Despite Covid-19’s Emotional Traumas, Student Mental Health Services Dry Up
By: Abigail Kramer
When New York City released its "Bridge to School" plan in late August, officials called on teachers to make students' mental health needs their top priority. The Covid-19 pandemic – combined with months of quarantine, widespread job losses, and a national reckoning on racial injustice – “have resulted in significant stress, trauma, grief, and loss for our 1.1 million students," City officials wrote. "Many of our young people are in pain.”
But as kids finally resume classes – remotely this week and in classrooms next – they will find that many social workers and other mental health care providers have disappeared from school budgets.
"We're turning off the spigot to kids with serious needs," says Bill Baccaglini, the executive director of the nonprofit New York Foundling, which runs mental health programs in 22 public elementary, middle, and high schools, mostly in Upper Manhattan and the Bronx.
Like many providers, Foundling pieces together funding for its school-based mental health programs from multiple sources, including a $50,000 annual investment from most of its partner schools. Over the summer, Baccaglini heard from multiple principals that they likely can't afford to keep the programs going in the coming year.
Still more schools are waiting to see what the fallout will be from a $9 million cut in the City budget to the Community Schools program – an initiative that brings extra services, including mental health care, into previously struggling schools. And several nonprofits that offer school-based mental health care through one-off contracts with schools or the New York City Department of Education (DOE) have already reported major losses to their funding and ability to keep programs running.
The consequences could be dangerous, Baccaglini and other mental health providers say.
Since long before Covid-19 arrived in New York, the state has faced a chronic shortage of mental health care for children and adolescents, with sick kids often sitting on waitlists for months to see a therapist or child psychologist. The State Department of Health estimates that one in five New York children has a diagnosable mental health disorder, yet fewer than half of those kids get any kind of professional care, according to surveys. Suicide is the second-leading cause of death among New Yorkers aged 15-19, with numbers rising fastest among Black teenagers.
Over the past decade, dozens of New York City schools have cobbled together strategies to bring mental health clinicians directly into school buildings, where therapists can respond to emergencies and work on site with students. For example, students in approximately 500 of the City’s 1,700 schools have access to onsite mental health clinics or to medical clinics that may offer some clinical mental health care according to the DOE. In recent years, the administration of Mayor Bill de Blasio added in-school, clinical services to an additional 200 schools through its Thrive NYC programs, as well as hiring a cadre of 85 clinical social workers to respond to emergency requests.
The bulk of Thrive money, however, has gone to consultants and training programs for school staff, rather than clinical care for students. The DOE does not publish a total count of schools with clinical services on site (and did not provide that number on request), but advocates for students say that clinical care is available to just a small fraction of New York City students, either through school-based clinics or special initiatives. In 2019, 44 percent of schools did not have a single social worker on staff, according to an analysis by the Independent Budget Office.
And now – as budget forecasts for New York City and State grow ever more dire— nearly every funding stream that supports mental health programs in schools faces a serious drought.
Resources are drying up at a time when many kids need mental health care more than ever, experts say. At best, six months of pandemic lockdown have upended children’s lives and routines. While there is no official count of young people who have lost family members, thousands have seen their homes destabilized by lost jobs and income. In the neighborhoods hit hardest by Covid-19, many young people are also subjected to the emotional toll exacted by police violence against Black communities, as well as the ongoing fear caused by federal crackdowns on immigrants.
“If you had a pre-existing condition, it’s exacerbated,” says Aaron Newman, the deputy director of behavioral health for Children’s Aid, a large nonprofit that offers mental health services at several City schools. “We had one student that had more traditional OCD [obsessive-compulsive disorder] symptoms and was starting to do really well. This just kicked it up more — now she had a real reason to do repetitive hand washing. For other kids, they’re all living in a world with tremendous fear and heightened anxiety. ‘Is it safe for me to go to school?’ ‘If I’m living with a grandparent, am I going to bring this virus home?’”
At the most dangerous end of the spectrum, doctors in various parts of the state have reported a sharp rise in young people who show up to emergency rooms in serious mental health crisis, including after suicide attempts.
There is plenty of research to suggest that school-based programs offer an effective way to help struggling kids. In national studies, 96 percent of students followed through on a referral to school-based counseling, in contrast to just 13 percent of students who were referred to outside clinics. Various researchers have found that young people who receive mental health services in school show significantly decreased absenteeism and tardiness, fail fewer classes, and get in less trouble in school. In one large-scale study, students who received counseling in school-based clinics had an 85 percent decline in school discipline referrals.
“The kid got on the school bus, then broke down.”
In New York, providers say that many of the students who show up in counselors' offices have experienced major upheaval, such as being placed in foster care or living with domestic violence. "Those trauma experiences impact their ability to connect with people," says Reina Batrony, the vice president of community-based services at New York Foundling. "We see a lot of depression and anxiety."
Because counselors have relationships with kids and school staff, they can respond immediately to a crisis, Batrony says. When a student at one of Foundling's partner schools committed suicide, the onsite social workers were able to do grief counseling with teachers, set up drop-in hours for students, and help the child's parents and siblings get support.
