Table of Contents
Why is mental health important for students?
We see the news headlines and hear the declarations from the Surgeon General about ‘the kids not being alright’ and ‘protecting youth mental health’.1
So, what does it really mean and how big is the problem? According to the CDC nearly one in five children have a mental, emotional, or behavioral disorder in the U.S.2 Today, many children struggle with anxiety, panic attacks, depression, and substance abuse as they navigate through important life events, personal challenges or any number of Adverse Childhood Experiences or ACEs, which the pandemic has heightened.
Despite the staggering number of children in need of help, about eighty percent of those who need mental health care will not receive the care they need because of cost, stigma, lack of access to providers, or other barriers.
We know that mental health issues make it more difficult for children to succeed in school and add stress to the home environment. It is essential that students have access to the mental health support they need, so they can learn and thrive.
How is this impacting the ability for children to learn?
This lack of equitable access is why many schools are working to expand health care support through multi-tiered systems of support (MTSS) including offering mental health services via school-based resources (which often include telehealth), and increased school staffing. Access to mental health professionals in schools helps give students more real-time ability to understand how to develop skills to cope with and navigate their emotions, including day-to-day feelings of stress or more serious mental health challenges.
Students with untreated mental health issues are more likely to face challenges in school. They are more likely to experience chronic absenteeism, lower grades, disruptive behavior, and higher dropout rates.3
According to a report from the Hopeful Futures Campaign, schools in every state are having trouble meeting student’s needs.4 The report graded schools' ability to address student mental health needs according to a list of factors, including staffing levels, teacher training, community engagement plans, funding, and mental health skills education.
The situation impacts millions of students in the United States.5 School counselors, social workers, and psychologists providing mental health support are frequently overwhelmed by the growing number of students in need. The increase in volume and lack of resources prevent many students from receiving help. On average, there are now over 1,200 students per school psychologist.6
The pandemic may have increased student mental health needs, but the challenges existed long before COVID-19.7 Students feel isolated from lost time at school. Many also are struggling with the loss of family members. Other factors like world events, school shootings, social media, and adaptation to a rapidly changing world contribute to increased student stress and anxiety.
Student mental health has received more attention from the federal, state, and local governments and other organizations since the peak of the pandemic.7 Many states, non-profit organizations, health plans, school districts, health systems, and community organizations have increased efforts to support student well-being.
In a countrywide survey of almost 1,000 parents, over half said their children had developed new or worsening mental health problems since the pandemic began.7
In October 2021, the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children's Hospital Association issued a joint statement declaring student mental health issues a national emergency.8 (American Academy of Pediatrics 2021)
Vivek Murthy, the US Surgeon General, released advice on the pandemic's impact on the mental health of young people:
"Childhood, adolescence, and early adult mental health issues are genuine and pervasive. An alarming number of young people suffered from feelings of powerlessness, sadness, and thoughts of suicide even before the epidemic — and rates have climbed over the past decade. The COVID-19 epidemic changed their lives at home, school, and in the community, with terrible consequences for their mental health. How we encourage and invest in the next generation will determine our country's future prosperity."
Children face unique mental-health challenges in school
Difficulties managing mental health symptoms are not uncommon in students. The symptoms can accompany both diagnosed and undiagnosed mental health issues. Sometimes, root causes are mistaken for lack of motivation or are inappropriately labeled, further compromising the student's educational journey and health outcomes.
Students with mental health challenges are more likely to experience:
- School absences and tardiness
- Disciplinary action and expulsion
- Failing grades
- Learning disabilities
- Lack of focus and attention to detail
- Difficulty making friends
- Withdrawal and alienation
Teenagers who try to manage mental health without help are more likely to have challenges with:
- Drug and alcohol abuse
- Self-harm and mutilation
- Unsafe sexual practices
- Restrictive eating practices
- Projected anger, harm, and violence
Students with mental health challenges often struggle to succeed in school. These challenges add a layer of stress to a phase of life already characterized by significant personal growth and change.
