How a hospital and a school district teamed up to help kids in emotional crisis
In 2019, the Rockville Centre school district in Long Island, New York, was shaken by a string of student deaths, including the suicides of a recent graduate and a current student.
“When you get these losses, one after the other, you almost can’t get traction on normalcy,” said Noreen Leahy, an assistant superintendent at the school district.
To Leahy, the student suicides exposed a children’s mental health crisis brewing for years. She had observed a concerning uptick in depression, anxiety and suicidal ideation among students. Her school district had a team of mental health professionals, but Leahy said they couldn’t provide the kind of long-term care many students needed.
“Remember, psychologists and social workers and counselors in school districts are there to make sure kids are learning,” said Leahy. “We’re not hospital wards. We don’t do psychotherapy. So it’s very limited what we can do for these students.”
She said she saw an urgent need to connect students to mental health care quickly and easily, and the 2019 tragedies drove her to find a way.
Her vision ultimately led to the formation of a unique partnership between several Long Island school districts and the nearby children’s hospital, Cohen Children’s Medical Center, part of the Northwell Health system. That partnership provides prompt access to mental health services for students and includes ongoing support for school staff members in addressing kids’ mental health, creating a mental health safety net for children and families in the area that didn’t exist before.
At its heart is a new behavioral health center, which the hospital opened in January 2020. Students are evaluated by the center’s child psychiatrist and mental health counselor, who start and continue treatment until a child can be connected to long-term care in the community.
The concerning rise in mental health issues noticed by the Long Island school administrators mirrors national trends. Roughly 1 in 5 U.S. children meet the criteria for a mental health disorder, and the rate of suicide attempts among teens has risen over the past decade, according to the Centers for Disease Control and Prevention.
Around the country, most kids who have mental health issues don’t get treatment. There’s a shortage of providers who work with children and it can take months to get an appointment.
“The wait times on average to see a mental health specialist on an emergency basis is somewhere between two to three months, and for regular basis is up to 12 months, which is an unacceptable wait time,” said Dr. Ujjwal Ramtekkar, a child and adolescent psychiatrist at Nationwide Children’s Hospital.
Without timely access to care, many kids end up with worsening symptoms and eventually land in a hospital emergency department, “as the fastest way to either avert [a mental health] crisis, or as the fastest way to get some kind of mental health evaluation,” Ramtekkar said.
“It sort of creates this ping-pong effect,” said Tina Smith, executive director of special education at Oceanside School District in Long Island.
It’s common to see students go to the ER only to be discharged soon after and return to school without a plan for follow-up care, she said. “And then the problems start to spiral again out of control,” Smith said, “and then they’re sent back to the hospital [ER].”
It was with these worries in mind that, after the student suicides in 2019, Leahy began raising her concerns with colleagues, school board members and other parents, including Gina-Marie Bounds, a hospital administrator at Cohen Children’s.
Bounds took the idea to the head of emergency child psychiatry and other hospital officials at Cohen’s and they got to work. Leahy spread the word to neighboring school districts, who were dealing with similar problems, and persuaded them to come on board. Several months later, the mental health center opened its doors.
This couldn’t have come at a better time, said Leahy.
As many large hospitals around the country saw a surge in the number of kids in mental health crises in their emergency departments, the new behavioral health center reports the opposite trend. The number of mental health visits to the emergency room by students from these school districts declined by at least 60% in 2020 compared with the previous year.
School administrators also say the health center has played a critical role in prevention by promoting the emotional well-being of students, families and school personnel. School and health center staffers meet twice a month via Zoom to check in and brainstorm ways to address emerging health and wellness concerns of staff members and families.
Getting kids the right help at the right time
The goal of the new health center is to provide kids with care as soon as symptoms emerge.
The center is staffed by a child psychiatrist, a mental health counselor and a medical assistant. It’s located next to a pediatrician’s office and within a few miles of the school districts it serves.
When a child first arrives, the child is evaluated to determine whether they need to be hospitalized.
“Most kids don’t need that,” said Dr. Vera Feuer, Northwell Health’s associate vice president for schoolbased mental health, who helped create the center and now oversees it. “Most kids need outpatient care.”
And the center starts that care right away — medication and/or therapy, depending on what each child needs — to stabilize the child and prevent worsening of symptoms, and connect them to ongoing care with a provider in the community.
In January 2021, a local resident, Tara, found herself calling the health center to make an appointment for her 17-year-old sister, who had been struggling with irregular sleep patterns and panic attacks for months.
Tara had recently become her sister’s legal guardian. KHN is not using their last names and only using the sister’s middle name — Jasmine — to protect their privacy.
Jasmine said she felt suffocated during her panic attacks.
“It felt like I was running, like my heart got really fast, and like I was being put in a little tiny box,” she said.
Jasmine and Tara met with a mental health counselor at the behavioral health center. The followup sessions were helpful for Jasmine, who learned about the importance of speaking with a trusted friend or adult any time she felt triggered. And the clinic helped Jasmine get connected with a nearby psychologist whom she now sees for weekly therapy sessions, Tara said.