Category: School Art Therapy

• Article by: Jeffrey Meitrodt
• Star Tribune

July 21, 2013 – 7:26 AM

The cigarette lighter sat on the family computer when Gianni awoke.

He said that a voice in his head, the one he sometimes calls Mr. Angry, told him to bring it to school — and threatened to punish him if he didn’t.

Hours later, after getting angry with his teacher, Gianni set fire to a bulletin board outside a special education classroom. The blaze was quickly doused with water bottles, but school officials had him arrested. He was charged with arson.

Gianni, who has been seeing a psychologist since the age of 3, spent the next 37 days in juvenile detention, five times longer than the typical adolescent accused of a crime in Ramsey County.

“I knew setting a fire was bad, but I didn’t belong in there,” said Gianni, who turned 15 while incarcerated. “Sometimes, my brain thinks of horrible things I don’t want to do.”

Gianni is one of thousands of students afflicted with serious mental health problems who are flooding into Minnesota schools because they have nowhere else to go.

Their complex needs are bringing huge and at times dangerous challenges to special education classrooms that are already struggling to handle increasing numbers of students with other handicaps, including multiple disabilities.

In an era of tight budgets, Minnesota has retreated from more intensive adolescent mental health treatment options, at times leaving schools as a setting of last resort for students with problems ranging from schizophrenia to bipolar disorder. And even as special education teachers and specialists try to help, many are now working forever on edge — fearful that recurring outbursts by deeply troubled students could injure them or other children.

“Schools are in over their heads with mental health,” said Mark Kuppe, CEO of Canvas Health, a nonprofit company that works with schools to provide mental health services. “They think they can hire a few social workers and school psychologists to deal with this, but the reality is those folks aren’t trained in the clinical work.”

Brenda Cassellius, commissioner of the Minnesota Education Department, said she’s hearing a growing chorus of complaints from school districts that feel overwhelmed by students’ mental health needs. Schools need more mental health professionals, she said, but can’t afford to hire them.

“We just can’t meet the demand,” Cassellius said.

Superintendent Connie Hayes said the problem has reached “crisis” proportions even at schools such as hers in Intermediate District 916 in the northeast metro that are designed to handle children with the worst behavioral problems. A decade ago, she said, students with mental illness were rare. Now 75 percent of her students have mental health issues.

“It’s like night and day,” she said.

Her district does what it can to provide clinical services with limited resources, Hayes said.“But it simply is not enough.”

‘Can’t take responsibility’

Gianni set his first fire at the age of 6.

His mother, Shameka Griffin, remembers her son coming into her bedroom and waking her up about 3 a.m.

“Something really bad is happening,” he told her.

Flames crawled up the wall from his bed. Gianni, who has trouble sleeping, had found leftover sparklers in a closet and a lighter in her purse.

Shameka put out the fire before it spread beyond Gianni’s room. But their landlord evicted them.

“Gianni can’t take responsibility for his actions. He is not mentally stable enough to do that,” said Shameka, who decided to speak out about her son’s mental health history because she believes the state and the school system have failed him. She gave the Star Tribune access to his psychiatric and school records and authorized caregivers and others to discuss his case.

Gianni’s odyssey through Minnesota’s public school system shows how children with mental health issues can be lost in a system geared to help students with obvious physical and cognitive handicaps. Their care comes from a patchwork of services through schools, state and local agencies and private insurance — often with little coordination.

“Who is responsible for what?” asked Curt Haats, chief financial officer for Hennepin County Human Services. “You have a lot of parties that want to do good, but they all have some piece of the accountability. If everyone is accountable, then no one is.”

17 different drugs

Gianni looks like a normal teenager, but he is not. Over the years he has been diagnosed with psychotic disorder, bipolar disorder and pervasive development disorder. He and his 4-year-old brother both have autism.

“People think I’m not a right person, and autism is just an excuse for me to get into trouble, but it’s not,” Gianni said. “It is something deep inside of me. It’s been there for 15 years.”

Gianni was repeatedly suspended from kindergarten for outbursts. Doctors began medicating him in first grade, when he was diagnosed with emotional and behavioral disorders and began receiving special education services.

