Mental Health

As school administrators and instructors know firsthand, the post-COVID-19 return to school has coincided with an alarming uptick in mental health issues among K-12 students.

Blaming mental health problem on the pandemic alone, however, is a mistake. The truth is that student mental health was a simmering issue that has been exacerbated by COVID-19. While the situation can feel overwhelming, there are concrete steps that school leaders can take right now to help reduce risk and support students struggling with mental health.

What can schools do to support student mental health? The Cornell Mental Health seven-step framework is a great place to start:

  1. Foster a healthy educational environment
  2. Promote social connectedness and resilience
  3. Promote help-seeking behaviors and minimize stigma
  4. Help identify students in need of support
  5. Adjust approach to intervention and utilize all health resources
  6. Deliver coordinated crisis management
  7. Restrict access to means of violence

This article will discuss each step in more detail, after reviewing the facts around K-12 student mental health.

Part I: the troubling landscape of K-12 mental health

Research from the past two years has painted a stark picture of the state of mental health for students in the U.S. But as a population, children in the U.S. were already suffering from mental health problems when the pandemic hit. Prior to COVID-19, Centers for Disease Control and Prevention (CDC) data found that one in five children had a mental disorder, but only about 20 percent of those with disorders were receiving care from a mental health provider.

The arrival of COVID-19 added extra pressure to an already tenuous situation. In a 2020 survey of 1,000 U.S. parents facilitated by the Lurie Children’s Hospital of Chicago, 71 percent of parents said the pandemic had taken a toll on their child’s mental health, while 69 percent said the pandemic was the worst thing to happen to their child. A spring 2020 national survey of 3,300 high-school students found that close to a third of students felt unhappy and depressed much more than usual.

Clinical data supports the feelings of those parents and students. According to the CDC, in 2020, mental health-related emergency department (ED) visits among adolescents aged 12 to 17 years jumped 31 percent compared with that during 2019. In May 2020, ED visits for suspected suicide attempts began to increase among 12- to 17-year-olds, especially girls. From February to March 2021, ED visits for suspected suicide attempts were 50.6 percent higher among girls aged 12 to 17 years than during the same period in 2019. Among boys in that age group, ED visits for suspected suicide attempts increased 3.7 percent.

These pressures can ripple throughout a school community. As a Pew report from late 2021 stated, “Anecdotal evidence from Stateline interviews and media accounts indicates that violence and other behavioral challenges, including truancy, bullying, anxiety, depression, and suicide risks, were up this fall in K-12 schools.”

With this in mind, we recommend schools take steps to support student mental health. In addition to improving the quality of life, health, and educational outcomes of students with mental health disorders, supporting mental health helps schools provide a safe and effective learning environment for all students.

Part II: a seven-step framework to mitigate risk and support students

While the state of K-12 student mental health is alarming, the good news is that there are concrete steps schools can take to mitigate this serious issue. The seven-step framework offered by the Cornell Mental Health integrated public health approach draws on research of best practices advocated by leading resources in suicide prevention and mental health in education.

1. Foster a healthy educational environment

A healthy school climate is at the foundation of any education-based mental health initiative. School climate is based on patterns of experience in school life and reflects norms, goals, values, interpersonal relationships, teaching and learning practices, and organizational structures. The University of Maryland’s National Center for School Mental Health offers a way to assess and improve a school’s environment through the School Health Assessment and Performance Evaluation System (SHAPE). You can also measure your school’s climate through surveys, such as those developed by the U.S. Department of Education.

2. Promote social connectedness and resilience

Teaching students to recognize their emotions, learn emotional resiliency, and seek help when needed is a key part of alleviating student mental health challenges. In the past two years, many districts have adopted school-wide mental health days — a significant step in prioritizing mental health and providing support. But there are also many easy ways to add opportunities for emotional connection and mental health lessons to your existing curricula:

  • Some schools have implemented mentor programs that allow students opportunities to connect with older peers, teachers, or trusted adults in the community. Mentors serve as role models and advisors as well as offer emotional support.
  • Cultivating gratitude builds resiliency and helps students gain perspective on their problems. As part of their regular journal-keeping assignments or as a separate activity, students can keep gratitude journals and participate in daily or weekly discussions of gratitude.
  • Connection is crucial, especially for adolescents. Create multiple opportunities to socialize outside of the classroom. Don’t forget that meetings for clubs, volunteer work, charity work, and other endeavors can be in-person or virtual.

For additional ideas on how to help your students build their mental health toolkit, the National Center for School Mental Health (NCSMH) offers a guide with activities that foster positive social, emotional, and behavioral skills and well-being of all students, regardless of whether they are at risk for mental health problems.

