Lessons in Sadness

The following story includes discussions of suicide and self-harm.

Rising senior Amulya Mulakala had never wanted to miss a day of school. But in her second semester of seventh grade at The Academy for Technology and the Classics, when the COVID-19 pandemic hit and shifted schools nationwide to online learning, the “feeling of enjoyment” she says she had always experienced from learning quickly subsided.

“I wasn’t in the classroom, and I didn’t really get to talk to my teachers anymore. It felt really impersonal,” she tells SFR. “I lost a lot of motivation to be at school and to actually try in my schoolwork.”

Naturally, Mulakala was excited when Santa Fe Public Schools returned to in-person education for the 2021-2022 school year, just in time for her to start high school. But one part felt different.

“Talking to students, the social aspect of it? That was really difficult,” Mulakala says. “In ninth grade, I struggled with making friends, and it made me kind of quiet, and really upset with how my situation was.”

The feeling has been common with students in Santa Fe—and across the nation. According to the national Youth Risk Behavior Survey, 42% of high school students in 2021 (the most recent report) said they had experienced “persistent feelings of sadness or hopelessness.” By comparison, 28% reported such feelings a decade prior.

Jenn Jevertson, assistant director in SFPS’ Office of Student Wellness, says she has “definitely seen an increase” in the number of students being referred to school counselors and other mental and behavioral health services.

“Some of it is hard to provide the actual datapoint evidence for,” Jevertson tells SFR, but “anecdotally, our counselors and other staff have talked about how students’ anxiety is significantly higher.”

The Student Wellness department at SFPS provides a broad range of services and programs: school counseling; nursing; social-emotional learning; school-based mental health; teen health centers; supports for teen parents, homeless students, LGBTQ+ students, undocumented students and more.

But Jevertson and the department’s executive director, Sue O’Brien, see one major gap they want to help fill.

“We really should get some more robust, direct mental health curriculum into the schools,” Jevertson says.

To start toward that goal, O’Brien and Jevertson presented a plan in early May to the SFPS Board of Education for a pilot curricula in the upcoming school year that would include Signs of Suicide and Mental Health First Aid programs. The former is a direct set of suicide prevention lessons intended for middle schoolers, and the latter focuses on mental health more broadly, such as how to respond to mental health and substance abuse challenges. While “nothing is set in stone,” Jevertson says, they should know later this summer if they can launch in the coming school year. And if the pilots succeed, she adds, the department would work to implement the Mental Health First Aid program into the required health class that students take in their freshman year.

The effort comes amid worrisome data for local students. In the most recent results of New Mexico’s biennial Youth Risk and Resilience Survey available—which captured responses from middle and high school students in 2021—rates of the students’ mental health struggles were high. Santa Fe County, while slightly below the state average, reported that among high school students, 42% “felt sad or hopeless;” 30% had “frequent mental distress;” 16% had “seriously considered” suicide; 12% had made a plan to take their own life; and about 10% attempted suicide.

Middle school students in Santa Fe County reported higher rates among suicide-specific questions: 25% of students said they “seriously thought about” suicide; about 18% reported they made a plan to take their own life; and nearly 12% reported they had attempted suicide.

New Mexico’s suicide rates have consistently ranked among the highest in the US, with Mental Health America in 2022 ranking the state 47th for its higher prevalence of mental illness and lower rates of access to care for youth. The state health department tells SFR that year, the most recent data available, saw 20 suicide deaths in the state among people 18 years or younger, three of them in Santa Fe. In February of this year, an eighth-grade student at Mandela International Magnet School died by suicide.

While youth suicide rates have declined slightly in recent years—in New Mexico and nationally—the state’s suicide death rates have been at least 50% higher than US rates over the past 20 years.

According to Jevertson and O’Brien, SFPS staff conducted 218 suicide risk interviews in the 2023-2024 school year. Suicide risk interviews are administered after a student expresses suicidal thoughts, and determine whether the student needs a full clinical assessment by a mental health provider and/or other emergency medical services.

