School-Based Mental Health Services: More Important Than Ever

With homecoming parades and midterm exams in the rearview mirror, teachers and students alike are confident of one thing: the honeymoon period of the new school year is over. 

For anyone struggling to recall just what it’s like at the start of a new year, kindly walk back to your own fresh starts…

  • The excitement of connecting with old friends and seeing new faces
  • The camaraderie of after-school sports and clubs
  • The intrigue of new classes with new teachers
  • The thrill of moving into upperclassmen status
  • The reprieve of cooler temperatures with the arrival of fall 

It’s almost palpable. Everyone is on their best behavior in the beginning. Everyone seems to have a renewed vision for the year ahead. 

That is, until enough days and weeks go by to realize that this year is not, in fact, so different from all the rest. The hardships that youth face are immense. Even with the cultural shift toward the de-stigmatization of mental illness, mental health challenges in youth are as pressing as they have ever been. 

We are in the immediate aftermath of a global pandemic that pulled the rug of normalcy out from under us. For students, COVID-19 ushered in disorienting routines, interruptions to learning, and waves of grief and loss. 

No one has been more vulnerable to the disruptions of the past few years than youth. The teachers and supporting school professionals who stand by them day in and day out are uniquely positioned to be a positive, caring force in their lives. 

So, school professionals, this article is for you.

It is for the school social worker and the school counselor; the contracted behavioral specialist; the school nurse and the pediatrician who receives referrals from the school nurse; the case worker who makes site visits to the alternative high school; all of the professionals working in school-based health centers; and so many others. This article about the intersection of youth mental health and the school system is for you.  

Running the Numbers: Understanding Youth Mental Health in the Post-COVID Era

Let’s start with the numbers. Understanding the data helps us maintain a clear picture of the reality we (and the youth we serve) are facing. 

The Centers for Disease Control and Prevention (CDC) published data in the spring of 2022 that shed light on the worsening mental health among high school-aged students. In 2021,  

  • More than a third (37%) of high school students reported experiencing poor mental health during the COVID-19 pandemic 
  • Close to half (44%) reported feeling persistently sad or hopeless during the past 12 months
  • More than half (55%) stated they experienced emotional abuse by a parent or caregiver in the home. Including swearing, insulting, or putting down
  • 11% reported experiencing physical abuse by a parent or caregiver in the home 

Data from this survey confirmed what many school-based health professionals already knew from their lived experiences – the pandemic created or exacerbated traumatic stressors that have negatively impacted students’ mental health. 

To take it a step further and look at the connection between declining mental health and bullying, substance use, sexual activity, and other high-risk behaviors, we dive into data from the Rapid Adolescent Prevention Screening (RAAPS). 

RAAPS is a standardized, validated risk screening tool designed to help professionals across disciplines identify risk behaviors in youth. It screens for depression and mood disorders, suicidality, bullying, substance use, and more. RAAPS is used by state health departments and public health organizations around the globe. 

In a recent sampling of data between September 2021 and September 2022, researchers looked at participant responses to the question:

During the past month, have you been threatened, teased, or hurt by someone (on the Internet, by text, or in person) causing you to feel sad, unsafe, or afraid?

Of the 1776 responses, 192 participants answered yes. That’s 11% of the total responses that answered affirmatively for bullying. Of the 192 respondents that answered yes to experiencing bullying, 63 stated they continued to feel threatened, teased, or hurt the following month, showing a continued and ongoing risk. 

Students who experienced bullying were 425%  more likely to report suicidality, 300% more likely to report depression and 50% more likely to engage sexual health and substance use risks. In other words, mental illness is closely tied to bullying and increased risk behaviors. 

Warning Signs That May Suggest a Mental Health Challenge

When a young child has a stomach ache or takes an extra nap one day, many parents adopt a ‘wait and watch’ approach. Meaning, the parent pays close attention to how their child seems to be feeling over the next few hours and next few days to determine if they need an intervention, like an extra day of rest, medicine, or a visit to the doctor. 

