Today’s high school seniors have lived through a deadly pandemic, increasing rates of climate disaster, and an armed insurrection at the U.S. Capitol — all before getting their driver’s licenses. Contentious national politics, global crises, social isolation, and the personal and academic pressures of high school have fueled what U.S. Surgeon General Vivek Murthy has called the “crisis of our time:” a national mental health emergency among young people.
The American Academy of Pediatrics declared a national emergency in child and adolescent mental health in October 2021 due to “soaring rates of mental health challenges” amongst young patients, noting that COVID-19 exacerbated a decade-long trend of worsening mental health and suicidality in young people.
Nearly two years after their announcement, profound mental health challenges persist. A CDC report released in February found that 42% of high school students felt “so sad or hopeless almost every day for at least two weeks… that they stopped doing their usual activities.” For female and LGBTQ+-identifying students, it’s even worse: the report found that almost 60% of female students and 70% of LGBTQ students “experienced persistent feelings of sadness or hopelessness.” Meanwhile, a national shortage of mental health providers, including child psychiatrists, therapists, and psychologists, has kept many young people from receiving necessary care.
Amid this crisis, school-based mental health services are a promising strategy to provide young people with mental health supports – yet many schools still struggle to adequately meet the needs of their student bodies. The Biden administration has sought to expand access to school mental health care, allocating over $42 million to develop school-based programs and expanding Medicaid support for school-provided services.
For World Mental Health Day, Teen Vogue spoke with 14 student mental health advocates in eight states about how high schools should support their student’s mental health this coming school year.
Small Changes Can Go A Long Way
Larger-scale efforts like access to care or implementing learning systems might come to mind when we think about school mental health interventions. But some students say that even small shifts like a daily conversation on mental health could make a big change.
Farrah G., a high school senior in West Des Moines, Iowa, said that normalizing mental health conversations through gestures as simple as a “five minute check-in” at the start of class can help change cultural norms around mental health. “I think that's a huge thing, because I think we all just avoid it at school because there's so much pressure to [appear] put together at school. And I think just talking about it helps everyone realize that they're not alone and that other people are going through their own mental health struggles as well,” she said.
Landon D., a high school senior in Middlebury, Indiana, likewise expressed hope for more open, understanding conversations about mental health in the coming year. “I would personally like to see [from] the teachers and administration [mental health being] talked about more,” Landon said. “That this is not something that is [just] talked about when something unfortunate happens.”
According to Dorothy Stubbe, MD, a professor of child and adolescent psychiatry in the Yale Child Study Center and medical director for the Yale Hub ACCESS-Mental Health service, this kind of open conversation can be baked into school curriculum. She proposed that a “social emotional curriculum” that discusses “mental health issues from a very early age,” teaches skills to manage emotions, and destigmatizes mental health concerns can play an important role in school mental health services.
“I think adding it to the curriculum, making it a normal aspect of coming back to school – [such as] ‘how did you do over the summer?’” Dr. Stubbe suggested. “Not just, ‘did you read your books?’ But ‘how were you feeling over the summer?’”
Structural Changes Aren’t Out of Reach
Reducing stigma through open conversation about mental health is important, but having systems in place to help people once they do open up is crucial, too. These changes, students suggested, can come as small tweaks to existing infrastructures, or complete overhauls.
Macy C., a student in Millis, Massachusetts, encouraged schools to make mental health days a reason for an excused absence from class. Daniel S., a high schooler in Bethesda, Maryland, added that schools should work to educate students about the many different structural issues that can deteriorate mental health.
“I definitely think that there is a mental health crisis among youth. I'd say some things that might be contributing to that are systemic issues that have to do with race, gender, identity, and religion,” Daniel said. “But also, things like climate change and issues that are plaguing our entire country, or the entire world. “
Joan Asarnow, PhD, clinical psychologist and professor of psychiatry and biobehavioral sciences at the UCLA David Geffen School of Medicine, said that while the outside world might be stressful for students, schools should make sure they are a safe space. Schools should assess their “school environment to make sure that they don’t have an environment that is adversely affecting the kids.”
Support Services Are Crucial
Students also discussed the role of formal support services in high schools, and the importance of widely advertising such programs. Bella N., a high school senior in Gilbert, Arizona, said that having strong in-school mental health support is crucial for students whose families might not be supportive of them seeking care outside school.
Grace F., a student in Fishers, Indiana, said that she would like her school to increase the number of social workers students can access for mental health support and to advertise their services, including connecting students to external therapists.
Despite the increasing discussion of, and funding for, school mental health services, Steven Adelsheim, MD, director of the Stanford Center for Youth Mental Health and Wellbeing noted that schools may face multiple logistical challenges in ensuring student access to mental health care, including ensuring “continuity of care” outside of school hours, having the space for mental health facilities, and administrative beliefs. “Not every school administrator believes that the role of schools is to provide health and mental health care,” he noted. “It's been great how many have been willing to do it, but we also have many administrators and school leaders that don't see that as the role and responsibility of the school.” Students may likewise hesitate to use mental health resources due to concerns over confidentiality and privacy, he said.
To fill in the gaps, schools can also advertise and partner with external mental health resources. Brendan S., a student in Phoenix, Arizona, said that his high school shares the numbers for mental health hotlines on the back of student ID cards. Brendan has worked on the establishment of mental health centers in Arizona, and encouraged schools to invest in similar spaces “where they can have students chill and just relax — even if it’s for 15 minutes from the school day, that’s really helpful and useful.”
Sienna N., a student in Germantown, Maryland, also emphasized the importance of student groups in advertising available mental health resources. “Usually kids will learn from their peers and maybe not listen to teachers, because they have that mindset — “oh, you’re not going through the same thing.” So if they hear someone going through the same struggles as them, they might listen more,” she noted.
Hannah Y., a student in Potomac, Maryland, added that school counselors occupy an important role in mental health services due to their relationships with students. “School counselors are in the most convenient position to understand where the problem is coming from because they’re directly interacting with the students,” she notes. “And they’re in a position of relative power to tell the authorities “hey, this is what we need to change.”
Some students see youth-led mental health clubs as integral to raising awareness of, and funding for, mental health services. Tabitha T. and Hannah T., founders and leaders of their school mental health club, said they hope their club’s advocacy will encourage their school to increase the number of mental health resources available.
“We don’t have an on-campus licensed psychologist, and so we don’t have a whole lot of resources that we can take advantage of,” Hannah said.
“Having this club is the first step into having more resources because people are going to see, higher-up admin are going to see – people do need this and it’s not just another club, people are actually benefiting from it and using it regularly,” Tabitha added.
Any Service Must Be Inclusive
School mental health resources should also reflect the mental health stressors faced by certain high schoolers, including LGBTQ+ youth and students of color, said Dr. Adelsheim. Schools should capitalize on the increased resources being provided to support student mental health, he added, while “build[ing] out these resources in a way that will support the diversity and needs of all of our students in schools, and particularly our marginalized populations that are often more isolated.”
“It's really important to be attentive to the fact that there may be microaggressions or many other issues that kids of color or gender diverse kids may experience that need to be checked in on,” Dr. Stubbe added.
Matthew Q., a high school junior in San Diego, California and a student board member of the San Diego School Board, noted that mental health needs may vary widely based on the conditions at individual schools and the backgrounds of their student bodies. He advised that schools “listen to your students about what they need,” and to provide the “space” for such conversations.
“That's your job as educators and leaders and administrators,” he added, “to make that happen, to listen to your students, and create an inclusive environment.”
