Editor’s note: This article contains discussion of mental health and substance abuse.
Living in a family that didn’t know where their next meal would come from or how long they’d keep their home, Zack didn’t have it easy.
When the Malheur County teen’s disruptive behavior at school reached new heights, his high school principal acted to get Zack – not his real name – mental health counseling.
One year, 50 unanswered school calls to his home and one report to the state Department of Human Services later, Zack still hasn’t gotten treatment.
He’s not the only one.
The latest available data shows nearly 13% of Malheur County youth – some 1,030 kids – had unmet mental health needs in 2020. Across Oregon, half of the 40,000 kids who had a major depressive episode last year didn’t receive mental health treatment.
Having good mental health means having the emotional skills to deal with life’s ups and downs. When kids undergo trauma, which can include high levels of stress, abuse or neglect, they can develop mental illnesses like anxiety, depression or post-traumatic stress disorder.
Although there are no official counts in the county, Malheur educators say the number of children experiencing mental health issues noticeably worsened during and after Covid. Isolation and school shutdowns during the height of the pandemic left kids struggling to stay mentally well at home. With some parents away at work, children were left alone to watch younger siblings and forage for food once free school lunches ended.
Rates of anxiety and depression among kids and teens grew sharply over the past few years, say school officials across Malheur County.
In the Ontario School District, threats of suicide more than doubled from about 30 in 2021-22 to about 75 last school year, said Jose Marquez, the Ontario School District mental health supervisor. The school district makes an average of one call a week to Lifeways about a student disclosing suicide intent or ideation, Marquez said.
Defining child poverty
Children who grow up in families enduring economic hardship can be impoverished by lack of life’s basic needs. They often do not have a stable supply of food, adequate and safe shelter, means for education or care for their medical and mental health traumas. As a consequence, children’s physical, cognitive and emotional development is affected.
“It was actually prioritized as one of our district goals to increase access to mental health support,” said Alisha McBride, Vale School District superintendent. “The challenge, though, is we’re doing our best to increase it in educational institutions, but our care providers are struggling to meet the demands.”
An investigation by the Malheur Enterprise sought to understand why the mental health needs of Malheur’s children are not being met. There are no easy answers.
Need is high, but staffing and facility shortages, long waits, transportation difficulties, and a lack of trust in professionals impede families from getting help.
Vale High School referred about 10% of its students to outside mental health counseling – about 30 of 290 total students. At least four were referred to urgent crisis care.
And that’s just one school in the county.
Malheur County Sheriff’s Deputy Derrick Peasley, who serves as the Vale School District school resource officer, said he’s seen more elementary school students referred to mental health counseling in the past year.
There’s a “direct connection” between students having untreated mental health issues at school and living in low-income families, said Lucas Tackman, until recently Vale High School principal.
Zack, who hasn’t been treated for mental illness despite his high school’s numerous pushes, hasn’t seen a therapist because his family – which struggles with housing and access to food – didn’t respond to the school’s suggestions, school officials said.
In the last school year, Tackman set out to help students living in poverty by giving them support that they would otherwise not get at home.
“A lot of our parents are constantly in fight or flight when they’re at home because they don’t have a lot, and that translates into the kids being in fight or flight, but they don’t know that they are,” Tackman said. “The hardest thing is kids don’t recognize because what may not be normal to me is absolutely normal to them.”
What “normal” means to students from low-income families might include inadequate housing, food and job insecurity, unstable internet access, and substance use, said Nancy Longoria, Lifeways therapist and clinical supervisor for its child and adolescent team.
“Poverty means they don’t get the basic means and the essential nutrition. If you have children coming to school hungry, they’re not ready to learn,” Longoria said.
Falling behind in school can lead to anxiety and depression, she said.
The Treasure Valley Children’s Relief Nursery in Ontario, which provides social-emotional learning classes for young children at no charge, serves stressed families, including single parents and unhoused families. Cindy Lucht, the nursery’s outreach coordinator, and Alicia Ruiz, a lead teacher and home visitor, say they see the effects of high stress at home on children’s development and emotional skills.
“You tell the parents about the effect of stress and their situation,” Lucht said. “Kids hear things and they think, ‘Oh, cops are going to come take dad away because mom’s mad.’ It’s a difficult situation. The parents don’t understand that their kids are hearing everything.”
Nearly half of patients at Altruistic Recovery in Ontario are children and youth, said Annette Volk, executive director of the outpatient mental health and substance abuse counseling center. Kids often come in because of trauma, law enforcement or state agency involvement and difficulty at school, Volk said.
