Editor’s note: In March we are publishing a four-part series on mental health. Each Tuesday edition of Daily News and News Monitor will feature a different aspect of how we are addressing mental health and mental illness in our communities. Each story will also offer available resources.
March 9: Part 1 takes a look at how school leaders and teachers are managing not just their own mental health, but that of their students, during the coronavirus pandemic.
March 16: In Part 2 we feature student athletes and hear how they are coping, as well as speak to healthcare professionals who work with youth and mental illness.
March 23: Part 3 focuses on law enforcement’s role in addressing inmate mental health and the diminishing resources available to assist them.
March 30: Part 4 features interviews with area families affected by the suicide of a loved one.
Half of all mental health conditions start at 14 years of age, according to the World Health Organization (WHO). Most of those mental health conditions go undetected and untreated.
“The consequences of not addressing adolescent mental health conditions extend to adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults,” according to the WHO website.
Suicide is the third leading cause of death in 15-19-year-olds, according to WHO.
School counselors are an essential part of the school ecosystem, providing help and resources to students to ensure they can live healthy lives.
In the U.S., there was an average ratio of 430 students to every one school counselor during the 2018-2019 school year, far exceeding the American School Counselor Association’s (ASCA) recommended ratio of 250 to 1.
In the 2018-2019 school year, North Dakota ranked among the best in student to counselor ratios. Vermont ranked number one with a 191 to 1 ratio, followed by New Hampshire with a 219 to 1 ratio, Hawaii with a 275 to 1 ratio, New York with a 288 to 1 ratio and North Dakota with a 295 to 1 ratio.
Beginning in the 2010-2011 school year, North Dakota Century Code required one full-time seventh-12th counselor for every 300 students.
“The state as a whole has been very proactive about mental health as compared to other schools and they put on student limits as to how many students can be per counselor,” School Counselor Alison Orgaard said.
Orgaard is the K-12 school counselor for Lidgerwood Public School and seventh-12th grade at Wyndmere Public School.
Currently, Orgaard estimates that her student to counselor ratio is 1 to 250-275.
“I know all of my kids, I know their siblings, I know their parents for the most part and I feel like I’m not a stranger to these communities,” Orgaard said.
Wahpeton Elementary third-fifth Grade Counselor Julie Carlson and Middle School Counselor Hailey McCall each have a ratio of approximately 300 to 1.
“We’re fortunate in North Dakota that we have schools that support school counselors,” McCall said.
What is a school counselor?
As school counselors, the three provide academic, personal and social counseling for students. They meet in groups or one-on-one with students to discuss their lives.
A school counselor’s job is both reactive and proactive. They react to immediate crises in a student’s life and make sure to build connections so students feel comfortable when it’s time to talk about mental health.
“I try to be really intentional with getting out and being available and kids see me when I’m in the buildings because I’m not in each school every day. So the days that I am there, I try to get out in the hallways and be available and connect with kids,” Orgaard said.
Carlson, McCall and Orgaard hold classroom lessons for their younger students where students are given lessons on character values, coping mechanisms and other life skills.
Older students learn about things like suicide prevention, McCall said.
”I would say our lessons are geared more at the proactive side and then my check-ins with students are more proactive. If I know there’s a kid who’s struggled with something in the past ... I’ll try to check in with them every couple of weeks to just see how they’re doing and make sure we’re addressing all of their needs,” McCall said.
Orgaard has a website where students can be referred to her and families can find resources for addressing mental health.
“Because I am split between two schools, I have to be really intentional about being available to students when they need it, and so I wanted my website to be a one-stop shop for kids and parents,” she said.
Family, faculty and peers can recommend students to Orgaard using a Google Form on her website.
“Outside of myself, we’re in a small school so we work as a team between myself and the principals and the teachers. We work together to keep an eye on the kids and see how things are going,” she said.
At Wahpeton, counselors work together with each other and other school faculty to address students’ needs and keep an eye out for when a student may need help.
For certain students, their mental health needs may go beyond what school counselors are able to provide them.
“The one thing about school counselors is we really don’t do long-term counseling. If we feel like that’s what the student is needing, then we’ll refer them out. We also don’t diagnose. It’s just kind of a numbers issue. We just don’t probably have the time of the day to see all those kids long-term,” Carlson said.
Wahpeton, Wyndmere and Lidgerwood Public Schools all provide their students with outside counselors who visit schools once or twice a week to meet one-on-one with students who need long-term and more intensive mental health services.
Bethany Peterson is a school based mental health and intensive in-home family therapist from The Village Family Service Center based in Fargo. The Village Family Service Center contracts with schools to bring outside therapists directly to the schools.
Peterson currently works at Wyndmere with eight to 10 students a week in all grade levels.
“I cross that gamut for real intense trauma grief work to younger students trying to understand emotional reaction,” Peterson said.
