For five months during her freshman year, Tuli Hannan called New York City mental health providers in her mother’s insurance network after outreach to her school guidance counselor fell flat. In 2016, most therapists she contacted near her Queens home looked to put her on a six-month or longer wait list.

Hannan, who grappled with the will to live at that time, ultimately found a therapist she felt comfortable with at the end of her sophomore year, more than two years after she identified a need for support. Though her search began long before the traumas associated with COVID-19, large numbers of young New Yorkers are facing the same difficulty in accessing mental health support at a time when demand is intensifying.

“You don’t know where to narrow it down, you feel so lost,” Hannan said. “Being the person that’s struggling, you have to keep a stable mind and the patience to look for these services.”

The process led her to become an advocate for expanded mental health support in NYC, where a plethora of services — from community-based organizations, hotlines, in-school clinics and private professionals — left her spiraling and continues to confound her peers, who will return to classrooms next week.

A February 2021 survey of about 1,300 New York City youth, aged 14-24, found that who sought mental health support received it. Across the city, 35 percent of young people surveyed expressed a want or need for services; in the Bronx, half of youth surveyed wanted access.

“People my age, my friends, they normalize the fact that we won’t get the help that we need,” said Hannan, who worked with the Citizens’ Committee for Children of New York on the “Voicing Our Future” survey while she was a student at Information Technology High School.

New York’s School Response Clinicians, a group of 85 social workers helping students in crisis to lessen 911 and emergency room outreach, , up from 242 students from July through September.

The data from NYC mirror mental health stories across age groups nationally — from elementary schoolers to . That the pandemic is exacerbating a pre-existing youth mental health crisis is by now well documented.

At least 28 states have pledged to bolster social-emotional and mental health support with pandemic relief funding. Oklahoma, for instance, of licensed mental health professionals. And since 2020, seven more states now allow mental health days as from school.

To help support the 26 New York City neighborhoods most deeply affected by the pandemic, the city’s Department of Education partnered with to establish more mental health clinics in schools.

The DOE has hired at least as a part of its $635 million academic recovery plan. In the city’s 2022 budget, . No line items reference youth mental health specifically. This could be a red flag in an already-murky support area — many providers fit under the same umbrella of “mental health services,” though not all provide services to adolescents.

Jennifer March is executive director of Citizens’ Committee for Children of New York, the nonprofit advocacy group which specializes in research and conducted the February youth mental health survey. March has led campaigns to improve young New Yorkers’ well-being and is .

“While the recent New York City FY22 approved budget takes tremendous steps in New York’s recovery, the level of suffering and trauma the city’s children and families have experienced requires further action to address. The lack of specificity on how the city will ensure access to critical behavioral health supports and how public dollars will be spent to address long-standing racial disparities in access to child mental health care is deeply concerning,” March wrote in an email to �鶹��Ʒ.

Looking for help and finding the internet wormhole

For students and families looking for mental health support, the first question becomes: Where do I start? In the internet age, they’re likely to find four sites in a quick search: the DOE’s , the for accessing supports at home, the Department of Health’s and , the confidential 24/7 text, chat and call hotline.

The sites link to each other frequently — the first section of the DOE’s page, for example, lists how to contact NYC Well for immediate assistance, and the Office of Community Mental Health site refers anyone looking to support a young person to the DOE. Yet the relationship between the agencies, and which mental health professional might exist at yours or your child’s school, are unclear without spending hours of research or calling a school directly.

The stigma and fear associated with reaching out for mental health support may prevent someone from turning to a school administrator. One Brooklyn student shared in the write-in portion of the mental health survey that they believe support outside of school should be made free to increase accessibility.

“I feel like people are afraid to talk to people in school in fear that someone will tell their parents what they say. Even if it’s just giving special access through an app like BetterHelp or offering phone calls for 30 minute sessions with therapists who will just let people vent about problems. I’m not sure who would organize that or even if this is already a thing. If it is, it should be better promoted.”

