By Donna St. George and Valerie Strauss

The change was gradual. At first, Riana Alexander was always tired. Then she began missing classes. She had been an honors #student at her Arizona #highschool, just outside Phoenix. But last winter, after the #isolation of remote learning, then the overload of a full-on return to #school, her grades were slipping. She wasn’t eating a lot. She avoided friends.

Her worried mother searched for #mentalhealthtreatment. Finally, in the spring, a three-day-a-week intensive program for #depression helped the #teenager steady herself and “want to get better,” Alexander said. Then, as she was finding her way, a #girl at her #school took her own life. Then a #teen elsewhere in the district did the same. Then another.

“It just broke my heart that there were three different people who were going through what I was, and they never got the chance to heal,” said Alexander, 17, now a #highschool senior.

After that devastating stretch in May, families and classmates in the Chandler Unified #School District mourned the three 15-year-olds. They would enjoy no more summer vacations, no birthdays or graduations. The losses ignited a debate about what #schools should be doing to support #students in despair.

Nationally, #adolescent #depression and #anxiety — already at crisis levels before the #pandemic — have surged amid the #isolation, disruption and hardship of #covid-19. Even as federal #coronavirus relief money has helped #schools step up their efforts to aid #students, they also have come up short. It’s unclear how much money is going to #mentalhealth, how long efforts will last or if they truly reach those who struggle most.

“The need is real, the need is dire,” said Alberto Carvalho, superintendent of the Los Angeles Unified #School District, who recalled hearing just that day from the district’s #mentalhealth partners that calls about #suicidalthoughts had quadrupled. “We’re living through historically unprecedented times,” he said.

More than 75 percent of #schools surveyed in spring said their #teachers and staff have voiced concerns about #student #depression, #anxiety and #trauma, according to federal data. Nearly as many #schools cited a jump in the number of #students seeking #mentalhealthservices.

But #mentalhealth is not the only #pandemic priority. #Schools are spending vast sums of their #coronavirus relief money on ventilation upgrades, expanded summer learning, after-#school programs, tutors and academic specialists.

The federal spending plans of 5,000 #school districts nationally show that more than one-third intend to bring new #mentalhealthprofessionals into #schools, and around 30 percent plan to fund social-emotional learning efforts, according to an analysis by FutureEd, a think tank at Georgetown University’s McCourt School of Public Policy.

“This is an incredible increase in the amount of money being spent and the number of districts pursuing it,” Phyllis Jordan, associate director of FutureEd. But it is still, advocates say, not nearly enough.

“We simply don’t have enough people in our profession to meet the need.”— Kelsey Theis, president of the Texas Association of #School Psychologists

In many areas, even when money is in hand, hiring is not easy. As this #school year opened, nearly 20 percent of #schools reported vacancies in #mentalhealth positions, according to federal data. #Schools often said they employed too few staff to manage the caseload but also complained about difficulties finding licensed providers, the data showed.

“We simply don’t have enough people in our profession to meet the need,” said Kelsey Theis, president of the Texas Association of #School #Psychologists. When families seek private #therapists, “sometimes there’s a wait list of months and months before they get help,” she said.

In Maine, waiting lists grew so long last year that #school #counselor Tara Kierstead began looking out of state for #therapists who had openings — a solution that was not practical for many families.

“It was the hardest I’ve ever had to work to get resources to people,” Kierstead said. “I know some #kids who were never seen.”

Surgeon General Vivek H. Murthy called out the “devastating” effects of the #pandemic on #youth #mentalhealth in a public advisory last December. Earlier that year, the #American Academy of #Pediatrics, the #American Academy of #Child and #Adolescent Psychiatry and the Children’s Hospital Association together declared “a national state of emergency” in children’s #mentalhealth. They pointed out that young #peopleofcolor were especially affected and linked the struggle for #racial justice to the worsening crisis.

A year later, this October, they sounded the alarm again. Things are not getting better.

