Psychiatrists Raise Concerns Over an Uptick in School Referrals

Fernando Kaskais

March 1

Visual: DigitalVision Vectors via Getty Images

Psychiatric evaluations are meant to keep students safe. But psychiatrists say schools misuse and misunderstand them.

THE 9-YEAR-OLD had been drawing images of guns at school and pretending to point the weapons at other students. He'd become more withdrawn, and had stared angrily at a teacher. The principal suspended him for a week. Educators were unsure whether it was safe for him to return to school — and, if so, how best to support him.

So, as schools around the country are increasingly inclined to do amid heightened concern over school violence and threats, administrators sent the child to meet with a psychiatrist. There the child sat, in a chair a bit too big for his small frame, fidgeting as he listened to the psychiatrist over a video call.

This story was produced by The Hechinger Report, a nonprofit, nonpartisan news outlet focused on education.

"Some people in the school asked me to talk with you to try to figure out how we can make school easier for you and understand what happened," psychiatrist Nancy Rappaport told him, according to a recording of the call. She had documented the session, anonymizing some details, to share it as a case study with a room full of hundreds of child psychiatrists who faced similar requests.

They had come from across the country, gathering at an annual professional meeting of the nation's child and adolescent psychiatrists last October, to learn how to conduct similar evaluations effectively. Many were seeing more children wind up in their offices and emergency rooms, pushed into psychiatric evaluations by their schools. Sometimes their young patients had made threats or been violent in class. Other times, the catalyst was less clear; perhaps the school had called police to take the child to the hospital during a behavioral or mental health crisis, or told a parent that their child would not be allowed back without a doctor's sign-off. They needed to know how to respond.

"None of us can predict violence — we don't really have a future [predicting] ball," Rappaport, who is also an associate professor in psychiatry at Harvard Medical School, said later. When assessments are deployed well, she explained, they can be essential to preventing violence in schools and mobilizing resources for a struggling student. But determining which child could pose a threat to themselves or others is a delicate process that schools frequently misuse and misunderstand, according to Rappaport and other experts familiar with the process.

Psychiatrists emphasize that schools need well-trained teams of mental health professionals and administrators who work alongside clinicians to assess whether students pose a threat and support children in crises. But, they say, relatively few districts have that level of resources. Instead, schools often offload the responsibility of evaluation and intervention onto outside psychiatrists and even emergency rooms.

The practice can keep students out of school for weeks or even months, and cast children into an already-overburdened youth mental health system that families must often navigate without any assistance from schools. Family advocates say that even sending a child to an emergency room for an evaluation can become a days-long ordeal.

Without clear policies, transparency, and staff support for schools and clinicians, many experts say these outsourced evaluations can result in a cycle of removals that leave children in crisis and schools with a false sense of security.

Determining which child could pose a threat to themselves or others is a delicate process that schools frequently misuse and misunderstand, according to experts.

"When you ask an emergency room, 'Is this child safe to be in school?' it's the wrong question," Rappaport said. "It gives the schools a false sense of confidence and, many times, it indicates that the school doesn't have in place what needs to happen."

No comprehensive national data exists about how often districts require such evaluations. But for many psychiatrists, the seemingly ever-spreading use of these evaluations without preventive measures or follow-up support for students is setting off alarm bells.

"The focus can't just be on identifying potential school shooters," said Deborah Weisbrot, a clinical psychiatry professor at Stony Brook University Medical Center who also helped lead the training session. "The focus needs to be about the underlying mental health and characteristics of all the hundreds and hundreds of kids who make threats, who will never become school shooters, and what are their needs."

DORRI AUERBACH wishes her district had offered that broad focus.

Her grandson, Carter, is a bubbly child with diagnosed ADHD and lots of energy. At the beginning of his first grade year in 2021, Auerbach asked his Long Island elementary school in New York to evaluate him for special education services, but he was found ineligible, according to Auerbach and a school therapist's report. At school, he did well in math and reading but often struggled to sit still in his chair and became frustrated when he felt misunderstood by other kids, she said. He met regularly with the school therapist to learn better coping strategies...

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https://undark.org/2024/02/27/schools-kids-psychiatrists/