Key student mental health statistics
- 60% of youth with depression do not receive any mental health treatment. Of those who do receive some treatment, only 27% receive consistent care.10
- More than 20 million children in the U.S. lack access to essential health care.11
- LGBTQ+ youth are 2x as likely as their non-queer counterparts to report feeling sad or hopeless, and 3x as likely to have considered attempting suicide.12
- 44% of teens feel persistently sad or hopeless.12
- Children and teens with mental health illnesses may miss as many as 18 to 22 days of school during any given school year.13
- Children and teens with mental illnesses had three times the rate of suspension and expulsion as their peers.13
- Only 32% of students with mental health diagnoses continue their education after high school.14
- The percentage of students reporting mental health being an obstacle to learning rose from 39% in spring 2020 to 49% in spring 2021.15
Impact on families
While there are many ways parents can help their kids manage stress, sometimes additional help is needed.
Parents and guardians want to help their children but often don't know about or can't access the resources they need. This added need for information gathering can add to household stress. Educating parents and caregivers about processes and the resources available through their child's school, healthcare plan, or community organizations can help.
Families in crisis draw inward and can become cut off from the community. This isolation makes it even more difficult for them to receive help. Families need access to a trusted healthcare provider or other resources for assistance.
Obstacles parents face
Parents and guardians face many obstacles to receiving care for their children with mental health needs.
The most challenging issue cited by parents and guardians is the inability to obtain health and social services for their child with mental illness.16 The CDC estimates that 3.7 million children do not have health insurance.17 Even if they have health insurance, there may be a lack of providers in their area, especially in rural communities.
Financial issues also hinder their ability to get care.
- Families below the poverty line are more likely to experience mental illness. These same families are less likely to have access to resources to help.
- Parents in single-income families are reliant on their partners. Those who do not have partners rely on aid from others, particularly relatives.
- Parents cite costs of childcare, medicine, healthcare, and transportation to health services as significant financial hurdles.16
Caring for a child with a mental condition has been linked to family social issues. Social stigma remains one of the more significant issues families face as they navigate caring for their child.
Common mental health diagnoses in children
Anxiety is common among students and can become overwhelming and disrupt daily living. According to the CDC, one in eleven children is diagnosed with an anxiety disorder each year.18
Anxiety in children can occur due to major life events such as moving, the loss of a loved one, or parents' divorce. They can also stem from everyday pressures like social media, school workload, stress, or family arguments.
Some of the most prevalent anxiety disorders in children include:
- GAD (Generalized Anxiety Disorder): persistent, severe anxiety that interferes with daily activities
- Obsessive-Compulsive Disorder (OCD): intrusive and irrational thoughts, anxieties, and obsessions that lead to compulsions and repetitive actions
- Panic Disorder: persistent dread and frequent, unexpected experiences of terror and panic attacks
- Post-Traumatic Stress Disorder (PTSD) occurs when a person watches or experiences a traumatic incident. Although traditionally considered an affliction in soldiers returning from war, many other tragic events like car crashes, physical abuse, or natural disasters can impact children. Individuals can, nevertheless, be traumatized without experiencing a significant traumatic incident.
- Social Anxiety Disorder: irrational worry, dread, self-consciousness, and shame in ordinary social encounters
Childhood Anxiety Symptoms
Anxiety in children may be hard to identify. Many anxiety disorders are misdiagnosed as everyday stress or dismissed as excessive worry. Panic attacks might be misinterpreted as a medical condition like a heart problem. Children, especially young children often lack the ability to understand and communicate when they are upset or worried about something. Older children might fear judgment or misunderstanding if they share.
Children experiencing one or more of the following behaviors may be struggling with anxiety:
- Frequent moodiness or tantrums
- Increased crying
- Being very clingy
- Refusing to go to school
- Difficulty concentrating
Anxiety disorders may also manifest in physical symptoms:
- Difficulty sleeping
- Nervousness or jumpiness
- Visible panic episodes
- Nausea, vomiting, diarrhea
Care Tip: Avoid condemning or dismissing the intensity of someone's symptoms, and instead encourage them to attempt anxiety-relieving coping skills. In most states, children under 18 will need assistance and consent from an adult to receive care from a professional.
