It no longer takes a crisis to get professional mental health counselors into schools.

 

As much as resources allow, mental health care providers are now there in force, helping to identify students’ needs and head off potential problems before they happen, but greater mental health awareness and recent national and world events have combined to increase demand to a near breaking point.

 

“The demand has increased significantly,” said Erin Goodwin, northwest region director of children’s services at statewide provider Arisa Health.

mental health

Erin Goodwin

Once, outside counseling was mainly made available on a case-by-case basis when the need arose, such as after a horrific event like a school shooting or disaster. However, school districts these days regularly contract with professional mental health service providers, who act as an augment to the counselors and teachers on the front lines when trying to identify students who may need help with an issue. With a parental referral, a student can now normally obtain professional counseling — perhaps on campus, perhaps off — as needed, when needed.

 

“What we try to do in the schools is when we first see signs of something, we meet with the parents and try to get early intervention for the student so they can have a positive school experience,” said Tiffany Randall, coordinator of student-centered support services with the North Little Rock School District.

Tiffany Randall

Increased awareness has lessened the societal stigma that can surround the subject of mental health in the U.S., while the COVID-19 pandemic and life in an uncertain world have contributed to the strain on school districts and especially the providers trying to help.

 

“What we are struggling with now is finding enough school-based providers who will be active and consistent and still committed to providing school-based services,” said VaShonda Eason, of northwest Arkansas-based Eason Counseling.

 

Need and knowledge

 

With a Ph.D. in educational leadership, Katherine Ellsworth spent 26 years in Alaska before coming to Arkansas during the summer to be closer to her daughter and to escape her former home’s long, cold nights.

Katherine Ellsworth

As director of student support services for the Bentonville School District, Ellwsorth’s impressions of student mental health needs in Arkansas track with what other districts have been seeing: a growing awareness of mental health issues in society fueling a greater need for services, a spike in that need due to the COVID-19 pandemic, and mental health issues influenced and exacerbated by social media and other external factors.

 

“A lot of stress here is due to affordable housing. People are doubling up,” Ellsworth said, while some are literally becoming homeless. Data USA reported that in 2022, Benton County, with one of the highest homeless rates in the state, had 11.7 percent of the population living with severe housing problems.

 

“It could be the home life, or it could not be the home life,” Ellsworth said. “Sometimes it’s the pressure to achieve academically.”

 

The Bentonville district contracts with Eason Counseling, Arisa Health and Community Services, all of which provide licensed therapists primarily in school settings, but also through office counseling.

 

“I wouldn’t call them full-time providers,” Ellswoth said. She explained that at the main high school there is a full-time provider, but often the therapists split time between schools.

 

“It depends on what the needs are,” she said.

 

Eason Counseling offers individual, family and group counseling in a school-based setting and works with the Bentonville, Rogers, Fayetteville, Springdale and Prairie Grove districts, offering two clinics in the downtown Rogers and Johnson areas.

 

School-based mental health care has become more popular as it has been made more convenient, Eason said.

mental health

VaShonda Eason

“The biggest purpose for school-based therapy, what we were seeing 20 years ago … for lack of a better term, it was inconvenient for parents to have to go check their kids out of school and take them to the office and take them back,” Eason said.

 

An intake appointment is typically held at an Eason Counseling office, after which therapy is normally held weekly. Some outlying schools are allowed to offer intake appointments on campus, again, for the sake of convenience.

 

“We are also depending on districts that allow us to do family or group at the schools,” Eason said.

 

While the situations are somewhat fluid as far as who is at what northwest Arkansas school location and when, Ellsworth said that within the individual counseling framework, there is consistency.

 

“Once you start with a kiddo, you stay with a kiddo,” she said.

 

Mental health therapists and school administrators agree that students have always dealt with certain stressors in their daily school lives, from tests to being accepted by their peers. Today, there is simply more outreach by those in need that is spreading mental health service providers thin.

 

“One of the reasons I think we see an increase in people reaching out to mental health providers is they’re more aware of how to do that,” Ellsworth said. “There’s not as much shame in seeking help.”

 

Caring for the caregivers

 

Arisa Health is the product of four community health providers in the state who combined under one banner. Arisa serves more than 2,100 schools in 48 districts and grades pre-K through 12.