Through the end of July, individuals seeking help were likely to encounter at least some broken links, such as those on an directing to a tool on how to start a conversation over mental health concerns with their child’s school, or one at the Mayor’s Office for Community Mental Health that offered resources for teens experiencing abuse. Now, both and resources have been fixed.

Given that each school’s need varies, mental health support systems range from community schools, which offer wraparound health services; to clinics, health centers, specialists and prevention/intervention programs.

For a parent urgently looking through the DOE’s site for the best person to call at their child’s school, the differences between these iterations and the listing what program each school has, without contact information, is not exactly user friendly.

The city’s Office of Emergency Management operates an . �鶹��Ʒ could not find a comparable online resource for mental health that lists drop-in youth centers, community-based mental health organizations, and/or school-based mental health services. The closest resource city-wide is  a health and social services directory, though it does not include school-based resources.

The Community Mental Health office does provide a map of programs on its , but that platform is primarily meant to track reach and impact of city services. A parent or student seeking support cannot use it to find location sites, contact information or learn more. For some youth-specific services, map markers do not populate.

Some students or families opt for the NYC Well hotline to streamline understanding of their options and connect with care providers. Of the people who called on someone else’s behalf in 2019, called for their child. NYC Well’s average answering speed or wait time was 33 seconds from July 2020 through June 2021, according to the Office of Community Mental Health.

In the , a number of youth acknowledged that accessing support could be easier if the process and resources were made transparent in school, where they spend so much of their day. Specifically, one Queens student recommended having therapists accessible in schools and dedicating days or weeks to mental health awareness and establishing healthy habits.

In-school mental health supports inconsistent

A number of schools adopted new mental health initiatives because of and during the pandemic to meet student needs. Now 19 and recently graduated, Tuli Hannan was able to see her school partner with a community-based organization to provide more mental health services.

Students at Information Technology High School in Queens can now access on-call therapists during the school day and take online courses related to mental health, including mindfulness, reflective writing and meditation. Having access to those resources when she searched in 2016 could have made all the difference, she said.

“Now it’s easier for us to reach out to our guidance counselors because they email us, letting us know that this is what’s out here, this is what’s accessible to you, and don’t be afraid to reach out to us,” Hannan said. “I wish that that was passed on to all public schools because I know it’s different at each school.”

The New York Foundling, a centuries-old institution providing care for families and children, is one of many community organizations operating in-school mental health services. Through satellite clinics and staffing school support teams, they assist a student population of about 4,000 at 11 K-12 schools in the Bronx, Manhattan and Queens.

The Foundling is also contracted to provide clinical support in school response teams, a mix of providers and school staff that address students in crisis — a group not tethered to a specific school location.

With an end-goal to break the stigma around mental health and sustain a young person’s well-being, they involve the whole school. In practice, that means year-round support is available for students, as are workshops, training or professional development with any of the adults a young person encounters: guidance counselors, teachers, school leadership and their own families.

“We don’t only focus on the students. We believe that in order for mental health services to be sustainable and effective in school, we have to address the entire school as our client, as a community that we’re working with,” said Reïna Batrony, vice president of services for community- and school-based programs.

To get the word out about their services and full-time clinical staff, Batrony’s teams show up. At PTA meetings, afterschool events or summer school launches, staff share contact information and talk about their work, with the added bonus of normalizing the topic of mental health with parents. Students can also self-refer to their services, they don’t require a staff person or parent to make the call.

“I think everyone tends to be hesitant about mental health support. [It] varies based on culture, based on the type of trauma they may have experienced,” Batrony said. “[It] may also vary based on prior providers they may have experienced.”

The Foundling doesn’t maintain a waitlist; at the schools they partner with, a full-time clinician responds to each referral and request, connecting students or families with their services or community-based resources. For therapy sessions, they meet with youth in a confidential school space, in their homes or at one of their borough offices.

