This article is published as part of the Mental Health Parity Collaborative, a national partnership between AZCIR and The Carter Center’s Rosalynn Carter Fellowships for Mental Health Journalism and other newsrooms throughout the U.S.
At times, seventh grade felt like one long string of panic attacks to Zoe Edelstein.
The Phoenix student, who’d been living with anxiety and panic disorder since early elementary school, had started in-person at a new campus in spring 2021 after a year of remote learning during the pandemic. Returning to the classroom and being surrounded by unfamiliar faces was “overwhelming,” she said.
Sitting in class at the charter school, the then-12-year-old would begin to feel a weight pressing on her chest as it became increasingly difficult to breathe. She’d start to hyperventilate until she was on the verge of passing out, a cold sweat coating her body. Her head would begin to pound as her body shook so badly she felt like her brain was rattling.
Though Edelstein sometimes leaned on her teachers in those moments, she said she largely handled the attacks on her own, given the absence of campus mental health professionals trained to help with conditions like hers. She often fled to the bathroom or the school’s designated calming space—a corner furnished with pillows and blankets where tranquil music played in the background—to try to control her breathing, a process that sometimes took an hour or more.
“There … wasn’t really a solid person to speak to. It was just a space you could go to,” she said of the school’s solution. “I always appreciate having somebody that I trust that I can confide in.”
Ultimately, the lack of dedicated, on-site mental health support played a role in her decision to make the switch to online school this fall.
Arizona students like Edelstein have long been among the worst-off in the nation when it comes to unaddressed mental health problems: The state ranks at or near the bottom on several key indicators of youth well-being, such as the percentage of kids with untreated depression. According to Mental Health America, about 98,000 Arizona youth experienced a major depressive episode during the school year preceding the pandemic, yet nearly 67,000 of them did not get the help they needed.
In the more than two years since COVID-19 hit, the situation has grown more dire. A recent federal report on pediatric emergency room visits showed an increase in the “number and proportion of visits for psychosocial concerns and for symptoms of mental health conditions and substance use” among children and teens nationwide. Suicide is the third leading cause of death among young people aged 10-24.
“When you think about only three out of every 10 kids with a major depressive episode (getting) treatment—if that occurred for any other condition, I think people would be outraged,” Angela Kimball, senior vice president at national mental health policy coalition Inseparable, said of Arizona’s statistics. “They should be for mental health as well.”
Many schools were still grappling with Recession-era cuts that had thinned the ranks of campus-based mental health professionals when the pandemic struck. A patchwork of limited-term grants has let some schools temporarily rehire, but a permanent funding solution has yet to make its way through the Arizona Legislature.
The consequences are well-known: Arizona’s student-to-mental-health-professional ratios are up to 13 times higher than what experts recommend. The state has 716 students for every school counselor and a staggering 3,382 students for each social worker. Those ratios should be 250:1. For school psychologists, Arizona’s ratio of 1,593:1 is more than three times the suggested 500:1.
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A 2021 move by the Arizona Department of Education to dedicate $21 million in federal Elementary and Secondary School Emergency Relief Fund (ESSER) dollars to unfunded campus counselor and social worker positions helped more than 140 district and charter schools meet at least some of the overwhelming need. The new counselors and social workers have provided one-on-one counseling, established student support groups, intervened to prevent suicides, connected families to food banks and other resources, and implemented a host of other services that have removed at least some of the strain previously placed on teachers and principals.
As students once again return to in-person learning for a new school year, though, it’s unclear just how long the newly hired mental health providers will remain on Arizona campuses. The emergency funding that pays their salaries was awarded on a two-year basis to supplement the Arizona School Safety Program, which until 2019 provided grants only to campus law enforcement. The stopgap funding will disappear after the 2022-2023 school year.
That means 83 new counselors and 59 new social workers could, too.
Some lawmakers have pointed to a line item allocating an additional $50 million to the School Safety Program in the latest state budget—again, for temporary grants—as a fix. But legislative leaders have stipulated the Department of Education must prioritize requests for campus police officers before using any of that money for counselor and social worker positions, reflecting an ongoing conflict among state officials about which positions more effectively keep students safe.
“Yes, this is a huge infusion of money to our school safety positions and to mental health positions, but we are still last in the nation,” said Richie Taylor, state Department of Education spokesman. “We can pat ourselves on the back, and we should, for this moving in the right direction. But we’ve got a long way to go to truly be meeting the need across the state.”
Meeting students where they are improves access
Experts said an ideal school environment has a team of mental health professionals that includes counselors, social workers and psychologists. The positions work in tandem, but also with teachers and families to help students reach academic, behavioral and emotional success.
Counselors generally take the lead on academic advising and short-term counseling, while social workers connect students and their families to concrete resources such as clothing vouchers and food banks. Psychologists have a more clinical focus, providing mental health assessments and intervening when students are in crisis.
