In an ambitious effort to transform behavioral health crisis response across the United States, the Behavioral Health Emergency Response Initiative (BHERi) convened national- and state-level funders and key stakeholders for the BHERi Impact Lab in April 2024.
Hosted by the NYU Marron Institute of Urban Management and the Flinn Foundation, this two-day event was held at the Detroit Athletic Club. The primary objective of the Impact Lab was to maximize innovation and develop strategies in Michigan and other states to improve the lives of those experiencing behavioral health crises. The long-term vision is to create actionable plans to scale Behavioral Health Emergency Response (BHER) systems across the nation that address mental health crises effectively, minimize the likelihood of harm, arrest or unnecessary emergency department visits.
Stakeholders considered broad levers such as financing and workforce development to facilitate statewide scaling. The aim, overall, is to reduce the reliance on emergency departments, prisons and jails for treating acute behavioral health issues.
The BHER initiative members are working collectively to create a future where behavioral health crises are managed with care, efficiency, and compassion. As a partner in this initiative, the Flinn Foundation looks forward to additional progress in the months to come.
On June 24-25, 2024, the Ethel and James Flinn Foundation’s Andrea Cole attended a special convening of global foundations as part of the Global Leadership Exchange on Mental Health.
The invitation-only event was held in Brussels, Belgium, and gathered key foundations from around the world to discuss shared challenges and opportunities around climate anxiety, democratic anxiety and the impact of social media on mental health.
One key element to the conversation was the harmful impact of social media and technology on young people and families.
“The loss of connection and social interaction that we all need as humans is something all mental health foundations and health organizations are worried about,” says Cole. “We discussed how to best lift up this information so parents and families know the damage that social media and device use is causing.”
As more research shows the effects of continuous device and social media use by young people, Cole predicts mental health organizations will share increased messaging about the relative harms.
“I look forward to connecting further with mental health foundations on a global scale. There is so much we can learn from each other and achieve when we collaborate as we did in Brussels,” Cole says.
Depression had became my best friend
She entered my life in a time when no one was around me and offered me her lies and comfort until she got me then she turned around and hurt me
She loves to spend time with me
She likes it when it’s just us so she can get to me personally on a different level
And she loves to talk a lot
Her words racing through my mind
She is a stubborn one because anytime someone opposes what she tells me, she assures me they are lying to me and are selfish,
You see she wants me all to herself and forces me to push away anyone else but it’s okay right?
Because we’re besties and she knows what’s best for me
And she closes me off from people so they can’t hurt me because when I let people in they hurt me
She’s protective over me
She convinces me to sleep all day because when I’m sleep I can’t feel and when I can’t feel you can’t hurt me
She tells me no one really cares about me
She tells me she’s all I have
Her fake comfort and lies draw me back in
Then she turns around and hurts me again
by R. Love
For young people and suicide risk, the numbers tell the story. According to the CDC, suicide is the second leading cause of death for children ages 10-14.
“I think people know that. But the bigger factor is that it’s increasing,” says Brian Galdes, Suicide Prevention Coordinator with Western Wayne Suicide Prevention Coalition. “(Suicide) used to be the third leading cause of death and now it’s the second leading cause of death. The numbers are going up, not down.”
It’s Galdes’ job to pay attention to these numbers — and work with local school districts to help move the statistics in the other direction. But Galdes also has a deeply personal reason for his passion for preventing youth suicide. His stepdaughter, Bethany, died by suicide at 17. “She was an honor student, beautiful, very artistic and had an engaging personality. She also battled with depression. Because of the depression, she did not see herself in that way,” he says.
About 10 years ago, in response to a community needs assessment, Trinity Health established the Western Wayne Suicide Prevention Coalition (WWSPC). Then, four years ago, Galdes reached out to Nick Griswold, CEO at Growth Works, a behavioral health agency based in Wayne County, to ask how they could work together to further the initiative on student mental health and suicide prevention. Growth Works committed to provide funding for a full-time coordinator role at WWSPC — an action that helped the organization gain focus and traction. Galdes is the second individual to fill the coordinator role (the first, also a former educator, retired and moved up north) and WWSPC is funded in part by a grant from the Flinn Foundation.