Their services and approach to involving everyone in a young person’s orbit in their mental health could have been impactful for a student like Tuli Hannan, who struggled to find support outside of school. The Foundling partners with just a sliver of the DOE’s and the decision about which ones get that level of support is made by its Office of School Health after assessing a school’s need for services, according to Batrony.

The result is inconsistent access to professional mental health support for students. For schools without full-time clinical staff or mental health centers, the baseline is a referral system and access to as-needed crisis response teams.

Guidance counselors, teachers and administrators receive on how to refer or respond in a crisis — according to the DOE, over 75,000 school-based staff were trained in Trauma Responsive Educational Practices since last year — but are not qualified to provide counseling, psychotherapy or act as social workers.

Ife Damon has been teaching New Yorkers for seven years, and says she proactively addresses mental health in the classroom to help students handle emotions and become self-aware. Since the pandemic began, she’s witnessed her English students at Curtis High School express “feelings of anxiety, stress, even depression.”

Damon makes it known to her classes that there is an in-house mental health center, and if they’re interested, they can connect with her, a guidance counselor, social worker or with the center directly. Young people, she says, typically talk openly about their mental health only “when teachers provide opportunities for students to do so.”

Located on Staten Island’s north shore, Curtis High serves predominantly Black and Latino students, who make up about 77 percent of the student body, and is . Their school-based health center provides vision, medical, dental and mental health care, coordinated by community-based organizations.

Damon serves on the community school advisory board, which hosts an annual forum open to students, parents and community members to assess community need and potential expansion. The forums also solicit feedback for the model, as Damon explains, “How can we better support you as a parent? How can we collaborate with you as a stakeholder in order to strengthen our school and help to make sure our students are getting what they need?”

The RAND Corporation’s found that the model boosted high school graduation rates, decreased chronic absenteeism and resulted in fewer disciplinary incidents for elementary and middle schoolers.

Community schools make up about 14 percent of NYC public schools. For students in the 267 schools, the model expands access to having many of their basic needs met; though citywide, . The DOE has plans to add 130 more community schools to support pandemic healing.

“We know that students cannot fully engage in learning unless their social-emotional and mental health needs are being met. Our expansion of successful established a common approach to supporting students through teacher training, resources, and direct clinical help,” DOE deputy press secretary Nathaniel Styer told �鶹��Ʒ in an email.

The department’s growing investments in clinical partnerships are “to ensure every student has a caring adult to go to when in crisis.”

More money, a new mayor and a critical moment

While the push to expand affordable mental health support to New Yorkers fosters a moment in which the city may turn its focus to youth and families.

Licensed master social worker Melissa Koppenhafer works with unhoused young people accessing mental health, housing and workforce support in CORE’s for 16- to 24-year-olds. She said that expanding school and community-based services is critical for the next mayor, but the cost must be subsidized to prevent further financial strain on young people. As CORE’s senior program director of youth and family services, Koppenhafer works with young people who are mostly covered by Medicaid or are uninsured.

“Programs that are available to them that accept Medicaid and are completely free, without a copay, are really going to be what’s successful,” she said. “Twenty dollars is a lot to them. If they’re working minimum wage, that’s more than their one-hour right there.”

In order to foster sustained mental health care for young people, Koppenhafer is also calling for the city to recruit and retain more mental health practitioners of color.

“As someone in the field, I find that people in general tend to like to have providers that they feel they can connect to via race, culture, history — any one of those things can help them connect to someone,” she said.

Though the DOE has hired for this school year, it’s unclear whether any efforts are being made to recruit social workers to better match a student population that is . Advocates say that while it’s a welcome expansion, meeting the recommended 250:1 ratio for students to social workers would .

Eric Adams, Brooklyn borough president, former city police captain and the Democratic mayoral candidate poised to win November’s general election, has of expanding mental health support for young New Yorkers. On the campaign trail, he argued in schools.