Jevertson notes while she’s curious to see the next round of results from the 2023 YRRS, which will be released sometime between this summer and the fall, “whether it’s higher or not with the statistics, we know our students are struggling.”

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As Mulakala’s social challenges continued freshman year, she asked her parents if she could receive therapy. And toward the end of the year, she joined her school’s WAVE program (Wellness Ambassadors to Voice & Empower).

WAVE clubs began with an emphasis on smoking cessation, but have evolved to include work on a variety of issues, including bullying, gun violence and suicide.

Joining WAVE, Mulakala says, “was the first step at understanding that I was struggling and accepting that it was OK to admit that. Before joining WAVE, I wouldn’t say I placed a lot of importance on [mental health], and that’s just because I really believed in that whole misconception that ‘emotions make you weak’ and things like that.”

Jakob Montoya, who will be entering his junior year at the MASTERS Program charter school at Santa Fe Community College, says he’s led two training sessions on the warning signs of suicide, and has guided his fellow students on whom to talk to about their mental health concerns. Additionally, he participated in last year’s #SeizetheAwkward campaign, which he explains encourages students to “take the first step interacting” with someone about their mental health.

Montoya tells SFR he initially joined WAVE without knowing much about the club, after spending much of his time during the initial COVID-19 outbreak playing video games and attempting to find social circles online. At the time, he says, “I was really depressed. I remember having school without social interactions—it was just so bad. But WAVE was definitely an uplift from that.”

One of the main ways Mulakala connects with fellow students is through mindfulness techniques—in other words, breathing and grounding exercises to help with anxiety. She notes that for the past few years, working with younger students has allowed her to see the level of burnout her classmates have been experiencing.

“It’s happening at faster rates among younger kids, which isn’t a great thing,” Mulakala says. “I kind of think of it like ‘senioritis,’ but if senioritis is hitting seventh-graders, then something’s definitely wrong. A lot of us have lost a lot of motivation.”

The public schools also receive services from The Sky Center—a local nonprofit that works to “get as far ahead of youth suicide as possible” in Northern New Mexico through educational programs, free counseling services and post-vention services when a school experiences a death by suicide. Apryl Miller, the organization’s executive director, says its classroom trainings for students mainly concentrate on managing depression and anxiety and how to help someone who is considering suicide.

“The stuff we really try to be focused on is helping kids not get overwhelmed by what they might see or hear in-person or on social media,” Miller says. “It’s a much more detailed version of ‘See something, say something’ in terms of showing love and compassion, concern and care—and seeking out healthy adults to turn to in this community.”

In addition to direct classroom education, The Sky Center reaches out to schools to provide wellness training to students through its Inner/Outer Life Skills and Natural Helpers programs, which teach problem-solving skills to students with behavioral issues, and help students understand the warning signs of suicide and how to help those experiencing suicidal thoughts, respectively.

During the pandemic, Miller notes, The Sky Center saw “a steady increase of about 25%” in the number of young people being served by the nonprofit’s counseling services and other programs.

“We were sort of at the epicenter of the tsunami that happened after the pandemic, after schools closed and there was so much loss and grief in our community, and anxiety and uncertainty,” Miller says. “That definitely had an impact financially, emotionally…I don’t think our numbers have subsided since the pandemic; they spiked up there and stayed up there.”

And services have not always caught up.

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According to data from the US Department of Health and Human Services, last updated in April 2024, only about 19% of the need for mental health care providers has been met in New Mexico.

Jevertson says she believes access to providers that don’t have waiting lists constitutes one of the biggest challenges people in the community face when it comes to mental health care.

