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Beyond the Basics

School EMS referrals, on the rise, catch City Council’s attention

Sonya Turner knew her daughter struggled in school, both socially and academically. But when an assistant principal called one afternoon last October  to say that her daughter, Cashmiere, had turned suicidal and needed to be sent to the Emergency Room for psychiatric evaluation, Turner said she didn’t believe it.

When she visited the school that afternoon to follow up, she was told she would not be allowed to speak with Cashmiere until she met with school administrators. Turner refused and angrily confronted school officials until she had to be restrained school safety officers.

“I was livid, I was cursing, I was very irate,” Parker said. ”If anyone should have been admitted to a psychiatric ward it should have been me, not my child,”

In the end, school officials sent Cashmiere to the ER anyway. She is one of hundreds of students who each year are forcibly referred to emergency medical services by principals who believe that they could be dangerous to themselves or others.

Those numbers are on the rise, education department officials told City Council members at a hearing on mental health services in schools today. During the 2010-2011 school year, principals and assistant principals sent students to the E.R. 947 times, a 12 percent spike from the previous school year.

“We have work to do because that number is not going in the right direction,” said Deputy Chancellor Kathleen Grimm said in her testimony.

Mental health professionals who work with students told the council that the increase signals a deterioration of the system’s ability to deal with students who require mental health care services. Budget cuts and a disorganized patchwork of multi-level mental healthcare providers have made it increasingly difficult to appropriately serve the thousands of students who received mental health diagnoses each year.

The practice of referring students to the hospital is the most extreme kind of intervention for mentally and emotionally disturbed students in New York City public schools. Special education and mental health advocates say it is not only expensive and traumatizing, but, in many of the cases, they are also often unnecessary.

A survey of doctors and psychologists found that as few as 3 percent of students who were sent to the Emergency Room were actually admitted to the hospital. In most cases, including Turner’s, the students are discharged within hours and sent home.

Turner said her daughter, the oldest girl in her seventh grade, was bullied and had grown frustrated by her academic status. But she was not suicidal, Turner said, and a psychologist at the hospital quickly agreed.

“She was safe to be back in school the next day,” said Turner, the only parent to testify at the hearing. Several parents in the past month who has spoken publicly about cases when their children were similarly sent to the E.R. as punishment for disruptive behavior. One parent said her her 10-year-old son was repeatedly taken to the E.R. for angry outbursts, and two families are suing a charter school after it placed kindergarten-age students on “psychiatric suspension.”

“We have seen that schools are too frequently referring students to EMS where school discipline is the issue, not medical or mental health treatment,” said Keren Farkas, an attorney at New York Lawyers for the Public Interest, which works with people with disabilities.

Nelson Mar, an attorney for Legal Services NYC – Bronx, said that there were plenty of solutions to the shortfall of mental health services. He called for the DOE to immediately create policy designed to minimize the use of EMS as an intervention practice. But he said more data was necessary. The DOE has so far declined to release disaggregated demographic information about students sent to a hospital emergency room and the reasoning behind it.

“Only with data can policy makers be able to quantify the depth of the practice and craft appropriate public policy to address it,” Mar said in testimony.

  • http://www.facebook.com/people/Tommy-Calderon/100000263260717 Tommy Calderon

    “Turner said her daughter, the oldest girl in her seventh grade, was bullied and had grown frustrated by her academic status.”  So the oldest girl in the grade was being “bullied” by the younger students and was “frustrated” by her academic “status”.  IOW, she has been held back repeatedly, doesn’t want to work and got pissed off at being required to behave.
    Now come on people!!!  It’s obviously the teachers’ fault.  The Decider Emperor has decreed that Special Education is unnecessary and all students will be mainstreamed to cut costs.  Teachers will tolerate all and any behavior and will immediately add being mental health counselors to their list of duties.  Oh, and by the way, we will need to close 6 more schools, open 20 more charter schools and lay off 1,000 teachers so we can pay the ER bills.  No biggie.

  • Michael M. (parent still)

    No mention of what kind on counseling is available in-school, and whether that level has changed over time?

  • guest

     I think that’s a very important question to ask. In addition, what kinds of rules and regulations are passed down to school staff to lessen the chance of lawsuits from parents? For example, if a student is threatening self-harm or to hurt someone else–and cannot reach parents–a school has to protect itself, and it’s only option might be to call EMS for a psychiatric evaluation because it at least then has the proof that it dealt with the situation seriously and in a responsible manner.

  • Tim

    And then there’s the fact that administrators are under an enormous amount of pressure — a lot of it applied by organizations like the one that Keren Farkas works for — to not use suspension as a disciplinary tool. I’m assuming Ms. Farkas and the various special-ed and mental health advocates didn’t mention this in their testimonies. 

    I’m also assuming that there wasn’t any testimony from parents on how they felt on having their child’s education compromised in the name of “mainstreaming” kids who are impossible to control. 

    And in the face of all the complaining about budget cuts, I’m assuming that no one from the DOE or any of the advocates cited the total sum of money that’s directed at special ed programs every year, or a per-student figure. 

    The EMS calls are a desperate cry for help from administrators who have slowly had all of their tools taken away.

  • Mikeremhead

    You are damned if you do and damned if you don’t.  When a student expresses sucidial ideations, there are few people who have the expertise to determine if they are active or not.  There is, of course, a difference in degrees (I feel depressed as opposed to I have a plan to kill myself) but only a Psychiatrist can make the a medical determination as to whether the suicidal ideations present a danger.  To ask school personal to do this is foolish.

  • Sgjhynt

    It is my understanding that there is a regulation that if a student express credible suicidal ideation that the child must be taken to the hospital. If the parent can’t be reached, the school must call EMS. Is this the case? 

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