Allie Skjonsberg is a mental health therapist with Essentia Health who visits Wahpeton Public Schools one and a half days a week.
“It’s awesome to see more schools getting on board with contracting with outside agencies to fulfill this mental health need because it’s gotten so great and I honestly feel like it’s going to just continue to be more and more of a need,” Skjonsberg said.
Counselors can refer students to Peterson and Skjonsberg if they believe the student needs long-term counseling.
The program has been so successful that at times there have been waiting lists at Wyndmere and Lidgerwood, Orgaard said.
Skjonsberg estimated that she could be at Wahpeton schools every day.
The program also has a number of benefits for students such as not having to miss class time for sessions and having sessions in a place they feel comfortable and safe.
“It’s been great, I think parents appreciate having this available in the school and think that students have really benefited from not missing as much school and parents are excited about not having to get out of school and travel with their kids all over the place,” Orgaard said.
Outside of conveniences, the program also gives students the opportunity to receive mental health care when they otherwise may be unable to, Peterson said.
Wyndmere High School Principal Scott Strenge said staff has been trying to build relationships and assist students, particularly as COVID-19 has disrupted many students’ lives.
“When kids are struggling with things either at home or with their daily lives, it does hinder their education and kids need help. This year has been probably the toughest year I’ve had as an educator,” Strenge said.
Having talked to educators across the country, Strenge said mental health is one of the top issues facing schools today.
Orgaard said that being in a rural setting and having in-class lessons continue has been beneficial to students’ mental health.
“I definitely feel that when the kids have been more isolated, that could be tougher on kids. Overall, I noticed some more mental health flare-ups a little bit earlier in the year. I feel like everybody’s kind of under some unique stress right now,” Orgaard said.
Some students have continued distance learning throughout the year. For distance learners, Orgaard said she checks in with students weekly or bi-weekly.
For therapy, Skjonsberg said she saw an increase in need from Wahpeton students.
“I think a big piece is the isolation in regard to COVID-19 … I think some kids were able to hold on, even if they were having their own mental health stuff prior to this or to cope well, but I think COVID-19 was the thing that sent them over the edge, she said.
In Wahpeton, Carlson said when COVID-19 first hit, it was difficult, but the situation has improved over the last year.
“For a while there, I felt like our goal was to get the basic needs met like making sure our families had food. Just checking in on our kids … so right away, I feel like a year ago when COVID hit, I felt like it was just supporting their families and making sure they had what they needed,” Carlson said.
Last spring, McCall and Carlson said they were doing more home visits to check in on students than before the pandemic.
They both began bringing ice cream bars to home visits to ease any concerns a student or parent may have.
“I don’t want people to see us and be like, ‘Oh great, now the counselors are here,’ but if we couldn’t get a hold of them by phone, even though there’s a pandemic, we need to communicate with these families and make sure they’re okay,” Carlson said.
Parents, pupils and perceptions
Self-stigma and general stigma can be a roadblock to receiving adequate mental health care.
A 2017 study titled “Self-stigma as a barrier to recovery: A longitudinal study” found that “Stigma limits life opportunities of persons with mental illness. Self-stigma, the internalization of negative stereotypes, undermines empowerment and could hinder recovery.”
Strenge has been an educator since 1996. Over his 25 years in education, he’s seen a change in the way mental health is addressed by students.
“I think they’re more comfortable than they were,” he said. “You don’t hear the joking about it, making fun of kids when they’re getting help. I think today’s kids really understand that more than when I started in 1996.”
Carlson said her third-fifth grade students are receptive to one-on-one meetings with her and enjoy the time they spend with her.
“Third, fourth and fifth grade, it’s still an age where they love the one-on-one and when you walk into a classroom to grab a student and they’d be like, ‘take me, take me.’ They love going. There’s no negative stigma to it. It’s just kind of a norm at the elementary school,” Carlson said.
At the middle school level, McCall deals with students with a wide variety of mental health needs due to their varying maturity levels.
“At the middle school level, it depends on the place where they’re at with it. Whatever they’re dealing with, where they’re sitting with that issue. But for the most part, I would say yes (they’re receptive),” McCall said.
Orgaard echoed Strenge’s sentiment stating that today’s students and parents have much different views on mental health.
“With this generation, people are just open to meeting the needs of kids and whatever they’re lacking and trying to figure out how we can support them,” she said.
Parent support is essential to the success of counseling and therapeutic services.
“When we first started bringing in outside counselors we were a little curious about how long it would take to fill the docket and to get them really rolling with students because parents had to sign on and agree,” Orgaard said.
McCall, Orgaard and Carlson all agreed that they have supportive communities and love working with students.
“I’ve been lucky to have been able to work in these communities that value mental health and that want to have proactive services here too,” Orgaard said.