♪ opening music ♪ ♪ <Gavin> Welcome to This Week in South Carolina.

I'm Gavin Jackson.

The Department of Health and Human Services recently partnered with the University of South Carolina to help combat the growing child and adolescent mental health crisis.

Health and Human Services communications director Jeff Leieritz joins us to discuss the new school Behavioral Health Academy.

But first this past September, the Violence Policy Center released its When Men Murder Women's study.

And for only the second time since its release in 1998, South Carolina was not in the top 10.

Sara Barber, Executive Director of the South Carolina Coalition Against Domestic violence, and sexual assault, joins us to talk about what needs to be done to protect people from becoming victims.

Sara, welcome back to the show.

<Sara> Thank you.

Thank you for having me.

<Gavin> So Sara, let's start with the latest data on domestic violence in our state.

The Violence Policy Center found that in 2020, South Carolina ranked 23rd in the country when it comes to the number of women murdered by men.

That was 41 women and 2020 or 1.52 per 100,000 women.

So we went from six from the year prior to 23rd.

Is that encouraging?

Is it still troublesome?

Or is it all pretty much relative in your opinion, <Sara> I think it's always good news, when you see data like that.

Any improvement is good news and obviously, that's fewer people who lost their lives that year.

But it was 2020.

It was the beginning of the pandemic.

That's a very unusual year.

And if you look at the data across all the states, you'll see some states the rate went way up.

Some states it went way down way down from compared to previous years.

So I think what we're going to have to look at is the pattern of how that starts to play out in years to come.

Whether that was the start of a trend, or whether that was a blip in a year where who knows what was going on.

So I do take encouragement from it always, you know, when you do this work, you'll always have to keep that hope alive.

But I do think we need to be cautious and not jump to any conclusions about what that data truly says about whether things are improving or not in South Carolina.

<Gavin> Because that was a concern when we talked last year, and years prior just about, you know, were you expecting more troubling numbers because of the pandemic because of, you know, creating such a unique situation for people to be, you know, even more so trapped in.

So I guess somewhat encouraging.

But still, you think there could be more behind that data?

<Sara> Yeah, then.

So that's lethality data.

And we were surprised by the fact that we dropped down.

And when I talked with somebody at the National Domestic Violence Fatality Review initiative out at Arizona, they were surprised by our data to because it was not what they were seeing in other parts of the country.

But what we still know is that there's, you know, 25,000 incidents of domestic violence reported to law enforcement approximately each year.

And so that's still going on.

And during the pandemic, I think there were probably more that weren't reported.

So I don't know that we'll ever get a true picture of what domestic violence really looked like during that time.

<Gavin> It's 25,000 reports a year in South Carolina?

<Sara> Yes.

To law enforcement, and in an underreported crime.

The numbers really are staggering.

<Gavin> When we look at that data, and I don't know, again, if we're still trying to understand it, but when you look at the laws that were passed previously, and years previous, do you think maybe that's helping affect those numbers?

Or do you think that we're seeing some changes as a result of those laws that were passed?

<Sara> I would hope so.

But I think it's also very different to parse out.

You know, we've been number six, while we've had since there's laws have changed, we've been number three, since those laws have changed.

Now we're number 23 In lethality.

The numbers and incidents reported stay around the same.

Our member organizations are still fielding around 15,000 hotline calls every year.

We're still providing shelter to around 3500 women and their children every year.

And we're still providing, you know, thousands of people with community based services.

So we still have a huge problem here.

And the criminal justice system, and the laws that, that run through are only one aspect of what we're dealing with.

Domestic violence is in many ways like an octopus, and that its tentacles go through every system.

They go through housing, they go through medical.

They go through mental health.

They go through people looking for work.

I mean, there's just so many ways, I think we concentrate so much on the criminal justice system that sometimes we forget, there's a whole sort of big shadow endemic level of domestic violence that we may not be seeing in those numbers.

<Gavin> Yeah, we'll talk more about what it takes to get out of these situations.

And I know how difficult it is because we've talked about them before and you brought up a lot of good points about how just so many facets there are when it comes to these situations that we have to deal with, especially women in these situations.

Before we get there.

I want to ask you just about, you know how we get to this problem in the first place.

You know, we were talking about seeing record drug overdose deaths in 2020.

We see increased rates of alcohol use and abuse.

We have mental health problems, we have a system that's somewhat broken.