 

“It depends on the districts, but as of this summer, we had about 229 school-based providers,” said Goodwin, a 14-year industry veteran who explained that, depending on school population, location and other factors, there could be two therapists at one school or one therapist serving a three-building smaller district.

 

Goodwin noted that the favored term these days is “behavioral health,” which is more encompassing than “mental health.” That is partially due to the wide range of issues that can affect students but are also seen in other settings, such as jails and police departments. Trauma, post-traumatic stress disorder, anxiety, adjustment issues, attention-deficit/hyperactivity disorder and substance abuse are problems many people share, whether they are school-age or older.

 

“It’s everything,” Goodwin said.

 

The pandemic certainly marked an increase in demand for mental health services, Goodwin said, but demand was on the rise beforehand.

 

“I think we had seen a rise in access to services,” she said. “Our numbers as far as client services were increasing before the pandemic.”

 

The COVID-19 pandemic, however, certainly marked a great divide, a clear before and after. For example, Goodwin observed that suicide rates had been dropping before the epidemic, then went back up after the pandemic struck. Data from the Centers for Disease Control and Prevention shows a 4 percent increase in overall suicide rates from 2020 to 2021 after two consecutive years of decline. CDC data from 2020 showed about 19 percent of high school students had considered suicide the previous year and about nine percent had made a suicide attempt.

 

“Even before [the pandemic], there were things like cell phone usage and social media increasing isolation and depression in students,” Goodwin said. “There’s other factors — just the traumatic things going on around the world.”

 

Indeed, overlaying the more common problems kids might deal with, such as fitting in socially or achieving academically, are the fears that come with living in an uncertain world full of violence and economic instability.

 

“We have seen an increase in both the number of clients or students needing services, as well as the intensity,” Goodwin said.

 

The accelerated demand has strained the ability of behavioral health providers to provide services to those in need.

 

“We’ve had to say no, unfortunately, I think more than we have in the past. We want to protect the wellbeing of our therapists and not spread them too thin,” Goodwin said.

 

According to the Commonwealth Fund, as of March, there were 160 million Americans living in areas with mental health professional shortages, and more than 8,000 more professionals were needed to maintain an adequate supply.

 

“I could probably hire 100 more therapists tomorrow and get them full and seeing clients,” said Goodwin, adding that Arisa has attended recruiting events at universities and even high schools, including a recent event in central Arkansas, in a search for talent.

 

“I would agree that both the awareness, which is huge and wonderful that help is available … that has been a positive thing for accessing services, but then definitely the demand is tough, and also the decrease in therapists is an issue that we face,” Goodwin said.

 

Eason pointed out that while awareness was increasing demand pre-pandemic, most mental health service providers were also negatively affected by the COVID-19 pandemic. Clinics shut down for safety reasons, and people were not as likely to allow others into their homes, so there was an interruption in services right when students may have needed them the most.

 

“What I gather and the information that I get from my agencies, the thing is the issues were there before the pandemic, maybe not glaring in our faces,” said Lisa Williams, mental health coordinator with the Little Rock School District. “However, after the pandemic, the world had shut down. Families had to stay together. There was abuse, loss of jobs, coming back to school. What did we see? An exacerbation of illnesses, an increase in underlying things that were already there and whatever they experienced during the shutdown, when the school was closed and the world was closed.”

 

Now that the providers are back in business, the pent-up demand, already on the rise before the pandemic, returned with a vengeance, overworking therapists and thinning their ranks.

 

“Since 2017, we’ve lost three major agencies in this area where we’re pioneers. … They’ve closed for a multitude of reasons, but one of the reasons is not having enough people to work in a school-based setting,” Eason said.

 

Additionally, professional health care counselors began utilizing telehealth or telemedicine, essentially taking their caseloads, leaving their agency and going into business for themselves.

 

“We found that a lot of our clinicians would go into private practices,” Eason said.

 

Fewer counselors meant those who remained were being asked to do more, double up workloads or have a presence in more schools. School-based counselors would encounter their own isolation issues because they were essentially flying solo without colleagues or immediate support.

 

“It can lead to burnout, and it’s not for everyone,” Eason said.

