Responding to a significant increase in mental health crises among students, Shrewsbury school officials are reaching out more than ever to families in an attempt to address problems like anxiety and depression.
“It became even more evident during this school year that children are dealing with more significant mental illnesses than ever before,” said Erin Canzano, the School Committee’s chairwoman. “Especially at the high school level, they’re seeing more emergency referrals that need to go to hospitals for things like hurting themselves or suicide attempts.”
The state does not have guidelines on mental health for schools. With no standard model to follow and tight finances, the delivery of mental health and behavioral health services in public schools is a tricky area. So Shrewsbury, like many school districts, is working to carve its own path in delicate terrain.
“I think school districts are recognizing this is a big important issue, but how each district is addressing it is different,” said Bob Babigian, president of the Massachusetts School Psychologists Association.
His group is working on recommendations to give schools some guidance in the constantly evolving mental health arena. As a starting point, the generally favored approach is termed “wraparound” support, he said, which means there are school-based professionals who get to know students and school culture, in addition to specialists outside the schools who can be called upon for their expertise.
Having every school district approach mental health differently has pros and cons, said Babigian, a school psychologist in Brookline’s system.
“I think it’s nice in some ways because different schools have different needs and different populations,” he said. “At the same time, some school districts may be underutilizing the resources they have.”
It sounds like Shrewsbury is doing more than most, he said, but he worries that for any district, financial constraints might prevent schools from doing important work.
Shrewsbury has struggled with school financing. The latest budget proposal for next fiscal year shows level funding for the school district, which should mean no cuts in mental health services. But without the option for additional funding through a Proposition 2½ override to raise taxes, which selectmen had discussed but decided not to propose this spring, the district will not be able to fully address the mental and behavioral health needs of students in the most effective way, said Canzano.
Shrewsbury educators hypothesize that there are three factors at work in the recent increase in mental health issues: the lagging economy has put extra stress on families, a high-achieving atmosphere means students are under pressure, and larger class sizes leave teachers with less time for every student.
“In 2010, we started to see a real increase in the level of mental health issues in both regular education students and special education students,” said Melissa Maguire, director of special education and pupil personnel for the Shrewsbury school district. “As you see the turn of the economy, you also see increases in depression and anxiety, not just in students but in parents.”
Hospitalizations are on the rise, even among elementary school students, and the youngest students are showing signs of illness that normally do not become evident until children are in middle or high school, she said.
“We’re seeing kids who are in AP courses, who are brilliant kids, really, really struggle,” said Maguire.
Mental health services have expanded in recent years, and in January the district increased the role of a psychiatrist who has worked in the system since 2010.
Dr. Kim Kusiak, the consulting child and adolescent psychiatrist for Shrewsbury’s schools, now works for the district 15 hours per week.
Most of her time is spent on cases at the middle and high schools, Kusiak said, but she has seen children at the elementary level having problems with executive functioning. That means children have trouble following directions with multiple steps, then they get frustrated and often anxious, and ultimately fall behind in their school work.
In middle school students, she said, she sees anxiety, including levels so severe that a child feels unable to stay in class, and attention-deficit hyperactivity disorder.
At the high school level, it gets even more complicated.
“Very frequently you’ll hear about kids who are cutting, self-injury,” said Kusiak. “You get kids who are dealing with depression, you get a lot of kids who become overwhelmed [with] anxiety again so they stop coming to school, and then there are a ton of kids that get into really difficult social interactions and can’t navigate the social component and want to drop out.”
She said it has become more common in the Boston area to have a psychiatrist affiliated with a school district because there are so many teaching hospitals in the region.
But that does not mean all districts use the expertise the same way. In Shrewsbury, Kusiak said, she observes students, meets with families, and provides strategies for parents and teachers.
“My job also is to help the people in the schools to understand how they might best come at a kid,” she said. “So if they’ve got a kid being oppositional, maybe that kid is so overwhelmed with anxiety that if you approached it this way instead of that way” the result might be better.
Kusiak leads monthly forums for parents on various topics and also runs a course every semester, with eight to 10 sessions, for parents who want to spend more time learning strategies.
She does not diagnose, but she can refer families to the type of professional, program, or even book that might help their child.
“It’s such a new realm that there really is no standard of care yet,” she said.
And Kusiak can troubleshoot. Psychiatrists are not trained to understand school rules or special education regulations, so sometimes they can make suggestions to patients that are impossible in a school setting, and that end up causing problems in the relationship between the school and family, she said.
So another element of what Shrewsbury does is work with psychiatry fellows in their training at the University of Massachusetts Medical School in Worcester to help them understand the intersection of medicine and public education.
“We’re trying to bridge that gap,” she said.
In its quest to provide as much help as possible, Shrewsbury has developed some partnerships, like one with Jewish Family Service of Worcester.
The agency sends staff for two hours per week into the schools to observe individual students or whole classrooms, and then offer advice to teachers to deal with whatever the situation might be, said Beth Greenberg, director of school-based services for Jewish Family Service.
Such work is largely preventative, she said, and the idea is to help the students who might otherwise fly under the radar because their behavior is not severe enough to warrant crisis intervention.
“Schools are forced to focus on the students with the greatest need,” said Greenberg. “The long-term goal is to cast a little bit more of a safety net over a broader population of students.”
Babigian said looking after a child’s mental health is just as important as academic support because the two are intertwined.
“If they’re not getting the support and resources they need in that area, they’re not going to be available for learning,” he said. “It’s a huge part of a student’s development, and it can’t be ignored.”