Can you talk to us about how addiction, substance abuse and just all of this kind of plays into what creates domestic violence in the first place in our state?

<Sara> So I don't think there's a cause of factors, but I think they are very sort of, they are intricately involved that correlates of what we're looking at.

Alcohol and Drug Abuse can turn what might be an argument into a violent incident, because people's defenses are lowered.

People's self control is lowered.

And so that often lead to violence, not only in domestic violence, but in other violent crimes, too.

Mental health is the same way.

I mean, I think what we have in this state, and in many states is sort of this toxic brew of so many different things that come together to create levels of violence in our homes that really undermine the lives of victims and their children, and so become intergenerational in effect.

<Gavin> And that kind of brings up the thing I was talking about when it comes to creating healthy relationships and what a healthy relationship is, especially now when we talk about the term toxic masculinity.

That's something that's really kind of gotten more awareness, and we're talking about.

You know, what it means to be a man, you know, not being able to show emotion.

That's that phrase, toxic masculinity kind of encapsulates there.

So what is up with the myth of what's up with a misunderstanding there?

I guess, when it comes to, you know, having communications with families, to have healthy relationships for children.

What needs to be said.

What do parents need to be on the lookout for so they can maybe break this cycle?

I know, it's difficult when you're raised in a family there when there is domestic violence.

But if you're trying to prevent your child from becoming their abuser in some way, or thinking that oh, this is what it means to be a man instead of, no, you can have an actual healthy relationship with a female.

What do parents need to know about these situations?

<Sara> So I think, first of all these relationships and how we learn about love, and how we show love and relationships does start within our sort of nuclear family, within the home.

But we also have to look at what our culture tells us, and that social media is telling us and the influences that have that has on people's perceptions of what a relationship is.

I think we really need to make a much heavier investment in prevention.

To do healthy relationship works in schools.

I know sometimes people don't want schools to talk about these issues and sometimes everything is put on schools to do to fix every social problem.

But I think that is a place where we can reach all children, and it needs to start young, in age appropriate ways.

But we need to start talking to children every year.

You know, the research shows that a sort of a a one time thing is not really going to help in the long term.

But if we do it everywhere, and we create situations where people are prepared to call out their peers.

And I say call out, which is a phrase people don't really like but to identify these issues when they're happening in their peers, and to address those and to expect accountability from a young age.

I think we also need to be very honest in how we talk about relationships.

High school students, middle school students are very good when they're calling and identifying things that aren't true.

So when we sugarcoat things, or we don't talk about what relationships really involve, and we're not talking to them on a level they can understand or respect then we're not going to make change.

But I think it we need to start doing that work in our schools, in our faith communities everywhere, and so that we're reinforcing the idea of healthy relationships so that the whole community can move towards that.

<Gavin> Because it's going to be harder to do later on.

<Sara> Absolutely.

I mean, if you look at the C.D.C.

's numbers from the Youth Risk Behavior Survey, 10 percent of high school girls who have experienced violence in an intimate partner relationship.

First of all, we have to admit that high school students have intimate partner relationships.

But they're reporting high levels of violence from that young age.

And that's only going to carry on and get worse.

<Gavin> When we talk about some big changes we've seen this past year, the U.S. Supreme Court overturned Roe v. Wade, that's about 50 years of abortion access precedent.

Tell us how you see that affecting women in domestic violence situations.

We're talking about abortion access, and in this feeling of being trapped essentially.

<Sara> Well, it's a big issue.

And it's something that people don't really talk about when we talk about abortion, abortion access, people will talk about rape exceptions, limited as those are and as damaging as those can be.

But nobody ever talks about reproductive coercion.

What happens when women are not allowed to use birth control when things such as stealthing happens.

When they're pressurised to have sex against their will that happens in violent relationships.

It's not as easy as if you don't, if you don't want to be pregnant, don't have sex.

For women who are in violent and coercive relationships, that's not a choice that they have.

And so removing their access to abortion care that they need or may need is a further continuation of that abuse.

I mean, it really enables batterers to get what they want from women.

And I think it's very sad when we have sort of the apparatus of the state enforcing that abuse and furthering it.

<Gavin> And then you're talking about creating that cycle that we were just talking about trying to break.

<Sara> Yes.

I mean, it's very hard to leave a relationship.

It's almost impossible when you have three, four or five children, where are you going to go?

The question is often asked, Why didn't she leave?

And the question, I mean, leave and go where?

You know, we have no affordable housing.

