Mental health problems mount nationwide while budgets for treatment and care are shrinking
In late 2009, as the unemployment rate in San Joaquin County, California, reached 18 percent and one in twelve homes were being foreclosed, two high school students in the town of Ripon, population 15,000, committed suicide within two months of each other. Over the next eighteen months, sixteen more teenagers around the county took their own lives, a not-uncommon occurrence that public health researchers refer to as “suicide contagion.”
Years of declining budgets had cut the number of counselors, nurses and psychologists in county schools, impairing the ability of individual districts to handle the needs of grieving students, parents and communities on their own. So school officials in cities like Ripon, Stockton, Lodi and Linden turned to each other for help.
The districts made use of a mutual aid pact they’d set up, like those employed by firefighters and police from the same region. On the morning after each death, school nurses and counselors trained in suicide response, along with a team of therapists from Valley Community Counseling, a local mental health agency, descended on the school the student had attended. They spent days, sometimes weeks, meeting with pupils and parents, focusing on kids who knew the victims or seemed at particular risk.
The spirit of cooperation helped the team fashion an effective crisis response and ease the pain of some survivors, said David Love, executive director of Valley Community Counseling. But, by definition, it came too late, he said. “We’re doing everything we can to partner and develop these mutual aid plans,’’ Love said. “But we’re still band-aiding. When you’re doing crisis work, you’re at the back end. The tragedy is that we don’t have the resources early in the process.”
As the U.S. economy struggles to pull out of the worst funk since the 1930s, public services for the country’s most vulnerable populations—children, the elderly, the mentally ill—are being cut or disappearing at a time when the need for them is greater than ever. Faced with gaping deficits, states have slashed $1.6 billion from mental health programs over the past four years, according to a report by the National Alliance on Mental Illness. The pain is being felt everywhere.
• Illinois has slashed $187 million from its mental health budget and plans to close three of nine psychiatric hospitals. A budget passed in November by the Chicago City Council will close half the city’s 12 mental health clinics.
• In Detroit, the county mental health program has lost $30 million in state funding over the past three years, forcing numerous cuts to the agencies it supports. Detroit Central City Community Mental Health, which provides outpatient treatment and reentry programs for people leaving jails and psychiatric hospitals, lost a quarter of its funding and cut its staff by a third. Charlotte House, a transitional housing program for people with psychiatric disorders discharged from the county hospital, closed its doors.
• California has cut mental health funding by $765 million, or 21 percent, since 2009. In Oakland, the number of children waiting to see a counselor at West Coast Children’s Center, a community mental health clinic, has swollen to 50. “It’s not a good feeling that there are kids on a waiting list and you can’t hire more clinicians,” said Stacey Katz, the center’s director. “It stresses everybody out. How do we triage? How do we decide who needs services the most without violating our mission that kids should have mental health services when they need it?”
Meanwhile, homelessness, domestic violence, and child abuse are rising. Nationally, nearly 1 million schoolchildren were homeless in the 2009-2010 school year, a 38 percent increase in four years, according to the U.S. Department of Education.
University of Pittsburgh researchers reviewing hospital records from parts of Washington, Pennsylvania, Ohio, and Kentucky found that the rate of children younger than five brought to emergency rooms with abusive head trauma—brain injuries from being shaken or struck— was 65 percent higher during the 19 months of official economic recession that began in December 2007 than in the previous four years. Sixteen percent of the children died.
“Families are losing their jobs, they’re losing their housing, they’re on the street,’’ said Amy Weiss, director of Parents Place, a San Francisco program that offers counseling and support services to children and families. “We’re seeing more domestic violence, more complicated cases, more poverty. Our caseloads are bigger because there are fewer people and resources. We’re trying to do more with less.”
The economic misery that has swept the nation has savaged places like San Joaquin County, a place of long-standing poverty, large numbers of children and large tracts of homes purchased for little money down by people with scant savings and insecure jobs. To that mix, add years of declining investment in schools and social services.
The 900 students at Ripon High, where the suicide cluster started, have just two guidance counselors to help them. There was a third but the district laid her off before the start of the 2009-2010 school year after losing $6 million in state funding over three years. The cutback hinders the remaining counselors’ ability to address both mental health and academic needs, said Superintendent Louise Johnson.
Ripon High’s student-counselor ratio is better than the California average of one counselor for every 810 students—the second worst of any state. Neighboring Manteca Unified School District has no counselors in its elementary schools and has gone from four counselors at each of its seven high schools to two, said Caroline Thibodeau, the district’s director of health services. The number of school administrators and nurses has also declined, Thibodeau said.