Police interventions for students in emotional distress , according to a recent analysis by Advocates for Children of New York. Looking into 12,000 incidents where children were transported to hospitals for psychological evaluations, data shows that Black students and students with disabilities were disproportionately affected and handcuffed.

An found that NYC students vastly preferred more guidance and mental health support over police, and more than two-thirds of those surveyed agreed police should be removed completely.

Advocates contend that NYC’s particular context — on the eve of a mayoral shift, with families’ demand for accessible care mounting along with an influx of federal pandemic relief funds — positions city leaders to make lasting change for youth facing mental health challenges.

“There is a critical opportunity in the year ahead,” said the Citizens’ Committee’s Jennifer March, “to invest in place-based preventive and clinical interventions in pediatric settings, child care and pre-K, schools and communities as our children and adolescents are in crisis and their behavioral health needs have skyrocketed.”

Lead image: At I.S. 584 in the Bronx, sisters Melody and Delany received in-school mental health care from the New York Foundling. (Ryan Lash / New York Foundling)

Ashley Crandall’s second grade students didn’t like remote learning during the pandemic, and they hated wearing masks.

But they did like keeping their friends and family safe, and, as Crandall told them, the best way to do that was to keep masks up and to social distance.

“It’s bigger than just us,” Crandall reminded the kids when they would complain about the masks. “We have to really think ‘big picture’ about what’s happening in our community.”

Crandall did her best, largely successfully, to keep the scariest parts of the pandemic at bay in her classroom of 19 seven- to nine-year-olds at Democracy Prep at the Stewart Campus on the southeast side of San Antonio ISD which was hit particularly hard by COVID-19.

“They’ve all been impacted in some way,” Crandall said, referring to lost jobs, family members who fell ill or died, and the general anxiety swirling through the community. “School provided a place for students to disconnect from fears that might have been placed on them.”

Because she could provide that safe place, fear, happiness, and relief showed up in artwork the students created for �鶹��Ʒ, when they were asked to illustrate the “best” and “most challenging” parts of the year. The drawings conveyed two distinct messages:

First, the kids loved their friends, teacher, and community, and had suffered during remote learning.

Second, the kids saw the value in safety protocols even though they hated the masks.

One girl even added a little second-grader shade to her response, “I like how people couldn’t get in my fase [sic] because of Covid.”

The mental health effects of the pandemic went beyond fear, grief, and loss related to the virus, and even the additional economic strain placed on families. Experts say the disruption and discomfort of safety protocols were stressful for kids.

“Kids are more sensitive, they’re not all rolling with the punches,” said school counselor Phyllis Fagell, author of the book Middle School Matters. It’s the job of the adults in their lives to keep stress from turning into anxiety by giving them tools to cope, she said.

Powerlessness — feeling that the pandemic and all of its protocols have been forced upon them — was part of the stress, Fagell said.

Having the power to help protect their loved ones and friends could actually help, if framed correctly, Fagell said. “We want them to focus on what they can control and what they care about.”

That’s a lesson that extends beyond the pandemic. Mask-wearing isn’t the last opportunity kids will have to embrace an inconvenience or disruption by seeing it as a contribution to their community.

Crandall’s success in helping alleviate her students’ anxiety meant that the kids didn’t feel the urgency of mask wearing out of fear. She instead had to appeal to their shared values as a class — empathy for those who might have been fearful, civic duty to “slow the spread”, and care for the health of others.

So instead of “the school is making me wear this uncomfortable mask,” Crandall would emphasize that choosing to wear a mask is a way to strengthen the community bond, because they knew they were sacrificing some comfort to keep each other safe.

The mind-shift worked: “keeping our community safe” was the best part of the year, student David Sutton said.

Lead photos by Bekah McNeel, design by Cheryn Hong

Updated 

For years, kids in Veronica Salgado’s “transition camps” have enrolled because they are anxious about making the challenging leap from elementary to middle school, or from middle to high school.