WWSPC members include: Northville Public Schools, Plymouth-Canton Community Schools, Livonia Public Schools, Wayne-Westland Community Schools, South Redford School District, Redford Union Schools, Garden City Public Schools, Clarenceville School District, Taylor School District, Corewell Health and Trinity Health.
In all, WWSPC represents about 65,000 students. Galdes recognizes this number for what it means in relation to other CDC statistics related to youth mental health and suicide:
“If you look at a school district like Northville, the high school has about 2,600 students. If you extrapolate that 9%, the number would be 230 Northville High School students have attempted a suicide in the last 12 months,” he says. “I’m not saying that there’s a documented 230, but if you just extrapolate those numbers,” you get an idea of the impact.
“This crosses socioeconomic standards, this crosses race, this crosses religion. This really is everybody’s problem,” he adds.
Initially, WWSPC brought together social workers and counselors from the nine districts for an open conversation and to explore effective ways to support them and the students they serve. A steering committee was formed with two individuals from each district: one boots-on-the-ground person who works with students and one district-level decision making administrator with direct access to the superintendent.
“We’ve trained about 5,500 adults, bus drivers, teachers, administrators, crossing guards, in QPR (Question, Persuade, Refer),” Galdes says, adding that it’s a goal to also train every high school student in QPR. Every district and both hospital systems have agreed to use a common screener.
“And so now people are talking the same when they’re talking to kids and families in crisis,” he says. “We also provide a lot of professional development for mental health professionals that work in schools.” Each fall, WWSPC hosts a conference, with 350 attendees last year and an anticipated 450 this year.
Silos are beginning to evaporate because districts now have a network of like-minded people to brainstorm with and provide mutual support. This is especially helpful when suicides do occur because support staff can come in from a neighboring districts to provide help that is one step removed. And, local legislators have visited the schools, talked with staff and toured the emergency room at Trinity Health Livonia to learn more about adolescent mental health.
The coalition has also developed subcommittees to research solutions for common issues and concerns and best practices. Other initiatives developed by the coalition since 2021 include establishing a data collection system to measure program effectiveness and to help maintain funding to support ongoing work.
In 2024-2025 and beyond, WWSPC will focus on:
In 2023, Trinity Health Livonia received the Ludwig Award from the Michigan Hospital Association for its partnership with and support of WWSPC, an honor that included $5,000 “to assist in health improvement efforts.”
Every initiative the WWSPC launches is designed to continue putting resources into the schools to help students and families, Galdes says. “We really have to attack stigma. It’s a huge impediment to us making a big difference to moving that needle down as opposed to that needle still going up,” he says, quoting a University of Michigan survey that estimates 40,000 adolescents in Michigan identified as having a mental health condition, but aren’t getting treatment due to stigma, access to care or affordability.
“I keep telling my steering committee this is a marathon. It’s not a sprint,” says Galdes. “It’s going to take time but we have to do something. We have to make a difference. Ten percent of our high school students have attempted suicide — it’s just not acceptable.”
This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline is available by calling or texting 988. Learn more about Western Wayne Suicide Prevention Coalition through Growth Works. Visit gwcares.org.
Detroit Public Schools Community District (DPSCD) is laser-focused on the mental health of its students. Since 2020, through a partnership with TRAILS, school-based staff at DPSCD have provided evidence-based Cognitive Behavioral Therapy and Mindfulness sessions to help students manage common mental health concerns, such as depression and anxiety, feelings of hopelessness, worried thoughts and avoidant behaviors.
TRAILS is an acronym for “Transforming Research into Action to Improve the Lives of Students,” and was established initially through funding from the Ethel and James Flinn Foundation, along with other organizations and philanthropic foundations.
A 2018 comprehensive needs assessment netted responses from 3,000 DPSCD staff and more than 12,000 students, according to Alycia Meriweather, Deputy Superintendent at DPSCD. TRAILS CBT (Cognitive Behavioral Therapy) and Mindfulness is designed to be delivered by school behavioral health professionals, including school counselors, social workers and psychologists.