OCD in children
Obsessive-Compulsive Disorder (OCD) can interrupt the daily flow of life for a child. Students with OCD may spend an hour or more per day focusing on rituals. These children miss out on activities or become upset when they don't get to finish the pattern.
Common signs of OCD in children include:
- Lengthy and frequent grooming rituals: brushing hair, washing hands, brushing teeth
- Frequent counting compulsions: counting steps, counting items, counting aloud or in one's head
- Repeatedly checking windows and doors
- Repeatedly checking the stove or oven
- Repetition of words, phrases, or questions
- Strong sense of lucky and unlucky numbers
Depression in children is characterized by chronic sorrow, despair, and a loss of interest in formerly pleasurable activities. It can make the student perform poorly at school and extracurricular activities and strain relationships with parents and siblings.
In the worst-case scenarios, depression can lead to self-harm or suicide. Suicide is one of the leading causes of death for children aged 10 to 19.19
Signs and symptoms differ from student to student. Symptoms of depression, according to the American Psychological Association, can include:
- Trouble sleeping or an unwillingness to get out of bed
- Rapid changes in weight (teens are more likely to gain weight)
- Withdrawal from activities that used to be fun
- Feeling hopeless
- Having difficulty concentrating or paying attention
- Difficulty comprehending and completing tasks at school
Some of these symptoms might not always indicate that the child is depressed. If symptoms occur regularly for two or more weeks, the child should get expert care.
Suicidal thoughts and ideation are characterized by a tendency to think about or plan one's death. Suicidal thoughts that are overpowering or highly detailed are considered a mental health emergency by mental health specialists.
If a child is thinking about killing or hurting themself, get help now by contacting The National Suicide Prevention Lifeline by dialing 1-800-273-8255.
Substance abuse in children and teens
Substance abuse represents a pattern of physical or psychological dependency on one or more substances. The National Institute of Health found that children who try alcohol, tobacco, or cannabis for the first time between the ages of 11-14 are more likely to develop a drug abuse problem.20 For this reason, they stress the importance of discussing and preventing drug use prior to teenage years and continuing the conversation throughout high school.
According to the Center for Disease Control, nearly two-thirds of teens have tried alcohol, and half have tried marijuana before graduating high school.21 It is important to remember alcohol and marijuana are not the only drugs students use. By 2018, 38% of teens reported vaping, including nicotine and other substances.22 Non-medical use of prescription drugs is also common with 10% of adolescents admitting to misusing or abusing medicine in the last six months.23
Substance Abuse Signs and Symptoms
- Slurred speech, bloodshot eyes, or a lack of coordination
- Sudden experience of fear, anxiety, or paranoia
- High tolerance to alcohol or drugs (in other words, the person may need to use more and more of a substance to obtain the same effects)
- Changes in sleep patterns
- Sudden weight loss
- A rapid shift in activities or interests
- Changing friend groups
- Frequent fighting or getting into trouble at school
Education and quality information are essential weapons against substance abuse. Use compassion when approaching a student struggling with addiction. Let them know that these behavioral indicators reflect a higher-than-average risk of developing a drug use problem.
Supporting student mental health in the classroom
Mental health is part of everyday health
While more complex mental health challenges may cause urgency and action, developing an environment that supports mental health daily can improve whole-child wellness and help reduce the likelihood that minor setbacks become bigger problems.
Seeking support from a licensed mental health provider specialized in meeting the unique needs of children
Helping children with mental health challenges succeed in school requires diverse services as needs vary significantly from child to child. Students may be dealing with problems at home, face bullying, have trouble making friends at school, or lack proper nutrition.
Both young children and adolescents benefit from learning effective coping strategies. Mental health professionals teach age-appropriate coping skills like:
- Effective verbal and non-verbal cues
- Peer interactions
- Boundary setting
Many schools in the United States support student mental health by offering therapy services through telehealth providers, like Hazel. Hazel provides access to culturally competent health care providers trained in age-appropriate approaches to addressing mental health concerns.