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A deepening crisis

Not long after the #pandemic started, researchers began to document declines in #child and #adolescent #mentalhealth. The numbers are stark.

Hospital emergency room visits spiked for suspected #suicideattempts among #girls ages 12 to 17, according to the #CentersforDiseaseControlandPrevention. From February to March 2021, the number jumped by 51 percent compared to the same period during 2019. For #boys, the increase was 4 percent. Early research from MIT suggested the #suicide rate for people aged 10 to 19 increased in 2020, compared to before the #pandemic. More recently, #CDC provisional data for 2021 showed an increase in the national rate from 2020 to 2021, especially for people ages 15 to 24.

In other research, the #CDC found nearly 45 percent of #highschoolstudents were so persistently sad or hopeless in 2021 they were unable to engage in regular activities. Almost 1 in 5 seriously considered #suicide, and 9 percent of the #teenagers surveyed by the #CDC tried to take their lives during the previous 12 months. A substantially larger percentage of #gay, #lesbian, #bisexual, other and questioning #students reported a #suicideattempt.

Family upheaval, meanwhile, was widespread, particularly in the early #pandemic: Nearly 30 percent of #students said an #adult in their home had lost a job, and 24 percent said they went hungry for a lack of food.

There are no directly comparable pre-#pandemic studies, but Kathleen Ethier, the #CDC’s director of the division of #adolescent and #school health, said #student well-being is significantly better for #teens who report feeling connected to their #schools — a problem for a population that, nationwide, was kept out of them for so long.

“There is 20 years of research showing that it not only has an impact on how young people do while they’re #adolescents, but it has 20-year impacts on all kinds of measures of health,” including emotional well-being, suicidality and #substanceuse, she said.

It also left many #children grieving. More than 230,000 U.S. #students under 18 are believed to be mourning the ultimate loss: the death of a #parent or primary #caregiver in a #pandemic-related loss, according to research by the #CDC, Imperial College London, Harvard University, Oxford University and the University of Cape Town. In the #UnitedStates, #children of color were hit the hardest, another study found. It estimated that the loss for #Black and #Hispanic #children was nearly twice the rate of #White #children.

Too much need, too little help

In Maryland, Julia Horton, 16, recalls that, as her struggles worsened last year, she fell asleep in class a lot and did not turn in work; her grades dropped. Looking back, she said, “it is very obvious it was a cry for help.” Some #teachers were compassionate, but others less so. “A lot of #teachers talk about understanding #mentalillness, but they don’t act upon it,” she said.

Her #school in suburban Montgomery County had two #mentalhealthprofessionals within its wellness center, county officials said, but Horton — like many #students — had no idea. She talked to a #counselor she liked about getting more time for assignments but it did not help. Her mother ultimately found her an excellent #therapist to help Horton with her #depression and #anxiety, but she wonders about other #teens who may not be as fortunate.

Montgomery County school officials said they inform #students about #mentalhealthservices through community messages, their website, #student forums and advisory period lessons — though #School Board Member Lynne Harris said messaging should be more robust and focused on platforms #students use most.

In Philadelphia, Mikayla Jones, then 15, took care of her father in spring 2020 when he caught #covid-19 and she had little contact with #teachers and friends during remote learning. She wanted to talk to a #therapist, but her mother couldn’t find one with an opening and she’d never heard of any #mentalhealthspecialist at #school. “I feel like this should not be something that’s possible,” she said. Now a 17-year-old senior, Jones is starting a club to advocate for #mentalhealthsupport across Philadelphia’s #schools. “All #youth deserve someone to be there for them.”

Philadelphia officials said #counselors were meeting with #students virtually or in person during the #pandemic to assess their needs and help decide next steps. Still, the #highschool senior never found a #therapist. The first meeting of her #mentalhealthsupport club is later this month.

