Abstract
This paper discusses the Affordable Care Act (ACA) and legislature related to the mental health programs in the youth education system. It will delve into the importance of some of the major programs funded by the ACA. The positive impact it has with these programs and the future outcomes of youth will be described. There will also be a brief discussion of the Michigan school budget in regards to mental health and support services. The school staff supporting the students play vital roles in the community and will also be addressed as well as some personal experience to applicable situations.
Introduction
There have been countless studies on the impact of mental health on a student’s academic achievement (Child Trends, 2013). The stigma of mental health has been improving over the years with improved education and techniques to cover a variety of issues preventing youth from achieving success. Although, there is still a need for more education and additional resources. Repealing the Affordable Care Act (ACA) could have a major negative impact on these services. Education budgets have experienced excessive financial stress over the last couple of decades. Michigan offers incredible incentives for students to succeed in school, such as the Kalamazoo Promise, as well as many other resources (i.e., dental and health provider services) that many children may not otherwise receive through their guardians or care takers. Many of these programs are funded through Medicaid reimbursements. This paper will cover many of the issues related to the potential ACA repeal as well as some of the direly needed programs that may not exist in these schools much longer.
Discussion
The ACA defined minimum standards of health care coverage leading to significant changes in the health insurance industry. It also provided for incentives from the federal government for expansion of Medicaid coverage at the state level. School districts are given financial assistance through Medicaid reimbursement which is used to provide support services for students with special needs. The following sections will discuss the history of the ACA and some of the reasoning for the need of continued financial support in schools.
History of the ACA
The Patient Protection and Affordable Care Act (ACA) came into existence to reduce the number of people without health insurance. It was originated by the 111th U.S. Congress and was signed into law by Barack Obama on March 23, 2010 (eHealth Insurance Resource Center, 2018). This gave coverage to the people within the lower 40% of income distribution by adding a new tax which generally applied to those in the top 1% of income in the U.S. The ACA also included an individual mandate which required most Americans to get health care coverage or pay a tax. In 2017 the Tax Cuts and Jobs Act eliminated the “individual mandate” (HealthSherpa Blog, 2018).
There are many issues with health care in the U.S., with the focus mainly being on the failure of efficient and affordable coverage to the population as a whole. This law has been extensively reviewed to find ways to improve it and also to find ways to improve the healthcare system as a whole. There are also significant debates about whether to convert the U.S. health care system to a universal health care format or find ways to lower the cost of coverage from private health care companies.
Some of the most important legislative history of the ACA was the announcement to repeal and replace the ACA with the American Health Care Act in 2017. Since then the government has attempted to work with different insurance companies to provide plans with lower prices and less coverage to help more people to afford health insurance. During 2014, around 32% of the American population were at or below the poverty line (Ballotpedia, 2018). Close to a third of the population have a difficult time affording health care as a result. In 2014, 89.6 percent of the U.S. population had some type of insurance, with 66 percent of workers covered by a private health insurance plan. According to the U.S. Census Bureau, in 2017, there were 39.7 million people in poverty (Message, et. al, 2016).
Education Budgeting
Michigan governor, Rick Snyder approved the 2019 state budget that included early intervention, funding per-pupil for K-12 schools ($7,871-8,409), and tuition incentive programs for students with low incomes (MLPP, 2018). Unfortunately, it did not pass at-risk programs for high-poverty schools or school aid dollars. From personal experience being in schools with a high population of at-risk students, the feedback I receive is baffling. I hear stories from school staff making statements, “He will be in jail by the time he leaves school. There’s nothing I can do for them.” Not enough staff are being trained correctly on how to handle these situations and, as a result, are also being overwhelmed by the high student to staff ratio making these jobs immensely more stressful and increasing susceptibility to burn-out and fatigue. This displays the need for special education facilitators and special programs aimed to help staff and students be successful.
School Mental Health and Support Services
For the 2018-19 school year, Michigan received $30.0 million from the School Aid Fund to be transferred to the School Mental Health and Support Services Fund. The spending from this fund is to be decided in upcoming supplemental appropriation (Senate Fiscal Agency, 2018).
Suicide Prevention and Mental Health Education. The policy being highlighted is an excerpt from The Revised School Code (Act 451 of 1976). This code will bring suicide prevention and awareness to all Michigan schools, making it mandatory to have some type of suicide prevention education. These education programs will include K-12 ranges and give age-appropriate instruction. With the ACA experiencing constant push for change, mental health coverage may be altered, making it more difficult for children to receive it. This causes great concern when the rate of suicide is still the second leading cause of death in young people.
This policy, also deemed the ‘Chase Edwards Law,’ will be implemented in schools for students and school staff to be trained in seeing the warning signs and risk factors for suicide and depression (Legislative Council, 2017). These programs will also give students a chance to ask questions and be guided towards the proper mental health resources if needed. Studies show when a difficult topic, such as suicide, is discussed in a safe way, people are more likely to feel comfortable asking questions and seeking help for themselves or someone else. The short-term goals are to provide education in suicide prevention and getting help when someone is experiencing a crisis. The long-term goal is to reduce the rate of suicide in young people in Michigan.