Building social and emotional skills into the curriculum
Social-emotional learning (SEL) can be incorporated into the classroom's regular routines. Short exercises can go a long way toward making kids feel safe, included, and accepted. These strategies provide students with a consistent technique for dealing with their feelings, especially when they begin to feel out of control.
Releasing those emotions and safe expression is paramount. Children can learn to manage their emotions better by learning critical sensory clues. Students might choose to illustrate their feelings through journal prompts, poetry readings, role-playing, media debates, or even quick group check-ins about feelings.
The idea is to give students a permissive safe environment to feel whatever they're feeling at the time. The key takeaway is to arm them with practical management tools to better cope with negative emotions.
Inclusion and acceptance: building respectful relationships
Bullying in-person and online can wreak havoc on a student's emotions. Nearly 37% of students will experience cyberbullying, according to a 2019 study.24 Many schools have adapted their student conduct policies to discourage cyberbullying.
The process of building respectful relationships can be included into everyday activities. Parents and teachers can create more inclusive and safe environments using proven methods.
Mindfulness is deliberate and nonjudgmental attention to the present moment. The following basic exercises incorporate mindfulness:
- Begin the day with a two-minute meditation of deep, quiet breathing
- Focus on mindfulness during activities like sketching, dancing, listening to music, or even eating
- Help children notice small details in their environment. What can you tell me about what you are hearing, smelling, seeing, feeling, and tasting?
Incorporating meditation into a child's routine can help them establish strategies to calm their mind and body.
Transparency and communication
Mental health experts encourage active communication strategies surrounding one's mental health.
It’s important to normalize talking points about fears, doubts, concerns, and other "feelings" accompanying mental health challenges. A place for safe expression helps students prevent negative feelings from spiraling into more substantial problems, and helps them feel a sense of belonging and care.
Accomplishing this in a group setting may be best achieved through visualizations, short films, and personal stories. Hazel's trusted mental health professionals can provide tools to assist these objectives.
Sensory engagement tools
Even after school has begun, many children still have a lot of free time and are limited in their activities. As a result, children frequently spend much unstructured time in front of devices, which can harm their mental health.
Teachers can help by including as many physical, hands-on activities in the day as feasible. Create a list of fun non-screen activities for a class (such as going on a walk, playing board games, or painting) and have students perform one of these as part of their daily schoolwork.
Optimize the classroom environment: tools for success
Morning Social Hours
Teachers can assess each student’s mood and learning capacity before the day begins. Getting a temperature check on a child's emotional state provides time for early intervention and engagement. Outside of the classroom, families can help their child establish a consistent morning routine that starts their day off right.
These teachable tools help kids self-analyze based on an emotional scale and allow children to choose colors to symbolize emotions (frustrated, sad, worried, delighted, etc.).
Provide students options and alternatives for activities. It allows children a safe place to reset without disrupting normal classroom function.
Partnering with a telehealth professional service provider
Many districts are experiencing staffing shortages, including shortages of psychologists and counselors to support student mental health. To ensure they’re able to meet the needs of every student, school districts are partnering with Hazel Health to expand access to licensed mental health professionals.
Hazel’s telehealth services help schools provide mental health services to every student at no cost to families.
- Hazel offers HIPAA-compliant practices and complete privacy and confidentiality
- Hazel uses technology specifically designed for the school setting and offers at-home service for students far from school
- Each in-school physical visit with Hazel saves an average of three hours of missed teaching time, and each mental health visit shortens the time it takes for students to get help.
Hazel is here for students and families. Learn more about how Hazel can support your school district's student health initiatives.
Whether it is the everyday struggles of childhood or more challenging scenarios, students, schools, and families should know that resources are available to help.
Hazel's goal is to provide a safe platform for children to receive mental health support and improve equity in mental health access among students. Through telehealth, Hazel stretches the boundaries of care by providing access points to students at school and home.
Parents, children, schools, and organizations can work to lessen the instances of self-harm, anxiety, depression, substance abuse, self-harm, and other mental health challenges by teaching students better ways to cope with the feelings they experience.