Since then, he’s been on 17 different drugs, including antipsychotic medications and mood stabilizers. Reports show the drugs often helped him do better in school, but some produced frightening side effects.

When he was 9, Gianni spent three weeks in the psych unit at Fairview Riverside Hospital after he began talking on an imaginary phone and “voicing homicidal threats against his family and others,” according to a hospital report. Doctors blamed the hallucinations on a change in medications.

When he returned to Minneapolis schools, he was removed from mainstream classes and put in a room with other students with autism. He received no mental health services at school but was seeing a psychiatrist through Shameka’s insurance plan.

The next year, Mr. Angry became a regular companion.

In April 2009, Gianni wandered up to a neighbor working on a truck in his driveway. Gianni picked up a hammer and hit the man in the back of the head.

“He didn’t say hi, bye or anything,” the man told police. He required seven stitches but sustained no serious injuries.

Gianni could not explain what provoked the attack and cried when an officer pressed him for answers. He later told a therapist that his left hand “just did it” because “Mr. Angry” told him to.

Gianni was charged with assault, but the case was dropped months later when he was found mentally incompetent, county records show.

The incident “scared me to my core,” Shameka said. She decided to pull him from public school and enroll him in a residential treatment center, where he could undergo psychotherapy daily and be monitored 24 hours a day. She wanted her son “somewhere he could be safe.”

She was finalizing arrangements when police came to question Gianni again. They wanted to know whether he was the person seen trying to start a fire in a vacant garage. Once again, he confessed.

Gianni was immediately placed at St. Joseph’s Home for Children, which charged $2,000 a month for his long-term treatment. The costs were covered by Shameka’s insurance from her $30-an-hour job as a hospital X-ray technician.

But Gianni’s yearlong stay at St. Joe’s took a heavy toll. Constant visits with her son made Shameka late for work so often that she was fired. Three years later, she still hasn’t been able to find full-time employment.

She now depends on public programs for Gianni’s treatment.

Changing directions

Schools are not equipped to deal with students like Gianni, superintendents say.

Ten years ago, a child with his mental and behavioral history might have been put in a group home with other mentally ill children and attended a day-treatment program for academic instruction and mental health services.

But in an attempt to keep children out of pricey treatment centers and hospitals, Minnesota changed directions in the past decade, pouring millions of dollars into early-intervention programs while cutting funding for longer-term care. The state now serves twice as many children as 10 years ago — 55,000 in 2010, but spending per child is down 47 percent.

“The average age of the children we’re serving has been going down,” said Chuck Johnson, deputy commissioner for policy and operations at the state Department of Human Services. “We’re getting ahead of the problems earlier.”

But, some top educators say, the state did not account for the needs of students with more serious mental problems. Those children now sometimes have no place to go for help when they break down, turning schools across Minnesota into de facto treatment centers.

The number of beds at residential treatment centers in the state has fallen 27 percent in the past decade. Counties also have cut funding for day-treatment care by 55 percent since 2007.

“When I came here, Minnesota had a reputation as one of the best places to go if you needed mental health services,” said Dr. Carrie Borchardt, who has been working as a child psychiatrist in Minnesota since 1983 and with Gianni since he was 9. “And I don’t think that’s true anymore. We are providing much less.”

Schools, which once referred difficult cases to expensive day-treatment programs, have also scaled back. Canvas Health stopped getting referrals from six suburban districts in recent years, Kuppe said.

Lifespan, another day-treatment provider, was cut by several of the state’s largest school districts — including Minneapolis, St. Paul and Anoka-Hennepin — after years of treating their students.

Liz Keenan, special education director in St. Paul, acknowledged that her district can’t provide the same treatment children receive at Lifespan, which typically provides three hours of individual and group counseling per day. St. Paul paid Lifespan about $2,500 per month for each student.

“It comes back to funding,” Keenan said. “If the schools have to absorb the costs, it becomes too difficult to sustain it.”

