It's only in recent years that New Hampshire has begun to seriously address the mental health needs of children. Under a 2016 law, the state is supposed to provide a more coordinated system to help children with mental health needs that have been intensified by the opioid crisis and a troubled DCYF system. Suicide remains a top cause of death for N.H. teens.
Schools are now playing a major role in helping to identify problems -- using "trauma-informed" techniques to help children cope with psychological stress and challenges that can interfere with academics and learning.
According to the National Institute of Mental Health, 50 percent of all lifetime cases of mental illness begin by age 14, and 75 percent of them hit by age 24.
School counselor Fern Seiden, of Thorntons Ferry School in Merrimack, says community mental health centers have been vital partners.
"We're trying to reimagine what it means to be a school in a community," said Seiden on The Exchange. "That means we're breaking down those silos and reaching out across our borders. It's going to take that in order to meet this challenge because right now the numbers of students with these mental health disorders and mental health challenges are really outstripping our ability to provide the care we need. We have to work as a system."
Seiden says the school setting provides an opportunity to develop "therapeutic relationships" with students.
"Our challenge is that we are here to help the kids be available to learn, so we can't say, 'Oh, it's a hot potato-- here, you catch it, community mental health agency.' Or 'You take care of it, crisis team.' If we do that we are missing opportunities to help our students. As long as we don't define this as a community-held responsibility -- with schools being really a huge part of every community -- we're going to miss those opportunities to help our kids."
Jody Lubarsky is director of Child, Adolescent and Family Services at Seacoast Mental Health Center. As she describes it, the challenge is to look beyond a child's behavior to what might be an underlying mental health condition, such as anxiety or depression. For these children, she says, being sent out of a classroom for a time-out can be a kind of relief -- allowing them to avoid anxiety-producing tasks the are routine for other children. "If you have a child who is truly dealing with anxiety and we're treating it as oppositional behavior we're not providing the appropriate treatment and we're potentially letting things go for two, four, ten years before we finally get to a place of appropriately addressing it."
Lisa Provost's 16-year-old son has struggled with many challenges, including bipolar disorder, PTSD, and autism: "Those behaviors that we see and treat as oppositional, or a problem, are oftentimes a function of a deeper and more more complex situation going on like depression or PTSD or autism," she said. "And so I think that we need to have a stronger and more rigorous collaboration between school, home, the medical profession, and our community- based supports in order to fully treat and fully deal with children holistically."
Provost says students like her son need a lot of support. "When our children are in school they are going to have a hard time accessing curriculum because they need to be treated on a constant basis for their mental health issues, in conjunction with learning skills and academics. So we have to bring that level of support and therapy into the school, not just with a school counselor, but with really qualified individuals who work probably in other organizations throughout the state."
"As a parent, navigating the systems is absolutely a nightmare. I don't work out of the home. I'm a full-time mom. I can't imagine some of the parents who have to do these things during their work break. It's frustrating. So you know we really need to do better providing better access and support."
But for Exchange listener Delllie, who works with the N.H. Children's Behavioral Health Collaborative, today's parents have much to be grateful for: "My son was diagnosed with a serious and persistent mental illness 10 years ago. And I am so jealous of the services people are receiving today. He didn't have wrap-around services 10 years ago. The system has improved greatly. We still have a lot of gaps. We still have a lot of work to do but coordinated efforts are in place today because of the system-of-care law. I think parents need hope and they need to know that wraparound services are could be more prevalent but are existing in our state."
Wrap-around services are part of a new program that helps children with severe problems, according to Erica Ungarelli, director of the Bureau for Children's Behavioral Health at the Department of Health and Human Services. "The child and their family get to drive what happens, and they get the very intensive in-home support that they need to have that child be successful in the home, in the community, and at school. It uses a team approach," she says.
Still, Exchange listener Molly expressed frustration about her own daughter's experience. "When she was in preschool, she was almost asked to leave the program because of her behaviors. When I tried to get services and have her evaluated I was on a waiting list for six to 12 months at both Dartmouth-Hitchcock and Boston Children's Hospital. And I just called this morning again to see if that waitlist has changed. It's still anywhere between 9 and 14 months just to be evaluated."
Lisa Provost's son, meanwhile, is doing better in certain ways, after finally getting a full diagnosis. "He's falling behind academically, but socially, he is starting to come into his own. An after-school program has really helped him. It works towards doing community projects and helping other individuals. The program includes neurotypical peers who are really welcoming and supportive, and that has really helped him shine. We're working hard on trying to find the right methodology to deliver academics to him."