Told about the #school system’s comment, the #teenager said: “If the #school does not communicate the availability of #counselors, and their role as #counselor has been repeatedly labeled as ‘#college #counselor,’ then how will we know that they are there as a #mentalhealthresource?”

Shortages of #mentalhealthprofessionals have been the norm in #schools. Professional organizations recommend one #school psychologist per 500 #students, but the national average is one per 1,160 students, with some states approaching one per 5,000. Similarly, the recommended ratio of one #school #counselor per 250 #students is not widespread. The national average: one per 415 #students.

National research from 2019 showed that #studentsofcolor have not received equal access to #school #counselors. At that time, 38 states were shortchanging #studentsofcolor, #students from low-income families or both, according to the study done by the Education Trust.

As the #pandemic has persisted, #students have spoken out — in Nebraska, Arizona, Connecticut, #Washington.

In #Seattle, #students who formed the #Seattle #Student Union to promote #racial justice decided this year to push for #mentalhealth supports in #schools. Chetan Soni, a 17-year-old who co-founded the union, said there are too few #mentalhealthprofessionals to meet rising #student needs. The district told him it doesn’t have the money, he said.

#Seattle #teachers who went on strike in September included a call for more #mentalhealthsupports for #students as one of their bargaining points. The strike settlement included part-time #socialworkers at most #schools — a sign of progress, Soni said, but not enough to help all. “#Students are suffering from the #pandemic and so many other things too,” he said.

His #school, Lincoln High, is fortunate in having a #school-based health clinic, run by Neighborcare Health. But just one #therapist works there, said Rachel Gordon, the company’s #school-based #mentalhealth clinical manager. Nearly all #therapists based at #Seattle’s #schools have full caseloads and wait lists, Gordon said. Many run group therapy sessions as a way to serve more #students. “We’ve seen increases in #anxiety, disordered eating, #suicidalideation, #OCD and many other #mentalhealthchallenges,” she said.

In rural Montana, the squeeze was different: Altacare, a for-profit provider, decided to halt services in the state this year amid recruitment difficulties and funding issues. Districts scrambled to cover for the loss, but many could not, and state officials were limited in what they could do. “Unfortunately they were serving a lot of the very small #rural #schools that were already struggling,” said Mary Windecker, executive director of the nonprofit #Behavioral Health Alliance of Montana.

The shortages meant that Montana #kids who needed residential care, for the most serious #mental illnesses, were mostly being sent to other states, she said: “Not because we don’t have beds for those #children but because we don’t have people to staff those kids,” she said. “Imagine a six-year-old with a serious emotional disturbance being sent as far away as Georgia. That’s happening.”

One result of all these deficiencies: More #students are acting out. Last #school year, nearly 40 percent of #schools nationally reported increases in physical attacks or fights, and roughly 60 percent reported more disruptions in class because of #student misconduct, according to federal data. Las Vegas officials reported several alarming attacks on #teachers. In Louisiana, dads at a Shreveport #school showed up to help keep the peace after a particularly heated week of #student fighting.

National test scores also plummeted to levels not seen since 1999, according to recent data — setting off a wave of alarm among educators, many of whom consider the #mentalhealthcrisis a contributing factor.

Violence in #schools is on the rise

Scrambling for solutions

#School administrators across the country are clear-eyed about #students’ worsening #mentalhealth, many of them strategizing about #school initiatives that may help.

“We know that when #kids are mentally well, they’re much more likely to attend #school and do well in #school,” said Sharon Hoover, co-director of the National Center for #School #MentalHealth.

In Maryland’s Montgomery County, the state’s largest #school system has expanded #school-based wellness centers that provide #mentalhealthservices: Five are open, a sixth debuts in January and 19 others are being phased in.

In Georgia, Hawaii and a host of other states, #schools rely on telehealth services to help meet the gap. They often involve contractors — such as Hazel Health — that respond to referrals from #teachers, #school #counselors or #parents; services are often covered through government funding or payer reimbursements.

