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By Sheila Mulrooney Eldred | Sahan Journal

In 2000, few of Minnesota’s public school students had access to mental health therapy within the school building. Today, over half of students do. 

, published in the Journal of Human Resources, quantifies how many lives these embedded therapists may have saved. Researchers calculated that suicide attempts decreased by 15 percent across 263 Hennepin County schools that implemented school-based mental health. 

Health officials want families to know that students can access mental health services at school, whether or not they can pay. In-school mental health looks different from district to district, and even from school to school. And high demand can lead to long waiting times. But state grants ensure that over 1,000 Minnesota public schools provide therapy in their buildings.

Farah Hussein, a mental health therapist, says that her team at South High School, in Minneapolis, tries to make sure that students get equitable access to therapy. We asked Hussein for more details on exactly how students and families can access the services; her answers are below.

Earlier evaluations of school-based mental health had shown promise, but the Minnesota researchers believe this new study is one of the first to employ rigorous statistical methods.

The results are “incredibly encouraging,” said the study’s lead author, 

, who studies the economics of mental health, and mental health care policy as an associate professor at the University of Minnesota School of Public Health. 

“There are countless examples of promising programs that, when rigorously evaluated, don’t seem to be doing as much as we hoped,” Golberstein said. “In this case, we have very meaningful results, particularly for suicidality and increased rates of mental health services use.”

The researchers made their calculations using data from Medicaid and the Minnesota Student Survey, which includes self-reports of suicidality. Researchers were able to examine that data  during the time period that Hennepin County launched school-based mental health programs. 

“We realized we could look at what the effects are when schools implement this model,” Golberstein said. 

Still, the results were more of a relief than a surprise. 

 has been working with Hennepin County and Minneapolis Public Schools since the beginning of the mental health program in 2005. (In Hennepin County, therapists usually share space with a school-based medical clinic — but the location of therapists’ offices varies by school, district and county.)

Sander and other program coordinators had already estimated that about half the students seeking therapy at school were getting mental health treatment for the first time. And of those, about 40 percent were severely emotionally disturbed, Sander said.

“These were kids who were potentially at risk for out-of-home placement in the next year,” Sander said: kids could be referred to foster care or in-patient hospital care. “It wasn’t just the worried well”–that is,  people who may be unnecessarily anxious. “It was students who couldn’t get into community-based care.”

Black and brown youth benefit most from school-based mental health care

The new study confirms that Black and brown youth showed the greatest increase in using school-based mental health services. And the researchers found some evidence that increased access to therapy is linked to fewer suspensions and juvenile justice involvement.

“We work hard to prioritize families who have been historically marginalized,” said Farah Hussein, from South High School. “We try to reach those students and families who typically would not have access to these services. We work with school counselors and social workers; they are teasing out families who are extra-resourced vs. families who are not able to access services.”

Often, that’s because of socio-economic status or cultural stigma, Farah said. 

Despite some positive findings in the study, increased access to mental health care didn’t show benefits in every area of schooling. For example, kids with access to in-school mental health did not seem to fare better on test scores or attend school more often. 

But Sander hopes that the study will help more cities, counties and schools get funding for services — especially since these new school-based services often can’t keep up with the demand. 

“There’s a lot of need in all the schools,” Farah said. Minneapolis Public Schools has two therapists at each of its 

, up from one. But kids often have to be waitlisted before receiving treatment, Farah said.

Students can see therapists for everything from major mental health conditions (such as anxiety, depression, self-harm, suicidal ideation, and trauma) to less urgent issues (such as poor concentration in school, conflict with peers, or transitions in life), Farah said. Therapists work collaboratively with school counselors and social workers. Teachers are often the first to identify a student who would benefit from therapy. 

Want to know more? We posed common questions that students and families may have to Farah at South High School.  Her answers, below, have been lightly edited 

The programs work similarly at all public schools in Hennepin County. If you’re outside of Hennepin County, see if your school offers services 

. School principals, social workers or counselors should be able to answer any school-specific questions.

Question: I haven’t been feeling like getting out of bed. When can I come and talk to a therapist? Do I need an appointment? 

 You can walk in and ask about mental health services. It’s called self-referral. The assistant at the front desk will see if we’re available immediately. And then we’ll explain our services, go over our informed mental health consent form and talk about next steps.

Or, you can meet with your school counselor if you already have a relationship with that person. Then they will assess and refer you to us if needed.

I’m a high school junior stressed out about college. Whom should I talk to? 

If you’re not already seeing a therapist at school, you would want to connect with your school counselor. School counselors are doing a lot of the academic planning and college planning, so when a question like that comes up, you would want to talk to that counselor. 

Do I need to tell my parents about asking to see a therapist in school?

As of this year there’s a minor mental health consent form. So, if you’re 16 or older, you can consent to your own mental health treatment. If you feel really uncomfortable with your parents knowing–-if there is significant cultural stigma around therapy or you wouldn’t be safe at home with your parents knowing—you can consent to your own treatment and we don’t need to talk to your parents. [Editor’s note: If you’re under 16, parents need to consent to treatment.]

The student is the primary client, but oftentimes young people are OK with their parents knowing. And we can do family therapy if the students and parents are open to it.

If you’re in serious danger of harming yourself or someone else, or if you are being abused or have been abused (verbally, emotionally, physically or sexually) within the past three years, we are legally and ethically bound to break confidentiality. 

I don’t have health insurance. How much will an appointment cost?

Our services are no cost, although if your family has private insurance and is able to pay something, we will bill insurance. If it’s a high copay you can’t pay, we pay it — we don’t put that burden on families. And not having insurance is not a barrier for seeking our services.

How long will I have to wait for an appointment? What if I need to see someone today?

If we are not full, we follow up within 1-2 weeks. If we are full, we are communicating with the support team, and it becomes the responsibility of the school’s social workers and counselors in connecting you to community services.

I’m worried about my student. Can I make an appointment for them? 

Parents can refer their children. That is absolutely an option. 

If my student talks to you, can you tell me about it?

We are not sharing details about what we talk about unless we have a safety concern. 

We do like to involve parents to the extent that it is possible and necessary, but we are not sharing details about everything we talk about in therapy. In order to respect the privacy of our students to trust us, we’re not calling parents and divulging details of what happened in therapy. 

We won’t share things about a student’s identity or whether or not they’re in a relationship without their consent. 

But we often do encourage our students to share things with their parents. 

How long can my student keep seeing you? Do they have to transfer somewhere else eventually?

We work year round, we’re not off for winter break, spring break. Even when school is done in mid-June we continue seeing students as needed: either at school, if the building is open;  or telehealth; or in-home; or at a park near their home. Students can be on our caseload for as long as feels appropriate. 

Seniors can see us until the end of August after their senior year. And if they still want to do therapy we connect them with someone in the community or their college. 

We schedule appointments so they don’t always have to miss the same class, although teachers are very supportive and they are excused from class. We do offer before and after school appointments, too. 

I speak Somali, so I am able to explain the process in Somali. We also have a Spanish-speaking family liaison I have worked with. 

And schools can use the language line to communicate with parents who don’t speak the same language as school staff.

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Farah Hussein, a mental health therapist in Minneapolis Public Schools, wants families to know that students can sign up for free therapy, and that care is confidential. Meanwhile, a new study examines how students benefited after public schools in Hennepin County began offering mental health services to all.

All Minnesota public school students can access free mental health care

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