Real estate is very hard to find.

And there was a report that came out recently that I think Charleston, Greenville, and Myrtle Beach are among the cities with the highest increases in rent.

So we're asking people to leave, people who may not have been able to work, people who don't have any control over their finances.

People who are living in fear and the violence may get worse, if they leave.

You know, we're asking them, why didn't they do something instead of looking for solutions for them that might make that possible?

<Gavin> So what can women do in those situations right now that they're watching, if they might know someone who's in a situation like that, what can they do to help them when it's so daunting?

<Sara> If it's somebody, if it's a victim themselves, we would ask them to reach out to one of our member programs in the area in which they live.

They can find that number and the services that are offered on our website.

There's also the National Domestic Violence Hotline, which can also direct calls if somebody can't find a local program.

If it's a friend, we ask that you really take the steps to listen to them, to believe them, to help them find resources.

And to stay in support of them.

People might not leave the first time.

People might not leave the second time.

But to be that sort of rock that they can depend on, someone who's not going to judge them, who's going to understand that they are the expert in their life, and will know when it's safe and when they have somewhere to go.

Just to be there for them.

That's what victims need is for somebody to believe them, and to help them.

<Gavin> And Sara, so we know that domestic violence, it's not just physical, right?

There are so many other aspects to this.

So many things that people can see.

If you're in a relationship, and you maybe experience something like what's the situation there?

Do you just automatically say no, you know, I got hit one time I'm done.

I mean, sometimes it's not that easy to do that.

But, you know, walk through some of these scenarios where people should start identifying patterns or situations that are just basically trapping them in this situation.

<Sara> It can be very difficult when you first enter a relationship.

It can sort of mimic the romance that we're all familiar with, when we first get into relationship, and you want to be with someone all the time.

But as the relationship progresses, if somebody stops you seeing your friends, if somebody stops you seeing your family, somebody's controlling where you go, if somebody's wanting to check your cell phone, if somebody's taking over financial control of you, these are all things that should be red flags for you.

Violence doesn't always happen on an ongoing basis.

You know, sometimes violence only ever has to happen once and then you know, as a victim, that if you disagree with that person, again, that that threat is always hanging over you.

What people don't go out on a first date somebody hits them, and they can decide to continue their relationship.

You know, oftentimes the violence starts later, once you're emotionally involved in that relationships when it's hard to leave.

But keep a lookout.

If you do see worrying signs, try and find somebody to talk to, come to.

As I said, you can you could call one of our member organizations and talk through a safety plan with them.

We know it can be difficult to leave.

We know that sometimes when you are physically abused, you'll there'll be lots of apologies, and it will never happen again, those kinds of things.

But probably will.

This is a cyclical kind of problem in relationships.

But we just want people to know that there is help, there is hope, and that you can find your way to safety and peace again.

<Gavin> And with just about a minute left, Sara, I want to ask you just what needs to be done.

Maybe on the state level, when we talk about legislation.

Is it more funding?

Or is it just better preventative awareness that you're talking about in schools or in other places?

What needs to be done to tackle this, in your opinion?

<Sara> I think the most helpful thing that could be done is a really big investment from the state in prevention education, and making sure that's available in communities across the state.

Always more funding for services.

You know, when you hope in the long run, if you invest in prevention, that the need to invest in intervention will decrease.

But right now, we need heavy investments in both because we have a serious problem here, that according to the Jamie Kimball Foundation, who published a report last year costs our state $352 million a year.

<Gavin> Yeah, so definitely, like you're saying prevention could have really helped us out in the long run <Yes> there too.

But sometimes, unfortunately, we don't take the best advice.

<Sara> It can help us include economic terms and in the, in the, just the way people live and the happiness that they can experience in their homes.

<Gavin> Well, thank you so much Sara Barber.

She is the director of the South Carolina Coalition Against Domestic Violence and Sexual Assault.

Always good to see you.

<Sara> Thank you, Gavin.

<Gavin> Joining me now to discuss mental health in schools is Jeff Leieritz.

He's the Director of Communications at the Department of Health and Human Services.

Jeff, welcome to the show.

<Jeff> Thank you, Gavin.

Thanks for having me.

So, Jeff, let's start by talking about this executive order that the governor issued earlier this year for D.H.H.S.

to perform a comprehensive review of the Department of Mental Health School Mental Health Services Program.

What prompted this review?

What did it find?

