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At 9 on a chilly February morning in Austin, Elizabeth Minne met in her office with a former counseling client and her mother. The three were all smiles, catching up for the first time in ages. As their laughter faded, they recalled their weighty introduction five years before, when Minne’s mission to create a comprehensive mental health-care system for Austin’s schools was still in its infancy — and her client, Sarah Luna Newcomer, was a teenager who wanted to die.

The room in Crockett High School was carefully arranged to evoke an atmosphere of calm for Minne’s clients, its walls lined with colorful tapestries illuminated by the warm glow of softly lit lamps. Many of the people treated here are coping with severe mental health conditions and extensive trauma. For some, this is the only safe place in their lives.

The abrupt ringing of the bell shattered the serenity, a signal that Friday classes were underway.

Newcomer, who is now 21, shuddered in mock disgust, recalling how the sound once embodied her hatred of classrooms.

A few years have passed since Newcomer left Crockett, where she was among the first students to receive on-campus treatment from Minne’s counseling practice, now known as Vida Clinic. Therapists have their offices within schools, where they treat students directly rather than assessing and referring them elsewhere. The Crockett clinic was the first of its kind in the state in 2014. Now it’s one of more than 40 in Austin run by Minne, who has a doctorate in psychology.

Moments later, tears streamed down Newcomer’s face as she detailed her struggles throughout middle and high school.

As a teenager, she faced unrelenting depression, battled trauma stemming from a sexual assault, grappled with her older sister’s several suicide attempts and felt the strains of her mother’s multiyear unemployment. Everything was scarce during those times, especially peace of mind, she said.

But when Newcomer met Minne, her pain began to melt away. She had a refuge within steps of her classes and someone to advocate for her needs to both her teachers and her parents. Most of all, she had daily access to clinically licensed mental health-care services. Newcomer felt secure, she said, for the first time in her life.

“For years, I just wanted to die. I didn’t want to exist,” she said. “But within a few months of beginning therapy, it was the complete opposite. I began feeling like I mattered, that my life mattered. It opened up a world of possibilities for me.”

Over time, Newcomer’s depression and anxiety decreased, her happiness and confidence increased and her grades and attendance skyrocketed — breakthroughs that propelled her to graduate from high school a year early.

“Growing up is hard enough as it is,” Minne said. “When you add in common challenges like anxiety, substance use issues, severe school stress or family-related trauma, it’s incredibly difficult for a child to develop healthy coping habits without the proper support. That’s where we come in.”

Early stages

Four years ago, Vida Clinic partnered with the Austin Independent School District (AISD) to create on-campus mental health centers at three area high schools. Their goal was to prove that accessible, trauma-informed mental health care can significantly aid students struggling with depression, anxiety and a host of trauma-induced conditions.

Within a matter of months, kids who had been exposed to abuse, sexual assault and other scarring experiences saw striking improvements in their grades, behavior and overall happiness, according to evaluations by Vida and the school district.

Tracy Spinner, AISD’s director of Student Health Services, was impressed. “Not only did these kids’ mental and emotional health improve; their attendance improved and they became re-engaged in school altogether,” she said. “We couldn’t help but do a double take and think, ‘Did that just happen?’ It was stunning.”

In late 2017, with Spinner’s support, AISD secured $4.5 million of state funding through the Victim of Crimes Act to open Vida Clinics at 22 elementary schools in some of Austin’s highest crime Zip codes.

The district’s thinking was simple: because children living in high-risk areas are more likely to be exposed to traumatic events, their schools need to be more dynamic in meeting their mental health needs.

“People with unaddressed trauma are often the ones who end up falling into drug habits or the school-to-prison pipeline,” Minne said. “If we’re catching those people early on and giving them the support they need, they’re not going to be hospitalized or in the legal system down the line.”

Minne argues that every community needs access to mental health resources, which is why one of her three original clinics is in a school known for its high academic achievement and affluent student population.

“Many students are facing immense school-related stress that can fuel self-destructive behaviors. Their struggle is very real,” Minne said. “Mental health issues don’t discriminate by race or socioeconomic status. Every community wrestles with them in deep, painful ways.”

The concept of school-based mental health has been around since the 1890s and the Progressive Era, but on-campus counseling services have traditionally been limited in America’s education system. Many schools’ mental health professionals (academic counselors or social workers, for instance) typically do not have the capacity or professional training to aid students suffering from severe mental health issues similar to Newcomer’s — suicide ideation, anxiety and other symptoms of severe trauma — on a daily basis. Instead, struggling students often are assessed before being referred to an outside therapist.

The ratio of students to a school’s mental health professionals is a vital piece of this conversation.