When a teen begins to display troubling behaviors, like changes in appetite or excessive worry, it may be wise for both parents and the adults in the youth’s life to consider a similar approach. 

Some of the warning signs listed below may eventually be explained by passing circumstances and fade with time. For example, if a teen is feeling very worried and has difficulty sleeping for the week leading up to a public speaking assignment, and then speech day comes and goes and their behavior returns to normal, there probably isn’t much to worry about. 

In other cases, however, changing behaviors and concerning patterns may suggest a need for professional help. As adults, we must pay careful attention to all of these red flags.

  • Changes in sleep habits (excessive sleepiness or difficulty falling or staying asleep)
  • Extreme fatigue (beyond what’s typical)
  • Changes in appetite (eating too much or too little), especially when changes cause a noticeable weight gain or loss
  • Loss of interest in usual activities
  • Withdrawal from family and friends
  • Excessive worry
  • Ideas of suicide
  • Physical ailments with no clear cause (headaches, stomach aches, digestive problems)
  • Mood changes, including drastic mood swings, 
  • Prolonged periods of sadness and feelings of hopelessness
  • Increase in aggression and irritability
  • A noticeable or sudden drop in academic performance
  • Substance use, including misuse or abuse of alcohol, nicotine products, illicit drugs, prescription drugs
  • High-risk sexual activity

When you notice these behaviors or other changes that seem unusual or concerning, pay attention. Again, it’s possible that a youth’s declining interest in their after-school sport or club is simply a reflection of changing interests, but it’s also possible that the waning participation is a signal that something deeper is going on. 

School-Based Mental Health Resources: Youth Depend On It

School-based mental health is becoming a cornerstone of wraparound services for youth with mental illness. Wraparound services include a multi-pronged approach to treatment, with providers across disciplines working together toward shared goals.

Wraparound services can include school-based case management (through a social worker or counselor), individual and family counseling, crisis care, education services, community resources (meals, transportation vouchers, etc.), support groups, and more.

School-based mental health programs look different across districts and schools, and the role of the school social worker, school counselor, and school psychologist often vary from one school to the next. For example, in some settings, the school social worker serves more as a case manager and facilitator of resources and referrals; in other settings, the social worker does more direct clinical intervention with students and families. 

School-based professionals who recognize the warning signs of youth mental illness work together with students and their families to provide resources and interventions, including:  

  • Prevention programs
  • Early identification of mental illness
  • Brief interventions, including short-term counseling, education, and sharing of resources 
  • Support groups
  • Referrals for more specialized care  

The school-based resources and interventions play a critically important role. School-based mental health professionals and programs serve as a kind of ‘home base’ for the multidisciplinary wraparound team. Studies have shown that comprehensive school mental health programs lead to several important benefits for individual youth and for the community. Here are some of them:

  • Improved access to care, especially for underserved populations including children and youth from low-income households and students of color 
  • Better mental health outcomes for youth 
  • Greater academic success
  • Improved social skills, leadership, and self-awareness
  • Connections to caring adults in the community
  • Improved schoolwide truancy and discipline rates
  • Increased high school graduation rates

Youth with mental illness, those who are being bullied, and those who are engaging in high-risk behaviors depend on school professionals like you for the support they need. 

What’s Next? … Here’s One Thing

As someone who works with youth every day, you’re probably already familiar with the research on Adverse Childhood Events, or ACEs. (If you aren’t, here is a great place to catch up). You know it takes just one caring adult to make a positive difference in the life of a youth facing toxic stress.

There are a lot of ways to be a caring adult in a youth’s life – as a teacher, a coach, a mentor, a counselor, an administrator, and more. Perhaps the most important thing to remember is simply to be consistent. 

Keep showing up, keep checking in, and don’t give up on them.  A few simple, sincere words like, “I’m so glad you’re here today,” can make all the difference. 
If you’re ready to learn more about how evidence-based risk screening tools can help you and your team clearly identify which of your youth are struggling with mental health challenges and plan tailored follow-up interventions, schedule a call here. We’re ready to talk.