Caden McKnight was elected student body president of his Las Vegas high school in February 2020.
A year later he was in his room, attending a Zoom meeting of the Clark County School District Board of Trustees, pleading with board members to reopen the district’s schools.
Just being together in person and having a normal routine, McKnight said, would help kids cope with mental health struggles. He told the board members about his own grief over the death of his friend, Mia, who died just after Valentine’s Day this year from an accidental drug overdose.
“I knew her since I was 11,” he said of Mia, who had been his date to a homecoming dance. “I grew up with her and she got to see me grow up. It’s tough as a 17-year-old kid when these people around me are dying. I love my family, but I have no outlet to express how I’m feeling the way I used to when I was at school with teachers and friends.”
From loneliness and anxiety to severe or suicidal depression, the coronavirus’ mental health impact on youth has surged into its own epidemic, swelling the number of children’s visits to emergency rooms for mental health problems. National screenings show that children, adolescents and teens have struggled emotionally during the pandemic more than any other age group. More than one-third of teen girls and one-fifth of teen boys have new or worsening anxiety, according to a January poll by the C.S. Mott Children’s Hospital in Michigan.
But as waves of young people return to school, the system of mental health supports that await them remains patchy and overburdened.
As of 2018, each of the 37,000 school psychologists in the U.S. was responsible for an average 1,200 students, nearly double the recommended number. In some school districts, one psychologist is responsible for as many as 3,000 students, according to the National Association of School Psychologists.
The nation’s 43,000 school social workers were responsible for, on average, 1,200 students each, in 2018, according to data from the U.S. Bureau of Labor Statistics. That’s nearly five times the recommended ratio of 1-to-250. And millions of students attend schools where there is no social worker or psychologist.
School mental health providers are in critically short supply for two reasons: There aren’t enough training programs for those interested in entering the field, and those who do obtain credentials can earn more as in the private sector.
Mental health providers are also concentrated in cities. In rural areas of the country, districts often can’t fill open positions and are beginning to opt for connecting students with practitioners by video.
Experts, including Robert Boyd, president and CEO of the School-Based Health Alliance, also worry that most providers are white women. Especially needed, he said, are pathways for young people of color to become licensed and certified mental health providers without accumulating massive debt.
“It’s best to have practitioners who can relate to the students,” said Boyd, whose organization is working to expand programs focused on recruiting middle and high school students into the field.
But that approach, Boyd concedes, will take at least a decade to make a dent. No state in the country meets the recommended ratio of 250 students per social worker.
Many districts, even while under pressure to accelerate learning, are adding behavioral health programs as they reopen schools. In some cases, this means flipping the way students receive help from the traditional referral-based system to proactive outreach. Social workers are calling students who they have seen before to ask how they are doing and using surveys to assess other students for signs of distress.
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“They may not understand how to reach out, so we are reaching out,” said Terrilyn Rivers-Cannon, a social worker at Booker T. Washington High School in Atlanta. “We have to be careful and ask, ‘Is everything OK?’ We massage the conversation from there and then find out about the sleepless nights.”
And once they start talking, many kids are more open than they were before the pandemic. In general, said Rivers-Cannon, youth and parents who never would have spoken about emotional issues are more comfortable sharing.
“We do have cultures that are not willing to discuss it, and that’s OK,” she said. “We come in and provide information that everyone, at some point, can relate to. Then they may reach out and say, ‘Yes, I need the help.’”
Investment in kids’ mental health
Many states are rethinking their lack of investment in student mental health. While it won’t address the workforce shortage, retooling state Medicaid plans could generate millions of dollars, enabling districts to add more mental health providers. Most states have typically restricted the use of Medicaid funds in the schools to services for students eligible for special education. Eleven states recently amended their laws to allow school social workers and psychologists to bill for time they spend with any Medicaid-enrolled student.
For example, when Michigan lawmakers expanded the state’s list of Medicaid-eligible services, districts were able to hire additional masters-level psychologists and behavioral health analysts. The state projects an increase of $14 million in funds for school-based mental health services, resulting solely from being allowed to bill Medicaid for the services of psychologists. Eight other states are either considering the same change or are in the process of doing so.
Most young people have experienced what experts call “disenfranchised grief” — the sadness and irritability of missing out on life, with no return to normal in sight, coupled with a sense that such feelings don’t rate attention when other people have lost loved ones.
