This article is Part 2 of coverage on the proposed quarter-cent sales tax for children's mental health that Boone County voters will see on the Nov. 6 ballot. Read part 1 here. A summary of the proposal can be found in the Missourian's Voters Guide.
COLUMBIA — The primary job of the outreach counselors in Columbia Public Schools is referring kids with depression, eating disorders and other serious mental health issues to appropriate services.
But when those services aren't available, counselors are at a loss.
Betsy Jones, the Columbia Public Schools guidance and counseling coordinator for grades 6 to 12, said there are simply not enough counseling and therapy services in Boone County for the number of students who need help.
Even when working with students who are suicidal, it is difficult to get immediate care, because of waitlists, lack of insurance or inadequate bed space, she said.
"There are some fabulous mental health resources in our community, but we recognize that those resources are packed," she said.
Counseling is the largest unmet need of Boone County kids, according to the children's mental health survey commissioned by the coalition promoting a mental health tax for kids and their families.
The study identified 357 children who were unable to get counseling at the time of request in 2010 and, at some clinics, wait times were a minimum of three months — a wait mental health professionals say is too long.
Jones said that revenue from the proposed sales tax for children's mental health on the Nov. 6 ballot could help schools simply by adding to the available agencies and programs.
If the tax passes, money could go toward a variety of services listed in the state law that allows counties to levy a tax for children's mental health, including temporary shelter, crisis intervention and early intervention. Seven counties in Missouri have passed a tax similar to Proposition 1.
Early intervention includes individual counseling, family and group therapy, outpatient psychiatric treatment and prevention efforts in schools. Counseling and education address problems early on and can help keep children out of hospitals and shelters, mental health professionals say.
The role of schools
When children do not get the services they need, their mental health problems can show up in distracting classroom behaviors such as difficulty working in teams or getting along with other students, Chris Belcher, superintendent of Columbia Public Schools, said.
"A small population with extreme needs pulls attention away from the general population in a dramatic fashion," he said.
Belcher has been a proponent of the sales tax for children's mental health since the Putting Kids First group started the conversation several years ago.
"If you ask any elementary principal, what is their No. 1 concern? They would say, child mental health programs," Belcher said.
Counselors in Columbia Public Schools spend 40 percent of their time doing counseling and referrals and the rest on guidance curriculum and college planning, Jones said. But in-school counseling does not take the place of treatment.
"We’re not doing therapy," Jones said. "We’re doing brief counseling to help stabilize, get kids back into class or get them to the services they need."
Belcher said that if the tax were passed, he would like to see schools in Boone County collaborate with agencies to offer services on site — a model used in St. Louis after passage of a similar tax.
"That’s becoming a popular thing, to take your neighborhood schools and use them as a site to deliver a variety of services," Belcher said.
These services could include group counseling, family consultations or psychological evaluations, which are not available in Columbia Public Schools. Programs would occur before and after school and not during class.
St. Louis passed a sales tax for children's mental health tax in 2008, and the money has been used by 12 agencies to provide mental health services in 22 school districts, as well as private schools. These services include counseling, family consultation, outpatient psychiatric treatment and education programs to prevent bullying, child abuse, violence and suicide.
Columbia Public Schools already collaborates with Missouri Psychiatric Center and Burrell Behavioral Health Center, Belcher said. Both have come into schools to observe kids for diagnoses, and Burrell has provided counseling to suspended students.
The cost of counseling
In addition to wait times, cost is an obstacle for many families whose children need counseling services.
"The poverty index coincides with kids needing more care," Belcher said. "They’re just not getting it because it costs money."
Seventeen percent of children in Boone County, or 5,580 individuals, were living in poverty, according to 2012 data from the Small Area Income and Poverty Estimates program through the U.S. census.
There are only a few counseling providers in Boone County that take Medicaid, said Melissa Lawson, a pediatrician who specializes in adolescent medicine.
St. Louis has used the revenue from its tax to establish programs that provide free social services, including counseling.
The Children's Foundation of Mid-America in St. Louis, for example, used the revenue to establish a therapeutic mentoring program and an in-home family counseling service called Family Solutions for Kids.
"The clients do not have to pay anything," said Angie Brown, vice-president of community relations for the agency. "These are folks that certainly would have not been able to afford such services before.”
In 2011, the therapeutic mentoring program served 396 people and Family Solutions for Kids served 362 people. Through mid-October of this year, therapeutic mentoring had served 511, and Family Solutions for Kids had served 355.
"That’s a direct result of the children’s service fund money," Brown said. "If we didn’t have that money, we couldn’t have that money, we couldn’t serve those kids."
Awareness and education
Mental health providers say there is also a problem of parental awareness, especially with topics such as suicide.
This year, 9 percent of Boone County students between grades 6 and 12 have contemplated suicide, 8 percent planned an attempt, and 5 percent attempted to kill themselves, according to the 2012 Missouri Student Survey by the Missouri Institute of Mental Health.
Scott Perkins, project director for the Missouri Suicide Prevention Project, compared suicide awareness to an iceberg.
Suicide deaths are tragic, but they only represent the surface of the problem, he said. The number of kids who consider suicide or attempt suicide go unnoticed and unacknowledged because their problems aren't as visible.
Nationwide, there are an estimated 100 to 200 suicide attempts for every completed suicide in people between the ages of 15 and 24, according to the Centers for Disease Control and Prevention.
Perkins spoke at a recent town hall on suicide hosted by Inside Columbia magazine, where panelists and attendees agreed that public awareness is key to a solution.
Students in Columbia Public Schools receive suicide education starting in middle school and continuing through high school. Younger students learn about bullying prevention, and older students learn that depression is treatable.
“If you had a broken arm, you wouldn’t think of not going to get that fixed," Jones said. "Well, this is the same thing. A mental health disorder can be treated, and there is hope, and there are cures.”
But some parents aren't aware mental health can be treatable, Lawson said, and others resist getting counseling for their kids because they worry it would reflect poorly on their parenting.
St. Louis and St. Charles counties have used some of the revenue from their taxes for children's mental health to hold town halls for parents to learn about the variety of causes and treatments for mental illness. This year, St. Louis focused its town hall meetings on drug abuse, specifically heroine.
Christine Corcoran, who has been leading the coalition promoting the tax in Boone County, said similar meetings in Boone County could help diminish the stigma attached to mental health and give parents tools to recognize signs early on.
"It looks different in kids than it does in adults," she said. "Depression often looks like anger in an adolescent."
But no amount of early identification can help kids who have to wait three months for counseling or can't afford counseling at all, Corcoran said.
Money from the proposed tax could go to both education and services, so the problems of awareness and accessibility would be addressed hand in hand, she said.
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