Anne Klein, whose daughter has been diagnosed with bipolar disorder and depression, said public schools don’t do enough to address children’s mental health. One school worker was openly skeptical about her daughter’s condition, remarking in an e-mail: “Do you ever get the feeling that this whole mental health issue is a bunch of baloney???”

“It was just so wrong,” said Klein, whose family paid to send the girl to Lifespan for nine months after the school district refused to cover the bills. Klein said Lifespan “saved her [daughter’s] life.”

Threats at school

After a year at St. Joe’s, Gianni started seventh grade in a new school.

He was transferred to District 916, which takes children whose behaviors are too extreme for regular schools. In its evaluation, the district found Gianni was highly maladjusted and was likely to have conduct problems. He was assigned a full-time aide and was to meet with a school psychologist three times a week in 50-minute counseling sessions.

Gianni’s first year at the school was rough. Every day, he threatened to hurt and even kill other students, even though most of his anger was directed at himself, kicking furniture or hitting a wall. In his first five months, he was locked in the seclusion room three times and physically restrained once, school records show.

In a December 2010 e-mail to Gianni’s Anoka County social worker, Shameka pleaded for advice, saying her son “may not be ready for school and that perhaps a more psychiatric setup would be more appropriate for him.”

The social worker questioned the need for an out-of-home placement, suggesting that “maybe there have been too many changes within the last few months.” Instead, the county arranged for more therapeutic services. In July, the social worker noted in her log that the sessions were not going well because Gianni “is fighting it.”

The school district’s response to Gianni’s escalating behavior was to reduce his mental health services. In his second year, he received just 45 minutes of in-school therapy a week from a social worker, school records show. County and school officials declined to comment on Gianni’s care.

Gianni’s behavior grew worse. In December 2011, school workers started searching Gianni daily because he was bringing things to class that could injure others, including a broken CD.

He was suspended the next month after he tried to hit another student with a heavy book and threatened to “blow your frickin’ head off,” school records show.

The school called local police, who charged Gianni with making “terroristic threats” and placed him in juvenile detention overnight. The charges were later dismissed when Gianni was found mentally incompetent.

District 916 officials recommended that he be removed from school and enrolled in a day-treatment program, according to the social worker’s log. The move would have given Gianni three hours of therapy a day.

The county rejected the plan, “due to his aggression,” the social worker wrote.

For the rest of that school year, Gianni attended just a half day of school in his own classroom with his own teacher, isolated from other students because of “his escalating behaviors and concerns regarding his mental health,” school records show. He went home each day at 11:30 a.m.

Without commenting specifically on Gianni’s case, Superintendent Hayes noted that her district and two others that specialize in high-needs children routinely wind up with students who have been kicked out of residential treatment or day treatment for aggressive behavior.

“It begs the question: If they are too aggressive for a mental health treatment environment, why is a school environment the best place?” Hayes asked in an e-mail to the Star Tribune. “Our state has allowed a system to develop, due to a lack of planning at the policy level, for schools to be the default placement for these seriously mentally ill students — without any planning, preparation, collaboration or resources to do so successfully.”

Mr. Angry resurfaces

Worried the school was failing Gianni, Shameka asked the district to move him. At his new school, administrators allowed him back into a classroom with six other disabled students for the 2012-13 school year, despite concerns about his mental health problems. Gianni’s therapeutic sessions were reduced to one 30-minute session weekly with a social worker.

Workers at the Little Canada school no longer searched his pockets and backpack, Shameka said.

Initially, at least, Gianni stayed out of trouble. Even when a classmate insulted him with a racial epithet, he did not become violent, records show. A January report shows that Gianni was making adequate progress on his academic and mental health goals.

Then, on April 16, Mr. Angry spoke up again, demanding that Gianni bring the lighter to school. Gianni admitted he used it to set fire to the bulletin board. The school was evacuated, frightening dozens of disabled kids.

“If they had just checked my pocket, all of this wouldn’t have happened,” he said in an interview with the Star Tribune.

School officials agreed with police that Gianni should be arrested because of the “severe” nature of the incident, police records show.