Since launching, TRAILS has grown. At the very start of the COVID-19 pandemic, TRAILS responded by developing a group manual to be delivered virtually by school staff. TRAILS and DPSCD also collaborated with Children’s Hospital of Michigan and New Oakland Family Services to establish a suicide risk assessment and protocol tool and a confidential two-way communication loop.
“This protocol serves as a communication tool for external providers, school staff and families to better understand students’ needs, while keeping schools up to date about the students they refer for support,” Meriweather explains.
In the 2023-2024 school year, nearly 1,000 students at DPSCD participated in the CBT and Mindfulness program, either in groups or individually, Meriweather reports.
Currently, DPSCD and TRAILS are evaluating the overall effectiveness of the CBT and Mindfulness program through a randomized controlled trial that assesses student mental health and academic achievement outcomes.
When they participate in the CBT and Mindfulness programs, students develop valuable skills they can use across the lifespan. To date, 94 school-based staff have been trained in the program.
In addition to TRAILS, DPSCD supports student well-being with counselors and/or social workers at every school. DPSCD also partners with community based organizations to provide behavioral health services to various groups of students: whole school, small groups and individuals.
The start of the school year is significant for student well-being, says Dr. Angelita Jacobs, Executive Director, Whole Child Support at DPSCD.
“Transitioning from a less structured environment back to a more structured school setting in the fall can positively impact the behavioral/mental health of students by providing a sense of security through established routines, decreased anxiety with planned activities, increased positive engagement with others, personalized attention from teachers and school staff, and access to additional supports and resources,” she says, adding that all of these elements can enhance overall well-being for students.
Through proactive strategies and interventions, teachers, staff and administrators at DPSCD attend to the social, emotional, psychological, physical and academic development of students, Jacobs says.
These strategies foster “prosocial behaviors which contribute to a climate and culture where students feel valued, respected and connected to their peers and school,” she says.
“Access to supportive behavioral/mental health services through community partners allows students to receive additional assistance in a convenient, familiar environment. By intentionally addressing mental health — which is a foundational part of overall behavioral health — students are being further equipped to thrive personally and academically.”
Learn more about Detroit Public Schools Community District at detroitk12.org/families.
When it was safe to return to school after the worst of the COVID-19 pandemic, Marina Hanna Kaminski was thrilled to see her students fill the classrooms at Detroit Innovation Academy, a small K-8 charter school in Detroit’s Cody Rouge neighborhood.
Somehow, though, things weren’t exactly the same as before, says Kaminski, who has served as Detroit Innovation Academy’s principal for the past six years.
“I started noticing a real shift in our students’ behavior and mindset. They were struggling with their self-esteem. They were having trouble connecting with their peers and even just communicating with their peers,” Kaminski says.
Lack of social experiences and isolation led to behavior problems among students — and Kaminski wanted to support the mental health of her students as they returned to on-site learning. She worked to create a mentoring program with a difference. Many schools have mentors to support student academics, but few are focused solely on mental health.
“It hit me at that time that we needed a solid mentoring program to help them work through these challenges. The pandemic had taken a toll and we needed a way to support our students in rebuilding their confidence and finding their voice and forming those meaningful relationships with each other,” Kaminski explains.
Kaminski sought the support of two established Detroit-based mentoring programs — Building Better Men and PrettyBrownGirl — and sought staff recommendations for students who could benefit from participating in evidence-based programming.
“Initially, we were just offering it to middle school students because those were the students I noticed were having the most difficulty after COVID with transitioning back,” Kaminski explains. “And this past school year, we expanded it to third- through eighth-grade students as well.”
DIA offered separate weekly groups for elementary and middle school students, with about 20 students in each group, experimenting with after school meetings and school-day programming, similar to a “specials” class, like art or gym.
“For Building Better Men, they really try to equip the males with showing them they can be successful despite their challenges and their experiences in life. Their philosophy is to address those complex needs of African American males and provide that intervention through advice and practice and developing social skills and offering a positive role model and alternative choices,” Kaminski says. Through literacy-based programs, young men learn appropriate social behaviors and self-esteem.
“They typically start with playing basketball, and that leads to more of a conversation where they build trust with the individual they are speaking to,” she adds. “They start with activities that break down the walls and allow them to open up.”