While the number of adults attending to students has been falling, students needs keep rising. The number of homeless children in Manteca has more than doubled in the past five years to 700, Thibodeau said. Rates of alcoholism, drug abuse and child abuse are up, putting families under enormous stress, said Love. And over the past three years, he and his colleagues at Valley Community Counseling treated 60 percent more children who’d been exposed to domestic violence and 50 percent more whose parents were substance abusers.
“It’s a big circle,” he said. “Family stress, community stress, student stress equals higher levels of depression and related issues among caretakers and children. With school cuts, counselor cuts and classroom sizes going up, the schools are seeing more mental health issues and have fewer resources. We’re getting more kids sent to us with clinical depression, PTSD or behavioral acting-out issues. And all this increases the possibility of suicide.”
Cities across the country are grappling with the same issues. In St. Louis, the number of homeless children in the city’s public schools has almost doubled in the past three years to 3,000. Until a few months ago, Elizabeth Snowden, 17, was one of them.
Elizabeth (her middle name) spent her high school years coping with headaches, fear and anxiety as she slept on streets and in overcrowded shelters, searching for quiet places to do homework and escape the stress that has engulfed her family of six since her mother Audrey lost her customer-service job at a St. Louis department four years ago.
“The stress affected me at school emotionally and physically,” she says. “I had a headache every day. I’d argue with my sisters and brothers and take everything out on them. It was tough keeping my grades up. I’d get them up, then fall back down and then I’d get stressed out. I got to the point I couldn’t take it any more.”
Audrey (who asked that her last name be withheld) moved the family to Mississippi, where a promised job evaporated in a region reeling from two hurricanes. When the family returned to St. Louis, they couldn’t regain their housing subsidy and had no money to rent a home. They ended up on the street.
Elizabeth and Audrey have been helped enormously by a social worker whose know their pain firsthand. Deidra Thomas-Murray, now director of homeless services for the St. Louis schools, spent years in her native New Orleans working in schools and with juvenile offenders, then became a refugee after Hurricane Katrina destroyed her home. She and her five daughters and foster daughters spent two weeks sleeping on the floor of a friend’s house in Baton Rouge, then went to Missouri, drawn by a relative’s offer of help. For a while, she said, five families crowded into a two-bedroom apartment while Thomas-Murray collected food stamps and hunted for work.
She found a job as a drug counselor, then a family therapist, and in 2006 was hired as a school social worker. Since 2009 she has coordinated the program for homeless students, networking constantly to solicit donations of clothing and sleeping bags for families. Her main focus: getting teachers and principals to know their kids so they can identify those who are homeless and make sure they get the services they’re entitled to by law.
“A lot of times we’ll see stuff happening with kids, but never ask what’s going on,” she says. “We just assume they’re some BAKs (bad-ass kids), which in many instances, isn’t the case. We, the educators, play a major role in how we embrace this population.”
Her advocacy has helped the district identify more homeless children, one reason their numbers have grown. The other reason is obvious. “More and more families are becoming unemployed and losing their homes,” she says.
Thompson-Murray is painfully aware of the damage being homeless inflicts on kids. “They worry about where they’re going to sleep at night,” she says. “They have difficulty separating from parents. If there’s been violence in the family, they’re preoccupied with whether the parent is safe. They have difficulty focusing. They stare off into space. They can be invisible in a crowd of kids. Or they can be the most disruptive in the class.”
The stress of economic uncertainty isn’t confined to the jobless, or people who have lost homes or services. Therapists working in government-funded agencies are under intense pressure as they absorb the distress of their clients, handle heavier caseloads and fret about their own flat salaries and job security.
Places for People, a St. Louis agency serving the city’s mentally ill, opened a drop-in center in April that offers assistance to anyone in need. The number of help-seekers climbed from 248 in May to 509 in August. “It’s off the charts,’’ admits executive director Joe Yancey. The spike in demand has been so intense that the agency is grappling with whether it has the capacity to continue helping all comers.
The ability to meet the needs of the poor and distressed depends increasingly on extraordinary efforts. Megan Heeney, 26, is an outreach specialist with Places for People by day, helping people being released from psychiatric hospitals. At night, she’s part of a Catholic Worker community that provides housing for homeless women and children. She helped organize volunteers to bring homeless people off the streets when the temperature dips below 20 degrees and recruited local churches to provide shelter.
“We try as hard as we can to help people manage their crises,” she said. “We want to aid people in moving toward recovery yet because of economic conditions, we’re constantly doing crisis management.”
In a time of austerity, superhuman social workers can only do so much.
Rob Waters writes about health, mental health and science from his home in Berkeley, California. His investigative feature in Mother Jones, “Medicating Aliah,” examined pharmaceutical industry influence over prescribing guidelines and won the Casey Award in 2006. His articles have appeared in Bloomberg Businessweek, Mother Jones, Health, Reader’s Digest and other publications. More Rob Waters.
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