Part 1 – Malheur County continues to have one of the worst rates of child poverty in Oregon, despite determined local efforts.
Part 2 – Children are living in substandard housing, as Malheur County’s shortage of homes remains challenging.
Part 3– Getting enough food to feed children is no easy task for many Malheur County households.
Part 4 – Schools in Malheur County step in to serve children in need with more than an education.
Part 5 – Shortage of facilities and professionals leaves children’s mental health needs unmet.
“The people that I do see have generational difficulties of poverty, employment, housing, substance use,” Volk said. “It does play a role, but I don’t think that neglect, abuse, substance abuse goes away based on your income.”
Across the county, mental health providers struggle to hire enough behavioral specialists and clinicians. Ken Hart, the chief executive officer of Valley Family Health Care, said recently that three of his seven specialist positions are vacant.
“There is a significant need now,” Hart said. “That is compounded, usually, when you’re in a rural setting, being able to find providers and get them where they need to be, whether it’s in a clinic setting or at the school level.”
Hart is trying to hire more therapists based in Idaho to work in Malheur County, but it’s taking a long time to get them licensed in Oregon. During Covid, some rules for licensing and telehealth were relaxed, he said, but the “wall around Oregon is going back up” now that emergency measures are lifted.
Marquez, a former counselor at Lifeways, saw the staffing shortage firsthand. Marquez said his caseload at Lifeways once counted 87 patients. Stretched thin, he struggled to provide patients with the care they needed. Some came every two weeks, some every three.
Marquez’s year at Lifeways was his first in the counseling field. Some young professionals and interns see patients for about a year before moving to more desirable jobs and locales, Marquez said. This makes it difficult, he said, to retain counselors and keep a full staff.
“Most people, myself included, would come to Oregon, work as a mental health professional and, once they get their license, they leave – like a stepping stone,” he said.
VIDEO: What people say about solutions
No place to go
Compounding a slim supply of clinicians, eastern Oregon has no in-patient mental health facility to treat kids in dire need. When schools and community agencies refer kids to Lifeways for crisis care – when they’re suicidal, or having a meltdown that endangers themselves or others – they don’t have a place to go.
Longoria from Lifeways said the only options available to families are traveling to an in-patient mental health hospital in Portland, a six- to seven-hour drive, or going out of state. For Malheur County families on the Oregon Health Plan, those options are out of reach.
Children in crisis can spend up to two weeks in the Saint Alphonsus Medical Center emergency room in Ontario if they’re not deemed stable enough to return home. They sleep there, and they wait for a slot in treatment.
On his routine patrols, Officer Chris Bolyard of the Ontario Police Department sees the same mental health patients languishing in the ER bay for weeks on end.
“Emergency services are being used as mental health housing,” Bolyard said.
Families with greater means may afford a trip across the state or an out-of-pocket stay at a specialized hospital in Idaho. When demand for beds outweighs supply, those with less money and less time – to take days off of work, for instance – are left without, said Malheur Circuit Court Judge Lung Hung.
“Frankly, that’s another poverty issue,” Hung said. “People who have the resources can get a bed.”
Malheur County District Attorney Dave Goldthorpe said having a substance abuse detox center and an in-patient mental health center – neither of which are found in the county – is “essential” to addressing poverty. Goldthorpe has written letters requesting mental health and drug treatment funding from the federal government, but they’ve never been approved.
“If we had that money from the federal government, or from the state government, or both to build those facilities and run those facilities, I believe you’d see, in a very short time, a dramatic change,” Goldthorpe said.
Schools on the front lines
When kids are in need of mental health support, schools are often the first responders.
Tackman said his Vale school is trying to do more for students by providing more counseling and layers of support to meet student needs before referring them to professional treatment.
Jenn Susuki, the Malheur County Education Service District student wellness coordinator, said schools across the county are doing the same thing.
“We’ve been increasing the number of mental health providers in the schools,” Susuki said. “We’re trying to provide more universal solutions for all kids, like social emotional learning in the classroom.”
Malheur County school counselors, who support students on everything from academics and careers to mental health, see volumes of students well above the American School Counselor Association-recommended 250 students to one counselor.
“A lot of school counselors have anywhere from 250 to 500 kids on their caseload,” Susuki said.
Lifeways sends a mental health counselor to some schools in the Ontario School District to supplement school counseling. Counselor Sam Galan sees about 60 students, many suffering from anxiety and depression. They can be referred to Lifeways for more frequent and specialized support.
State funding allowed for Galan’s counseling, but it’s uncertain what that funding will look like in the 2023-24 school year.