In the 2023-2024 school year, 296 SFPS students were referred to school-based behavioral health services, and about 117 received those services from Presbyterian Medical Services or TeamBuilders, depending on the school. About 46% of students referred chose to not pursue the services or did not respond, and as of April 30, about 42 students referred (14%) were still on a waitlist to receive these services. Data up to the end of March 2024 shows that 86 students from Capital High School and Santa Fe High School visited their respective school-based health centers for mental health-related appointments. Statewide, surveillance between Jan 1. and March 31 of this year show 1,625 youth (ages 5-17) emergency room visits that included a mental health issue.

“As far as behavioral health therapists go, there has been a shortage in Santa Fe of available therapists where you’re not on a waiting list and you can actually get in to see someone. That was true before the pandemic. It feels like it’s even more true now, but statistically I don’t know if it’s ‘the same’ bad or ‘worse’ bad,” Jevertson says.

According to Nick Boukas, director of the Behavioral Health Services Division of the Human Services Department (part of the state Health Care Authority as of July 1), New Mexico experienced a “significant jump in providers between 2019 and 2023,” including an increase in behavioral health providers and “almost doubling the number of psychologists and psychiatrists in the state.”

According to the database of providers the Health Care Authority maintains, the number of core behavioral health providers in New Mexico increased from 3,186 to 5,511 in that time period, and the number of Medicaid psychiatry providers increased from 346 to 705: 73% and 104% increases., respectively.

“Is that exactly what we need? The answer is no. We still need more providers, but that is a significant jump.” Boukas says. He also notes that his department has seen an increase in reimbursement rates for providers. “I think that’s very attractive to people as they’re coming into the state to help us provide services to the Medicaid population, which is almost 50% of New Mexicans,” he says.

Jevertson says school-based mental health services, using partnerships with local health organizations, are a major way to help students receive the care they need. Jevertson explains that when a school counselor determines a student needs more support and the student’s parents agree, the counselor then sends a referral to whichever provider is assigned to the student’s school.

“In a way, it’s an outside referral, but it takes place during the school day on school grounds,” Jevertson says. “If all the kids in Santa Fe who were in school and needed therapy and wanted therapy could only go in that little bit of time right after school, there wouldn’t be enough providers to see enough students. This really helps remove some barriers, plus parents won’t have to transport them. It makes it a lot more accessible for a number of our youth.”

O’Brien tells SFR via email that the Office of Student Wellness “deeply values its relationships with community providers that give students school-based mental health care,” including TeamBuilders Behavioral Health, Presbyterian Medical Services and Serna Solutions.

“In their ongoing efforts to serve more students in the school setting, Presbyterian has historically increased the number of therapists in our schools, resulting in more students being served,” O’Brien says. “We still need more school-based mental health providers to meet the growing number of students needing behavioral health services. Waitlists, whether in our school-based behavioral health services or in private practice, still exist.”

According to Miller, The Sky Center also strives to open its doors to as many people as possible, although increased volume can lead to wait lists. She says she believes The Sky Center’s creation in 1994 was necessary to the community because “we definitely needed a place in Santa Fe where it was easy access for young people and their families to gain mental health services without regard to income, citizenship and insurance. We really have focused on having no barriers, obstacles, and ideally, no wait list.”

O’Brien adds that some ways to improve the district’s mental health care would include partnering with more behavioral health services to grow the student wellness department’s capacity, and collaborating with hospitals to “ensure students are getting the appropriate level and program of care once released from the hospital for acute behavioral health needs.”

SFPS Superintendent Hilario “Larry” Chavez tells SFR that the school district must also advocate for the state to increase its investments into the mental health care profession.

“When it comes to vendors or contractors, we use them as a last resource. We would love to bring it in-house or have employees provide those services,” Chavez says. “It’s a difficult task, but we’re trying to also bring those services back to Santa Fe Public Schools. When we have to go to outside contractors, usually it’s because there’s a need, and it’s a need that we don’t want to leave unmet. Contractors provide valuable assistance to address that area because of the lack of providers we can bring in-house.”

