Hennepin County’s school-based mental health program has contributed to a significant drop in self-reported suicide attempts among students in grades 6-12 over the past 20 years, according to University of Minnesota researchers.
The program, which brings independent mental health therapists into the county’s public schools, has been the subject of research by associate professor Ezra Golberstein at the University of Minnesota’s School of Public Health, who wanted to see if having easy access to mental health support would have an impact on the lives of students and staff.
“We did find what I think is pretty robust evidence that, after schools implemented this model of school-based mental health services,” Golberstein said, “the average rates of students at school reporting that they had attempted suicide in the past year went down by a number that is both statistically significant and, in my view, pretty meaningful.”
The researchers believe school-based mental health services have resulted in 260 fewer self-reported suicide attempts by Hennepin County students in grades 6-12.
Thanks to funding by a research grant from the Robert Wood Johnson Foundation as well as a grant from the University of Minnesota Center for Urban and Regional Affairs, Golberstein analyzed results of the Minnesota Student Survey, a large-scale triennial survey of the state’s students. His research was published last fall in the Journal of Human Resources.
[image_caption]Ezra Golberstein[/image_caption]
Other meaningful impacts that Golberstein’s team discovered included a “pretty significant and very meaningful” increase in the use of mental health services, he said, and increases the rate in which kids are being diagnosed and treated with mental health problems.
In-school mental health programs began in five Hennepin County schools in 2004, said Mark Sander, director of Hennepin County’s school-based mental health program. The program has since expanded to 231 schools in the county, employing some 200 independent, contracted therapists.
Many schools across the state now offer school-based mental health programs.
[image_caption]Mark Sander[/image_caption]
“The grant money provides support so that therapists that are in schools aren’t just doing therapy,” Sander said. “Therapists are also teaching teachers. They are part of a school’s mental health team meetings and are really embedded. It’s a great partnership.”
Crunching the numbers
Throughout his career, much of Golberstein’s research has been focused on mental health, the economics of mental health and mental health care policy. Minnesota’s school-based mental health programs fit neatly into his interests.
Golberstein found these programs intriguing, especially the fact that they were being introduced in a staggered fashion. “As an applied economist,” he said, “I thought, ‘Taking a closer look at the way this program is rolled out would be a good way to study the effects of where some schools are getting it and other schools aren’t.’”
Around the same time, Golberstein learned about the Minnesota Student Survey. This extensive, publicly accessible survey of student behavior, Golberstein said, enabled him and his colleagues access to “really incredible administrative data on kids over time that allowed us to identify which kids were in which year and then we could link that with Medicaid data for kids on Medicaid that would tell us what mental health services if any they got every year.”
Collecting and analyzing this data was “an enormous lift,” Golberstein said. “We had to pull together over 19 years of information on every single non-charter public school in Hennepin County and whether or not they implemented this program and what year they implemented it in.” Because the team knew they had to set some limit on their task, members decided to focus on Hennepin County for this study, rather than analyzing data on students statewide.
Golberstein and his colleagues used Minnesota Student Survey results to estimate by how much school-based mental health programs were reducing suicide attempts.
“We have our estimate of the causal effect of implementing this type of school-based mental health program,” he said, “After a school implements this, on average the rate of self-reported suicide attempts goes down by this amount.’ Then we multiply that percent reduction by the number of students in each school after this program has been implemented. That’s how we came up with that number.”
In the economics “trade,” Golberstein explained, “that’s what we know as the ‘back-of-the-envelope’ calculation.’
University of Minnesota researchers also linked Minnesota Student Survey results with state juvenile justice data. The team was also able to link their results with other school data like test scores, attendance records and suspensions to see if there was a link between mental health needs and these larger concerns.
These connections produced two results that are less definitive than the numbers on averted suicide attempts. “We have weaker evidence that, after schools implemented in-school mental health services, there were reductions in suspensions in that school and there were some reductions in juvenile justice involvement for kids in those schools,” Golberstein said. “Then there were things we just didn’t find in our research. For instance, we didn’t find changes in test scores. We didn’t find changes in attendance, either.”
Helping youth ‘get what they need when they need it’
The school-based mental health model focuses on mental health clinicians providing psychotherapy to students in a school setting. This focus on therapy is important, Sander said, “because early on people thought, ‘You are going to come to my school and you are going to give my kid medication.’ One of the things for me that got proven by this research was, ‘Nope. It is really about the person-centered therapy work that happens, and yes, if medication is needed, it gets utilized, but we did not see a spike in medication among students.’
Sander believes the program, while not a cure-all, has provided key mental health support to many students who otherwise may not have found outside help for their concerns.
“For over 10 years, we saw 50% or more of the kids getting mental services in the schools were students who were getting it for the first time,” he said. Having therapists available in the schools makes mental health care accessible for everyone. And because therapists also provide support to the larger school community, “they are helping teachers, administrators, all staff understand how to support youth with mental health needs better.”
Simply having a therapist in the school helps to raise awareness of the impact of mental illness on the community, Sander said. “In all these schools, we hope there is a mental health team that is having conversations on a weekly basis, and that teachers and paras and principals are saying to therapists, ‘I’m wondering about this student,’ and the therapist is weighing in.” While the student may not need mental health support, these kinds of conversations spur discussion and make talking about mental health feel like a normal part of the school day.
In Minnesota, school-based mental health programs have received financial support from the state Legislature, Sander said.
In 2008, for instance, DHS created a grant program to help uninsured students pay for school-based mental health. Such support is key, Sander said, but he said health insurance pays for 60-70% of the program’s cases.
Sander said this kind of financial support has helped to make not only Hennepin County, but all of Minnesota, “a national leader in how we blended the funding. Minnesota has done a really good job of providing mental health care to students. I do think we’re moving forward, but there is still more funding needed. There are significant increases in depression and anxiety among youth in the state. There are more and more schools that need this kind of support.”
This legislative session, Sander said he hopes lawmakers will consider additional funding for the Department of Human Services’ school-linked mental health program. “We’ve got a great program,” he said. “There is already $17.5 million a year. They increased it this past year by another $7 million, but there’s still more needed.”
Sander said increasing funding for a “proven intervention” is key to supporting the mental health of young Minnesotans: “This in-school partnership really helps youth get the mental health help they need when they need it, which is really the whole point.”
