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On mental health, do Clark County schools make the grade?

Fellowship Story Showcase

On mental health, do Clark County schools make the grade?

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The Las Vegas Sun spent several months exploring community challenges created by lack of treatment for children with mental problems. The project was supported by the Center for Health Journalism at the University of Southern California's Annenberg School for Communication and Journalism. In November and December, we'll bring you stories from the parents, educators, doctors, juvenile court judges and children affected by these issues.

Other stories in the series include:

How Nevada struggles to help children battling mental illness

In Nevada, mental health crisis among children merits a closer look

Helen Melendez visits a plaque memorializing her daughter on Monday, Nov. 16, 2015, at Discovery Park. Her daughter, Claudia, killed herself five years ago and, since then, Melendez has pushed for more mental health awareness in the community, especially at schools.
Las Vegas Sun
Tuesday, November 24, 2015

When Helen Melendez browses photos of her daughter, Claudia, two versions of her oldest child stare back.

First, the happy-go-lucky Claudia: Her artistic, kind-hearted daughter, wearing a bandana, smiles for the camera with her younger sister.
Then, the depressed Claudia: The 15-year-old stands among her siblings on a beach vacation, expressionless, arms crossed.

The photos were taken during the same trip to Carlsbad, Calif., when Claudia’s emotions fluctuated wildly despite the soothing ocean and her family’s presence. A month later, on Sept. 30, 2010, Claudia killed herself.

The bubbly teen who loved theater had withdrawn to her bedroom that summer. She ate less and wore sweatpants and baggy shirts. She teared up easily and, in the week leading up to her death, fixated on news stories about teens who died. Melendez and her husband hadn’t pieced it all together.

They chalked up Claudia’s behavior to normal teen moodiness, perhaps fueled by trouble fitting in at Foothill High School, separated from friends who were assigned to a different school.

If they had understood their daughter’s despair, they would have intervened.

“We just thought it was a phase,” Melendez says. “We did not pick up on those warnings.”

Melendez, a former teacher, wondered how many other teenagers were living in darkness. If she was too late to help her daughter, maybe she could help others. So she created a PowerPoint presentation called “How Suicide Affected My Family” that she has shared with School Board trustees, a former superintendent and various principals — the last being the most important. The principals, she says, are “my key people because they are the ones who have authority to change things at their schools.”

Her presentation lists mental health resources just the click of a mouse away. Saving lives, she thinks, boils down to awareness.

Someone needs to sound the alarm about children’s mental health, Melendez says, and so she works behind the scenes to force change. When Claudia died, a crusader was born.

A slide in her presentation says it all: “I have been given a second chance after losing my firstborn to suicide.”

• • •

School officials understand their burden: Parents and caregivers might not spot red flags indicating a child’s internal strife. That means principals, teachers, counselors and coaches are the next line of defense.

“We know that sometimes kids fall into crisis,” said Robert Weires, director of psychological services for Clark County School District. “(Teachers) spend a lot of time with kids, and sometimes they self-disclose.”

Even if they don’t give signs, educators know that a number of students in each Clark County classroom may be battling emotional or behavioral challenges — some so severe that they lead to hospitalization.

Last year, the school district formed a support squad to aid students returning to school after crisis-induced hospital stays. The Mental Health Transition Team works with parents and psychiatric hospitals to develop re-entry plans, which could include designating a staff member the child feels comfortable checking in with every day and strategies so students don’t fall behind in school. The team includes two school psychologists, a school nurse and school counselor.

It’s not entirely new. The district has been working with Desert Willow, Southern Nevada’s only state-run psychiatric hospital for children, for the past five years to help ease children back to the classroom. Last year, the district expanded the program to include children coming out of private psychiatric hospitals as well.

In the 2014-15 school year, the team helped 1,485 students adjust to school after mental health-related hospitalizations. Even more students are expected to need help this school year. “I think we were all a little bit surprised,” Weires said.

The Mental Health Transition Team studied the numbers. Here’s what it found:

• Major depressive disorders were the most common single diagnosis, affecting 35 percent of the students hospitalized, followed by mood disorders (14 percent) and bipolar disorders (10 percent). Twenty-nine percent of hospitalized students received multiple diagnoses.