It won't happen overnight, but together, we can all work to put the system of support in place and employ the tools and resources to improve student mental health.
- Office of the Surgeon General. Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. December 2021.
- CDC. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention. April 2022. https://www.cdc.gov/childrensmentalhealth/access.html
- Andersen, S., Davidsen, M., Nielsen, L. et al. Mental health groups in high school students and later school dropout: a latent class and register-based follow-up analysis of the Danish National Youth Study. BMC Psychol 9, 122 (2021). https://doi.org/10.1186/s40359-021-00621-7
- Hopeful Futures Campaign. America’s school mental health report card. Hopeful Futures Campaign. Feb 2022. https://hopefulfutures.us/wp-content/uploads/2022/02/Final_Master_021522.pdf.
- Anderson, M, Cardoza, K. NPR. Mental Health In Schools: A Hidden Crisis Affecting Millions Of Students. NPR Aug 2016 https://www.npr.org/sections/ed/2016/08/31/464727159/mental-health-in-schools-a-hidden-crisis-affecting-millions-of-students
- NASP. Shortage of School Psychologists. National Association of School Psychologists, 2021. https://www.nasponline.org/research-and-policy/policy-priorities/critical-policy-issues/shortage-of-school-psychologists#:~:text=NASP%20recommends%20a%20ratio%20of,a%20ratio%20of%201%3A5000.
- Mott Poll Report: How the pandemic has impacted teen mental health. C.S. Mott Children’s Hospital. March 2021. https://mottpoll.org/reports/how-pandemic-has-impacted-teen-mental-health
- AAP. AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health. American Academy of Pediatrics, 2022 https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
- HHS. U.S. Surgeon General Issues Advisory on Youth Mental Health Crisis Further Exposed by COVID-19 Pandemic. U.S. Department of Health & Human Services, 2021 https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html
- MHA. The State Of Mental Health In America. Mental Health America, 2022. https://mhanational.org/issues/state-mental-health-america
- Children’s Health Fund. Unfinished business: more than 20 million children in US still lack sufficient access to essential health care. Children’s Health Fund, 2016. https://www.childrenshealthfund.org/wp-content/uploads/2016/11/Unfinished-Business-Final_.pdf.
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- Ambikile JS, Outwater A. Challenges of caring for children with mental disorders: Experiences and views of caregivers attending the outpatient clinic at Muhimbili National Hospital, Dar es Salaam - Tanzania. Child and Adolescent Psychiatry and Mental Health. 2012;6:3–11.
- Cha, AE, Cohen, RA. Demographic Variation in Health Insurance Coverage: United States, 2020. National Health Statistics Reports, Number 169, February 2022. Hyattsville, MD: National Center for Health Statistics.
- CDC. Anxiety and depression in children: Get the facts. Centers for Disease Control and Prevention, 2022. https://www.cdc.gov/childrensmentalhealth/features/anxiety-depression-children.html
- CDC. Facts About Suicide. Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/suicide/facts/index.html
- NIDA. Age of first use and drug dependence: Data from 617 consecutively ascertained subjects. National Institutue of Drug Abuse; 2015. https://nida.nih.gov/international/abstracts/age-first-use-drug-dependence-data-617-consecutively-ascertained-subjects
- CDC. Fetal Alcohol Spectrum Disorders (FASDs). Centers for Disease Control and Prevention; 2020. https://www.cdc.gov/ncbddd/fasd/features/teen-substance-use.html
- NIH. Vaping Rises Among Teens. National Institute of Health; 2019. https://newsinhealth.nih.gov/2019/02/vaping-rises-among-teens#:~:text=About%2037%25%20of%2012th%20graders,use%20nicotine%2C%E2%80%9D%20says%20Dr.
- The Medicine Abuse Project. Partnership to End Addiction, 2019 https://www.justice.gov/sites/default/files/usao-sdca/legacy/2012/10/05/INFOGRAPHIC_FULL.pdf
- 2019 Cyberbullying Data. Cyberbullying Research Center, 2019. https://cyberbullying.org/2019-cyberbullying-data