In Arizona, students often don’t have even one such professional on campus full-time, given the state’s abysmal ratios of kids to mental health professionals.
Experts said embedding mental health professionals within schools can help streamline student access to mental health services overall, providing care where and when it’s needed. When kids have to leave campus to even begin the process of getting help, they said, it may take much longer to get treatment—or not happen at all.
“There’s already a workforce shortage for behavioral health care across the country,” Kimball said. “If you layer on top of that the fact that it is challenging for a lot of people to get time off of work, to have transportation, to take their kids out of school—all those create additional barriers to getting mental health care.”
It can take three to four months to get a child seen for an evaluation with an outside psychologist, according to at least one parent, and another several months to get on a counselor’s schedule, particularly if seeking one that accepts insurance.
That’s assuming families aren’t discouraged by the sometimes insurmountable stigma surrounding mental health care in many communities, according to Kimball. “When you have mental health services available in school,” she said, “it sort of normalizes them, and it takes away all of the usual barriers.”
Several of the districts and charters that hired counselors and social workers using federal ESSER funds noted a marked increase in successful mental health interventions over the past year. Mental health professionals interviewed by AZCIR reported meeting with anywhere from 20 to 65 students on a weekly basis and interacting with hundreds more over the course of the school year.
They also hosted group sessions focused on anxiety and grief, provided one-on-one counseling, administered assessments, and connected families with food pantries and clothing vouchers. They referred students for therapy, developed crisis policies, led parent meetings and trained teachers on how to manage students recovering from trauma.
At Vista Grande High School in Casa Grande, Natalie Hunter’s ESSER-funded job as a social worker largely focused on assisting students who, like Edelstein, struggled to return to in-person learning after having to “adjust to the isolation” of remote classes during the pandemic.
At Vail Unified District, suicide interventions increased dramatically after the southern Arizona school system brought on eight new ESSER-funded counselors, according to director of student supports Heather Stough.
At Leman Academy of Excellence’s Sierra Vista campus, social worker Jennifer VandeWeg hosted parent nights to help families understand the difference between typical childhood ups and downs and behaviors requiring outside intervention. She met one-on-one with parents of struggling students to ensure strategies employed at home and at school were consistent as well.
VandeWeg also worked with teachers to help them distinguish between mental health issues and misbehavior. Instructors had previously tended to “rely quite heavily on administrators and sending kids out of the classroom” whenever students had behavioral outbursts, she said, as that was often their primary option.
“We try to look at, ‘What (the student) did was not OK, but why is the behavior occurring?’” she said. “Then we help mitigate a lot of those situations from continuing into disciplinary measures.”
Illustration by Zach Van Arsdale for AZCIR
Abrupt loss of campus mental health posts could create ‘devastating’ chain reaction
Phoenix parent Nikkie Whaley, whose 16-year-old son has ADHD, anxiety and a mood disorder, has seen firsthand how widely her son’s school experience can vary depending on the staff a campus has in place, and the scope of that staff’s training.
In preschool and early elementary school, she said, Miles was kicked out of class and sent to the principal’s office when he grew agitated. In middle school, because he would flee the classroom when overwhelmed, she said his school had a campus police officer follow him around, exacerbating his anxiety further.
Miles’ experience at Washington High School has been completely different, Whaley said. The team there has worked to understand the needs outlined in Miles’ 504 plan—a protection that outlines accommodations for students with conditions that interfere with learning—and respond to outbursts in a way that maximizes his chances of calming down and returning to class, rather than simply ejecting him when he has trouble.
Yemen Bernal, president of the School Social Work Association of Arizona, said families often don’t realize the breadth of services certain campus mental health professionals can provide until those services become available to them—and it can be a shock when they disappear.
If ESSER-funded mental health positions aren’t covered beyond the 2022-23 school year, the losses could be “pretty devastating,” she said. Schools would likely give up not only direct services but also secondary community partnerships typically managed by social workers, such as with food banks or Big Brother, Big Sister, she explained.
Arizona students and families have endured such losses before, when the Great Recession forced districts and charters to slice deep into their budgets.
Kim Seh, assistant superintendent for Somerton School District near Yuma, was working as a principal when her school lost its part-time counselor because of budget cuts. She ended up taking on many counseling duties herself—“anything from behavioral, home life things, academic, whatever it could be”—and leaned on outside crisis agencies for “matters that were more tender or pressing or urgent,” she said.
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Over the last few years, Somerton was able to hire five counselors using a mix of ESSER and School Safety Program grant funding. But officials don’t think the district can afford to extend the positions without additional grants.
Instability surrounding campus mental health funding has made it impossible for some districts to even temporarily restore positions they’d cut.
Southeastern Arizona’s Safford Unified District lost counselors as a result of “trimming not just to the bone, but into the bone” during the Great Recession, according to superintendent AJ Taylor. The district was selected for a School Safety Program grant to fund two counselors in 2019, but had no luck hiring, he said.