• More than 60 percent of hospitalized students were in general-education classes.

• Students in eighth, ninth and 10th grade are at greatest risk for mental health-related crises. Of all the hospitalizations, students in those grades accounted for 45 percent.

The data betrayed a troubling trend: an increasing number of younger children — including kindergartners — struggling with emotional and behavioral problems beyond what is normal for their age.

Five or 10 years ago, elementary-age children with mental health-related problems were few and far between, Weires said. Last year, the transition team assisted 53 third-graders, 39 fourth-graders and 70 fifth-graders. It’s common for school children to begin to receive treatment, such as therapy or medication, at a young age.

The school district has begun studying the transition team’s effectiveness by tracking students’ academic performances and subsequent hospital visits, but Weires said it was too soon to draw any conclusions.

Tammie Roitman, a long-time school psychologist for CCSD who helped launch the transition team, said she thinks health-care providers too often classify problems as mental illnesses without more thorough inquiries. Is it a behavior problem that could be corrected by better parenting techniques? Or are the behaviors symptoms of a psychiatric illness?

Doing so, however, would take a team approach, with parents, doctors, therapists, educators and social workers working together to address a child’s emotional and behavioral issues, she said.

“You have to find out why the behavior problem is occurring,” she said. “What’s going on that is causing the child to react that way? I don’t think the time is being taken to figure that out.”

The community ought to have more services, she said, such as parenting classes focused on behavior management, programs to boost children’s self-esteem, support groups for children and families and maybe even more creative fixes, like yoga and meditation, in schools to teach children to settle and focus.

“We pick the scab of a wound,” she said, “and watch it ooze.”

• • •

Most students with mental health problems attend their neighborhood schools across the Las Vegas Valley. But not all of them. About 120 students, from kindergarten through high school, who are affected by the most severe mental and behavioral issues transfer to the Miley Achievement Center.

Buses bring kids to Miley, east of downtown, from as far as Pahrump and Moapa, said Cheryl Joyce, who taught at the school for 21 years and has been principal for eight. (In November, she was temporarily reassigned to another project within the school district.) The school boasts smaller classes, specially trained teachers, group and individual therapy, and a curriculum focused on core subjects plus students’ personal goals, which could be anything from keeping their hands to themselves or not bolting the classroom when upset.

The students — about 80 percent of whom take some type of psychiatric medication — may attend for 45 days, a few months or until they graduate, depending on their stability.

Joyce is quick to clarify that Miley is not a school designed for mischievous students; rather, it’s for children whose mental health needs require an alternative learning environment to foster progress. Most students have normal or above-average intelligence levels, so the school combines a regular curriculum with daily guidance teaching students emotion-control techniques, such as using music therapy or calming down in a relaxation room attached to each classroom. Posters illustrating the “crisis cycle” — the path from contentment to anger — hang from the walls, reminding students not to let their emotions spiral out of control.

Design elements, like a calmer color palette, intervention rooms and outdoor patios attached to each classroom, help. On a recent day, several elementary students dribbled basketballs on an outdoor court, giggling and chattering in the morning sunshine.

“They’re amazing individuals,” Joyce said in October. “They need support, but they can do anything in the world. They’re so beat down often by the time they get to us.”

Miley serves a distinct role in the district, but most students with mental or behavioral disorders will never pass through its doors, so the need for mental health-trained staff members exists at all schools.

Fulfilling that need is a constant challenge.

Federal money earmarked for staff training on how to detect and respond to mental illness has helped. The program teaches staff, including teachers, how to assess for suicide risk, listen nonjudgmentally, provide information and reassurance, encourage appropriate professional aid and support self-help strategies.

As of October, 580 staff members had received the training and 17 more sessions were scheduled through December.

“We know we need to get the word out on mental health,” said Susan Sernoe, director of CCSD’s Wraparound Services Department, which, true to its name, tries to envelop struggling or at-risk students with appropriate help and resources.

For proof, look no further than a whiteboard hanging in the central valley office with an ominous name: Department of Student Threat Evaluation and Crisis Response. The office, staffed by licensed counselors and school psychologists, assesses threats made by students to commit lethal violence or suicide, and intervenes when necessary. The whiteboard, an organization tool detailing help being offered to students in need, is never blank.