But this summer, after more than a year of isolation, the struggle to keep up with online learning and little contact with friends, Salgado, Youth Development Manager for Family Service Association, and her team are seeing bigger problems than just helping kids figure out how to find their lockers or make new friends.

Anxiety levels are skyrocketing as kids worry about their ability to keep up with school work, focus in a room full of peers, and navigate social situations with peers they have not seen face-to-face in more than a year. The need is so great that some of the kids in the camp are in non-transitioning grades.

“It’s all hands on deck, for sure,” said Salgado of the camps, hosted in coordination with school districts, and now connected to a hub of mental health services, many established just months before the pandemic hit in March 2020 in what was once a mental health desert on San Antonio’s South Side.

Counselors say it was just in time too: The six organizations at the hub were inundated with requests for services during the pandemic. Now, with the pandemic waning and re-entry weighing on the minds of anxious students and families, they are going full steam to prevent disaster.

At the transition camp, Salgado and her colleagues are on alert for signs of what educators and healthcare providers are calling a “second pandemic” of mental health issues in young people.

“We want to keep them as motivated as possible,” Salgado said. Without someone making a deliberate effort to draw them out, she said, many remote learners will not simply bounce back into the social rhythms of school. “They just go back into their shell.”

While students are participating in transition camps, other family members can access counseling, addiction support, and parenting classes.

The pandemic itself originally accelerated the demand for mental healthcare. Where they had expected to provide about 300 people with counseling and related services in their first few months with the collaborative, said Talli Dolge, CEO of Jewish Family Service, which provides counseling services at the hub, by May 2020 her organization saw over 1,600.

Demand stayed strong in the next school year: From August 1, 2020 to May 27, 2021, the collaborative served 4,619 people.

Most of the counseling during the pandemic had to do with grief and fear as jobs disappeared, loved ones fell ill, and domestic violence increased.

The collaborative weathered the pandemic with telehealth, including donating burner phones to families who didn’t have access to the necessary technology. Family Services continued seeing clients in person, and Communities in Schools, another collaborative partner, made house calls.

But now there is a new issue: re-entry.

Kids started going back to school mid-year, Dolge said, and instantly the mental health crises exploded — the hazards of being isolated at home gave way to all out panic over returning to school.

“The crisis rates are up tremendously,” Dolge said. “Social anxiety is huge and across the board.”

It’s a daunting forecast, but two years ago it would have been devastating.

In 2018 student advocates in South San Antonio ISD hadn’t begun speaking out on the mental health challenges they faced, and the extraordinary lengths they had to go to in order to get help. Texas ranks 50h out of 51 states (and the District of Columbia) in access to mental healthcare for children and adults, and the situation is far worse for lower income communities like the South Side of San Antonio.

The first Mobile Mental Wellness hub opened at a building on the campus of a South San Antonio ISD elementary school in November 2019, not knowing then that a once-in-a-lifetime crisis would soon begin on the other side of the globe.

Going forward, organizations like Rise Recovery, a hub partner, will have their work cut out for them. Alcohol, marijuana, and prescription drug abuse rose during the pandemic as teens self-medicated in isolation.

Experts say they won’t really know how much until students return to school, where the eyes of teachers, coaches, and counselors can spot the warning signs.

What worries Rise Recovery CEO Evita Morin and others are the new cases, the ones that have been hidden behind screens during remote learning.

“The lack of data (during the pandemic was) disturbing,” said Morin said, “I’m not a fan of disciplining kids with addiction, but at least before COVID schools were catching drug use and they could report it to us.”

Because Texas schools started bringing a percentage of students back in the fall of 2020, educators got early glimpses of the coming mental health crisis. So, even with the pandemic still raging in San Antonio, other school districts asked the collaborative to set up shop in their district.

Neighboring school district Harlandale ISD launched their hub in November 2020, and Edgewood ISD, where the pandemic was falling heavily on working class and impoverished neighborhoods on the city’s West Side opened a hub in January 2021.

