We Need More Psychiatric Resources in our Public School Systems

A few years ago, my son was bullied in elementary school.  His perpetrator, while only in elementary school, seemed to suffer from very obvious mental instability.  The kid wouldn’t just tell you he was going to kill you, he would tell you exactly how he would do it (with a knife), and how you would struggle (pointlessly), and how the blood would run down your body as he cut and cut your neck.

We live in a world where a higher portion of kids are being diagnosed with serious psychiatric disorders at younger ages.  That said, teachers are educators, not psychologists.  They are not trained to recognize nor deal with problems of this magnitude.  And like so many of us when confronted with an enormous problem that they’ve no way to solve, they often ignore it and hope it will go away.

I’m not sure if kids are really sicker today, or they’re just being diagnosed more.  Either way, we have a lot of kids in public school systems that are not equipped for their needs. Some examples:

-about 2% of kids in any given year meet the criteria for bipolar disorder. http://www.nimh.nih.gov/news/science-news/2012/rate-of-bipolar-symptoms-among-teens-approaches-that-of-adults.shtml

-3% to 9% of kids meet the criteria for depression in any given school year.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016699/

-2% of kids meet the criteria for conduct disorder in any given school year http://www.nimh.nih.gov/health/statistics/prevalence/any-disorder-among-children.shtml

So every school year, 7% of the kids in the public school system are suffering from serious psychiatric disorders.  The lucky ones are diagnosed and under treatment.  Most are not so lucky.  Pediatric psychiatric disorders are difficult to diagnose and difficult to treat.  They are not revealed on a blood test, or some other absolute indicator.  They are subjective diagnoses, and they’ll only be diagnosed by a competent clinician when parents are aware enough to recognize the symptoms and seek medical care.

This leaves a tremendous burden on the public school system.  And what are we doing during this time of psychiatric crisis for so many of our kids in public schools? We’re reducing the number of school psychologists.  In my public school district, a coveted suburb of Boston, school psychologists typically cover more than one school.  That said, it doesn’t appear that school psychologist were ever intended to address the types of needs we have in our public school systems today.

The National Association of School Psychologists recommends that districts employ one school psychologist for every 500 to 700 students.  If 7% of kids are in crisis, that’s 35 to 49 crisis kids at any point in time.  No one person could serve these needs.  But in fact, no one person even gets the chance.  In actuality, the ratio of school psychologists to students can reach 1 to 3500.  http://www.apa.org/monitor/2012/09/squeeze.aspx

In an ideal system, this wouldn’t matter.  Crisis children would be transferred to therapeutic environments designed to meet their needs and aid their recovery.  That doesn’t happen.  There simply are not enough resources.  Public school budgets are tight, and while expenditures per individual student can range from $7000-$12,000 for each typical kid, a therapeutic environment is upwards of $50,000 per student per year.

So what happens? These kids remain in the public school environment, most of them undiagnosed and suffering.

I think it’s shameful that we’re failing these children.  We need to increase the psychiatric resources in our public school system to identify crisis students and build a network of support systems to ensure their recovery.

In our district, we’ve built a support infrastructure.  There’s a district run therapeutic school.  It has a maximum capacity of about 20 students.  There’s also an intensive check-in program where students stay in school but get extra services.  That program also has a maximum of about 20 students.

Our district enrollment is nearly 12,000 students.

Even with good intentions, economic resources and trained professionals are too scant to meet the psychiatric needs of our kids.  There are two costs to this.

The first cost is of course to the child in crisis.  They suffer.  Often in isolation.  And their suffering takes a toll not just on their academic performance but on their self-esteem, their sense of well-being, and their sense of hope for the future.  Many of these kids give up on themselves.  Even some families do.  I wonder what their futures could be like if they could get the help they need at a young age?

There’s also a secondary cost as we fail to meet the needs of these children.  That cost is paid by other students.  Please note that few of these kids become violent, as we sadly experienced.  Most of them turn their anger inward, becoming consumed by self-loathing.  But as these kids often require extra attention in the classroom, teachers have less time to spend with other students.  That means the learning environment has been diminished for everyone.

I wonder how much better our kids would do in school if teachers could spend more of their time actually teaching?

As we talk about school reform, I’ve yet to hear anyone address the crisis in student mental health.  How much longer will we fail these kids?