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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.

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