3. Promote help-seeking behaviors and minimize stigma

Knowing that mental health issues are common can alleviate the stigma associated with using mental health services. But many people, particularly in some racially and ethnically diverse communities, still believe that seeking help is a form of weakness, or they think they have to be in crisis before seeking treatment. Schools should help normalize the idea that therapy is a routine part of self-care — like maintenance for a car — rather than something to be sought only in a state of breakdown.

Often, students and families who are suffering don’t know how to get help. For this reason, it’s critical to inform students, staff, and caregivers about available resources. Within school buildings, display posters, flyers, and pamphlets of services — whether they are self-help or through someone professionally trained. And because it’s equally important to reach parents and caregivers at home, leverage email newsletters, web resources, and on-campus events (such as orientations, resource fairs, convocations, or family weekend programs) to spread the word about mental health issues and services.

4. Help identify students in need of support

Don’t forget to provide training on a regular basis — for both school personnel and students — on how to help recognize and support students facing mental health challenges. According to mentalhealth.gov, a student in need of care may exhibit one or more of these behaviors:

  • Sadness or withdrawal from previously enjoyed activities for more than two weeks
  • Attempts at, or plans of, self-harm
  • Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing
  • Involvement in fights or expressing a desire to hurt others
  • Severe out-of-control behavior that can hurt oneself or others
  • Vomiting, refusing to eat, or using laxatives to lose weight
  • Intense worries or fears that interfere with daily activities
  • Extreme difficulty concentrating or staying still
  • Repeated use of drugs or alcohol
  • Severe mood swings that cause problems in relationships
  • Drastic changes in behavior or personality

Your school should also create a multidisciplinary intervention team, comprising school mental health providers, teachers, students, parents, and administrators, to help evaluate the severity of risk for individuals and decide on a course of action.

5. Adjust approach to intervention and utilize all health resources

The pandemic is uncharted territory for everyone, and prepandemic approaches aren’t always effective. When faced with problem behavior, such as emotional dysregulation, unmanaged anger, withdrawal, or self-harm, many schools have switched from punitive to support-based approaches. Rather than punishing a student who acts out, the student might be offered an opportunity to engage in mental health activities such as talking to a counselor or visiting a school “re-set center” where they are provided space to process complicated emotions.

At a minimum, students with distress in their daily lives should have access to school psychologists, social workers, and school counselors. These school-based mental health professionals can choose to provide direct services (either individually or as part of a group), provide referrals to outside agencies, or both.

6. Deliver coordinated crisis management

While your school should conduct crisis preparedness drills, carefully consider the level of involvement you expect from students. Exercises and drills that advance adult readiness to meet the unique needs of children in crises and further children’s preparedness and resilience are effective. However, when children believe that events are an actual crisis and not merely a drill, there is a significant negative psychological effect. The American Academy of Pediatrics (AAP) issued a caution in 2020 about the potential negative impact of these drills on children. While having an emergency plan in place is critical in case of a crisis, having a robust threat assessment process, which involves officials acting on and preventing emergencies, empowers school officials to be prepared instead of simply reacting to a crisis.

7. Restrict access to means of violence

If students cannot access weapons and drugs, the risk of dangerous activity goes down. For this reason, schools should take the lead in helping educate the community about the careful storage of weapons and medications. Parents need to ensure students have no access to weapons, including firearms, knives, and other instruments able to cause harm. The only acceptable practice is to keep all firearms securely stored and locked. For the same reason, all medications — even seemingly innocuous over-the-counter varieties — need to be secured out of kids’ access.

According to the American Psychological Association, reducing gun violence begins with programs to help parents raise emotionally healthy kids and should include efforts to identify and intervene with troubled individuals who are threatening violence. Some steps that schools can take to support these efforts include:

  • Deploying weapon-detection systems. Unlike metal detectors in airports, these systems feel less ominous — like theft detection systems at major retail stores. Cellphones, most brands of laptops, keys, and other metal items can pass through just fine — no alarms will sound.
  • Creating a threat assessment team. Behavioral threat assessment is becoming a standard of care for preventing violence in all sectors of society. Threat assessment teams analyze information to assess whether a person or group poses a threat of violence or self-harm, and then take steps to intervene.

Moving forward

In the wake of the pandemic, America’s children are facing unprecedented levels of stress and trauma. According to the AAP, more than 140,000 U.S. children lost a primary or secondary caregiver to COVID-19, with youth of color disproportionately affected. Thousands more are affected by parents who are now living with long-term health issues or have lost their jobs. With children’s home lives often in turmoil, schools offer stability and a place to receive help. By putting concrete steps in place now, school administrators can reach more students before they reach crisis — and make schools safer for everyone.

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