An instructor assists a student during a classroom discussion. (Photo by Brandon Bell/Getty Images)
This story originally appeared in Stateline, an initiative of The Pew Charitable Trusts
After more than 18 months of school closures and social isolation, the nation’s more than 50 million public school children are mostly back at their desks. But two months into the fall semester, teachers and students already are saying they need a break.
The grief, anxiety and depression children have experienced during the pandemic is welling over into classrooms and hallways, resulting in crying and disruptive behavior in many younger kids and increased violence and bullying among adolescents. For many other children, who keep their sadness and fear inside, the pressures of school have become too great.
Nearly every child in the country is suffering to some degree from the psychological effects of the pandemic.
– Sharon Hoover, National Center for School Mental Health
According to the federal Centers for Disease Control and Prevention, emergency department visits for suspected suicide attempts among adolescents jumped 31% in 2020, compared with 2019. In February and March of this year, emergency department visits for suspected suicide attempts were 51% higher among girls aged 12–17 than during the same period in 2019.
Last month, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared that the pandemic-related decline in child and adolescent mental health has become a national emergency.
On top of social isolation and family instability, the medical groups said, “more than 140,000 children in the United States lost a primary and/or secondary caregiver, with youth of color disproportionately impacted.”
“Nearly every child in the country is suffering to some degree from the psychological effects of the pandemic,” said Sharon Hoover, co-director of the University of Maryland-based National Center for School Mental Health. “Suddenly everyone is talking about mental health. Parents, teachers and students are openly discussing it.”
The pandemic may subside, but its mental health effects will be around much longer, Hoover and other experts say.
“That’s why schools need to invest now in the mental health and well-being of our kids in a broad and comprehensive way—not just for children with learning disabilities and diagnosed mental health conditions, but for all students,” Hoover said.
One good thing to come out of the pandemic, Hoover added, is that it lowered the stigma around mental health. “We’re all feeling it, so it’s OK to talk about it.”
School administrators and school principals know that the only way to get students back on track academically is to reduce the mental health barriers to learning, Hoover said. “They’re as eager to invest in mental health resources as anyone. That wasn’t always the case.”
The pandemic also prompted the federal government to provide historic levels of relief funding for education.
The American Rescue Plan Act and the Elementary and Secondary School Emergency Relief Fund, combined with other 2020 pandemic relief funds for schools, amounts to more than $190 billion in education and health grants available over the next four years, some of which can be spent on mental health.
The money goes to states based on their school-age population, but local school districts have decision-making authority over the lion’s share of it.
Ninety percent of the money allocated to states must be re-allocated to school districts. Schools have wide discretion over how to spend the money, as long as 20% or more is spent on programs to address learning loss, including summer school and after-school academic programs.
No federal grants are specifically earmarked for mental health, but according to Hoover, nearly all states are spending part of their share of federal relief money on mental health and encouraging school districts to do the same.
Ohio, for example, is recommending that school districts invest in partnerships with community mental health providers to offer students mental and behavioral health services virtually or in school buildings that can be billed to Medicaid or private insurers.
Georgia is directing schools to use federal dollars to train counselors, social workers and nurses to identify students with substance use and mental health needs as they return to the classroom, then refer them to community mental health and local substance use providers.
Arizona is spending federal relief funds to hire more counselors and social workers in K-12 schools to improve the student to mental health professional ratio.
And Maryland is developing a school mental health response team to address the needs of students who have experienced trauma during the pandemic and are stressed beyond their ability to cope. The teams would quickly respond to local schools as needed.
In addition to new investments in school mental health, states also are enacting a variety of new laws aimed at relieving pandemic-related stress on students and teachers and improving overall school mental health and academic success.
Arizona, Colorado, Connecticut, Illinois, Maine, Nevada, Oregon and Virginia enacted statutes this year and last that allow K-12 students to miss a certain number of school days for mental health reasons.
In addition, some school districts this fall called time outs for teachers and students to help release some of the pressures of trying to make up for lost time in the first two months of in-person learning.
In Chapel Hill and Carrboro, North Carolina, public schools gave teachers and students a full week off for Thanksgiving to support their mental health. And Richmond, Virginia, schools gave teachers and students a week-long mental health break around Election Day.
Tennessee enacted a law requiring schools to conduct mental and behavioral health screenings during the 2021-22 school year for all students in kindergarten through eighth grade to evaluate the effects the pandemic has had on their mental health. Utah enacted a law allowing schools to conduct mental health screenings for students whose parents consent.
A ‘River of Referrals’
In most schools, it is the school psychologist who is responsible for working with counselors, social workers, nurses, teachers and principals to develop a school-wide mental health plan and to promote well-being for all students.
School psychologists also are called on to provide one-on-one counseling for students with mental or behavioral health needs and identify students with developmental and learning disabilities who may need a special education plan.
But this fall, long-term planning has largely gone by the wayside as school psychologists respond to what one called “a river of referrals.” In an internal survey conducted by the National Association of School Psychologists in September, a substantial number of school psychologists reported sharp increases in the number of requests they were receiving to provide students with mental and emotional health supports.
“We’ve seen a huge increase in the need for mental health services for both adults and children,” said Andria Amador, director of behavioral health services for Boston Public Schools.
“All of our schools are struggling to make up for learning loss,” Amador said.
“But the schools that are the most successful are those that are focusing first on re-creating the school community,” she said. “Schools that are focusing purely on academics without helping kids feel like things are back to normal, are really struggling.”
School psychologists, in short supply nationwide, also are receiving more requests than in previous years to run a battery of tests required by federal law to determine whether a child has a learning disability or physical or mental health condition that requires a special education plan.
Known as individual education plans or IEPs, about 14% of K-12 students in 2019 were deemed in need of federally funded special education accommodations under the 1975 Individuals with Disabilities Education Act. It’s not yet clear whether an apparent increase in IEP testing this year will result in more students receiving special education supports.
“School psychologists are being swamped with referrals for just about everything,” wrote Katherine Cowan, director of communications for the school psychologists’ association, in an email.
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.
National data is not available on mental health related absences and referrals for mental health services in K-12 schools this year. But data from child mental health specialists on the effects of the pandemic is dramatic, said Dr. Carol Weitzman, director of developmental-behavioral pediatrics at Yale School of Medicine.
An estimated 16.5% of children ages 6-17 had at least one mental health diagnosis in 2016, according to data from the National Survey of Children’s Health. According to the CDC, 7.1% of children ages 3-17 had a diagnosis of anxiety and 3.2% had a diagnosis of depression.
“Then came the pandemic,” Weitzman said in an interview with Stateline. “We don’t know a lot about how it has affected children’s mental health yet. We’re just starting to learn. But we do know that about one-quarter of all kids are showing up with symptoms of depression and one-fifth with symptoms of anxiety.
“That’s millions more kids than before the pandemic.”
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