Over the winter, when coronavirus cases spiked in the Bay Area, the isolation of remote learning got really hard for Aurora, an eighth grader in Oakland. To protect her privacy, Aurora gave her middle name and asked that her last name not be used.
“Every single day of my life has been the same for almost a year,” she said. “It drags you down after a while.”
Aurora began feeling depressed and disconnected during the winter, partly due to all the time she was required to spend staring at a screen on Zoom. She found her way through it and when school reopens, Aurora said, she doesn’t want to spend a lot of time in class talking about how she feels.
“If I’m going to be completely candid, schools and teachers and administrators can do nothing to affect how comfortable I feel,” she said. “What schools can do is make interesting curriculum and give us time to talk to our friends, who are going through the same things.”
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The type of sadness Aurora experienced, over missed social gatherings and other everyday things, can be easy to minimize, said Kathleen Minke, executive director of the National Association of School Psychologists.
“Kids will look at those things and grieve their losses, but they’re not the same as the friend whose dad died,” she said, and that can lead to guilt layered on top of grief. Ignoring such feeling can lead to problems later on.
Experts say that most kids will respond positively to two things that schools provide naturally: routine and friends. Few age groups are as developmentally social as teenagers; being able to safely return to typical peer group interactions may be all some kids need.
“I’m a really social person,” said Amelia Harris, a senior at Burlingame High School in Burlingame, California. “In school, I’d have these little side conversations. Now, I have three close friends. There are all these loose friendships that have fallen by the wayside.”
Harris, 18, is editor-in-chief of her school newspaper and works closely with a teacher adviser to train writers and produce the paper. That teacher, Harris said, is the only adult at her school whom she could imagine approaching if she was feeling overwhelmed. She said she isn’t even sure how to access mental health services at her school.
Changes following Parkland shooting
Some districts have had more practice spreading the word about available mental health services. Following the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida, when a gunman killed 17 people and injured 17 more, Broward County voters approved allocating $93 million a year for four years to pay for teacher salaries, school security and behavioral health providers. Florida tacked on another $69 million to fund school-based mental health services throughout the state.
“Are we where we want to be? No,” said Ralph Aiello, director of school counseling for the school district in Broward County. “But we are certainly making tremendous progress.”
The Broward County School District has 260,000 students and more than 400 mental health professionals on staff, 155 of whom are social workers. In contrast, the Clark County district in the Las Vegas area has just 133 social workers for more than 320,000 students.
Broward County also offers support and training to the 15,000 teachers who work with students day-to-day.
“They can’t teach grit and resiliency if they’re not exemplifying it themselves,” Broward County’s Aiello said of his district’s teachers, who also receive instruction on how to identify students who may be in distress.
“You need resources, but in addition, the culture is what has changed,” Aiello said. “We are much more receptive and open to the needs of our students and staff that go beyond academics. If we don’t address those non-cognitive factors, they won’t succeed academically, which is ultimately what we are held accountable for.”
For many kids, just getting back to normal won’t magically make anxiety and depression go away, experts say. Robust, school-based mental health programs that last beyond this year will be critical to identifying and helping all the kids who need support. Such programs have been thin on the ground for decades, but advocates are hopeful that the federal reaction to the pandemic could help schools change course.
The Biden administration has urged state lawmakers to direct some of the federal relief funds earmarked for K-12 public schools — $195 billion between the CARES Act and the American Rescue Plan — to mental health supports.
All of this might help address student needs in the short term. But the if the shortage of professional providers persists it will only get bigger. States can make long-term investments to expand that workforce by recruiting young people to train as mental health professionals and paying for their education, enabling them to return to their home districts to work, said Boyd of the School Based Health Alliance.
“Short-term money is important, don’t get me wrong,” said Boyd. “We’re working with superintendents to recruit kids out of the schools we’re seeking to serve, to increase and diversify the workforce over the next 10 years. It’ll take that long to do it.”
Back in Las Vegas, schools have re-opened, as Caden and many others begged them to do. But Jesús Jara, the school district superintendent, worries that the new mental health initiatives his district has put in place will fall short.
“I still think, are we doing enough?” he said. “Are we doing enough dealing with this pandemic?”
This story about mental health was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.
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