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As concerns rise about mental health and younger residents, New Jersey lawmakers are stepping up measures to help school districts expand access to treatment and add additional safety measures for students. A package of bills in the state Legislature geared toward meeting the growing demand for mental health services in grades K-12 and bolstering Medicaid reimbursement for services statewide is moving forward.

The bills follow measures discussed in the 2021 legislative session by Assemblyman Louis Greenwald (D-Camden) to address the student mental health crisis. One of them, which created a grant program in the Department of Education to connect school districts with colleges and universities as a way to train school psychologists and remedy the lack of mental health professionals in schools, was signed into law by Gov. Phil Murphy last year.

But the need for mental health services continues to rise, as students and faculty wrestle with growing nationwide gun violence and an ongoing pandemic.

“…This last year and a half has been so challenging,” said Adrienne Hill, the principal of Hedgepeth-Williams School of the Arts, a public school in Trenton. “And not only for students, but for the adults around them. And so when the adults around them are stressed, and in trauma, that in turn makes the students in trauma.”

High school students are also feeling the mental burden of the pandemic. An April 2022 report from the Centers for Disease Control and Prevention  said more than a third (37.1%) of high school students experienced negative mental health symptoms during the pandemic; 44.2% had ongoing feelings of sadness and hopelessness; nearly 20% contemplated suicide; and 9% attempted suicide in the year before the survey was taken.

Counseling children where they are

Lawmakers introduced legislation in mid-June that would require school districts that already have a psychologist on staff to now offer virtual counseling to students in grades kindergarten through 12th grade who are not able to attend in-person sessions. The bill, which is still in the Assembly, would take effect immediately in the following school year.

“The purpose of this bill is to allow services to be rendered outside of the classroom,” said Assemblywoman Angela V. McKnight (D-Hudson), the primary sponsor. “We have children who continue … to go through a lot in the home as well as, you know, in school, and when the schools are letting them go, they have to remain home, services should not cease.”

Although the bill introduces a telehealth option for students seeking therapy, there’s a shortage of therapists who can help students in need.

Hill, the Trenton principal, said lawmakers could put at least one mental health professional in every school. “I mean our counselors were inundated with students who just needed to talk. Having anxiety. Wanted to self-harm. Wanted to give up. Didn’t know what to do,” she said.

Building a team to assess potential harm

A second bill in front of lawmakers seeks to create a threat assessment team in each public school district that would also serve New Jersey’s private and charter schools. The legislation calls for a team comprising school psychologists, social workers, counselors, principals, safety specialists and police liaisons. Their job would be to try to identify students who are considered to be a threat to themselves or others.

The bill, which was reported out of the Assembly Appropriations Committee with amendments, would take effect in the following school year. A statement from lawmakers on amendments to the bill called for the assessment team to be trained in childhood trauma, adverse childhood experiences and cultural competency. It also required the team to consult the individual education plans (IEPs) created for special education students to ensure the response doesn’t infringe on their rights.

Assemblyman William F. Moen, Jr. (D-Camden and Gloucester) said one of the goals of the threat assessment teams is to avert dangerous incidents like school shootings. “But frankly … this kind of program that’s in place … really could address some of the smaller issues before they build into something like that.”

But some people expressed worries about the bill.

“Our concern is that every time there’s a mass casualty, we do bills like this and we don’t look at the framework of what’s happening,” said Peg Kinsell, program director for the Statewide Parent Advocacy Network (SPAN), during a Senate hearing on the threat assessment bill. “… I appreciate assessments and I think it’s important that we understand what’s happening on the ground, but we have to have a framework and we have to have some leadership from the department around kids that are sent home, kids that … aren’t even getting home instruction …It’s just really tumbling out of control.”

Dr. Lee McDonald, an assistant superintendent at the West Windsor-Plainsboro Regional School District, said mental health services could be improved throughout the state. He agreed with Hill that the lack of mental health professionals is a problem.

“School counselors are still not required in the state of New Jersey,” he said. “So that to me is an issue. It’s low-hanging fruit. When the budget gets tight, unfortunately, and I’m going back to 2010 when a lot of districts had to make some really big cuts, a lot of school counselor jobs went away. And I don’t think that that field has recovered from that.”

McDonald said these bills are always well-intended and seem to make sense, but don’t include the input of those who must implement the proposals. “So that to me would be a welcomed conversation about, ‘OK, so we want to do this, what does this look like on the ground level?’” he said.

Medicaid rates for mental health services

A third bill in front of the Senate would increase Medicaid reimbursement rates for mental health services beginning July 1, bringing them equal to Medicare rates for the same services, which are significantly higher. This increase would include mental health professionals who are licensed clinical social workers, psychiatrists and psychologists, as well as primary-care providers.

The bill would also require the commissioner of Human Services to review the state’s Medicaid rates in general and recommend changes to enhance access for providers and boost the quality of care for underserved residents. A report on those recommendations would be due to the governor by July 1, 2024.

Higher payments could help expand the pool of mental health providers, lawmakers believe. “It’s always been necessary to increase rates to attract providers,” said Sen. Joseph F. Vitale (D-Middlesex), a co-sponsor of the bill. “The Medicaid rates have been traditionally underwhelming and really don’t provide for an incentive for primary-care providers, or therapists or others to participate or have a practice that is solely Medicaid. It really becomes unaffordable for them to remain in practice. So this encourages more participation by providers because it’s necessary to provide more access for patients,” he said.