Elementary schools focus on student mental health needs
When Jennifer gets a call from her son's school, she immediately feels anxious.
Jennifer is the mother of a fifth-grade student at a Spartanburg County public school. The boy was exposed to cocaine in utero by his birth mother, and Jennifer adopted him as an infant. Jennifer's last name and her son's name are being withheld to protect the child's privacy.
The boy suffers from depression, severe anxiety and mood instability, Jennifer said.
"One of the most dreaded things that happens to me — I'm a working mom — when I see the school calling in the middle of the day, I say, 'Please, just let it be a fever. Please let it just be that he's sick, and it's not a major issue.'"
Since children spend most of their day in school, Spartanburg County school district officials say it's vital to have mental health resources available for them. It's becoming more common for districts to have a psychologist on staff, but statewide the need remains for more mental health care providers in schools.
A 2016 report by the Child Mind Institute, a nonprofit organization that advocates for better mental health care for children, determined one in five children suffers from a mental health or learning disorder.
And the earlier children can get help, the less likely they are to struggle in school and in life, mental health advocates say.
"Eighty percent of chronic mental disorders begin in childhood," the institute's Children's Mental Health Report concluded. "There is an urgent need to identify the signs of these conditions early in life if children are to get the care and support they need to thrive."
Getting treatment
Jennifer's son has been regularly seeing psychiatrists since he was 4, but studies show he's more the exception than the rule.
National Institute of Health researchers found that over a year, only about 2 percent to 3 percent of children between the ages of 3 and 5 used mental health services.
Yet more than 17 million students across the country will be affected by mental health disorders before turning 18, according to the Children's Mental Health Report.
Jennifer said her son's school has worked with her family, giving her son a "fast pass" that allows him to leave class to visit a guidance counselor at any time, no questions asked.
"When you have a teacher that doesn't understand mental health, they could label him a 'problem child,'" Jennifer said. "The hardest thing I've ever done is when my child was 4, to get him in to see a psychologist."
Psychologists focus on therapy, while psychiatrists are doctors who can prescribe medication.
Lynn Collins, executive director of the S.C. Association of School Psychologists, said school psychologists typically counsel students and provide testing services to determine which students need special education services. They also can take on the role of counselor, she said.
“The biggest difference is with our younger ones, we do more things that are play-based, more social skill development," she said.
The roles of school psychologists and guidance counselors can sometimes overlap. Often, schools without a psychologist will have guidance counselors assume that role.
In Spartanburg County, all public schools have at least one guidance counselor on staff. In high schools, several guidance counselors are on staff to provide a variety of services, including mental health counseling, to students.
Most Spartanburg County districts also have school psychologists on staff who visit several schools each week and are available as needed.
A new approach
Jennifer said her son's anxiety sometimes leads to outbursts at school. He tries to control his behaviors and reaction to certain things, Jennifer said, but it's hard to do consistently.
"He'll say, 'I can't stop it,'" she said. "He's usually ashamed of what he's done afterwards, and upset with himself that he couldn't control his emotions. He told us it has impacted how other kids see him, and that upsets him."
The Compassionate Schools Initiative is one way schools are seeking to help children who are acting out rather than punish them.
The national program, implemented locally with help from the United Way of the Piedmont and the Spartanburg Behavioral Health Task Force, gives educators tools to work more effectively with children.
“We try to delve deeper for the reasons behind the actions,” said Carridy Bender, a child advocacy attorney who works closely with Spartanburg School District 6.
Jennifer Parker, director of the University of South Carolina Upstate's Center for Child Advocacy Studies, leads training for the program.
Teachers learn how to better communicate with students who act out or struggle in school, and students are encouraged to express their feelings when they're upset or confused.
“This kid who gets the zero on her homework, she acts up again and gets a silent lunch. And if she acts up again, she can’t go out to play (at recess),” Parker said. “Those are three overwhelmingly negative experiences that day. When we take recess, we’re creating more harm. When we put kids on silent lunch, we’re creating more harm by taking away social interaction. When we give them zeroes, we’re reinforcing those negative feelings of stress."
Jennifer said she already has seen some benefits for her son from the new approach.
"I love the idea of the schools being a partner with us on this journey, being a partner to help us help our son," she said. "They spend about as much time with him as I do. Teachers need to understand the difference between behavior problems and lack of discipline and what is a true mental health issue."
Safe zones
One way for elementary schools help children self-monitor their behavior is the use of safe spaces. These are places in the classroom that typically feature small things students can tinker with, or comfortable seats where they can go and calm down without judgment or punishment.