 

Since behavioral health counselors are as human as their young clients, the age-old issue of care for the caregivers has surfaced due to the increased demand for services. While caring for clients, Arisa Health and other providers are also trying to care for their own overworked people. For example, Arisa partners with the Whole Health Institute through the Walton Family Foundation to help provide for employee wellbeing.

 

“They are just overwhelmed,” Goodwin said of the therapists. “They have more students than they can handle.”

 

The new normal

 

The North Little Rock School District keeps a list of approved providers on the district website. The first item on the list is approved mental health service providers. Randall said the providers must sign a memorandum of understanding with the district allowing for confidentiality, and parents will sign a referral form for the provider they choose.

 

“We just give the therapist a space on our campus for them to do the work they need to do,” Randall said.

 

The North Little Rock district’s main provider is the STRIVE School Based Program of the University of Arkansas for Medical Sciences in Little Rock. The program allows there to be a full-time therapist on every one of the district’s campuses.

 

“It all has to go through the parents, of course, and they have to fill out the paperwork and do all that, but they have that at their fingertips if they want that for their child,” Randall said.

 

Williams said the Little Rock School District works with in-house guidance counselors, district-employed social workers and 13 professional mental health care providers with which the district contracts. She stressed that while there are 13 agencies, each one could potentially represent five to six therapists per school.

 

A former school-based therapist herself, Williams said mental health care has become more prioritized at the district level than when she joined Little Rock 12 years ago.

 

“At that time, agencies, mental health providers were kind of coming and going,” Williams said. “There were no contracts with a district as a whole. There were contracts with schools.”

 

With district help, Williams cleaned up the process to allow for qualified district-level contracted mental health service providers.

 

“The need is there. I’ll tell you that,” Williams said. “You’ll be surprised the need is there. Even though I have that many [personnel], the need is there, and I could possibly use more.”

 

Forgetting for a moment the pandemic, recent wars, economic uncertainty, and other current and recent events that add direct or indirect stress to the everyday lives of young people, kids have always been kids, which means they have always had the kind of unique issues that come with growing up and finding their places in society.

 

It is important to remember that the first time a student deals with something, it is the first time they are dealing with something, meaning an event can seem like an overwhelming tragedy for a student while also providing an opportunity to learn how to cope with stress and challenges in a healthy way.

 

“Depression symptoms, anxiety, conflict resolution, adjustment issues,” Williams said. “That runs the gamut from anything — loss of job, changing family dynamics — any unaddressed trauma.”

 

Normalizing mental health care and making it a part of everyday school life, as well as teaching students how to deal with problems as they arise now, can stave off problems that could manifest when students become adults.

 

“I tell my kids what you’re doing right now is practice for what adulthood will be like,” Eason said. “As we grow older, it becomes difficult for us to learn those skills.”

 

Having everyday mental health care and counseling in a school setting the same way speech therapy or remedial reading are provided further serves to normalize the notion that good mental health can be approached shamelessly and without stigma. Students today might actually point out their therapists to their fellow students, Goodwin said.

 

“I heard a couple situations where students say, ‘Hey you should go see this therapist I see,’” Goodwin said. “They’re a lot more open about who they’re seeing, and I think parents are more willing to sign kids up for therapy services.”

 

Goodwin noted satisfaction surveys that show 90 percent of the students who got some sort of counseling or help saw their mental health improve, and 91 percent saw academic improvement. Additionally, Arisa is one of the state’s providers that also offers free outreach services such as professional teacher development, behavioral health education for students, leadership education and Zoom calls with parents.

 

Mental health providers may be spread thin as they try to help the state’s students these days, and the underlying causes are many, but no one really wants to go back to the days when a mental health referral might be seen to a parent as an insult, an implication that there was “something wrong” with their kid.

 

The ranks of the therapists may be spread thin even while demand is on the rise, but the new awareness is giving school districts, teachers, counselors and the professional providers a fresh opportunity to show students that there is, in fact, nothing wrong at all; it is OK to talk to someone, it is OK to know you need help and to get it, and it is important to know that everyone is a human being, and all human beings have problems.

 

“If there’s nothing else I could say in my 12 years, that in itself is an answered prayer, if you will,” Williams said, “knowing that the behaviors don’t come out of nowhere.” 

 

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