Gianni spent the next five weeks in juvenile detention. His barren cell had a concrete bed and steel toilet.

Meg Kane, Gianni’s lawyer, tried to move him into a residential treatment center, but nobody had any vacancies and Anoka County social workers refused to help, citing “liability issues,” she said. Anoka County officials declined to comment.

Gianni was denied video games and other items that calm him. His mother could visit only twice a week. He said he was bullied constantly.

“It was pretty scary,” he said. “I felt like I was in there for 50 years.”

Shameka said Ramsey County officials told her Gianni had three psychotic episodes and threatened suicide after an incident on the basketball court. She said her son, who rarely smiles or shows emotion, cried on his 15th birthday.

Gianni’s teachers and therapists wrote letters to the judge pleading for Gianni to be sent to a treatment facility or released to his mother. On May 23, after once again deciding that Gianni was mentally incompetent to face criminal charges, a judge let him go.

“That’s unacceptable,” DHS’s Johnson said of Gianni’s ordeal.. “We shouldn’t have kids going into the juvenile justice system who don’t belong there.”

Sent to Utah for help

Children across the state are waiting as long as a year for their first appointment with a psychiatrist. If a young person has a crisis, they may be forced to go out of the state for help because there aren’t enough beds here.

“Our state is not capable of managing the complex mental health problems that we have here,” said Dr. George Realmuto, medical director at the state mental hospital in Willmar.

Realmuto recently had to send a boy from Hennepin County to Utah because he couldn’t find a residential treatment center able to take him anywhere in Minnesota. “How is it that Utah has more services than we do?” he asked.

In an interview, senior DHS officials conceded the move from institutional care has created a service “gap” for at least 100 students with behavioral problems too intense for schools or for existing state facilities. Minnesota may have to create a new type of facility that would provide intensive psychiatric care to such students for as long as three months, as well as offer other services, said Glenace Edwall, the department’s director of children’s mental health services.

“We want to acknowledge that we have a ways to go in creating and funding the children’s mental health system,” Edwall said.

Edwall noted the department recently received legislative approval to double a program that pays for school-based mental health services, but, department officials said, the nearly $10 million in funding for 2015 will still be $22.3 million short of what is needed.

Cassellius, the education commissioner, said she will meet with top officials at other state agencies — including corrections and Human Services — to address the crisis.

“Is this a problem because there are not enough beds on the DHS side, or is this a problem of adjudication (of juvenile criminal charges), or is this a problem of special ed in schools?” asked Cassellius. “How do we get at the root cause instead of coming up with a Band-Aid solution?”

Educators say the state has to rethink its approach to mental health and figure out which students belong in settings other than schools.

“We are teachers. We are counselors,” Hayes said. “We don’t provide medical, clinical therapy. That is not the mission of schools.”

Alone at his party

Gianni brandishes a makeshift sword alone in his back yard, battling imaginary enemies.

“The darkness will take hold of you,” he warns in an ominous tone. “No, it won’t,” he shouts in response, his voice spiraling higher.

Inside, his homecoming party is in full swing. Friends and relatives overtake the living room of the family’s modest home in Fridley, as Shameka, amid tears of relief, rushes to feed them some of Gianni’s favorite foods: hot dogs, steak, zucchini and asparagus.

Gianni flits through the party, pausing just long enough to accept an occasional hug or friendly question before retreating to his bedroom and his video games.

“He’s going to get tired of this,” says his grandmother, as Gianni wipes her kiss off his face.

Gianni is free, but the fallout from his jail time remains. His annual state aid of $30,000 of mental health services was terminated because he spent 30 days in juvenile detention, a disqualifying event.

Shameka is worried by her son’s new belief that he might belong in jail. Gianni’s psychiatrist said the extended jail time could permanently damage the boy. “He could develop worse anxiety or obsessions,” Borchardt said.

Shameka is still angry that school officials had her son arrested and that it took so long to free him. She is not sure where to turn or what to do about school come fall, even though she said the principal wants him back.

“To be honest, I don’t think the district is capable of handling Gianni.”

Jeffrey Meitrodt • 612-673-4132