First of three stories.

In the weeks since the deadly shooting at Marjory Stoneman Douglas High School in Florida, the need for better mental health resources has become part of America’s discussion about gun control.

In southern Maine schools, administrators from New Gloucester to South Portland say efforts to integrate social-emotional, behavioral and mental-health support with academics have increased in recent years. But even with more emphasis through classes, staff training and added support positions, cuts in state funding, insurance issues and stigma still remain roadblocks.

In the face of new issues such as cyberbullying and a heightened “acuity of need” around students’ anxiety and depression, Gorham Superintendent of Schools Heather Perry said people may be unaware of the demands on educators.

“The issues schools are dealing with now are not the same issues they had to deal with just 10 or 15 years ago,” Perry said.

More support needed

School districts across the region have been making more of an effort to take students’ mental health into consideration, in an era when, according to the 2017 Children’s Mental Health Report by the Child Mind Institute, high school students are twice as likely to see a mental health professional than teens in the 1980s.

On the whole, according to the National Alliance on Mental Illness, 20 percent of American children ages 13-18 live with a mental health condition. Of all lifetime cases, half begin by age 14, and 75 percent begin by age 24.

Districts are meeting the increased need for support in a variety of ways, including teaching about mental health in health classes and adding new staff positions. In Gorham, a new social worker, a substance abuse counselor and a new guidance counselor have been added in the past three years.

Similarly, in Cape Elizabeth, interim Superintendent Howard Colter said his schools are hoping to add an additional social worker at its middle school next year.

In Westbrook, one of several districts where social workers are contracted from outside providers to work with students, Superintendent Peter Lancia said his schools have also identified social work as a priority in expanding service.

Mental wellness-related professional development is also on the rise.

For example, the Brunswick School Department and Regional School Unit 1, (which includes seven schools in Bath, Phippsburg and Woolwich), are able to provide NAMI’s Youth Mental Health First Aid program to staff at no charge to the district, through a grant from Access Health.

Youth Mental Health First Aid is an eight-hour course that teaches adults how to identify, understand and respond to mental illness in adolescents.

Jenna Mehnert, executive director of NAMI Maine, said the program gives adults a greater understanding of youth mental health and discusses the difference between typical and atypical mental health development. It also helps people understand how to talk to struggling young people in a helpful way.

Though well-versed about physical health, Mehnert said, modern society is lagging in mental health understanding.

“If someone is anxious we tell them to calm down,” she said. “We don’t tell someone with cancer it will just go away.”

Emphasizing mental wellness

Since April 2013, all school personnel in the state and “anyone receiving a check from a school system” must have a one- to two-hour suicide prevention awareness training through NAMI. Mehnert said her organization would like to see “everybody who works at a school” be certified in youth Mental Health First Aid in the coming years.

“We are looking at (how to) create that mandate for youth Mental Health First Aid,” Mehnert said.

NAMI also offers a psychosocial educational curriculum for 13- to 18-year-olds called “Progression,” which teaches kids what they can do for their own mental health.

Progression teaches teens ways to maintain good mental health, how to recognize signs of stress, anxiety, depression and bipolar, and how to help loved ones understand what they are going through. Mental Health First Aid teaches adults the risk factors and signs of a variety of mental health challenges common among adolescents, and an action plan to help those developing symptoms of a mental illness or emotional crisis.

Programs like these are important, Mehnert added, because conversations around mental health tend to focus on mental illness, instead of promoting mental wellness for all.

She said promoting mental wellness is critical because according to data from the Centers for Disease Control and Prevention, only 17 percent of Americans are “truly mentally well.”

Mehnert added that when discussing violence, it is also crucial to look at mental wellness, and not blame people living with a mental illness.

People who commit violence such as school shootings, she said, are actually experiencing a mental health crisis, which can occur when a lack of supports such as housing, employment or family cause a person to have “no hope for a better future.”