So we had heard, obviously, anecdotally, with the governor's office as well, a lot of concerns and grips to the level that it wasn't really anecdotal anymore, with lack of mental health, access to lack of access to mental health services in schools in South Carolina.

So at the governor's direction, both in his executive order, and in his State of the State address, we looked into the mental health program that's operating in South Carolina schools that it was really operated by the Department of Mental Health, and found that there was only a mental health counselor in about every other school in South Carolina, about 50 percent of schools, and that the ratio of mental health counselors to students in South Carolina was about one counselor for 1300 students.

We are have worked in have actually already implemented several things that we think will help us bring that ratio down to one in about 625.

About 650.

We're trying to cut that in half in this year, and ensure that there is access to a mental health counselor in every school in the state.

And we have a long term goal to cut that in half again, to get down to about one in every 325.

<Gavin> So Jeff, you're talking about you heard anecdotally, is that?

Is that what you're talking about?

They needed this review, and you found out just how shocking these statistics were when it's, you know, went to 1300 Essentially?

<Jeff> That's right.

And then the governor directed us to perform a review to look into this program.

And that's, that's what prompted the this effort and has prompted the actions that we've taken that we think are going to help us get to that short term goal over this year in the longer term goal over the next several years.

<Gavin> So, Jeff, how do we get to this point where we, you know, have you know, we have all this mental health awareness, but there has been discussions about it.

You know, thankfully, we haven't had a major mass shootings at schools.

There have been some incidents over the years.

But in light of those situations, both here and nationwide, there's always discussion about more mental health access.

But when we talk about this, this ratio of student counselors to students, it's kind of shocking.

So how do we get to that point?

<Jeff> By examining, actually addressing one of the things that you brought up there, with school safety.

We absolutely view this as something that's important to school safety.

It's important to meet those unmet needs of children for the sake of that child.

But there is absolutely a school safety component of this as well.

Also a productive environment component of this where we have children that are acting out because they have behavioral health needs that aren't being met.

They're likely causing a distraction for the other children that are in that classroom and for the teacher.

But back to how we got here, we this is an issue that has existed long before COVID, the issue of adolescent mental health.

But we've absolutely seen an increase of it, of the demand that's related to the pandemic.

You can look at the data that ties back to that.

So if there is a silver lining with COVID is that it's drawn, much needed attention to this issue.

We were also fortunate here in South Carolina, that schools were open that next year.

They were open for the, by and large, were open for the calendar year, school calendar year 2020 and 2021.

We've seen this issue is not local to South Carolina or not just to South Carolina, it is certainly something that we view here but you've seen really off the charts, numbers of mental health needs for students and learning loss for students, particularly in stage the that essentially remain closed for that next year.

<Gavin> So Jeff, when we talk about trying to have that number of one counselor, every 1300 students, you're trying to get to 750, 650.

Can you tell us about how you're attacking this?

What's being done in the short term to try and get that number in half?

<Jeff> Absolutely.

So before, before our audit, the, most schools would see, most schools had a mental health counselor that was part of the contract with the state's Department of Mental Health.

As we were just talking about, we've seen an increased demand for mental health needs in schools, but we also saw a decrease supply of mental health counselors.

We saw a lot of counselors that were leaving the field.

We were paying D.M.H.

a rate that that would have supported a counselor salary that was about double what they were offering as a starting salary for counselors.

But we were also paying D.M.H.

affiliated counselor significantly more than a counselor, if a school went out and hired their own mental health counselor or contract with a private counselor.

So we've gotten rid of that rate disparity.

We're increasing, and by doing that, we're investing a lot more money in the school mental health counselor program.

And we're giving schools a lot more flexibility to go out and hire their own counselor or to go contract with a private counselor to, to perform those services in a school or continue along with D.M.H.

or do and in all of the above approach, some sort of hybrid where they might hire their own counselor and they also may contract with a private counselor or with D.M.H.

We're really still fairly early into the school year, but with those rates went into effect July 1st.

So they went into effect ahead of the school year, beginning and we've already seen some preliminary promising preliminary information.

Last year, we had 14 school districts in the state that hired their own counselor or that had their own mental health counselor, that was a school employee.

We've seen 30 districts that have that have told us that that's the route that they want to go just for the school year.

That's, that's an intent.

It's not, not schools that have already gone out and hired their own counselor.

But that's a promising early number, and hopefully will get us along the path that we want to go in giving schools more flexibility to really take in all of the above option there in terms of being able to increase access to these vital services.