This specific program will be included in state funding for public schools under the Michigan model for comprehensive school health education. There are currently many ongoing debates regarding control of the quality of the programs being taught in each school. Programs need to be taught in a safe and effective way, making sure to discuss each aspect of mental health and suicide prevention. Leaders of many programs are attempting to say theirs meet these requirements, but end up only focusing on bullying and violence. They end up having maybe one sentence about suicide prevention in the entire program and describe their program as suicide prevention oriented. Programs like this do not have enough information on suicide prevention and should not be recognized as meeting the requirements. Debates continue on how to control the quality of the programs. Some ideas that have been discussed are making sure the program is included in the Best Practice Registry. This means the program is using the most up-to-date teaching techniques available and doing so in a safe way. The Suicide Prevention Resource Center has a list of programs that meet those requirements.
The original policy began in 2006 making these programs recommended, but the new changes to make these programs mandatory has been constantly debated locally since 2017. There is a massive amount of scientific research delving into suicide prevention and mental health in young people. The American Association of Suicidology publishes some of the most up to date and accurate statistics as well as safe messaging techniques when discussing suicide.
The goals of this policy are legal but also extremely necessary as the rates of suicide are constantly increasing. The debate about each suicide prevention program and keeping it up-to-date and relevant help in making sure it is inclusive to all people. The policy does make sure that everyone is aware of all the resources available to anyone experiencing a crisis. The goal is an overall increase in quality of life though mental healthcare and suicide prevention. There is no quality of life downside to this policy as long as the programs are taught in a safe way. For example, keeping the groups small (no assembly style programs), using proper terminology, and keeping the information up-to-date and relevant to the current population. The policy contributes to positive social relations between all people because of the focus of mental health and seeking help for anyone experiencing a crisis. The people going through these programs could potentially help other people that have not experienced the program, leading to a multiplier effect. The goals of this policy align closely with professional social work in the aspect of mental healthcare and suicide prevention.
Special Needs Facilitators. Another need in schools are special needs aids. Schools all over Michigan struggle with finding ways to make sure all students get the emotional support they need. It was such an issue in one school, the school counselor even said, ‘We had so many students struggling with suicidal ideations and severe depression, and we just didn’t know how best to help them” (Hillman, 2018). This counselor is not alone; it is estimated 1 in 5 students struggle with depression or some type of mental health issue. There are many theories on the causes but the real struggle is having enough staff, let alone, trained professionals there to ensure all students are getting the assistance they need. Educating the staff and students can help with this, but many counselors are given multiple jobs at schools. These extra jobs take time away from helping students in a timely matter. As anyone who has experienced a crisis knows, time is of the essence and can mean the difference between life and death.
Special services in schools covered by Medicaid also include speech therapy, occupational therapy, and devices like wheelchairs (Klein, 2017). The AASA, the School Superintendents’ Association, receives around $4 billion a year through Medicaid. They “surveyed 1,000 educators in 42 states and found that two-thirds of districts use their Medicaid funds to cover salaries of professionals who work with students in special education. And about 40 percent use the money to hook kids up with other health services” (Klein, 2017). With the aid of the ACA implementation, many of the children were signed up for Medicaid, dropping the uninsured rate from 7.1 to 4.8 percent.
School-Community Health Partnerships. The ACA also covers partnerships with community providers, such as specialized education (mental health services), Prevention and Public Health Fund (PPHF), and dental programs. For many young students, these are their health care providers as some families are unable to take time off work for their children to get their normal health exams.
Changes for the Future
There are many ways to improve the current mental health system in schools. Some consistent feedback received from larger public schools has been the counselors feel overwhelmed. They are often forced to take on other roles in schools including, front desk or administrative tasks, standardized testing, teaching non-mental health subjects, and filling in wherever they are needed. It seems like they are being used more as a substitute or part-time staff than using their credentials for what they went to school for and what their job description entails. This leads them to become susceptible to “vicarious trauma, empathic stress, secondary traumatic stress, burnout, and compassion fatigue” (Killian et al., 2017). The budget cuts do make this a difficult ideal, but self-care for service providers is immensely important. There needs to be more focus on making sure the mental health support staff are not overworked and taking care of themselves, first and foremost. If they are successful, they will be better able to help their students thus increasing student outcomes for academic and mental success.
Unfortunately many people do not properly prepare for both outcomes when something significant occurs. Continuing with staff and student education is vital in case of possible loss of coverage in mental health services. Luckily, there are many free mental health training services available that staff could attend. Spreading awareness and safely educating can help normalize mental health problems and help the students recognize there is always help available. It is common knowledge that if you break a bone, you go to a hospital to receive professional help. It should be the same for a mental illness; to seek help from a mental health professional. The ACA repeal could mean loss of coverage in more than just mental health services. Although, as discussed in many aspects, mental health services are just the beginning of what is needed for these schools to foster successful academic achievement. For years, the U.S. has been significantly behind many other developed countries in academic achievement (OECD, 2015). Not having access to proper mental health care could cause an even greater deficit. In short, a healthy, happy child is a productive individual.
Conclusion
The benefits of school mental health and support services are many; improved student attendance, graduation rates, and academic performance as just some examples (SCHA-Mi, 2018). It also helps with treatable conditions that might prevent students from attending school, as well as to improve their overall mental and physical well-being. If the ACA is repealed, whatever takes its place must cover mental health care and support services. If the ACA stays, continued advocacy of school health services for the health and well-being of the youth is still needed.