The ability to respond to an emergency frees up teachers to focus on teaching, says Amy Duncan, a site supervisor for Astor Services, which provides school-based mental health services in the Bronx and mid-Hudson Valley.
"First thing in the morning, a child might be refusing to come into school, or sobbing as they get off the bus," Duncan says. A staff member will radio for Duncan, who's in the school building full time. "I might find out that someone in the family died the day before, or that the parents had an argument before school and someone got arrested. The kid got on the school bus, then broke down."
Duncan works with one student who has outbursts in the classroom, throwing things, knocking over furniture, and threatening to kill himself or hurt other kids. Because she's onsite and has a relationship with the child, Duncan can intervene and de-escalate the situation, coaxing the student into her office until he calms down.
That kind of intervention not only allows the rest of the class to continue learning; it's also crucial to keeping kids out of police cars and emergency rooms, advocates say
In 2019, New York City police officers removed students in emotional distress from their classrooms more than 3,400 times, taking them to hospitals for psychiatric evaluations that doctors say are often unnecessary and needlessly traumatic. In nearly 260 of those incidents, children were handcuffed.
Black and Latinx students bear the brunt of policies that send police into schools, accounting for close to 90 percent of so-called "child-in-crisis" incidents, though they make up less than 70 percent of public school students, according to an analysis of publicly reported data by the New York Civil Liberties Union.
Most of these police interventions could be avoided if schools were staffed with mental health professionals, says Dawn Yuster, the director of the School Justice Project at Advocates for Children, which represents and advocates for New York City students.
"If you want to compound the trauma that our students have already been experiencing because of the pandemic and because of police brutality and systemic racism, then you will operate as we did before schools shut down," Yuster says.
Bridge to School: Crossing troubled waters
When New York City schools shut down in March, school-based mental health programs went virtual, offering therapy sessions to students and their families by phone or video. They were also able to track down students who didn't show up for online classes, and to help get support to families directly affected by Covid-19, says Aaron Newman from Children’s Aid. One therapist in Newman’s program, for example, created an online bereavement group for students last spring.
Like many providers—and to some surprise in the field—Newman found that online mental health services worked remarkably for children and their families. In working with younger kids, therapists found it much easier to engage with parents and other family members online, rather than asking them to leave work and find care for other children in order to attend clinic appointments. With adolescents, therapists found that many were more comfortable and open on-screen than in-person. And for all families, having a view into kids’ homes makes the work more relevant, Newman says. “For many young people, this makes so much more sense than traditional ‘come sit in an office’ model.”
Also like many mental health providers, Newman predicts the need for such interventions will last for a long time. “After Covid subsides and we find a vaccine, the emotional scars for our families are going to remain. The next big pandemic will be a mental health pandemic,” he says.
Education officials seem to share that concern. Over the summer, the de Blasio administration raised $1.9 million from private foundations to pay for the Bridge to School plan, which offers trainings for teachers and a specialized curriculum on social-emotional skills for students. It also enlisted a national nonprofit, the Child Mind Institute, to run a hotline for the remainder of 2020 to answer teachers’ questions about mental health.
The City's Bridge to School plan suggests activities, starting on the first day of school and continuing multiples times each day, to build social-emotional skills and help kids manage stress. For teachers of the youngest children, for example, there are lessons on mindful art activities and body scan meditations. For middle schoolers, there are activities that ask students to share hopes and fears, and to help them build support networks.
The goal is, in part, preventative, officials say.
“By establishing this emotional foundation, the DOE is to reduce the number of students requiring intensive clinical mental health services,” wrote Scott Bloom, the DOE’s director of school mental health services. “This initial care also prevents adults from pathologizing behavior that reflects a typical stress response – in particular, students of color – and prevents students from being re-traumatized by a premature referral for clinical services.”
But critics contend that the Bridge to School plan – however well-intended – amounts to an impossible mandate, instructing teachers to triage mental health problems without nearly enough help from mental health professionals.
At a time when teachers and principals are debating Covid-19 safety guidelines, scrambling to fulfil staffing mandates, planning hybrid in-class and remote learning schedules, and contesting the DOE's assessments of windows that won't open and HVAC systems that don't work, the City hasn't answered a crucial question, says Yuster from Advocates for Children: Where's the help for students with serious mental health needs?
"We absolutely appreciate the City's proclaimed commitment to social-emotional learning, but we haven't seen or heard of any plans for providing direct mental health services," Yuster says. "The City has proven they can figure out really creative way to get money to pull together trainings. Those resources should be directed toward helping students, particularly students with significant mental health challenges."
"If everyone involved – if all the adults in schools, in the City government, in the NYPD – if everyone could think of every interaction involving a student who has mental health needs as if it was their own child, I think we would all be doing things really differently," Yuster continues. "We would be doing right by our students."
9/16/20: This story has been updated to include data and comment from the DOE.
Abigail Kramer is a senior editor at the Center for New York City Affairs at The New School.