According to NAMI, people with a mental illness are more likely to be victims of violence than perpetrators.

“Depending on the level of support and resources in our lives, any one of us can have a variety of factors trigger a mental health crisis, causing us to become mentally unwell and potentially unstable,” Mehnert said. “Those with underlying trauma or mental illness may be more vulnerable to experiencing such a crisis.”

To both reduce the stigma for students struggling with their mental health, and give adults better tools to identify crisis, Mehnert recommends pairing mental health education programs for staff and students together.

“If we got young people talking about mental health, we would be able to decrease that stigma … we would have the recognition to say ‘wow their mental health is really not good, get them to a crisis center,'” she said. “Young  people are resilient, but we need to respect their mental wellness and pay attention to it.”

Scapegoating mental illness

Pender Makin, assistant superintendent of the Brunswick School Department, said she worries about society potentially vilifying mental illness, and using it “as a scapegoat” in discussions about gun control.

“I think it’s very important for us to separate these issues; I don’t see them as being as connected as other people do,” Makin said. “When we have children who are traumatized by stories in the news or their own individual circumstances, it is critical we create schools that are trauma-informed.”

In RSU 1, although the district has not implemented NAMI’s Progression program, Assistant Superintendent Katie Joseph said a “mini mental-health first-aid” class is included as a part of a four-day program for freshmen in March.

“(The class is) designed to give students an introduction to the basic techniques that allow students to recognize signs of stress and mental fatigue in themselves and others,” Joseph said.

Districts not yet using NAMI’s programs have also implemented other techniques aimed at promoting mental wellness for students.

In Cape Elizabeth, in addition to traditional school supports, Colter said the district is “stressing more movement” for students, such as yoga. In RSU 14, (The Windham-Raymond school district), Superintendent Sanford Prince said all students take part in a six-minute mindfulness session each day during morning meeting period.

Cuts to state funding, however, have acted as roadblocks to schools across the region in providing social services.

South Portland Superintendent Ken Kunin, for instance, noted that his district partners with Opportunity Alliance, the community action agency for Cumberland County, to provide its Community Partners Protecting Children program.

The program, Kunin said, “provides on-the-ground support” for families experiencing stressors that could impact children’s school attendance and performance. He added it is “a critical partner” in improving the lives of his students, but is slated to be cut from the Maine Department of Health and Human Services budget this year.

Similarly, Portland Assistant Superintendent Melea Nalli said in her district, mental health counselors are available to middle school and high school students through school-based health clinics. This year, the state cut funding for the clinics, which the Portland Public Schools were able to restore.

But it could be an issue going forward.

“The (schools) restored funding for this year and is actively working with districts across the state, health advocates and legislatures to pass legislation restoring this funding,” she said. “If the funding ceases, it will be difficult to sustain the same level of support next year.”

In some areas, student access to social workers can also be limited by whether they are tested and identified for special education and have an Individualized Education Plan, or IEP.

In Westbrook, Lancia said while staff social workers are able to work with the general population of students, they have obligations to students with IEPs, which means they do not always have the capacity to meet with others.

Guidance counselors also address mental health issues in all students, but the varied nature of their role can be challenging.

“Guidance counselors have a complex role and support kids’ academic and social-emotional needs,” Lancia said. “This is true at all levels, but in high school, where the focus is on graduation and college, it becomes more challenging.”

Additionally, even in schools where social workers are present, lack of health insurance or lack of social work coverage benefits, are often an additional hurdle to providing services to students.

Administrators in South Portland and RSU 1 said health insurance can be a barrier in offering contracted social services. Kunin added, however, that having school-based social work from Sweetser is an “incredibly valuable resource.”

Statewide barriers to care

On the state level, funding for mental health resources is just as complex.

According to Kaiser Family Foundation, Maine only has enough psychiatrists to serve about one-third of its population.

