April 1, 2020
Updated: June 29, 2021
The U.S. faces a growing child mental health crisis, with nearly one in six children ages 6-17 facing a treatable mental health disorder – but only half of these are children receiving the treatment they need. Youth suicide has been on the rise for the past decade and is now the leading cause of death for 15-to-24-year-olds. In the April-October 2020 time period, the proportion of children between the ages of 5 and 11 visiting an emergency department because of a mental health crisis was 24 percent higher than the same time period in 2019; among 12- to 17-year-olds, that number increased by 31 percent.
The crisis has been exacerbated by the isolation and associated stress of the COVID-19 pandemic. In April 2020, over 80 percent of postsecondary students reported that the pandemic has negatively impacted their lives through increased isolation, stress, loneliness, and sadness. These devastating effects are not limited to postsecondary students; in fact, school districts throughout the country have been reporting alarming spikes in both suicides and attempts at self-harm. The American Academy of Pediatrics has closely tracked suicidal behavior for youth during the pandemic and found that rates of suicidal ideation were approximately 1.5 times higher from March to July 2020 than from March to July 2019. After 18 students committed suicide in the preceding nine months (double the previous academic year), Clark County, Nevada, reopened schools early in the 2020-2021 academic year.
Social-emotional distress may impact student populations differently. A UCLA study found that immigration enforcement in schools increased observed behavioral and emotional problems with immigrant students. National challenges that reach into communities and schools across the country – including social unrest, the global pandemic, and immigration policies that threaten to separate students from their families – all impact student mental health. As students come back to school, it will be more important than ever to provide mental health services and supports.
Research is critical as states and districts aim to expand mental health services to students because education and public health leaders need to understand exactly how the pandemic has impacted student mental health. In Congress, Senators Tim Kaine and Amy Klobuchar introduced the COVID-19 Mental Health Research Act, which will study the impact of the COVID-19 pandemic on the mental health of Americans.
There is a House companion bill by Representatives Paul Tonko and John Katko, titled the Medicaid Re-Entry Act. The bill would allow Medicaid to cover health services in the last thirty days before an individual is released from prison or jail. Currently, Medicaid does not cover health services for incarcerated persons. Student mental health is greatly impacted by the mental health and wellbeing of their parents, relatives, and caregivers. Students benefit from having caregivers in the home who have access to health care, are at lower risk of recidivism, and who are actively managing addiction challenges. This bill will increase the likelihood that formerly incarcerated adults living with K-12 students will meet these criteria and, as a result, student mental health could improve.
Understanding the significant toll the pandemic has taken on student mental health, policymakers and stakeholders must invest in the supports necessary to develop robust mental health support systems in their communities. The following considerations offer ideas on how that can be done.
Fund the screening of all children as they re-enter school. With schools re-opening, policymakers at the federal, state, and local levels must act quickly to fund the services necessary for the re-integration of students and educators. With the passage of multiple federal relief packages to date, Congress should work with school districts in their district to use flexible dollars (which could come from a variety of federal funds, including relief dollars or Title IV of ESSA funds) provided through federal sources to screen every child for mental health and trauma. Implementation of screening may require increased staff such as school nurses, school counselors, and therapists, as the screenings are designed to reveal the types of stress each child faces, as well as how that child should be cared for. Among the greatest advocates for universal child screenings is Dr. Nadine Burke-Harris, the Surgeon General of California who stated her dream would be for every student to be screened for “…childhood trauma before entering school.”
Work with school districts to develop mental health awareness and training programs for students. Districts should consider using federal relief dollars to develop these programs, as seen in Hall County Schools (who received Project AWARE funds) to hire new employees that would coordinate services and provide training for school personnel and other adults to detect and respond to mental health issues.
Work with the governor’s office and/or state department of education to consider using federal funds to support hiring additional staff to support mental health initiatives in schools. The national student-to-counselor ratio of 464:1 (American School Counselor Association recommends 250:1 ratio) was unmanageable before the global pandemic impacted student mental health, and school counselors are often taking on other responsibilities besides providing social-emotional support for students. More support staff are needed in schools. In North Carolina, Governor Cooper allocated $40 million in GEER funding for North Carolina’s public schools to hire more school counselors, social workers, school psychologists, and nurses.
Enlist local and regional agencies that can provide technical assistance and help coordinate local services. Policymakers can support in the delivery of robust mental health services by working with regional leaders to coordinate those services and provide technical assistance for district initiatives. Technical assistance can also come from members of the private sector, such as non-profits and universities (like the Community Schools Center at the University of Central Florida), and that assistance can come in the form of professional development for community schools practitioners via webinars and conferences; site visits to provide in-person coaching; working with district and school leaders in capacity-building; and developing and maintaining a database of community partners, programs, and resources that can support community schools.
Coordinate local services to meet students’ basic needs and address trauma and loss. Federal, state, and district leaders can coordinate on this work by conducting needs and assets assessments as students re-acclimate to in-person learning; an important component of this needs assessment will be the incorporation of a screener, and the School Mental Health Collaborative offers a universal screener, which can help identify high-priority areas of need and existing programs in the school or in the surrounding community that can help meet identified needs. The administration of needs assessments can be done through surveys, administrative data review, focus groups, and/or interviews with students, families, school staff, and community partners. In Cincinnati, Ohio, each school’s Community Learning Center (CLC) utilizes a OnePlan process, where each school assesses the needs of its student population. As a result, each school’s OnePlan describes the partnerships necessary to enhance opportunities for student success and community and parental involvement.
States and local entities have moved to address mental health in their states. The examples below are not inclusive, but highlight promising practices across the country.
States have legislated a range of mental health services and some could be relevant to your community. A sample of state legislation passing in 2019 addressing mental health is below:
|Colorado||HB 19-1120||An act that requires the Department of Education to create a mental health education resource bank and adopt education standards for mental health and suicide prevention and allows for children 12 years and older to receive psychotherapy services without parental consent. Includes appropriations.|
|Texas||SB 11||An act that increases teacher training on mental health and trauma-informed practices; creates a funding mechanism for schools to develop student mental health and suicide prevention strategies; requires schools to increase parental awareness and engagement on issues of mental health, suicide, and substance abuse; requires the Texas Education Agency to disseminate mental health resource information to education service centers; and creates the Texas Child Mental Health Consortium.|
The Jason Flatt Act has been passed in 20 states (New York has not passed the act) to provide suicide prevention training to teachers and certain school personnel to complete two hours of awareness and prevention training. This training is required for teachers to maintain or renew their licenses. The Jason Foundation provides free training modules to school districts or educators requesting the programs.
OTHER STATE INITIATIVES
Kansas | A Kansas School Mental Health Advisory Council was created, which worked with the Kansas Department of Education to create the “Social, Emotional, and Character Developmental Model Standards.”
Ohio | Ohio’s Department of Education has implemented programs to create Trauma Informed Schools.