Some relief is coming. New funding from the Biden administration announced last month will help Oregon schools expand mental health services they provide to students on Medicaid. That was three in eight kids across Oregon last year.
When schools can’t provide enough mental health care to kids, they refer them to outside counseling or in-patient care, usually at Lifeways, which Tackman said is “spread pretty, pretty thin.” His students wait about four or five weeks, he said, for such care.
Sometimes, when families have what they view as poor experiences with Lifeways, such as long wait times or inadequate care, parents start distrusting the school, Tackman said.
“A lot of our families don’t trust those entities,” Tackman said. “They’re very reluctant to go.”
There is also a stigma surrounding getting care at Lifeways, said Theresa Meiwald, Vale Elementary School principal. The provider is the main source for court-ordered rehab and mental health treatment, and is connected to state Child Protective Services so some parents see Lifeways as a “punishment,” she said.
Fears of judgment and confidentiality stop some from following through on referrals or taking their kids to Lifeways and parents “really pump the brakes as soon as you use the word Lifeways,” Meiwald said. “They’re like, ‘Nope, not going to do that.’”
When kids and families don’t trust mental health providers, they don’t get care. Providers at Lifeways said they would work with Manuel, an Ontario teen who said he wants therapy above anything else, if he came in. Even though Manuel – not his real name – recognizes his need for therapy, he said he doesn’t trust Lifeways and won’t go there.
Ron Van Ausdal, Lifeways’ outpatient clinical director, said he was surprised by the level of patient and community “frustration” with Lifeways when he stepped into the role a year ago. His goal of providing quality care and rebuilding trust hasn’t been easy, he said.
“I wish I kind of knew what I was walking into,” Van Ausdal said. “There’s a lot of history that I wasn’t aware of that we’re trying to overcome, and it’s been a little bit of a struggle.”
The stigma that surrounds Lifeways, Van Ausdal said, likely stems from the provider’s scattered focus in previous years. Instead of focusing all its efforts on better serving Malheur County, he said, Lifeways sought to become the preeminent behavioral health organization on the West Coast.
“That just didn’t make any sense to me,” Van Ausdal said. “We’re supposed to help these people. Why are we not helping them? Why are they focusing on other areas?”
To address distrust, Van Ausdal said Lifeways refocused on adequately training its counselors. The new Lifeways child and adolescent care facility, tentatively set to finish construction July 16, will create a place for kids to seek treatment without going through the main building, he said.
Longoria hopes the new facility will encourage more families to get care.
“This is the first time we’re going to have our own building just for children and teens, and we’re hoping that will diminish some of the stigma with coming in where everybody is,” Longoria said.
Transportation a barrier
When families are willing to get help from Lifeways or another community provider, getting to counseling appointments poses a significant challenge to some — especially parents who can’t get off work during the day.
The Oregon Health Plan provides free medical rides to appointments to its members, but Longoria said riding in a stranger’s vehicle might not be viable for patients with anxiety or trauma disorders.
Deputy Peasley said school employees and probation officers often step in to ferry kids to mental health clinics.
“It’s, you know, ‘How am I going to get my kids to these appointments? I can’t miss work’ … things like that,” Peasley said. “Teachers, principals, I mean, we’ve offered, even for our juveniles on probation, their probation officer, I’ve seen them volunteer to help out in those areas. I’m transporting them to and from appointments.”
Telehealth allows for remote counseling, which kids can access at school, but it comes with its own difficulties. Some households in Malheur County have trouble getting stable internet and providing a private space where children can comfortably share their emotions, said McBride of the Vale School District.
Trauma incurred from unstable or unsafe housing, insufficient food, and substance use continues to leave a mark on kids’ mental health that local agencies struggle to address.
To ensure children get the help they need to become functional adults, the district attorney, school officials and counselors agree that Malheur County needs a place for people to stay and get specialized care when they’re breaking down.
The county also needs more volunteers to step up as foster parents and respite providers, according to Longoria and Galan. Youth in unsafe or unstable households need homes where they can be kids – where they can recover and grow.
To see change in Malheur County, kids struggling with mental health need their parents, their communities and their county officials to care.
“These are our friends and our neighbors,” Longoria said. “They are living here and they’re going to grow up here. What kind of grown-ups do you want in your community?”
Reporters Andie Kalinowski, Shane Dimapanat, Suejin Lim and Venice Tang contributed reporting with supervision provided by Rebecca Haggerty and Judy Muller of USC Annenberg School for Communication and Journalism.
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