Alabama school officials say they’ve seen an increase in reports of mental health concerns from students over the last five years. The state has a program to put therapists in schools, but getting staffing can be difficult. (Getty Images)
Julie Box, director of student services at Sheffield City Schools, said students are bringing more trauma into school with them.
“Eight to 10 years ago, it was a very strange occurrence to make a referral for inpatient or have a student threatening self harm or making these type threats,” she said. “Now, it’s a very common, almost a daily occurrence.”
Liz James, chief executive officer at Riverbend Center for Mental Health in Florence, has a principal who calls her often, requesting that they have a therapist at the school every day.
Right now, doing so would not be feasible.
Many of Alabama’s students face mental health concerns.
Riverbend Center for Mental Health saw 860 adolescents in 2023 and 2024. Around 320 had a diagnosis of ADHD. According to the Centers for Disease Control and Prevention, children with ADHD are at higher risk for mental, behavioral and emotional concerns, including suicide.
Roughly 200 had an anxiety disorder. Nearly 100 were dealing with depression. Twenty-eight had oppositional defiant disorder.
Many of those students are able to access care through school-based therapists, but problems have persisted.
“I’ve got an assistant principal who says, ‘I should go back and get a social work degree, because that’s what I do. I talk to kids all day that make threats or get in a fight,’” said Wesley Puckett, social worker with Lauderdale County Schools. “It turns into this mental health thing. And so we’ve got people that are doing this, these things that don’t have the training to do it, and of no fault of their own. They’re just doing the best they can do, but they feel overwhelmed.”
In 2010, Alabama launched a school-based mental health program (SBMH), which provides therapists who visit schools during the day, removing transportation barriers for parents or guardians who would otherwise need to drive their children to therapy appointments.
Riverbend had been one of the pilot locations. Their first contract was with Florence City Schools in 1999. The center has 15 full-time mental health employees who cover an area of almost 2,000 square miles.
James wrote in an email that disciplinary issues impact other students’ learning, as well.
“Teachers, school counselors, assistant principals and principals would be dealing with issues that they are not trained or experienced to deal with,” she wrote. “There would also be an increase in disciplinary and attendance issues without SBMH being available.”
Gayla Cadell, senior program manager for child and adolescent mental illness treatment services, said that Riverbend had worked with school systems to model their program off of California, which was an integrated approach to put mental health services in the classroom.
James said it was loosely modeled on a program from UCLA over 25 years ago.
“In an ideal world, we would have to be able to pay higher, more competitive salaries for all of our therapists,” James said.
It would take about $560,000 to provide substantial increases in wages, while also adding more SBMH staff, she said, and five more staff members would mean better coverage.
Therapists visit the schools and provide care to the students. One counselor said that one of the issues with the model is that they have less contact with the parents, which prevents a fuller picture.
Melvia Moye, a school-based mental based counselor through AltaPointe in Mobile, works at an alternative school and said that one of the barriers for her work is parental consent.
“When we talk about having unlimited resources, if the families aren’t accepting the resources, then the amount or the unlimitedness doesn’t matter, because there are times when the parents say ‘yes’ to therapy for their children, and then I call and they don’t answer, or I call and they say, they tell me ‘yes,’ and then as I start getting the information that I need, then they don’t answer,” she said.
Moye said it’s important to convey what therapy can do for a child.
Therapists in the program are placed at a school so they know what’s going on at the school. In a more traditional clinic setting, patients can neglect to bring up their problems in schools.
“We have a lot of kids who get therapy from other providers, but the level of communication is not there because the relationships are not there,” Puckett said. “A big part of treatment is knowing exactly what’s going on, because kids can say all kinds of stuff, and it’s not always true.”
Collaborations
Riverbend Center for Mental Health has regular collaborative meetings with the schools in the area.
But geography can be limiting. Some of the students in the Riverbend Center for Mental Health area live in rural areas. When students need more intensive care, they could require a drive to Decatur, about an hour east of Florence, and a potentially lengthy wait in an emergency room.
Jacqueline Johnson, mental health coordinator for Sheffield City Schools, said that the therapists are able to help as a neutral party that encourages problem solving and reflection.
“I think students are more open to that,” she said.
Puckett said that a lack of power dynamic between the therapist and student also helps them.
The therapist doesn’t control grades or a school experience.
“They leave, and you don’t have to walk in the halls and see them every day after you told them you know, your deepest, darkest secret or whatever’s going on,” he said.
But the program is also limited by the constraints of staffing. According to the American Psychologist Association, the psychologist workforce projections for Alabama in 2024 are a supply of 810 full-time psychologists and a need of 1,490.
James said that, if she had the staffing, if she had the money, then all students who need help would receive it.
“That’s money and manpower,” she said. “That would make the schools a lot happier if we had somebody there every single day.”
She said that many of her employees leave for better work and pay. She said she understands that, and that they work to find people “that have the heart for it, that want to do this type of work.”.
“We’re staffed at this moment, but tomorrow could be a different day,” she said. “And that’s statewide. I think all mental health centers are struggling with getting qualified staff to do these types of jobs. And mental health pay is not good.”
More paid time off would be a luxury, she said. She said she wants to be able to pay people what they’re worth.
“I think manpower is a big portion of the problem, and I think salaries and being able to shore people up would help that a lot,” she said.
Next: Alabama jails are poor places for those with mental illness to be. That’s led to tragedy.