To aid with statewide shortages in mental health care, Santa Fe continues to host those entering the field through Southwestern College, a private graduate school that specializes in counseling and art therapy. Denise Moore, the clinical director of Southwestern’s Tierra Nueva Counseling Center, says 12 new students will arrive in the fall semester for counseling and/or art therapy training.

In addition to overseeing the training, Moore also develops Tierra Nueva’s programs for children, which include creative art and play therapy. Similar to The Sky Center, Moore notes that “people are in more need than before” of therapeutic services.

“I think folks are still coming out of isolation, and the other thing that was difficult was play therapy…the thing we know that works for kids and teens. We had to learn how to do play therapy online, and that’s a hard curve, because working with young people, there’s so much that is done face-to-face, in the non-verbal, the arts—what we call implicit tools in therapy,” Moore says. “That impacted how we worked with young people, and it impacted isolation for young people, because everything is on the screen, even their therapy.”

During the pandemic, Moore says they worked around online play therapy by providing apps and other online games and gave out art kits that people could pick up to do art therapy at home. And now that in-person therapy has returned, Moore emphasizes Tierra Nueva as a place for members of the community to connect, such as during free sand play events on Saturdays and other outdoor therapeutic activities.

“Humans are social beings,” she says. “We’re meant to be in community and we’re meant to interact, and we’re slowly but surely becoming more isolated in some ways.”

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Incoming junior student Rubi Saenz tells SFR that the hardest part of online learning was being apart from her friends.

“It also caused me some anxiety, and really reduced my ability to speak in front of people, share my thoughts and ideas,” Saenz says. “I became more shy than I was, and being inside my house with nobody to talk to…it was really hard to communicate and be confident.”

Joining Santa Fe High School’s WAVE program, Saenz says, allowed her to improve her leadership skills and connect with other students through mental health awareness. She recalls handing out the student wellness department’s “Reach Out” cards that list warning signs of suicide, helplines, local resources and suggest conversation-starters for talking to someone struggling with mental health to “encourage more students our age to get and give help.”

“I do not know for certain if WAVE’s suicide prevention campaigns get to help everyone, but I do know that there’s at least some people out there that we have helped,” Saenz says. “There are people out there who do not have anybody to talk to at home or they do not feel comfortable with. So in school, we try to help those people out.”

Jevertson notes that actions like this are part of why programs like WAVE are important to student mental health, and says the fact that it’s more socially acceptable to have conversations about mental health is “incredibly exciting.”

“Those youth are noticing things in their friends, they’re talking about it with their friends. If friends can notice they’re struggling, it doesn’t mean they have to solve it on their own, but it’s more people to surround that person and help get them to the care that they need to get through the crisis they’re in,” Jevertson says.

Christopher Allers, the district’s WAVE prevention specialist, tells SFR he has worked with Saenz since she joined WAVE in ninth grade, and that the personal growth he’s seen from her “has been incredible.” As she enters her junior year, she will be leaving SFPS to attend the United World College of the Adriatic in Duino, Italy, after receiving a scholarship.

“The first time we met, she was hardly even wanting to introduce herself, and now…leading trainings, icebreakers, going to school in Italy, doing all of these amazing things,” Allers says. “I in no way think WAVE is 100 percent of the reason for that, but I know it’s at least a small portion of that because it’s giving her and other students an opportunity to really find their voice by doing things they care about and having a lot of choice in what that means and looks like.”

Jevertson describes the way that student-led mental health initiatives work to help other students as “the lifeguard theory.”

“If you have a crowded pool of people swimming around, and you have two lifeguards trying to watch everybody, trying to interpret what’s going on, who needs help…unlike in some movies where they’re thrashing around and waving their hands, when someone does start to drown it’s quieter, they bob. It’s not always super obvious,” Jevertson says.

“So, it is a lot easier for just the two lifeguards to miss something sudden like that, especially when the pool’s crowded and there’s people moving around. But who’s most likely going to see that person bobbing? It’s going to be the people right around them.”