The average academic counselor has 455 kids under their watch, according to the American School Counselor Association, which recommends a 250:1 ratio. As of last December, Vida Clinic had nearly 60 therapists on hand to serve over 1,000 students enrolled in their clinics throughout the district — an approximate 20:1 ratio.

Even when school counselors are not overloaded, a referral-based process can have logistical and economic gaps. Commuting to therapy sessions, for example, can cause kids to miss extensive chunks of class and force their parents to leave work, an especially large barrier for low-income families.

There can be lengthy waiting lists for appointments, too; Newcomer’s mother said her eldest daughter faced a three-month wait to receive services after she experienced a mental health crisis in high school and showed suicidal tendencies. Unable to wait any longer, they admitted her to the hospital, the last (and costliest) resort.

Vida’s therapists are in schools every day, allowing them to engage students, their parents and school staff simultaneously. This equips school faculty with mental health training and gives students constant access to care.

“We work with teachers on developing core skills and being able to identify warning signs. We want them to know if a student’s action is typical or atypical and what to do if they see a student in need,” Minne said. “We’re here to help create healthier learning environments for teachers and students alike.”

Other states are putting resources into schools, too. California’s School-Based Health Alliance, for instance, provides myriad services to students (including mental health care) in more than 250 schools and is considered among the nation’s top systems for on-campus care.

But Austin is creating one of the country’s most ambitious school-based mental health systems in a state that, according to the nonprofit group Mental Health America, ranks last in the country in youth access to mental health care.

Vida offers data to show its clinics make a difference.

In 2017, it compared nearly 800 of its clients to a control group of over 300 of their peers, who were also identified with mental health and behavioral issues. Suspensions among Vida’s clients dropped by nearly 10 percent, aggressive behavior offenses and substance abuse violations dropped, and expulsions were cut in half. High school clients’ GPA was 20 percent higher than their control group’s.

“Numbers and cold hard data are much more difficult to refute,” Minne says. “They’re what truly speaks for our work.”

One former client described how the clinic intervened when her anger and depression poured into the classroom. Plagued by anxiety and problems at home, she frequently got into fights, disrupted class (if she showed up) and rarely did her schoolwork. Suicidal thoughts swam through her brain. She began cutting herself in secret.

Her therapist, Laura Johnson, saw she was grappling with a series of traumatic experiences.

“Once I saw Mrs. Johnson, everything changed,” the student said. “Now, I have friends I’ve been close with for years, have a better relationship with my grandma and I’m thinking about the future.” She plans to begin college this fall and eventually hopes to pursue a master’s degree in social work.

Community support

Funding these services isn’t cheap, but Vida has received steady support from AISD — especially Spinner, who has worked to secure previously untapped revenue streams to pay for the clinic’s expansion. In addition to the $4.5 million grant AISD received from the Texas state government in 2017, Spinner obtained another $9.1 million from the governor’s office to fund Vida’s services in 2018-2019.

“We were the first school district to ask Governor [Greg] Abbott for that kind of money for mental health services,” she said. “From that point on, we knew this was our chance to prove to the entire state that this approach to mental health care is for real.”

This funding has kept the clinics open and allowed Minne to treat anyone who enters her offices, regardless of their insurance coverage or financial situation. They even treat teachers, school administrators and clients’ family members — a holistic approach that aims to make a child’s entire surrounding environment healthier.

Still, Spinner wanted Vida and AISD to become more self-sufficient, so she overhauled the program’s funding model this summer. Now, instead of being almost entirely reliant on federal and state grants, the clinics collect money from insurance payments and local taxpayer dollars.

“The expectation is that, under this new funding model, Vida Clinic’s going to continue expanding within our district. Within the next three months, we’d like to be on every middle school campus in the city,” Spinner said. “Furthermore, within the next year or two, my goal is to have an on-campus clinic in every single one of Austin’s 130 public schools.”

To Spinner’s point, the AISD Board of Trustees voted on Aug. 12 to grant Minne’s clinic full ownership of all 43 of its on-campus mental health centers — including 16 that had previously been under the watch of Travis County’s local mental health authority, Integral Care.

Now, other Texas schools are considering duplicating what Austin — the state capital — has done. And Minne and Spinner lobbied Texas lawmakers to make mental health a priority during 2019’s legislative session. By the end of the session in June, six different bills related to mental health care and school safety were passed with bipartisan support and signed into law to expand Texas’ mental health workforce, provide aid for families and schools with high-risk children, and establish mental health training programs in schools.

Despite these breakthroughs, Minne knows Texas — and America as a whole — still has a long way to go in providing adequate mental health care. But if we’re going to start anywhere, she said, it has to start with our future: our children.

“With true care and compassion, we can help kids build resiliency over the long haul,” she said. “Bolstering their well-being can strengthen schools, heal families, and reshape communities.”