Altogether the three hubs have created mental healthcare access for 23,535 students from pre-k to twelfth grade.

For many, Dolge knows, the suffering is only getting deeper as the world moves forward, and traumas, anxieties, and grief goes unaddressed. She’s trying to raise more awareness in the community that help is within reach.

“If you didn’t know where to get help before,” Dolge said, “It’s so much more important to get help now.”

For mental health support related to COVID-19, call Texas’s 24/7 at 833-986-1919. You can also call the National Suicide Prevention Lifeline at 800-273-8255 or text 741741 from anywhere in the country to text with a trained crisis counselor. 

Dallas principal Ruby Ramirez knew trouble was brewing when the school counselor came to her office looking grim.

A once gregarious, curious student was disappearing before their eyes, the counselor told her, rarely speaking in class, ignoring his work and classmates, and combing his hair forward over his eyes as if to block out the world.

The bright middle schooler had been struggling with remote learning, and Dallas Independent School District’s School for the Talented and Gifted was able to convince his parents to send him to school in-person, hoping that would reignite his love of learning.

It didn’t.

The counselor also had an ominous message for Ramierez:

“He’s not the only one.”

That’s when Ramirez knew for sure: the second pandemic, the pervasive mental health challenges facing youth around the world, was at her doorstep. If her school didn’t get out ahead of it, they could lose their students. With the looming crisis, Ramierez decided it was time to revisit her training.

“We have work to do,” Ramirez said. Once she saw students’ languishment extending beyond remote learning, enduring into the school building, she knew deeper challenges awaited. “We had gotten to a point where the desire was fading.”

It was time to prepare her staff for the challenges to come.

Mental health professionals and doctors around the globe are warning that after more than a year of stress, isolation, grief, and fear, students will not simply spring back into school. Young people everywhere from to to the are reporting more anxiety, depression, and trauma symptoms.

In addition to withdrawal, increased moodiness and volatility, parents are reporting terrifying instances of self-harm, or young children expressing thoughts of suicide, which have led to a nationwide for children under 18.

The CDC reported that between April and October 2020, the proportion of emergency department visits for kids ages 5 to 11 was up 24% from the same period in 2019, the proportion of visits for 12–17 year-olds increased by 31%. Experts say the stressors of the pandemic have added to the already mounting crisis of anxiety-related disorders in , some as young as eight years old.

As a result, demand for the Mental Health First Aid courses is soaring among teachers, counselors, coaches — people who interact with kids, said Judith Allen, a certified Mental Health First Aid instructor.

Through her , Allen trained 500 adults this spring, and the nonprofit will triple instructors to meet demand this fall. The online courses made it possible for people from across the country to participate.

During her youth-oriented course — roughly seven to eight hours between the pre-work online, class session, and assessment — adult participants started by learning a foundational truth: administering first aid is not about the adult saving the day.

“You’re not a superhero, there’s no cape,” Allen said. In a session in early April, she showed the online group several scenarios where an adult might be tempted to come up with the saving insight or even offer an arm-chair diagnosis. The students in the scenarios expressing loneliness, hopelessness, and lack of motivation mirrored what parents and teachers are describing seeing more of in the wake of the pandemic.

Seeing a kid in crisis elicits a strong desire to save the day, Allen said, but rather than focusing on saying the right words to inspire, motivate, or even break through to a teen going through a mental health challenge, the training encouraged adults to be observant and open, listening to students without judgement or quick answers.

“(CPR training) does not qualify you to crack open their chest and massage their heart,” Allen told our class. She compared this to Mental Health First Aid: offering advice, diagnosis, or counseling should be left to professionals. “No one is leaving here with a doctorate in psychology or psychiatry.”

That didn’t mean walking away without new knowledge. Merely spotting trouble among adolescents can feel like something that requires just those degrees sometimes, and that’s where the course does offer tools most adults don’t already have, like looking for warning signs, indicators that something was amiss with the teen.