But like clinicians overwhelmed with patients, the school district also faces a worker shortage. The school district, home to 300,000-plus students, has only 25 school social workers, about 200 school psychologists and 200 school nurses spread across 357 schools.

The National Association of School Psychologists recommends a ratio of 500 to 700 students per psychologist; Clark County’s ratio is 1,500 students to one school psychologist.

A national shortage of school psychologists doesn’t help the district, which already suffers from a dire teacher shortage. “I would love to add 20 more overnight if I had the money and the candidate pool, but that’s not being realistic,” Weires said.

Some help may be on the way in the form of additional school social workers, who, among other duties, link families of unstable children to community resources. Legislation passed this year includes funding for more school social workers, but details remain fuzzy.

The prospect of more help thrills Donald Hayes, who has worked as a school social worker in Clark County for 15 years. He started as the district’s sixth social worker, covering 60 schools. Today, he covers 20 schools and estimates that more than half his caseload involves mental health.

“We still encounter schools that aren’t aware the district has social workers,” he said.

• • •

The petite girl with long, dark hair steps toward the microphone, facing her younger classmates in the Coronado High School auditorium.

“It normally starts in the morning,” she says, “a push, a shove and then the name-calling.”

The ninth- and tenth-graders who came bustling into the auditorium have fallen silent. The performances they’re watching are called the “Toe Tag Monologues” — a morbid ode to the tag coroners place on dead bodies. The first monologue described a drug overdose; the second, bulimia.

Now, the drama student reciting the third details how bullies threw her backpack in a pool and continued the torment at home, spreading lies on Facebook and Twitter. She wanted to tell someone but feared revenge.

“I felt so alone,” the teen says, displaying emotion that seems more real than rehearsed. “I used to cry so much, my eyes were always red and swollen. The only time I wasn’t crying was when I was asleep.”

She reaches into a backpack at her feet, slowly pulls out a rope and loops it over her neck.

“So I figured being asleep forever was best.”

She continues, bemoaning her regret at not telling someone about the bullying, the overwhelming sadness and the desire to die — all of which could have prevented her from making a decision should couldn’t undo. The message: Choose to live and if you know someone depressed or being bullied, tell someone.

The heavy monologues don’t gloss over issues like drug use, body image and suicide, and that’s the point, according to their creator, Byron Stringer. He’s the founder of Vision Theatrical Foundation, which has been visiting various Las Vegas Valley school and the juvenile detention center to put on the “Toe Tag Monologues.” In October, drama students at Coronado — a school grieving a student’s suicide in the spring — spent several days learning the monologues before performing for younger classmates.

School counselors suggested students grab a tissue on the way into the auditorium.

“Our kids are tired of us glossing over things,” said Stringer, a retired Metro Police officer. “Somebody needs to say, ‘Look, this is what you’re going through,’ or, ‘Look, this happened on your campus.’ Why do we have to soften everything? The truth is, the world is not soft.”

And more importantly: “If we don’t open the door and start talking about those issues, who is?” he asked.

Senior Sam Fagel, 17, who performed one of the monologues, says students shy away from revealing how they really feel. He hopes the performances serve as an eye-opener to his peers, opening lines of communication. “More schools should be doing this,” he said.

• • •

Every morning for six months after her daughter’s death, Melendez visited a makeshift memorial honoring Claudia inside her home. There were flowers, photos, candles and a cross. She prayed. She cried.

“I wouldn’t let it go,” she says. “It was very painful.”

These days, she frequently asks her surviving children — now ages 9, 13, 14 and 19 — questions whose answers might reveal inner pain: How are you feeling? Did anything upset you? Did another student say or do something hurtful toward you?

She’s protecting her children. She wants other parents to do the same.

“Don’t keep yourself in the dark. Educate yourself,” she says. “To say it will never happen to my family is the wrong way to go.”

Melendez isn’t ready to let the school district off the hook, either. She wants to see more progress addressing students’ mental health — because, as she knows, awareness can be a matter of life and death.

[This story was originally published by The Las Vegas Sun.]

Photograph by Mikayla Whitmore/The Las Vegas Sun.