How Minnesota became a leader in school-based mental health care

NINA MOINI: Did you know Minnesota is recognized as one of the leading states for school-based mental health care? A three-part series from MinnPost is exploring how that came to be and also where there are still gaps in care. Andy Steiner is the mental health and addiction columnist for MinnPost and wrote this series as part of a fellowship she was awarded from the Solutions Journalism Network. Andy joins me on the line now to share her work with us. Thanks for being here, Andy.

ANDY STEINER: Thanks so much for having me.

NINA MOINI: I really love doing this work around solutions journalism. I think that's really, really great. Let's start with the big picture. What is school-based mental health access like in Minnesota?

ANDY STEINER: It's pretty good. It's never perfect. But I'd say that about 80% of school districts in the state have school-based mental health offerings for their kids.

NINA MOINI: How does that compare nationally? Because I've heard a lot from providers in schools that they could sure use more help. Obviously, I'm sure no one would turn away more help. But how does Minnesota compare to other states?

ANDY STEINER: Minnesota is one of the top states in the nation for access to mental health care in public schools for kids. That said, it doesn't mean that every kid who needs mental health care can get it immediately or right away. But we're probably one of the top two states in the nation. That's what I heard from Nancy Lever at the National Center for School-Based Mental Health in Baltimore, Maryland.

NINA MOINI: And through your reporting, did you get a handle on how Minnesota came to be such a leader?

ANDY STEINER: It's interesting. I think Minnesota-- there's a number of reasons. But one of the people that I talked to from my story is Mark Sander, who is at Hennepin County and heads up this school-based mental health efforts there. Mark did some of his education in Maryland, the University of Maryland, where, really, a lot of the early starts of school-based mental health began. So Mark learned there, from another Mark there, who also worked in school-based mental health. And he then went on, when he came back to Minnesota, to be one of the leaders in advocating for this kind of care. And it's just really grown and been really supported on a bipartisan basis, really, in Minnesota at the state legislature.

NINA MOINI: And when we're talking about who is in the schools and who's providing that mental health care, what does that look like? Is it social workers, or psychologists, or counselors, or guidance counselors? You hear a lot of different terms. What are you seeing?

ANDY STEINER: It's a range of people that provide mental health care for kids in Minnesota schools. The first group of people that you talked about are definitely the foundation. Those are school employees who provide mental health care for kids. But then adding to that are contractors, community-based contractors, who come into schools, people who work for nonprofit agencies, like, well, a variety of them, including like people incorporated, perhaps, that come into schools and provide mental health care within the schools. And then there are also nonprofit agencies that come in and provide different kinds of mental health care, including substance use disorder support and maybe culturally-based, culturally specific mental health support as well.

NINA MOINI: And you also-- this is such a great series. And there's three parts to it, again, for people. You talk a little bit about the different needs that may happen, say, in rural areas versus more populated areas. What did you find there? What were some patterns?

ANDY STEINER: Yeah. Well, definitely, part of solutions journalism is you're trying to highlight where somebody, where an organization or individual, is doing something right and then explain how that happened but then also highlight, what are some of the gaps? And one of the gaps in Minnesota, well, we can say we're doing a good job at providing care for a lot of-- mental health care for a lot of kids in our state, there are definitely parts of the state, including Greater Minnesota, that really do have a lot of gaps when it comes to mental health care.

So in my first story in the series, I focused on what was going on in Grand Marais, Minnesota, way up near the Canadian border on Lake Superior. That's a very small school district. But it also has plenty of kids in that school, who, for a variety of reasons-- everybody struggles with mental health care for one reason-- mental health for one reason or another. But there are a lot of kids who struggle with their mental health and need support. But it's hard to get mental health providers up there, simply because of the distance reasons, trying to attract people to come and work there.

But also, if you're a kid who needs mental health care, and it's not available in school, you might have to drive as far as Duluth to get that kind of mental health support. And that could be a whole day off of work for a parent. So it's really a struggle. So in Grand Marais, my story talks about how they were able to attract one mental health provider who's really brought a lot to the school to help kids get the mental health care they need, everything from preschoolers to high schoolers. But they still need more. And they're having a hard time finding someone else to come in and pick up the slack.

NINA MOINI: Yeah, I'm sure one is better than none, that's for sure.

ANDY STEINER: Yes.

NINA MOINI: In your second piece, you also highlight mental health care for immigrant and refugee communities in the schools. You talked about culturally-specific care. What was your sense for how Minnesota is doing there?

ANDY STEINER: There's a lot of different challenges that people face. One organization that I highlighted is called Restoration for All, which is an organization that's focused on mental health support for the African, immigrant, and refugee community in the state. And that organization really talks about, looks at, specifically some of the issues that young people who come from immigrant and refugee families might face, that teachers might not understand, that peers might not understand.

If you're coming from a family where, maybe even you grew up in a refugee camp, or your family members grew up in a refugee camp, you might have trauma that has been passed on to the family, and there are different responses to different situations that a school worker or school professional might identify as one kind of issue, when it actually is a different kind of issue. So this organization, Restoration for All, has held some workshops in schools, with school employees, to try to talk to them about the different kinds of ways young people might be responding to different situations that might be unique to them because of their cultural background.

NINA MOINI: And to think that there has been a push on the federal level to move away from school-based mental health care-- Health Secretary RFK, Jr. wants to end mental health screenings in schools. How do you foresee any impact there on what has currently been built in Minnesota?

ANDY STEINER: Yeah, that's a really good question. It's hard to see that there won't be some kind of impact. I will say, as I said before, for the bipartisan support for mental health care in Minnesota has been heartening to people who advocate for that school-based mental health because it does seem like the state has been willing to give funding towards these efforts, which is really important. But it does seem that people are concerned, in a variety of ways, around the state, but specifically about school-based mental health, there is concern about that funding might go away, that there'll be less emphasis placed on that. And those advocates would feel like that is really too bad.

NINA MOINI: And funding could be one area of concern. But I also wonder if in your reporting you looked into availability, like staffing levels, demand. How does it look in that realm?

ANDY STEINER: Yeah, that's a good question. Well, in the state of Minnesota, there is definitely a demand for mental health that is not always met. And it's not just in greater Minnesota, though that is probably the place where it's the largest issue. But psychologists and psychiatrists are aging rapidly, actually, especially psychiatrists. Those are the people who prescribe medications for people. And those people are aging rapidly. We need to get a pipeline of younger people to come in and fill the spaces that are being left by people who are retiring. That's something I've written about in the past. So it's really a big issue.

Also, a big issue is mental health providers of color. There are organizations and different agencies that are trying to support that. And statewide, there have been funding pushes, scholarship programs, loan forgiveness programs, trying to get more, because kids want to work, often, feel more comfortable talking to someone who looks like them when they want mental health support.

NINA MOINI: There are so many moving parts. And again, your three-part series for MinnPost really gives a really good look and dives really in. So thank you very much for sharing your reporting with us, Andy.

ANDY STEINER: Thank you.

NINA MOINI: Take care.

ANDY STEINER: Thank you so much. Bye.

NINA MOINI: Andy Steiner is the mental health and addiction columnist for MinnPost.