In PrettyBrownGirl sessions, young ladies at Detroit Innovation Academy are empowered to be confident and proud through leadership and camaraderie-supporting opportunities, she says. “They learn a lot of self-love talk and character-building and leadership skills.” PrettyBrownGirl supports students with culturally responsive social-emotional learning practices.
Participating students offer positive feedback, according to Kaminski. And, they’re developing valuable relationships with their mentors.
“I’ve noticed a lot of benefits in their mental health because it gives them someone to talk to — someone who may have experienced similar things growing up,” Kaminski says. “They develop bonds with their mentors where it’s almost like having a safety net. The mentors show them how to handle different challenging situations or tough situations they can be in, and, while doing that, build their confidence and be a positive influence overall.”
This level of support is important for students who don’t have encouragement at home, or who don’t connect with their parents. And, having dedicated organizations and experienced mentors allows students a safe place to build trusting relationships.
“Sometimes students don’t want to necessarily talk to their teachers or open up to their teachers because they may feel they’re being judged,” Kaminski says. “I wanted to give them an alternative person if they didn’t feel comfortable sharing with anyone at the school, they can at least have another mentor, another person in their life they could go to.”
Detroit Innovation Academy’s two mentorship programs are so much more than pairing students with mentors, Kaminski says. “It’s about creating a community that supports the whole child. And it’s about helping them grow into capable, confident and compassionate individuals.”
This is critical in today’s social media-saturated society.
“That, on its own, can take a huge toll on someone’s mental health,” she says. “It’s really important to prioritize giving students another outlet to share their feelings and share their emotions with someone.”
The relative freedom of summer is not always joyful for every student. Recognizing this, Kaminski says teachers at Detroit Innovation Academy focus intensely on the back-to-school time period. She leads professional development to help teachers transition their students from summer to fall in a supportive classroom setting.
“You have to consider that every summer was not necessarily a positive one for our students. Some of them didn’t go anywhere, some of them were home and might not have been safe. We are a beacon of hope for some scholars. Coming here is their safety net,” Kaminski says.
The first two weeks of the school year are dedicated to trauma-informed instruction through “Character Camp,” a time focused on building relationships between teachers and students. What home situations do students have? What are their fears?
Character Camp is a two-week investment that pays dividends throughout the school year, she says.
“It’s a lot of different ice-breaker activities where they’re just getting to know their students. Before our students can trust you and learn from you, they have to understand where you’re coming from,” Kaminski says. “They have to know that you care about them.”
Learn more about Detroit Innovation Academy at diachampion.org.
For conversations about mental health, there’s a generational divide. Parents are often reluctant to talk about mental health with their kids — but kids are a lot more comfortable with the topic, says Kevin Fischer, Executive Director of National Alliance on Mental Illness (NAMI) Michigan.
In his role at NAMI, Fischer conducts programs alongside young people in recovery who tell their story from lived experience with substance use disorder or suicide attempts. And the most powerful part of the presentation, says Fischer, is the Q&A.
“Kids ask what it’s like to be in therapy, what it’s like to take medications. Kids want to have these conversations,” he says.
Through professional development with teachers, bus drivers, custodians, lunch aides and all the other adults who interact with students every day, Fischer recognizes the powerful — and often untapped — connection between student-athletes and athletic trainers.
“I met a gentleman who provides physical therapists and trainers to schools. He explained they have a unique issue where athletes are getting hurt and receiving therapy from trainers, and disclosing mental health issues and other issues at home,” Fischer says, adding that this contact was seeking training for the physical therapists and trainers to recognize and address these disclosures.
Recent media reports of professional athletes speaking out against the many pressures related to athletic performance have increased awareness of the mental health challenges often felt by athletes. Fischer says he has spoken with parents of college athletes who have been told to “suck it up” when they share mental health concerns with their coaches.
Even student-athletes at the high school level can feel tremendous pressure to perform, and may not want to share with coaches or parents how they’re feeling. But athletic trainers can be viewed as removed enough from the student-coach relationship to offer a safe space to share mental health concerns.
