Second of three stories.

Sometimes a headache is more than just a headache. 

When students are feeling anxious or stressed, they might first approach a nurse, but end up speaking with a social worker. 

At Yarmouth High School, nurse Stacey Hang works closely with guidance counselors Brenda Michaelsen and Beth Doane and social workers Shenaugh Tripp and Jill Frame, who doubles as a substance abuse counselor. 

Along with administrators and school psychologists, they are the school’s student support team. 

The team’s charge is to eliminate the stigma surrounding mental illness and encourage students to feel comfortable talking to a trusted adult about their troubles. 

In recent years, Michaelsen said the team has seen an increase in its caseload, in part due to an increase in student enrollment, but also as a result of increased awareness about mental illness.

At the same time, for the past five years or so, funding and staffing in the guidance and student health departments have remained relatively static. 

Additionally, school clubs and organizations, as well as the health science department, have brought mental health to the forefront of their discussions by talking about challenging topics, such as bullying and maintaining healthy relationships.

The Green Group, which took off this year, is a mental health education group in the high school that allows students the opportunity to come together and participate in facilitated discussions around mental health and wellness in the school and greater community.

“I think it helps kids feel like they’re not alone,” Michaelsen said. “As people talk about their stories, it becomes easier for the next person to talk about their own story. It’s going to take some time for it to continue to be something that it’s OK to talk about.”

For those not apt to speak publicly about their struggles or concerns, the layout of the high school puts student support at the heart of the building, while offering anonymity for students in crisis. Hang’s office is directly behind the school’s main office, along with the offices of Michaelsen, Doane, Tripp and Frame.

“When kids come in, no one knows if they’re going to the nurse or guidance or a social worker,” Hang said. “So it’s sort of an anonymous way to come in and there’s everyone here to help you. … It really creates a team approach.”

While it is common for school districts to offer social services to students with individualized education programs, or IEPs, Frame said Yarmouth High School is lucky to have barrier-free access to licensed social workers like herself and Tripp, who are both in the building four days per week.

“It keeps us very busy, but allows us to connect with kids that don’t have identified special educations but certainly are struggling,” she added. 

In fact, Frame said she thinks they see more students without IEPs on a regular basis. What she and Tripp typically see is students coming in with feelings of anxiety and depression.

Anxiety on the rise

“Anxiety is one of the most frequent concerns and that could stem from things going on in or outside of school,” Frame said. “Depression is also a huge piece of what we deal with. Those two often go hand-in-hand, so it’s hard to sort them out sometimes.”

Since she began working at YHS, about 12 years ago, Frame said she’s seen an increase in acuity of mental health issues.

“More kids are being diagnosed with more significant mental health issues now,” she said. “We see a little bit of everything.” 

Although Frame and Tripp shoulder most diagnosed cases of mental illness in the school, many of their referrals come from Hang or one of the school counselors, who typically focus on post-secondary planning. 

“Sometimes students and staff come to me saying they feel ‘off’,” Hang said. “They’ll ask me to take their blood pressure or say they have a headache or feel nauseous. Sometimes, you realize it’s a physical manifestation of their stress level or anxiety.” 

After “peeling back the layers” to sort out what’s going on, Hang said she’ll often refer both students and staff to Frame or Tripp as necessary. She added that students with chronic illnesses will often come in with symptoms of stress, not knowing that the feelings of anxiety may stem from their illness.

“It’s a hard thing to cope with knowing your illness is long term,” she said.  

Similarly, if Michaelsen or Doane notice a student coming in frequently to say they’re feeling anxious or down about something like a grade they’ve received or a class they’re struggling with, they may refer them to a social worker for more assistance. 

“We really work in tandem,” Michaelsen said. “We often have the initial conversations with students and then, if need be, we would triage them to the social workers if they needed more support … It’s really a team approach here.”

No resource officer

Unlike many nearby districts, the high school does not have a resource officer. However, twice a year, district administrators, nurses, counselors and social workers meet with Police Chief Michael Morrill, community faith leaders, and a technology coordinator, as the Crisis Intervention Team, to update and review protocols in the event of a building or district-wide crisis.

Protocols came to fruition in January after the death of a seventh-grader at Frank H. Harrison Middle School, which was investigated as a suspected suicide. 

Advisers – teachers, administrators, and other support service professionals – were given a clear script to use when they were approached by students with questions. The script gave the facts about what happened and suggested resources for those struggling.

“We have a really strong adviser-advisee program here, where every student has an adult that knows them really well and meets with them daily throughout their four years,” Doane said. 

After the district’s loss, the student support team was “on deck at all times” during school hours to talk with students and staff who may have felt confused or upset.

Greg Marley, clinical director and senior trainer of the National Alliance of Mental Illness of Maine’s Youth Suicide Prevention Team, was on site as well.

“In most cases, there will be a strong immediate reaction to these tragic events … (but) that level of feeling will go down rapidly,” Marley said during an interview in January. “The smaller number where that doesn’t happen is where you’d like to focus.”

That’s what Yarmouth has seen. 

“For a week or so, we had students more in that acute phase and then we started to work really closely with some of those who were more closely involved,” Frame said. “That’s been an ongoing conversation.”

The middle school also employs two licensed clinical social workers and a school counselor. Superintendent Andrew Dolloff’s proposed $25 million budget for fiscal year 2019 includes a $1,200 stipend to fund the expansion of one Harrison Middle School licensed social worker to run a co-curricular program for students, centered around mindfulness and mental health.

“Students will work with the coordinator to design and participate in activities that raise awareness around mental health issues and help them develop strategies and skills for dealing with challenging situations,” Dolloff said. “This portion of her position will equate to approximately one afternoon per week.”

Additionally, Dolloff has proposed expanding a part-time K-4 social worker to full time.

“(A) growing population in the Yarmouth Schools is a group of students requiring greater supports academically, socially and behaviorally. We are seeing more students, and younger students, arriving at school with needs in each of these areas,” Dolloff said in his budget proposal. “In order for students to learn, they must first be and feel safe, and they must be in a proper emotional and behavioral mode. For some students, getting to that place is very difficult and requires significant assistance from adults.”

Jocelyn Van Saun can be reached at 781-3661, ext. 183 or jvansaun@theforecaster.net. Follow her on Twitter @JocelynVanSaun.

The series

Part 1: 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/.

• 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.

• 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/.

The Yarmouth High School guidance office houses counselors, social workers and a school nurse in a central location at the building’s core. 

Yarmouth High School social worker and substance abuse counselor Jill Frame keeps her desk stocked with resources for students stuggling with anything from drug use to anxiety or depression. 

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