After two public school students in southeastern Minnesota committed suicide this spring, experts expressed concern about gaps in mental health services in Minnesota schools.
On the front lines are school counselors, whose jobs is to help students with problems before a crisis occurs.
But that's difficult in Minnesota, which has one of the largest ratios of students to school counselors in the nation - and a shortage of community counselors who treat children.
According to the Minnesota Association of School Counselors, the average ratio of students to counselors in the state is about 800 to 1.
"Minnesota is second to last in the nation as far as the ratio goes," said Kay Hertling Wahl, a professor of counseling at the University of Minnesota.
The lopsided student-to-counselor ratio makes it difficult for counselors to be effective in dealing with things like depression, addiction or bullying, Herting Wahl said.
“Minnesota is second-to-last in the nation as far as the ratio goes.”Kay Hertling Wahl, U of M
"Many children slip through the cracks because the school counselor is too busy," she said. At Barack and Michelle Obama Service Learning School in St. Paul, counselor Beth Coleman usually spends the first part of her day reaching out to students. She talks to them about bullying and anger management.
Coleman's afternoon is a flurry of meetings. Sometimes she talks with students who've caused trouble in class. At other times, she checks in with a student who is homeless or one who's having problems at home. Parents often set up meetings to talk about their child.
"I'm rarely sitting down," she said. "I try to do my paperwork, but a lot times that's done at home at night because I'm too busy during the day talking to people."
As one of two counselors at the school for students in pre-kindergarten to 6th grade school, she is responsible for half of its 670 students.
Being a counselor to more than 300 students may not seem manageable, but in Coleman's last school counseling job, she had more than 1,000 students to monitor.
Another problem in Minnesota is that counselors are increasingly being asked to do more in their schools, like administer standardized tests, Herting Wahl said.
Minnesota state law does not require schools to put counselors, social workers or psychologists on staff. Administrators in each school district decide whether to do so.
When school districts must cut budgets, counselor positions often are among the first to go, because it's a cut that doesn't increase class sizes. There are dozens of school districts in Minnesota that have no counselors at all.
That's unfortunate, said Chris Otto, president of the Minnesota School Counselors Association.
Otto, a counselor at Stillwater Middle School, feels fortunate to have only 400 students to monitor -- half the state average. She said her group has a simple message.
"The more people you can put in positions of providing that support, of providing the watchful eye and helping students and helping parents, the better," Otto said.
Teaching students how to cope with the pressures of school is an important part of a counselor's job. They also need to provide outside support and resources for students and their families, sometimes in the form of therapy.
But there's another problem: a shortage of mental health counselors who focus on children and adolescents in Minnesota, especially in rural areas.
Walter Roberts Jr., a professor of school counseling at Minnesota State University in Mankato, said students who need to see a therapist often wait three, six or even nine months before they can get an appointment.
"That becomes a lifetime, in and of itself, for a child who is showing signs of and perhaps maybe experiencing out-of-the-norm depression," he said.
Another problem, Roberts said, is a shortage of psychiatric facilities and beds in those facilities. Families in rural areas faced with the prospect of taking their children 90 miles to a facility for care, may instead decide handle the problem on their own.
Helping school counselors intervene earlier when students have problems could be key, said Dr. Peter Jensen, a Mayo Clinic professor of psychiatry.
"Let's not waste money on more counselors until the counselors we've got are trained and we're using our resource wisely," he said.
Jensen has seen some recent improvements in how Minnesota schools are monitoring students' mental health. Schools are training teachers to spot problems among students.
Some Minnesota school districts are starting to collaborate with community counseling agencies, to make sure counselors are available when students need them.