In light of recent school shootings, there’s been a renewed push for more gun control and more mental health care. And while Vermont lawmakers have passed gun control measures, mental health experts say the problem is more complex than simply more resources.
Being a child psychiatrist means Dr. David Rettew is a rare commodity in Vermont, which like many states is grappling with a shortage of psychiatrists. And that’s a big part of the problem.
Rettew directs the pediatric psychiatry clinic at the University of Vermont Medical Center.
“When I first got here 15 years ago, there were two child psychiatrists on staff,” he said. “And now there are eight, and we’ve gone from seeing, you know, several hundred patient visits a year to close to, I think about 10,000. And despite that dramatic increase in capacity we’re still, you know, struggling to meet the demand.”
For example, Rettew said the current wait time for an appointment is four months.
And the Burlington area is lucky. Most counties in Vermont and across the country don’t have any child psychiatrists.
Psychologists, social workers and others who provide critical mental health services are also in short supply — something many blame on low salaries and high burnout.
That means families often end up having primary care doctors in one town, therapists in another and psychiatrists somewhere else in the state. It’s a situation that Rettew said can lead to fragmented mental health care.
"In an ideal world, everybody is communicating with each other, but in reality that can be challenging, because ... nobody is paying for that communication,” said Rettew. “So sometimes we’re not talking together and focusing our efforts together as much as we should be or could be.”
There is some good news.
While school shootings make headlines, Rettew said the majority of adolescents are less defiant. For example, he says reports of bullying are down.
“The number of kids using substances, with the exception of cannabis, is on the decrease, and at levels that are as low as since we started measuring it,” he said.
“We’re seeing fewer kids winding up in juvenile rehabilitation centers,” added Rettew. “So in terms of the, you know, rebellious, defiant aggression realm, those things actually seem to be down.”
What teens are showing more of, according to Rettew, is stress, anxiety, mood disorders, depression and suicidal thoughts. And he says those things need more attention.
At Otter Valley Union High School in Brandon, staff see this on a daily basis.
Because of that, clinicians from Rutland Mental Health work at the school five days a week. Similar clinicians are at work in nearly every other public high school in the state; think of them as the mental health equivalent of the school resource officer.
Still, longtime guidance counselor Meredith McCartney says even with embedded clinicians, it can take weeks or even months to get an appointment.
“Within the school we have a wait list for Rutland Mental Health, and then Rutland Mental Health has a wait list for outpatient [services],” McCartney said.
She says if a student is suicidal or their issue is especially serious, she’ll call in a crisis team from Rutland Mental Health and work with the child’s parents to develop a response plan that same day.
More from VPR — Suicide Prevention: What To Do If You Think Someone Needs Help
McCartney says where things get tricky is if the student needs hospitalization. The Brattleboro Retreat is the only inpatient child and adolescent psychiatric care facility in Vermont, so if they’re full, the local emergency department becomes the next best option.
“And certainly that’s not a place you want to go with kids,” admitted McCartney. “But you’re going more frequently because you’re not able to access a psychiatrist in the community either.”
Some primary care offices in Rutland now have mental health clinicians on staff, and members of UVM's pediatric psychiatry clinic are available to primary health care providers statewide to answer questions by phone or email.
That all helps, says McCartney. But she and others say when it comes to the extreme behavior shown by school shooters, more gun control and better access to mental health care are only part of the solution.
“I think there’s a third factor as well: community,” she said, nodding. "And it’s about kids feeling connected and it’s about how we raise our kids."
"As a nation, we’re not doing a great job at that,” McCartney said sadly. “We’re not spending time with them.”
And meaningful face-to-face interaction isn’t happening nearly enough, she said, and that’s taking a toll.
“You know, you could look in and watch people eat dinner at a restaurant, and you’re not seeing the families having a lot of conversation," McCartney said. "You’re seeing some phones out at a dinner table.”
And if you’re of a certain age, you may remember watching TV together as a family, added McCartney — and that rarely happens today.
“Everybody in the household might be on a different device watching a totally different program, so there isn’t even a common point of reference,” said McCartney. “Or a way, that you’re sitting with your kiddo and maybe there’s inappropriate material on, but you’re able to talk through it and say, ‘Oh, geez ... I don’t like that.’”
She believes teens are more isolated and it’s affecting their behavior.
When McCartney sits down with a student to check in, she said she feels most worried when a teen confides that they have no one they can talk to. And that’s not uncommon, she said shaking her head.
Louis Josephson, CEO of the Brattleboro Retreat, believes these issues are where a lot of the extreme behavior shown by school shooters is coming from – not mental illness.
For instance, Josephson points to boys who grow up with domestic violence.
“They learn from an early age that when dad gets angry enough, he’ll hit and that’s how things get resolved,” said Josephson.
He says when you add in stress and feelings of inadequacy, "that can build up lots of feelings of anger and resentment that, along with a maladaptive behavior, can result in some really bad outcomes.”
He believes everyone in a family like that needs counseling, but Josephson said it can be misleading to label maladaptive behavior as mental illness.
“Especially,” he said, “because the data shows people who are mentally ill are much more likely to be victimized by violence than perpetrators of it."
“And so to stigmatize them and hold them out as these, you know, 'sickos' that are just waiting to prey on society is statistically inaccurate and again, reinforces negative stereotypes of people with mental illness,” Josephson said.
More mental health resources are definitely needed, Josephson said, but he and others believe the question of how to prevent school violence is extremely complicated — and it is one society will have to grapple with.
If you or someone you know is considering suicide, the following resources are available:
- National Suicide Prevention Lifeline: 1-800-273-8255
- Veterans Crisis Line & Military Crisis Line: 1-800-273-8255, Press 1
- Crisis Text Line: 741-741
- Vermont Suicide Prevention Center: http://vtspc.org/
- In emergency situations, call 911.
Disclosure: Brattleboro Retreat is a VPR underwriter.