Dr. Altekruse Discusses SOS Screening Process, District Mental Health Developments

Dr. Mike Altekruse, NJSD’s mental health coordinator, answers questions about the decisions behind Neenah’s Signs of Suicide screeners and shares observations of post-pandemic mental health in preK-12 education.


Ashlyn Jacobs, Editor in Chief

Satellite: Why did the counseling staff choose to spread out the SOS screener days on a once-a-month schedule?

Dr. Altekruse: “We normally just do two classes, 9th grade and 11th grade. Because of COVID, we noticed that there were a lot more kids who had been isolated. Perhaps they had been online, perhaps they had some stressors around the election results, or what happened to George Floyd and the social unrest in the pandemic. We wanted to be cognizant of that and do some screening to see if there were kids that were really struggling, so we did all the classes. We don’t have enough school counselors: we have six counselors and two of them are part-time. Doing all the students in one day would have been impossible, because when we have positive screeners, we want to talk to the students to make sure they are okay. And that takes a lot of time. Logistically, we’d like to do everybody at the same time. But it’s a lot. We bring in other counselors from the middle school and elementary schools to help us talk to students. It is a huge process, and a lot of folks do not know all the work that goes into it.”

Satellite: Could you elaborate on the decision to screen all grades 6-12 this semester?

Dr. Altekruse: “We’ve seen more anxiety about the future and about their day-to-day lives, and we’ve seen more kids who seem to struggle with their social skills.. It’s not just at the high school–we’re seeing that all across the district. We see that in Pre-K. When I talk to teachers across all different levels, they say students are disrespectful to one another, they’re disrespectful to teachers, they’re disrespectful to folks they don’t know. Our little kids are being rude to people at lunch and recess and . . . parents who volunteer.”

“Dysregulated adults means dysregulated kids. Period. Our adults are dysregulated right now, and that’s because they’re worried. What are they worried about? Some of it is misinformation and disinformation from folks that are telling them that the sky is falling. Some of it is real, because the pandemic is real and people are dying. We saw the anger with the political system. I think all of that has played a role in our kids’ reactions, particularly those kids who are more suggestible and more vulnerable. Usually anger has something to do with being hurt, feeling vulnerable, and feeling scared.”

Satellite: How effective are these screeners? What kind of impact do they make?

Dr. Altekruse: “In 2015, when I was hired, one in seven of our students said that they had made a suicide attempt in the last month. Now it’s one in 20, since we started doing the screeners: 95 percent of our students don’t attempt suicide. Of those 5 percent, many of them are on our radar and getting help. Because of the screener, we know, for the most part, who is struggling. We talk to them and we try to get them help. Now, you can only go so far in trying to get them help; it’s no one’s fault if someone dies by suicide. But you definitely want to do all you can to wrap around them and let them know you care and that they belong and that they’re not a burden. Those are the two big reasons why folks say that they lose hope and become suicidal.”

Satellite: How did the staff decide the order in which classes took the screeners?

Dr. Altekruse:  “We had the death of a [previous Neenah] student earlier in the year, and we . . . wanted to make sure that we were addressing any students who may have known him. And, in addition, I think the junior year has typically been a stressful year for a lot of students. School gets pretty tough; they have to start thinking about their futures. That’s always been a class that we’ve tested, so we wanted to do it first. Then, freshmen, because we don’t know them as well. After that, sophomores [went] before seniors because in our data, we have seen that our students who struggle the most with suicidality seem to be more freshmen and sophomores. It’s as though, as you get older, you learn more coping skills, or you are already in treatment or therapy.”

Satellite: Since you decided to screen all grades 6-12 this year because of the pandemic, will that continue, or do you foresee returning to every other grade in the future?

Dr. Altekruse: “The issue is capacity. We’ve been able to do that under great duress to our school counselors over the course of these last four months. If we continued to do that, we would need more counselors at the high school. It probably is not going to continue in that way. We will still screen freshmen, juniors, and grades six-seven.”

Satellite: When were these screeners first used in Neenah? Why did you decide to start using them?

Dr. Altekruse: “[Administration] was going to do a screening program that involved more of the parents. They have this at other high schools around the area. Dr. Pfeiffer looked at the cost of that and said that we could afford a mental health coordinator that could coordinate the screening not just for the high school but for the entire district. Also, he or she could do things like mental health programs and presentations, and look at our social-emotional learning programs. So, the position that I now hold was created [in 2015] because they looked at screening. Why did they look at the screening? Because of that statistic: 14.3 percent, to be exact, of our students said that they had made a suicide attempt in the previous 12 months. If you look back 10 years, those statistics range as high as 15 percent and they had never gotten lower than 10. We knew we had a problem, but we didn’t know why.”

Satellite: How did you begin implementing the screeners in Neenah? 

Dr. Altekruse: “When I got here, I started to look at the presentation. The presentation was more one of those shock-and-awe-type presentations. It was not helpful; it had a testimonial of a kid who had attempted suicide. When you make kids feel bad about themselves, they are not going to change their behavior. So, if you look at our presentations now, there’s a lot of hope. A lot of discussion about, yes, signs and symptoms of depression and suicidality, but also how you can help yourself, how you can help others, and then we talk about Sources of Strength.”

“All of that was put into the presentation, and then we added the screener. We piloted that with the health classes first, then we started with the ninth graders and the eleventh graders, then we added seventh graders and sixth graders. We try to hit students as many times as possible with knowing the signs and how to get help, because sometimes you are triggered with your first depressive episode as a senior, and sometimes you’re triggered as a third grader. It can be situational, but more than likely there’s a predisposition toward it in our brains. Trauma can also cause us to trigger it. Overall, we wanted to help students identify it for themselves and give them options.”

Satellite: Have you connected with other districts about these developments?

Dr. Altekruse: “At our mental health coordinator summit that I do once a month, we all lament together, we build each other up, and we talk about what we’ve seen and what we do. I’ve talked until I was blue in the face about how much the Signs of Suicide screeners have changed our culture as well as Sources of Strength, which is an upstream approach. We get students talking about mental health and what we are doing on a day-to-day basis to get through tough times, not just suicidality. A lot of [other districts] are doing screeners, a lot of them are doing Sources of Strength, a lot of them are doing groups that support staff. Because, again, dysregulated staff means dysregulated students; I can’t emphasise that enough. Staff are helpers, and helpers are fixers. They want to fix the unfixable and manage the unmanageable, and they put a lot of pressure on themselves. It’s very important that they take care of themselves. If I’m not healthy, I’m not going to be able to help others.”