Counselors for Northside and North East ISDs are reporting a greater number of students need mental health care services to address depression, anxiety and traumas, such as food insecurity and homelessness.

Carrie Trejo, director of at-risk/student leadership and support services for NEISD, said part of the reason there’s been an increase is there is less stigma attached to mental health, and more students are reporting needing help or reporting other students who may need help.

In a 2022-23 threat assessment survey conducted by district officials, there was a 217% increase in reports, she said.

“The mental health needs being brought to us are more complex,” Trejo said, adding students previously needed more medication management and now there are more students in crisis.

She said a greater number of younger students are also being affected and can show signs of needing help with their mental health by

displaying aggression, self-harming or threatening to hurt others, Trejo said.

“We’re seeing [more signs] really, really early on,” Trejo said.

Fewer students were reporting needing help, Trejo said, but the COVID-19 pandemic made things worse, with parents losing jobs and students sometimes losing family members.

“We’re seeing the domino effect in our community,” she said. “When you’re trying to triage food over mental health needs, food is going to come first.”

District data also shows an uptick in the number of “suicidal outcries,” she said. For the 2022-23 school year there were over 1,000 reported incidents.

“We know there is a need,” she said.

To address mental health, school districts are hiring more counselors, expanding programming and funneling more money into services.

North East ISD adds resources

NEISD is hiring two counselors, a district social services provider and support staff, and contracts with nonprofits and counseling offices to provide licensed mental health professionals for students, Trejo said.

District officials are also working to reduce the number of students assigned to each counselor, which on average for the 2022-23 school year was one counselor to every 500 to 550 students. For the 2023-24 school year, the goal is to have one counselor to 350 students at the elementary level and one counselor to 450 students at the secondary level, Trejo said.

Programming within the district targets at-risk youth, homelessness, student well-being and mental health. The district also provides the peer-to-peer leadership program Peers Assistance Leadership & Service, or PALS, and a program specifically for parents, Trejo said. The goals are to increase student connection, provide wraparound support, and provide notification and response services, she said.

Questions such as, “How do we decrease those disenfranchised,” and, “When we know kids are in crisis, what systems do we have in place,” help district staff determine what support to put in place, she said.

This summer, a new program, Beyond the Bell, was piloted that offered counseling services for students and their families when school was out of session, Trejo said.

Participants were surveyed, and 26.3% indicated needing support with healthy coping tactics and emotional regulation, she said.

Trejo said NEISD officials are also expanding a partnership with Texas Child Health Access Through Telemedicine, which offers telehealth services to help identify and assess students, and provide access to services.

District staff are also working on a youth mental health first aid program, Trejo said, with 16 people in training to roll it out districtwide.

“We know we have to be in this for the long haul and that’s why the sustainability of this is so important,” she said.

Northside ISD collaborates

NISD is the largest district in San Antonio serving over 100,000 students.

NISD Director of Counseling Mary Libby said counselors and administrators are seeing the same challenges as other districts and are focused on mental wellness for students.

NISD officials plan to extend the Social Emotional Education and Development with Students, or SEEDS program, which is made possible through a partnership with nonprofit Communities in Schools, that works to help students graduate.

SEEDS was started in 2018, and later received Elementary and Secondary School Emergency Relief, or ESSER, funds to support it. The funds are set to expire at the end of the 2023-24 school year, Libby said.

The program refers students for up to 8-10 clinical mental health counseling sessions held on campus, she said.

“We’re the first line of mental health counseling on campus,” Libby said. “It really allows us to get the right kid to SEEDS.”

Students can also do small group sessions, and parents can also do sessions with the counselors, Libby said.

The district also has partnerships with area nonprofits, including the Children’s Bereavement Center, Jewish Family Services and Project Hope, to better support students.

Increasing crises

One of NISD’s partners in providing care is the Clarity Child Guidance Center, a San Antonio-based nonprofit mental health care provider and crisis center specifically for youth.

Clarity CEO and President Jessica Knudsen said prior to the pandemic, school counselors and other health care workers were seeing more children were needing help.

One in five youth suffer from a behavioral issue or a mental illness, and 35% of referrals to Clarity are from school districts around San Antonio, Knudsen said. Since the pandemic has subsided, Clarity has seen a 162% increase in the use of its crisis center.

“Someone you know is going through this,” Knudsen said. “It’s very isolating.”

The pandemic only exacerbated things, Knudsen said. School-age children reported greater social anxiety and depression.

“I think we grossly underestimated the effects of closing schools,” she said.

County priorities

When Bexar County Judge Peter Sakai took office in January, one of the things he identified as a top priority was health care and, in particular, mental health care.

“Healthy families are the bedrock of our economy,” Sakai said in his state of the county address in May.

Sakai moved quickly to set up a new county department of public health and appointed Dr. Andrea Guerrero-Guajardo to lead it. The new department is focused on behavioral health, environmental services, preventative health and agriculture.

One of the department’s first acts, and the first aimed at youth, was to award $20 million in American Rescue Plan Act funds as grants to 14 school districts for the expansion of mental health care services. The ARPA provided emergency funding in response to the COVID-19 pandemic. The county has until 2026 to use the funding.

NEISD and NISD also received $2.6 million and $4.5 million, respectively. Neighboring district, Judson ISD received over $1 million.

Schertz-Cibolo-Universal City ISD did not win a grant because it is located in Guadalupe County, where officials opted to use $32.5 million in ARPA funds to address the county’s growth.

Guerrero-Guajardo said the county health officials set up the grant to enable districts to decide how to spend the money for mental health services.

Leticia Dominguez, the manager for the county’s behavioral health department, said each district knows best what students need. Those needs helped determine which outcomes each district would track as part of the grant. Criteria includes metrics such as absenteeism, disciplinary referrals and expulsions, Dominguez said.

“We wanted to make sure that each school district could use the money the way they wanted to based on their needs,” Dominguez said.

School districts can also use the grant funds for their staff, and some districts are working to train teachers and others on campus to identify students who may need help in what is being called “mental first aid.”

The county’s approach is deliberate, Dominguez said, and officials want to take a focused view of youth and meet the children where they are in school.

“Even before the pandemic, we knew schools were underserved,” Dominguez said.