Facing what multiple board members and the superintendent called a public health crisis at Palo Alto's two high schools, the school board voted unanimously Tuesday night to allocate $250,000 in district funds to hire two full-time licensed mental health therapists as soon as possible.
The board waived a two-meeting requirement necessary to take action in order to approve the funds immediately and not wait until the board's next meeting on April 21 after board member Ken Dauber made two motions to take both actions.
"Being able to move quickly to do something when there is a crisis it's our job," board President Melissa Baten Caswell said prior to the vote.
At Dauber's request, the principals of both high schools provided statistics that demonstrate the extent of the mental health crises on their campuses: There have been 16 Palo Alto High School students hospitalized so far this school year (there were 25 total last year) and 212 students identified as high-risk or at-risk in the four days following a student death by suicide earlier this month, Principal Kim Diorio said. As of last week, 42 Gunn students this year had been hospitalized or treated for "significant suicide ideation," Principal Denise Herrmann said.
"Our mental health team right now is really quite exhausted, as I can imagine Gunn is also feeling," Diorio told the board.
Both principals said the nonprofit Adolescent Counseling Services (ACS), which provides on-campus support at Gunn and Paly through one certified therapist at each campus and a team of interns, is at full capacity. The certified therapist also coordinates and oversees the interns on top of seeing students, Herrmann said.
She added that an additional licensed therapist could lighten that load, as well as support school counselors to do initial assessments of students and take leadership on planning workshops on coping skills, time management and other "upstream" services to support students' mental health and well-being.
"When we've been going through our crisis, it's been very significant when we have licensed (therapists) versus other volunteers and interns," Herrmann said. "We're thankful for every person who comes to our campus, but we definitely know someone who is licensed ... (and) has the training to model groups for us and has the training to do some of those upstream prevention and anti-stress workshops. I see this person being a member of our school counseling team, making sure it's both preventative as well as responsive."
Shashank Joshi, a Stanford University adolescent psychiatrist who has led much of the suicide-prevention work in Palo Alto since 2009, told the Weekly Wednesday that the two new hires will prove crucial not only for treatment, but also prevention.
"I think this is a very important step to take, not only with regard to the difficult year we've had, but also to get needed support for students at earlier phases before distress turns into crisis," Joshi said. "Having more licensed therapists on site, given the size of our high schools, is a needed step as part of a comprehensive school-based suicide prevention and wellness promotion strategy."
Dauber said Adolescent Counseling Services's on-site licensed therapist at Gunn told him that there are students expressing suicidal ideation nearly every day and that staff are overwhelmed and cannot meet the need. He also noted that local private practices are in high demand and full with waiting lists. Joshi said the community does not yet have a "well-designed system" for outside referrals that can meet the current demand.
Diorio also stressed the importance of having a permanent licensed therapist who gets to know the students and school community rather than a person brought in on a temporary, emergency basis.
Baten Caswell said that she wants to make sure that the schedules of ACS and school counselors are not completely full, so there is "some extra breathing room" to give prompt help to both at-risk students and others who need help.
"If it's only always the crisis-situation kids, then we will never get in front of it," Baten Caswell said.
Dauber echoed this earlier in the board's special meeting Tuesday night, urging his colleagues and superintendent to think about potential upstream expenditures as next steps. At a mental health "opinion leaders" conference hosted by the Stanford University Department of Psychiatry and Behavioral Sciences on March 20, one speaker pointed to the critical need to have in place both "downstream" interventions mental health treatment and support for depression, anxiety and suicide attempts, for example as well as "upstream" preventative work.
"These are downstream expenditures," Dauber said of the $250,000 in district funds. "These are designed to catch students who are experiencing symptoms, essentially. We really also need to invest upstream in order to reduce this level of distress," with the most important "upstream" issue being sleep.
Dauber pointed to a letter a group of health professionals recently sent to the board urging that Paly and Gunn start school no earlier than 8:30 a.m., in accordance with a recent American Academy of Pediatrics (AAP) recommendation.
The letter, first sent to the board on March 18 with 35 signatures, now has 92 signatures from a range of local and regional health professionals, many of whom specialize in sleep or adolescent psychiatry and some of whom are parents of current students in the district.
"We don't have any doctors on the other side telling us that that would be a bad move, and I think in the current crisis that that's the appropriate step," Dauber said.
Dauber has also proposed that the board eliminate academic classes during zero period, a topic of heated debate in the community that will return to the board for discussion at its April 21 meeting.
"The board is also are aware of facts that, due to student privacy, are not shared with the public," Dauber said. "I can't share all of what I know. What I can say is that there are reasons that I am worried about zero period and I believe that if all the facts were publicly known that the public would share my concerns."
Joshi told Dauber that "sleep deprivation cannot be ruled out as having played a role in at least some of our tragedies," Dauber said.
Dauber also suggested the district keep support for staff in mind with many teachers "working with post-traumatic stress symptoms."
"Our staff is also hurting and that's something we need to address in the next step," he said.
Dauber also suggested investing in professional development to educate teachers about the connection between sleep and teen health and to help them redesign courses so that there is less homework, particularly in Advanced Placement (AP) and honors courses.
Board member Heidi Emberling also urged the district to ensure it is providing sufficient mental health support at its elementary schools and to focus on teaching social-emotional learning and coping skills at an early age.
"We have not addressed this in the past with the alacrity and seriousness it needed," Dauber said. "I'm very happy we are taking these steps. I think this is all about stopping tragedies, saving lives and I think we need to keep that in focus."
Board member Camille Townsend requested more information about the role that the two new licensed therapists would serve at Paly and Gunn in the full context of the mental health services currently offered at both the high school and middle school level.
"If you look at part of the picture, it does not help us," she said.
Townsend was wary of putting the funding to a vote before having a more full-fledged report and discussion, but she ultimately voted in support of it after her colleagues indicated support for Dauber's two motions to waive the two-meeting rule and make the $250,000 available now.
Townsend also asked Superintendent Max McGee to look at bringing in an outside agency, such as the Centers for Disease Control and Prevention (CDC), to help the district better evaluate and gather data on the current suicide contagion.
McGee said that these two positions could be filled either by one of the district's partner organizations or from an outside agency, and there is funding available to support that. He also wrote in a staff report for Tuesday's meeting that he plans to recommend at least $500,000 from the district's reserve funds be earmarked for student health and wellness supports.
The new therapists would see students as well as work with school counselors and psychologists, Adolescent Counseling Services staff and teachers to coordinate support, interventions and education on all student mental health issues.
The $250,000 was put to the board as part of several proposed resource allocations for the 2015-16 school year; the board will vote on the rest of the proposals, most of which relate to new staffing throughout the district, on April 21.
For more coverage on teen well-being, go to the Weekly's Storify page.