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How NHC high schoolers, teachers, and clinicians are dealing with rise in mental health issues

Coastal Horizons has designated spaces for services at the district's high schools.
Coastal Horizons
Coastal Horizons has designated spaces for services at the district's high schools.

Coastal Horizons, a local non-profit, provides six clinical therapists who work in New Hanover County high schools. So what mental health challenges are they, along with some academics, seeing in students — and in teachers?

Coastal Horizon's clinicians are located at high schools around the district: one serves Laney, two are at Ashley, two are at Hoggard, and one is at New Hanover High School. For lower grades, New Hanover County provides 32 therapists working in elementary and middle schools.

Cristen Williams is the regional child and family services clinical director for Coastal Horizons. She said she has the flexibility to shift the therapists based on a school’s needs.

“That's how we ended up with two therapists at Ashley, for instance, they really needed more support. And so they also really wanted to be a part of this pilot program that we're doing for students who are newcomers to the United States, students who have recently emigrated,” said Williams.

She said the need was also great at Hoggard.

“The caseload got really high, and in order for that therapist to be able to really provide the services that each individual student needed, there was more need than there was time. And so we moved another therapist over there,” said Williams.

Williams said while supports are in place for students, the demand for services is getting higher.

“So we are seeing an increase in kids’ mental health symptoms. [...] We're also seeing the complexity of kids’ mental health symptoms changing, which is causing more clinician time to engage that kid and that family, and maybe do some safety planning and those sorts of things,” said Williams.

Williams added that Coastal Horizons doesn’t charge students and their families if they don’t have medical insurance — but they do help them figure out access to Medicaid and private insurance if they qualify.

“If you've ever looked at that Medicaid application, it's a beast. And so oftentimes, families don't know how to navigate that,” said Williams.

Her clinicians’ caseloads at the district’s high schools are in the 50 range. That differs from the elementary/middle schools, where the recommended range is around 25-30.

But according to Williams, these school clinicians can also refer to Coastal Horizons’ outpatient services at their Oleander clinics if they can’t service the caseload within the schools.

The need for more mental health workers in schools

Coastal Horizons received a Substance Abuse and Mental Health Services (SAMHSA) $124,929 federal grant to deliver free youth mental health first aid training in the Cape Fear region. They hope to give the training to about 250 adults each year over the grant’s five-year lifespan.

While New Hanover County Schools is increasing the number of mental health professionals in its buildings, the district is still falling short of the nationally recommended ratios for these positions. For example, there’s about one counselor for every 311 students. It’s advised that this be one to every 250 students.

Based on last year’s student count, 26,452, there’s one social worker for 519 students; one therapist for 696 students; and one psychologist for every 1,469 students.

The recommended ratio for social workers, like counselors, is one to 250 students. For psychologists, it’s one to 500.

The district said it hopes to provide updated ratios once it passes the 10-day attendance period when student enrollment counts are official.

Related Story: A closer look at the mental health services offered in New Hanover County schools

While teachers don’t take the place of these experts, they are receiving this training to deal with the growing student need.

“So then we can get new teachers and new educators that are coming in trained and they can use the same language and vocabulary and tactics, so to speak about how we intervene with youth,” said Williams.

UNCW associate professor Dr. Denise Ousley-Exum, who specializes in secondary and middle grades education, said her education students learn how to respond as teachers to those with mental health issues. Her students receive the same training through Trillium.

“For example, anxiety and young people. What is it? What are some signs and symptoms? What are the types? What are the risk factors, the importance of early intervention [like the] Mental Health First Aid action plan,” said Ousley-Exum.

Increase in mental health issues

According to the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System, student mental health nationwide declined in the decade between surveys in 2009 and 2019.

University of North Carolina Wilmington professor Dr. Robert Smith, Ousley-Exum’s colleague, said those results are cause for concern.

“And in terms of suicidal ideation, students considering or attempting suicide increased by 36% during that 10-year period. And that's really concerning, disturbing. One of the other pieces of data, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%,” said Smith.

Williams is seeing this rise in suicidal ideation locally. She’s also seeing students struggle in other ways.

“In the cases that I'm staffing with my clinicians, we're seeing a whole lot more eating disorders, too, than we ever did before. And I think some of it is, again, complex, but I think some of it stems from, what I see on social media must be what it's like 100% of the time,” said Williams.

Ousely-Exum said their student-teachers are receiving new training to identify student mental health issues and tap into the resources that will help the student.

She said the Youth Mental Health First Aid program helps teachers raise their awareness and lower their judgment of students who are struggling.

“Can you imagine if the scariest thing you're about to share with someone was met with, ‘thank you so much for sitting here with me and sharing that with me,' that is not the expected reaction that many of us are going to get,” said Ousley-Exum.

Teachers reaching all their students

Smith said the way UNCW’s Watson College of Education is educating future teachers is evolving. The focus is around reaching all students, no matter their issues.

“So it's not just about whether you're connecting well with 60% but the other 40% you're not as concerned about. Your [the teacher's] responsibility is to make sure that all students are engaged, are interested,” said Smith.

Ousley-Exum agreed with Smith — the goal is not just about teaching the curriculum.

“So we are there for the humans in the room first? And so I think that the hope is that we are also preparing content-prepared teachers; we’re high school teachers, we had better know our content, but what do I want us to know first? Students. I want us to know teenagers,” said Ousley-Exum.

There’s been a lot of conversation about dealing with student mental health — but the adults in the room are also a priority.

Valuing teachers' and clinicians’ mental health

“For me, it feels like an entire full circle, that we are able to offer our students that it's not just their students' mental health, about which we are concerned, it is our teachers’ mental health as well,” said Ousley-Exum.

Smith said he and Ousley-Exum are ensuring their future teachers are prepared to put on their oxygen masks first.

“There's a strong emphasis throughout the whole program in terms of you can't help others unless you're taking care of yourself.[...] So they need to make sure they've got a good balance in their life between working hard, but also making sure they have time for their family or time for themselves, where they can get recharged, and come back in, fully engaged in and positive about the work that they're doing,” said Smith.

Ousley-Exum said that this awareness was relatively new to her, too.

“So 12 years ago, I had a social work educator asked me, ‘Well, what's your self-care? I never heard the term. And then she says, ‘Oh, great, do I have some supports for you?’ ‘Solution-focused’ ‘strengths-based practice’: these were not terms 12 years ago that were being applied to the classroom. These were not terms being applied to teachers,” said Ousley-Exum.

And the work stresses of teachers — dealing with their own mental well-being as well as their students — are contributing to the turnover of the profession.

“Are we having teachers prepared to stay in the profession so that they are engaged, enthusiastic, highly prepared educators for our students?” said Ousley-Exum.

Williams said she’s also paying attention to her clinical mental health staff.

“Clinicians are really starting to burn out and less and less are coming into the field,” said Williams.

But Williams said if the supports are there, there’s hope.

Additionally, Smith and Ousley-Exum both said in order to do the job well — teachers have to rely on resources and the support of other teachers, administrators, social workers, and counselors.


Rachel is a graduate of UNCW's Master of Public Administration program, specializing in Urban and Regional Policy and Planning. She also received a Master of Education and two Bachelor of Arts degrees in Political Science and French Language & Literature from NC State University. She served as WHQR's News Fellow from 2017-2019. Contact her by email: rkeith@whqr.org or on Twitter @RachelKWHQR