The only applicant was someone who didn’t want to risk taking a job that would disappear if the grant wasn’t renewed, he said, so the district ultimately didn’t pursue an ESSER award.
“You have a parent give you a call and say, ‘You know what, our family’s going through a really tough time right now, and our kid’s having a hard time. Do you have a counselor that my child can speak to when they come to school today?’” he said. “And when we don’t have that, that’s really difficult.”
Despite additional dollars, schools say funding cliffs loom
The latest state budget allocates an additional $50 million to the School Safety Program, which, in theory, could be used to extend school counselor and social worker positions at schools that ask for help.
But the GOP-controlled Legislature has stipulated the money must go toward requests for school resource officers before anything can be spent on mental health positions, and the program does not include school psychologists.
The requirement reflects an ongoing dispute between some Republican lawmakers and education officials regarding which type of positions actually make a campus safer. During a June hearing of the House Appropriations Committee, Rep. Steve Kaiser, R-Phoenix, pressed Brenden Foland of the Arizona Education Association on the point as Foland advocated for an expanded investment in mental health resources.
“In your opinion, who would be better trained to stop an active shooter on a school campus, an SRO or a mental health counselor?” Kaiser asked.
“Rep. Kaiser, our focus is on preventing those incidents from happening, not responding to them,” Foland replied.
Even if all desired campus police, counselor and social worker positions end up funded through the latest School Safety Program allocation, it would again be on a temporary basis, since program grants operate on a three-year cycle. Administrators said such fiscal cliffs create uncertainty when schools are trying to hire for these positions, already an uphill battle given a shortage of mental health providers licensed and certified to work with youth.
Youth access to mental health care improved under Jake’s Law, but persistent barriers hamper its reach
Jake’s Law has covered behavioral health services for students who otherwise may not have received treatment. But provider shortages and other challenges have made it difficult for some children and their families to access care.
In interviews with AZCIR, Department of Education and school officials alike indicated base education funding—the annual dollar amount allocated to schools for general operating expenses—would be a much more stable source of revenue for the positions.
“Our philosophy… is that these types of positions should not really be funded as competitive grants,” said Taylor, the ADE spokesman. “Base funding is the better way to go because it provides that greater flexibility, and then you don’t have to get into this process of picking winners and losers when there is less money.”
Lawmakers did increase base education funding as part of this year’s budget, but it’s too early to say what, if any, portion of that could go toward permanent mental health positions, according to Taylor.
Districts over the past few years have relied on federal relief funding to fill gaps required to maintain basic operations, including some staffing and technology costs. Schools will need to use state dollars to cover those costs once relief packages expire. Districts also will no longer see hundreds of millions in proceeds from Proposition 208, the 2020 ballot measure that aimed to raise taxes on the state’s highest earners to help stabilize school funding, after it was ruled unconstitutional this spring.
The state’s shaky financial commitment to campus mental health is apparent not only to officials but to students like Edelstein, who joined the state superintendent of public instruction’s Student Advisory Council to advocate for more comprehensive services on campus.
She and other members of the council spoke at length at the 2022 Student Advisory Summit about stressed out students, stretched-thin campus mental health professionals and inconsistent access to assistance.
“When you have a mental health issue, the smallest thing can lead to a ripple effect, and there’s just so many small issues that have been building up over the years,” Edelstein told State Superintendent Kathy Hoffman. Yet “most students who need aid don’t even consider seeing a counselor as an option because they either don’t know they exist or think that they’ll be viewed as abnormal because of it,” she said.
Edelstein acknowledged the improvement in the state’s student-to-counselor ratio from 905:1 in 2019 to 716:1 in 2021, and noted that she expected to see further improvements over the next few years “with the help of grants.”
But when it comes to making campus services available to every student who needs them, she said, “it will likely take a lot more funding and time to make this happen.”
Many Arizona students lack consistent access to full-time mental health professionals on campus. For kids or families dealing with mental health crises or suicidal ideation and in need of immediate assistance, the following resources may help. Most are available 24 hours a day.
- The new 988 suicide and crisis hotline replaces the National Suicide Prevention lifeline. Calls to 9-8-8 will be routed locally, but texts will go to the line’s centralized system. A chat option is available at: 988lifeline.org/chat.
- Arizona’s Teen Lifeline connects teens with peers to discuss thoughts of suicide, depression, anxiety and other concerns. Call or text 602-248-TEEN or visit teenlifeline.org.
- The state’s Medicaid program maintains a list of crisis hotlines by county and tribal nation at: azahcccs.gov/BehavioralHealth/crisis.html.
- Arizona’s 211 crisis hotline connects residents of all ages with emergency services, including mental health care. Call 2-1-1 or visit 211arizona.org.
- Banner Thunderbird Medical Center’s Department of Behavioral Health offers several Phoenix-area outpatient programs for adolescents. Call 800-254-HELP or 602-254-4357 for a free assessment.