“In an elementary classroom, one of the things we demonstrate is a calm zone,” Parker said. “It might have a beanbag or some small toys, nothing loud. Teachers will tell kids, ‘If you’re feeling anxious or jittery, go there and just calm yourself down.’ It teaches the kids to realize when they’re having those type of feelings and calm themselves.”
Spartanburg School District 1 Special Services Coordinator Trish Beason said the district plans to implement safe zones in all classrooms and one larger space in each building.
“They could take on the look simply of beanbags being around the corner, so instead of sitting in their desk to read, (students) sit in a beanbag to read,” she said. “You might need noise buffering headphones, so we’ve provided those kinds of things. It’s really amazing that it’s really simple.”
In Hillary Hutcheson’s first-grade classroom at Holly Springs-Motlow Elementary School, the “calm area” is a desk removed from the rest of the class behind a curtain. Inside the middle of the desk are a couple of books, crayons and markers and noise-canceling headphones.
The space gives her students a place to calm down without drawing much attention.
“It’s kind of a place for them to unwind if they need a break from our school day or maybe just a step back. It’s never used as a punishment area, they can come and go as they choose,” Hutcheson said. “I do have one (student) that uses it often. He understands his triggers and monitors himself. He’ll signal to me that he’s going back there and I’ll recognize that.”
Additional resources
Statewide, schools need more mental health care providers, said Collins, with the state Association of School Psychologists.
“The psychologists just aren’t out there to hire, unfortunately,” she said. “They’re just not out there to fill those positions, but that’s not just an issue in South Carolina, that’s an issue nationwide.”
Having more staff with a behavioral health background would be an asset, Beason said.
“It would be great if we had additional support staff who have been trained in some of these kinds of techniques to help these students calm down. The ultimate goal is you want to catch a child before they reach the meltdown stage," she said. "When they reach a meltdown stage, it can be difficult to bring them back."
For Jennifer, it's always a concern when her son is out of her supervision for a long period of time.
"This is just one more thing we have to constantly work on," she said. "One day, he's going to be on his own and he'll need to be able to advocate for himself and mitigate his own behaviors."
Looking forward
Spartanburg School District 6 Superintendent Darryl Owings said teachers have become the first line of defense in spotting students with possible mental health issues. Teachers then either handle the situation themselves or reach out to a counselor if more skilled care is needed, he said.
“We just had a situation where a teacher saw a child upset in a hallway, and from there, that teacher took that child down to the counselor’s office,” Owings said.
Alan Eggert, District 6 special services coordinator, said officials determined the issue stemmed from a situation with an older sibling.
“All because a teacher walked down a hall and was trained to see a child and ask what’s happening,” Owings said.
Greg Wood, Spartanburg School District 5 assistant superintendent of administration and operations, said since mental health issues are present in the real world, they'll be present in schools, too.
“Our school is a microcosm of society," he said. "We’ve got to work to help students be our adults of the future. If we can help them understand mental health and mental wellness, hopefully that’ll help down the road."
Jennifer said she does worry about what will happen when her son hits puberty and is dealing with a combination of increased hormones, mental illness and medications.
"The psychiatrists have warned us, the teenage years will be difficult for anyone. When you add in a child with mental illness, particularly one using medication, it can become very difficult," she said.
Typically, Jennifer said her son doesn't lash out at others, and his anxiety and mood changes don't manifest in violence. But, she said, those responses could change over time.
That's why it's important for every person who interacts frequently with her son to understand his behavior and to help him understand it, too, she said.
"There is a concern with what will this look like as he gets older, as hormones come into play. That's why we're doing what we can now with medication and behavior," she said. "You can't just say, 'I want to do better, so I'm going to do better.' He's going to deal with mental health the rest of his life. This isn't something you grow out of. It's a chemical imbalance in his brain. He's having to learn, 'When are my medications not working and how can I control my own behavior?'"
The Centers for Disease Control and Prevention's first mental health report collected data on the mental health of children between the ages of 3 and 17 between the years 2005 and 2011.
Data showed:
6.8 percent — children diagnosed with attention deficit/hyperactivity disorder (ADHD)
3.5 percent — children with behavioral or conduct problems
3 percent — children diagnosed with anxiety
2.1 percent — children diagnosed with depression
1.1 percent — children diagnosed with a disorder on the Autism spectrum
0.2 percent — children diagnosed with Tourette syndrome (between 6 and 17 years old)
Source: Mental Health Surveillance Among Children — United States, 2005–2011 (CDC)