While mental health resources can be difficult for children and teens to come by, Multnomah County has one source of free help available to Multnomah residents ages 5 to 18: school-based student health centers.

Multnomah County’s eight student health centers, located in high schools in Portland Public Schools and the Parkrose, Centennial and David Douglas school districts, each have a mental health counselor to provide outpatient therapy. A growing number also have a behavioral health specialist who can address mental health concerns that don’t require intensive therapy.

A ninth location is scheduled to open at Reynolds High this winter.

All clinics in the network, which is entering its 33rd year in operation, are open to any school-aged student in Multnomah County. Entry-level mental health care is available to any young person at no cost, although intensive therapy is limited in most cases to youth who are uninsured or on the Oregon Health Plan.

One strength of the school-based health center system is that students who may not realize they have mental health needs can learn that they do and get them addressed at the same place they seek physical wellness care.

“Often they’re coming for a physical reason that’s a manifestation of a mental health concern,” said Leslie Balderson, the nurse practitioner at Parkrose Health Center, located inside Parkrose High School.

“Often they’re coming for a physical reason that’s a manifestation of a mental health concern,” said Leslie Balderson, the nurse practitioner at the Parkrose High clinic. Seeking treatment for stomach woes, fatigue or headaches, for instance, can lead to a diagnosis of underlying depression or anxiety that is highly treatable.

When it comes to physical and mental health, Balderson said, “It’s impossible to separate the two.”

All youth who receive care at a Multnomah school-based clinic -- at no out-of-pocket cost -- are given an overall health assessment, which can also flag underlying mental health concerns that might go unaddressed otherwise, she said.

“They seem to mostly be eager to talk and have help and be thankful that somebody’s asking,” Balderson said. Clinicians’ questions about irritability, stress and sleep -- alongside more direct questions about suicidal thoughts -- can give students a way to release concerns they may not have been able to talk about elsewhere, she said.

Multnomah County isn’t the only place in Oregon where students can get mental health care at school. In 2013, state lawmakers approved a grant program to help add mental health care in student health centers around the state. That grant has expanded over time, and for the new two-year funding cycle, the state will channel $7.5 million into mental health care in school health centers, according to Kate O’Donnell, the Oregon school mental health specialist who oversees the grants. O’Donnell emphasized how the money has increased the centers’ ability to help students with mental health needs. “You hear all the time how grateful centers are,” she said.

Jasmin Harshman counsels students at Cesar Chavez School, were she is pictured. She also works at George Middle School. Harshman is employed by Multnomah County Mental Health Services.

So far, except in a crisis situation or cases of extreme need, Multnomah County children and teens can get outpatient therapy at a high school clinic only if they are uninsured or on the Oregon Health Plan. The co-located therapist can’t bill private insurance because the county lacks capacity and internal infrastructure.

In her 19 years of working at student health centers, Balderson said she has seen more students with anxiety, depression and other mental health concerns seek care.

“I don’t remember feeling exhausted at the end of the day because so many kids have so many needs,” Balderson said. “It’s overwhelming and it’s also pretty inspiring that these kids are living their life and getting up every day and going to school every day.”

--Casey Chaffin; cchaffin@oregonian.com; @todaycaseysays