Some #school systems have adopted #student #mentalhealth “check-ins” to get a quick read on #student well-being. Others created calming rooms for #students or found ways to build mindfulness, yoga or meditation into #student life.

“We know that when #kids are mentally well, they’re much more likely to attend #school and do well in #school.”— Sharon Hoover, co-director of the National Center for #School #MentalHealth

A growing number of #schools now offer therapy. Many have forged partnerships with community providers who treat #students in person on campus. Health or wellness centers that are located inside of #schools numbered roughly 3,000 before the #pandemic.

“#School-based health centers fill a void, particularly in low-income communities,” said Robert Boyd, chief executive at the nonprofit #School-Based Health Alliance. “In #ruralcommunities, sometimes it’s the only provider around.”

How mindfulness practices are changing an inner-city #school

More broadly, #school systems are expanding social-emotional learning intended to help #students understand and regulate their emotions, develop positive relationships and face challenges. These lessons may be embedded in classes (say, a discussion of empathy related to characters in a novel) or they may come directly through an activity about, for instance, decision-making. In some parts of the country, social-emotional teachings are tangled up in the culture wars, particularly when material deals with #gender and #racial equity.

In California’s Natomas #School District, Superintendent Chris Evans brought in an administrator with #mentalhealth expertise seven years before the #pandemic. Each #school already had a #psychologist. But as the #pandemic began, #socialworkers were hired for each #school, too —a decision that no one regretted. “About one in every two of our #students,” Evans said, “accessed some form of #mentalhealthresource.” #Suicide assessments more than doubled last year, to 191, compared to 71 before the #pandemic.

A big worry in many areas is what happens when federal aid runs out. The #school board in Natomas voted this spring to retain the new hires even after the money is gone, Evans said.

Other efforts flowed from legislation. At least 12 states have adopted some form of “#mentalhealthdays,” which excuse #student absences for #mentalhealth purposes. In Illinois, #students are now allowed five days per year under a new measure approved by the legislature.

Ten ways to get #mentalhealth help during a #therapist shortage

Critics see the excused days off as counterproductive for #students who have already missed too much #school, but supporters say the laws recognize the stressful reality of many #students’ lives and elevate the stature of #mentalhealth so that it is comparable to physical health.

Twenty states also require #mentalhealth education in #schools — which Barb Solish, director of #youth and young #adult initiatives with the #NationalAllianceonMentalIllness, said will reduce #stigma and increase literacy so #students recognize symptoms and learn how to get help for themselves or their friends.

#Mentalhealth in #schools is expected to get a big boost, too, Solish said, from the passage of the Bipartisan Safer Communities Act, which allots more than $1 billion over five years to support #school-based #mentalhealthservices. More than $500 million is slated for a grant program to hire and retain providers in #schools, and another $500 million is for building a pipeline of future professionals.

A call to do more

Riana Alexander and other #students in Chandler, Ariz., showed up at #school board meetings for several months, distressed about the string of #suicides that left three 15-year-olds dead. At a meeting in June, many of them acknowledged their own #mentalhealth difficulties as they pressed the #school district to do more.

The father of a #teen who took his life joined them, his voice breaking in #grief. “I don’t have the answers,” he said. He vowed to work with the #students as they seek change and called them brave.

Then his voice stiffened.

“It’s a shame they have to come in here and ask for this,” he said.

Two months later, another #teenager took her life. She was 16. #School had been open less than three weeks.

“This is a crisis,” Sofia Borczon, a 10th-grader, told the board at another meeting. She’d had #mentalhealthstruggles for four years, she said, and never felt there were necessary resources. “Kids are dying — and they have been for years.”

She and others — part of Arizona #Students for #MentalHealth, which was founded by Alexander — asked for #mentalhealth “first-aid training,” so that everyone would know more about how to help #kids in need, and for “#student action boards” to elevate #mentalhealth concerns at #schools. They wanted to lead a town hall meeting, so their peers could be heard too.
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