State Sen. Cathy Breen, D-Falmouth, who has proposed a bill to increase the state’s reimbursement rate for mental health professionals, said the shortage has led Maine Behavioral Health and Kennebec Behavioral Health to report having 500 people each on a waiting list for care.

“There are community mental health providers all over the state who are not able to afford to have people on their staff to prescribe mental health (drugs),” Breen said. “It really varies state by state and administration to administration, but unfortunately mental health is often last in line of rate increases.”

Sheila Comeford, executive director of the Maine Psychological Association, said despite national laws requiring equal coverage, or parity, for mental and physical health, limitations dictated by insurance companies also often acts as a hurdle to receiving care.

“If you know your insurance company is only going to pay for eight sessions, regardless if you still need assistance after the eight sessions, what do you do?” Comeford said.

The stigma around mental health also acts as a barrier to individuals seeking care. Stigma towards those with a diagnosis can lead to discrimination, Comeford said, but people with mental illness can also feel internalized stigma, which can manifest as self-doubt, shame, and fear of treatment.

Breen echoed that sentiment, and said the stigma around mental illness can cause people to feel uncomfortable acknowledging when someone close to them is struggling.

“It’s really sad, but there are a lot of parents and a lot of teenagers that just don’t know a lot about mental illness and have a lot of fear,” Breen said. “It’s one thing if you get a cancer diagnosis; they bring over dinner. It’s different when you say my child is in a psych hospital.”

Mehnert said in addition to ensuring quality education from kindergarten through high school, attention also needs to be turned to factors that promote mental wellness such as housing, access to mental health and addiction treatment, abuse and sexual assault prevention and stable employment.

“As a nation, we should see the shootings as a wake-up call to provide the supports we need to ensure Americans are mentally well,” she said. “But that is not the current direction of our state or federal government.”

Staff writers Kate Collins, Matthew Junker, Michael Kelley, Juliette Laaka, Alex Lear, Bob Lowell and Jocelyn Van Saun contributed to this report. Elizabeth Clemente can be reached at 781-3661 ext. 100 or eclemente@theforecaster.net. Follow Elizabeth on Twitter @epclemente.

The series

This week: The challenges facing efforts to integrate mental-health support in area schools.

Mental health resources

• Cumberland County Crisis Response: Toll-free crisis intervention and suicide hotline, available to any resident of Cumberland County 24 hours a day at 888-568-1112. More information at https://goo.gl/8jjaas.

• NAMI Maine Helpline: Confidential helpline for peers, family members, friends, professionals and law enforcement, Monday-Friday, 8 a.m.-4 p.m. Toll-free at 800-464-5767, press “1.” Email: helpline@namimaine.org. More info at https://goo.gl/FWCAoG.

• Maine 211: Connect with specialists 24/7; a free and confidential service. Dial 211, text your zip code to 898-211, email Info@211Maine.org, or go online at https://211maine.org/.

• Federal Bureau of Investigation: To report a tip to the FBI Boston Office, which covers threats in the state of Maine, available 24/7, call 857-386-2000 or go online at: https://tips.fbi.gov/.

• Maine Behavioral Health:  24/7 information about treatment options. A “Rapid Access” program also allows callers to receive a mental health assessment quickly to begin receiving services. Call 844-292-0111.

Heather Perry, Gorham superintendent of schools: “The issues schools are dealing with now are not the same issues they had to deal with just 10 or 15 years ago.”

Peter Lancia, Westbrook superintendent of schools: “Guidance counselors have a complex role and support kids’ academic and social-emotional needs. This is true at all levels, but in high school, where the focus is on graduation and college, it becomes more challenging.”

Pender Makin, assistant superintendent of Brunswick schools: “When we have children who are traumatized by stories in the news or their own individual circumstances, it is critical we create schools that are trauma-informed.”

Howard Colter, interim superintendent of Cape Elizabeth schools, said one way his district is focusing more on student mental health is by emphasizing more movement in school, through techniques like yoga.