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Gun violence in schools has focused attention here and around the country on students' access to mental health resources.

In the school shootings at Sandy Hook Elementary in Connecticut in 2012 and in Parkland, Florida, in February, investigators found repeated red flags and missed opportunities for intervention. Both shooters had displayed worrying behaviors noticed by school staff, family members, peers and health workers.

After Sandy Hook, the Missoula County Public Schools assembled a mental health task force that recommended ways it could improve its mental health and intervention services to students.

This year, for the first time, MCPS screened all high school freshmen and sophomores for depression using a questionnaire, and educated them about signs of suicide and resources for help. Students who marked in the questionnaire that they were suicidal or had attempted suicide in the past were seen the same day by school psychologists.

About 27 percent of Missoula high school students reported feeling depressed in Missoula County’s 2017 Community Health Assessment. Anxiety is on the rise among students, and more families are using the district’s temporary homebound tutoring program for those whose anxiety makes it too difficult to attend school.

“There’s a lot of pressure put on schools to provide mental health services,” said Carol Ewen, student wellness coordinator for Missoula County Public Schools. “I think overall, society has put a lot of pressure on schools to provide all sorts of stuff in school, and it’s natural because that's where kids are, so it makes sense.

"But they haven’t given us more time in the day, or funding for it. So we're trying to do this in the regular school day we’ve always had, but it just makes it harder.”

Beyond educating students, schools must identify the ones who are struggling and either provide or refer them to the extra help they need. Students can’t learn well if they’re struggling with undiagnosed mental illness, trauma from their home lives, or unidentified learning disabilities.

While schools are well-stocked with counselors, psychologists and social workers, there’s a limit to what they can offer. If a student needs consistent, long-term mental health services, school psychologists and counselors pass the baton to parents.

“Once we tell parents, it’s really up to them,” Ewen said. “We can't recommend or mandate therapy.”

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If the screening for depression shows that a student appears to be in imminent danger, the parents are called to take the student to the emergency room for an evaluation.

Janet Metcalf, a school psychologist at Sentinel High School, said many Sentinel students have spent time at the adolescent partial hospitalization program at St. Patrick Hospital, where they can get their schoolwork as well as mental health support throughout the afternoon.

Mikki Odyk, a parent of an MCPS student, said her daughter was in that program for several weeks after the school counselor noticed some warning signs of suicide and an eating disorder. The school helped her get all the resources she needed, and allowed her daughter to miss final exams without suffering academically, Odyk said.

“I was told from some of the people at the hospital as well as the partial hospitalization program that it’s very common, actually, there are a lot of students that have gone through this program and done all this stuff,” Odyk said. “You wouldn't know just by looking at kids, unless they spoke freely of it. It’s nice knowing we’re not alone in it.”

Parents are usually motivated to get their child the help they need, but it isn’t always easy to access, Ewen said.

“One of the major barriers is finding child psychiatrists or finding someone who could do a nice evaluation for what medication a student might need. There’s waiting lists to get in that are very long, and sometimes that can be very frustrating for parents.”

Cost can also be prohibitive for parents seeking mental health services for their child. There’s a middle group of families who fall between those with Medicaid and those who can afford insurance that covers mental health, who are missed, Ewen said.

“There is a population that really gets left out of the equation when we look at serving kids with mental health issues. I think that is where sometimes schools try to make up for that gap. But we don't really have enough resources to do it."

Still, a lot of effort has been put toward improving the way Missoula schools provide mental health support and behavioral interventions in recent years. The mental health task force that formed after the Sandy Hook School shooting recommended that the Montana Behavioral Initiative (MBI) be implemented at all Missoula County Public Schools.

MBI is the Montana version of the U.S. Department of Education’s program called Positive Behavioral Interventions and Supports, an evidence-based system of emotionally and socially supporting students at school through positive reinforcement.

MCPS elementary schools and middle schools are a lot further along in implementing MBI, and high schools are beginning in earnest this year. (See related story.)

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Integrating mental health support into a student’s day is ideal, but changing school schedules can be very difficult, Ewen said. Sentinel High School has found success with that, through its alternating block schedule.

Students who use the high school's Comprehensive School and Community Treatment service spend four class periods a week with their therapist and behavioral specialist, and get credit for it. That way, students don’t have to be regularly removed from class to get the mental health support they need, said Metcalf, the school psychologist.

Metcalf also said many kids are on 504 plans, which are part of the Rehabilitation Act of 1973 that requires schools to make accommodations to ensure education is accessible to kids with mental or physical disabilities.

“We have a lot of kids on 504 plans that have diabetes, or a seizure disorder, or a peanut allergy, but we have a ton of them for anxiety and depression,” Metcalf said. "There’s a lot of kids that have struggled to get to school because of anxiety and depression, and it’s increasing.”

Students with disruptive behavioral issues in the classroom pose a challenge to teachers and counselors, who must decide whether to remove a student from class and place them in special education or other programs. Removing a student from the classroom is often not the best thing for them, even if their behavior is disruptive, Ewen said. But other students' educational experience also has to be considered.

“How do we as a community wrap ourselves around these kids and support them in a way that we can help them, versus maybe ostracizing them or removing them? Because we know that doesn’t work,” Ewen said. “We know that when you remove kids and put them in alternative placements, their outcomes aren’t as great as when they stay in the general education system.”

Metcalf said she feels it is the school staff’s responsibility to do as much as it possibly can for kids who have behavioral, mental, or learning problems. She said the district does not resort to expelling students who are problematic, unless there is strong cause for it. 

“I think we do try, with all different kinds of programs and supports to meet the needs of every kid,” Metcalf said. “I don't feel like we say, 'There's not a place for you here.' I think we try and try and try, and sometimes it comes down to the fact that the kid just decides they don’t want to be here and then we kind of lose track of them, but I kind of like that philosophy that we don't just expel.”

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