crisis in their communities, they are sounding the alarm. Advocacy can pay off. Using their data, school counselors convinced decision makers of the need for mental health care at the district level and in Maria’s community. Advocacy for high-needs children contributed to opening a new Children’s Services unit for mental illness and behavioral health at the local center for health care services.
Maria encourages all counselors to be active members of their state School Counseling Associations. They must voice their concerns and write their representatives at the state and national level to lobby for better mental health. Why bother? Because that’s the business they’re in. They’re helping to improve mental health support for parents and their children. Those children will grow up to be parents themselves. Mentally healthy children have a better quality of life and can become productive, responsible, law-abiding citizens. They are more likely to avoid taking the route of a school-to-prison pipeline that has ruined the lives of so many of their peers.
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A Culture of Caring: A Suicide Prevention Guide for Schools (K-12) was created as a resource for educators who want to know how to get started and what steps to take to create a suicide prevention plan that will work for their schools and districts. It is written from my perspective as a school principal and survivor of suicide loss, not an expert in psychology or counseling. I hope that any teacher, school counselor, psychologist, principal, or district administrator can pick up this book, flip to a chapter, and easily find helpful answers to the questions they are likely to have about what schools can do to prevent suicide.