Young & Rosenberg: 4 Major Concerns School-Based Mental Health Professionals Have for Students This Fall

Districts across the country are wrestling with fundamental questions about what schooling will look like this fall. Just as important as the logistics for safely educating our kids after a return to school is the state of their mental well-being. Effective schooling is possible only if districts anticipate the mental health challenges many of their students will undoubtedly face. As superintendents and school boards determine their plan for the coming year, it’s imperative that they ask a fundamental question: Do we have a flexible, powerful mental health safety net in place? If the answer is no, now is the time to act.

We have a long-standing crisis in America, with an estimated 1 in 5 young people suffering from a mental health disorder. The COVID-19 pandemic has exacerbated this problem, with educators and clinical staff reporting an uptick in mental health challenges in children due to many factors, including academic and family stressors and social isolation. The crisis has introduced not just sickness and loss of life but also loss of employment and income for many families. These dynamics can lead to increased mental health issues, alcohol and substance abuse, family discord and even physical abuse. In many ways, the pandemic has been a universally shared form of trauma among young people, and it is likely to increase the mental health challenges students will experience when they return to some form of physical schooling in the fall.

We recently surveyed dozens of school-based mental health professionals who are providing intensive, school-based support through virtual interactions with students and their families. They identified four major concerns for the fall.

Uncertainty about what school will look like. This will make it very difficult to effectively plan mental health initiatives for the fall, particularly because they must vary based on whether schools are open. If schools reopen, social anxiety and readjustment issues will be significant. Should remote learning continue, depression and isolation, as well as family and student concerns about lost academic progress, will become more prominent.

Lack of routine in students’ lives. The degree of structure in online learning has varied widely, and students — whose powers of executive function are still developing — have struggled with time management when they have not had the fixed metronome of a school schedule to set their daily cadence. A return to the classroom may be especially complicated, for example, for children with ADHD who may now be used to getting up and walking away from their computer whenever they feel frustrated or become distracted. Also, many children’s healthy sleep patterns have been significantly disrupted and will need to be re-established.

Social structures and norms. Clinicians responding to the survey predicted that reacclimating to the social aspects of school will be tough for many students. Self-esteem and social interactions will also be complicated due to an extended lack of in-person contact, and many students could see a rise in negative, attention-seeking behavior as they try to readjust.

School avoidance and refusal. The most common prediction was an increase in school refusal, a problem that occurs when anxiety or fear causes a student to chronically miss school. There are multiple drivers of this, including increased social anxiety and fear of getting sick. Many students who were previously school-avoidant have enjoyed the relatively stress-free environment of virtual learning, and it’s highly likely that districts will see this resistance in even more students, who pick up on their parents’ anxiety and apprehension.

To meet this unprecedented mental health challenge, districts must activate a powerful safety net that serves all students. As they design these systems, it’s important to understand that the most effective safety nets have two key characteristics.

• They take the form of a continuum of care. The key best practice that has emerged around school-based mental health in recent years has been the shift from a “random acts of therapy” approach — a series of well-intentioned but disconnected efforts in the school environment — to one in which mental health supports are “tiered” so that every student gets a level of support appropriate to their level of need. Well-established, comprehensive approaches such as Response to Intervention (RTI) and Multi-Tiered Systems of Support (MTSS) are effective tools that schools use to identify and address those behavioral and learning needs through tailored services and supports. These approaches can and should be adapted to address mental health in the same way.

A system like this includes Tier 1 universal supports (a high-quality social and emotional learning curriculum, mental-health-related professional development for educators), Tier 2 moderate-intensity interventions and Tier 3 intensive in-school programming for students with more severe challenges. All this should be supported by a mental health screener that can serve as an early identification system for potential challenges.

• The mental health safety nets that districts develop must be equally effective in supporting students both in school and at home, in the same way that schools are providing blended instruction for academic programming. A virtual mental health component is essential to provide continuity of services if schools close again.

As always, the big question is how all this gets paid for. Districts must continue to be creative in finding ways to fund both targeted and broader mental health initiatives. The “good” news is that there are often inefficiencies in district mental health care, and reducing those could free up funding. For example, the cost of sending a student out of district is often six to eight times that of providing the same support in school. Reducing reliance on out-of-district placements can allow schools to reinvest in superior levels of care at lower cost, broadening the safety net and focusing on prevention rather than simply intervention.

Now more than ever, school districts must elevate student mental health to the top of their priority list. These extraordinary times and circumstances must be the catalyst for finally putting appropriate mental health supports in place for all students. Our kids can’t thrive without them.

Duncan Young is the CEO of Effective School Solutions, a national leader in school-based mental health services. Linda Rosenberg is a member of the faculty of Columbia University Department of Psychiatry, past president and CEO of National Council for Behavioral Health and an Effective School Solutions advisory board member. Jerry Barone, chief clinical officer of Effective School Solutions, contributed to this essay.

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