<Gavin> So Jeff, when we look at the need for these counselors, and, and funding situations, obviously, we had, you know, just record amounts of money flowing through the budget this past year.

It's my understanding that there was some money slated for this need.

What ended up in the final budget that got to the governor's desk and and how was that money getting pushed out?

<Jeff> So a lot of what we've done with the additional money that we, that we have for this is that rate increases, is increasing the rate that counselors are able to reimburse are able to be reimbursed for performing mental health services in the school.

And we've also contracted with the psychology School Psychology at the University of South Carolina and they have developed the South Carolina Behavioral Health Academy, which is available at scsbha.com or scsbha.org.

And that is also to provide schools with resources in not just giving them flexibility and saying, okay, you can, you now have more opportunities to hire your own counselors, good luck.

It's also helping them integrate mental health counseling into their day to day operations, making sure that those resources are available for our school or for our students and our families in our schools.

<Gavin> And Jeff, then also, you're talking about that program at U.S.C.

Is that creating a pipeline also of counselors, perhaps to get out and not only in the state, but hopefully into the schools?

I mean, how are we incentivizing the next generation of counselors when we're talking about there being such a deficit?

And then you know, just the need to get trained up in the first place?

<Jeff> Absolutely.

We think that that's a, well, that 3.2 million dollar grant is to stand up this academy.

We're not going to be able to get to our long term goal of one counselor for every 300 students if there's not an increased pipeline of, of people entering this field.

So we think that that partnership is really an important part of this as well.

But a lot of it again, gets back into increasing the reimbursement rate, increasing the, this, which has a trickle down effect of increasing the salary that you're able to make as a mental health professional performing services in a school setting.

<Gavin> And it's my understanding that not all the counselors are licensed in the state.

Are they is that, what does that translate into?

I mean, they're still maybe up to snuff when it comes to professional certificates?

What's the difference between not being licensed in the state and being licensed in the state?

<Jeff> So that's correct.

The counselors that are employed by the State Department of Mental Health are not required to be licensed.

They are required to have a master's degree in a relevant field and are required to get through other training, but they're not required to be licensed like a private employed counselor is.

Part of the work that we're doing with S.B.H.A.

is a, is training for counselors to hopefully increase not just the availability of counseling and the integration of schools being able to provide these services, because it's a part of their their day to day operations, but it's also to improve the quality of counseling.

There is a three tiered approach that will be available in the curriculum that that's being developed through S.B.H.A.

They have an overview module that is available on their website now that's available for anybody who works for a school district.

It doesn't have to be a counselor, but to be able to support staff.

It's available to teachers.

It's available to school leadership and principals and vice principals.

Those other three tiers are really geared towards mental health professionals to improve the quality of care that's available, as well.

<Gavin> And Jeff, really quickly of 30 seconds, can I just ask you about the state of psych beds available in the state?

We're hearing from Robert Kerr, the director of D.H.H.S.

that, you know, there were more beds available 20 years ago than there are now.

Any idea about how many operational psych beds are in the state and how you guys are addressing that problem?

30 seconds.

<Jeff> So we were also given some money by the General Assembly, some one time money to look at the end to end behavioral health landscape in the state.

And one of the things that we're looking at is, is being able to triage people who are receiving mental health care, that right now they're receiving that care in an emergency room.

That's not the ideal setting.

We're looking at ways to look at that end to end spectrum of care from when somebody first is able to access treatment to people who who are needing to be in a facility where they have additional psychiatric needs.

So we're looking at that with the one time money that we've received from the General Assembly and really looking at building that infrastructure around that with a longer term goal of making sure that there's care throughout that continuity.

<Gavin> Gotcha.

Yeah, a lot of needs out there right now, especially when it comes to mental health in the state.

That's Jeff Leieritz.

He's Director of Communications at the State Department of Health and Human Services.

Jeff, thanks so much.

<Jeff> Absolutely.

Thank you, <Gavin> And tune in to E.T.V.

October 26 at 7pm for the only gubernatorial debate in South Carolina, between incumbent Republican Governor Henry McMaster and Democratic challenger Joe Cunningham.

I'll be moderating with the Post and Courier's Andy Shane.

Also to stay up to date throughout the week, check out the South Carolina Lede.

You can find it where we find podcasts and on South Carolina public radio.org.

For South Carolina E.T.V.

I'm Gavin Jackson.

Be well, South Carolina.