To be prepared for these situations, NAMI does recommend that physical therapists and trainers receive some kind of evidence-based training related to mental health, including “Question-Persuade-Refer” (QPR) and Mental Health First Aid.
Through working with former Detroit Lions quarterback Eric Hipple, Fischer says he’s learned just how closely athletics and mental health can be intertwined.
“Eric told me that when we retire, we have an opportunity to plan, but athletes don’t have that,” Fischer says. For athletes, one bad game can mean the end of a career, and this can take a toll on an athlete’s mental health. “There are mental rigors related to being on top, being a starting quarterback, eating free meals everyday — and then you are nobody.” Following a suicide attempt of his own and losing his 15-year-old son to suicide, Hipple became an advocate for behavioral health awareness.
Although high school student-athletes are not at the pro level, they can be under immense pressure to perform by themselves or by coaches and parents. In a 2017 survey in the Orthopaedic Journal of Sports Medicine, just over 57% of parents of student-athletes said they hoped their child would play in college or professionally.
For parents of student-athletes and kids returning to school this fall, NAMI offers ongoing education and support groups in communities across Michigan through 15 affiliate organizations. “We touch 86% of our state’s population,” Fischer says. “Parents can contact NAMI to get recommendations on how to prepare for back to school. They can learn about what to do if their child is bullied or they notice changes in behavior. We are leading connectors for individual and family behavioral health resources.”
Through NAMI’s Family-to-Family, a free educational program for family and friends of people with mental health conditions, parents can learn from others with lived experience. This is just one program NAMI offers. Learn more at namimi.org.
The Community Health and Social Services Center (CHASS) in Southwest Detroit promotes and provides comprehensive and affordable health care — including behavioral health — with an emphasis on the underserved Black and Latino population.
Unlike in a traditional primary care experience where clients would be referred out for therapy for mental and behavioral health, CHASS provides services in one location, breaking down the barrier to receiving support.
“We work off an integrated health care model, offering a one-stop-shop that reduces barriers to care, which includes transportation, stigma, costs and a variety of other things,” says Daniela Lopez, behavioral health specialist with CHASS.
With a team of five full-time clinicians, CHASS serves 80-100 behavioral health clients each week. Every client attending an initial primary care visit is given mental health-focused assessments for depression and anxiety. This normalizes mental health as an important part of overall health. A provider who sees symptoms can then have a conversation with the client and decide next steps.
“This gives the client the opportunity to talk with the primary care provider, who they might have more trust with,” says Lopez. “A doctor is more accepted by a lot of people than a mental health specialist.”
The primary care physician will also ask about suicidal ideation and if the client needs emergency services. If so, a connection is made immediately.
Because language and culture can be barriers, staff members at CHASS are bilingual and sensitive to the wide range of cultures in the population they serve. “Culture can be a barrier in the sense that we’re talking about emotions or feelings and that might be stigmatized, especially if they have traditional or conservative values of machismo and marianismo,” says Lopez.
Southwest Detroit spans so many cultural backgrounds, including diverse countries, ethnicities, languages, dialects, religions and more. “We meet our clients where they are in terms of their own intersectionality,” says Lopez. “We learn about their backgrounds and if we aren’t able to serve them, we connect them to the appropriate resources.” CHASS staff includes social workers and caseworkers to provide specialized support.
Cost, too, is a concern for many. “People wonder if they can afford this or can they attend a session. We offer telehealth services to give more access, which also helps with child care concerns,” she adds.
Additional funding specifically to add a psychiatrist to the in-house team would be helpful, says Lopez.
“Right now we have a psychiatrist in our telehealth services, but a doctor on staff could help us better connect with primary care physicians because they have similar training and background,” she says. “It would be really helpful for our clients to have different options for psychiatric care.”
Holistically, Lopez says there’s a long wishlist she has for her clients, including grants to support immigration services, language skills and job training, education and housing support.
And, Lopez shares her gratitude that CHASS exists. “I am grateful I get to work with peers who are culturally humble, and also with the clients I meet. They are amazing and every day I see their resilience and ability to survive and thrive,” she says.
Learn more about the Community Health and Social Services Center at chasscenter.org.