As students flood back into classrooms, experts are warning that the anxiety and mental health challenges could increase. Knowing the warning signs will be key to catching challenges early, getting the young person professional help, and possibly saving a life.

The course explained developmentally appropriate pulling away from family, changes in interests, and emotional expression and compared that to signs of trouble.

While most teens will pull away from family to some degree, pulling away from friends and mentors at the same time could be a sign of trouble.

Changing interests from childhood hobbies to more socially or ambitiously motivated interests is also typical. Losing interest and motivation in every area is a warning sign.

Watching the videos, it’s clear that a mental health challenge would be hard to spot from one interaction with a teenager. It was also understandable why signs were so much harder to spot over zoom: the intensity, frequency, duration of the warning sign is what Mental Health First Aid responders should note. While teachers might notice withdrawal or lack of motivation over Zoom, it was hard to tell where else that might be showing up. As Ramirez had noted, remote learning was tough for everyone, and it was hard to tell whether a child was experiencing Zoom fatigue or something more pernicious.

Teachers, coaches, and youth leaders who see the kids regularly and in person are ideally situated to catch the red flags when kids go back to school. Seeing students day in and day out will allow them to track the moods and behaviors that might need to be addressed. A bad day is going to happen, but lots of worsening bad days that extend into bad weeks is a sign of a mental health challenge.

Much of the data presented in the course helped lay people understand the difference between a mental health challenge and mental illnesses or disorders. One in five young people must manage a longer term mental illness in order to thrive, but many more will face a mental health challenge—for instance, a season of depression, substance abuse, or anxiety— during adolescence.

Thriving with a mental illness or disorder is possible if it’s properly managed, Allen reiterated during the training, just like with chronic physical conditions.

The converse is true as well. Mental health challenges can occur in people with no underlying mental illness.

That’s what’s going to be so tricky for teachers, experts warn. The conditions are right for just about anyone to have a mental health challenge in the next year. At the same time, mental illness, especially those illnesses related to trauma, will likely show itself more readily.

In some ways, Ramirez has been in the eye of that hurricane for a long time, though. Nearly half of all mental illnesses present by age 14, the last year of middle school.

Children who grow up in poverty, like 88% of the students at the School for the Talented and Gifted, are at for mental disorders, toxic stress, and trauma. They’ve also been more heavily impacted by the pandemic.

“It’s scary,” Ramirez said, “Traumas have set in for our students, in their minds, in their thinking, that are really going to hinder them forever if we don’t address them.”

Ramirez first took a Mental Health First Aid course, along with her administrative team, in 2018 through Mental Health America of Greater Dallas. Students are taught how to look out for each other as well. This year, with the increased urgency of the pandemic, 10 more staff members took the class so that a quarter of the adults on the School for the Talented and Gifted campus will be certified in Mental Health First Aid. She’s hoping to get parents to enroll as well.

“It changed the way that I saw mental health,” Ramirez said, “It helped destigmatize, for me and my administrative staff, mental health.”

For mental health support related to COVID-19, call Texas’s 24/7 at 833-986-1919. You can also call the National Suicide Prevention Lifeline at 800-273-8255 or text 741741 from anywhere in the country to text with a trained crisis counselor.

When parents tell Denise Pope, an adolescent well-being expert, they’re worried for their children’s mental health, she responds with a question.

“How many hours are they sleeping?”

That catches many parents off guard, says Pope, co-founder of the Stanford University-affiliated nonprofit Challenge Success. Few see their teenage children’s mental health as linked to their sleep schedules. And besides, most parents go to bed before their high school-aged kids anyway, right? When Pope points out that teenagers need about nine hours of sleep each night, many parents scoff.

They shouldn’t.

As concerns for youth depression, anxiety and suicide have skyrocketed amid a deadly pandemic that disrupted schools across the country and isolated teens from their friends, researchers agree that consistent, sweet slumber can go a long way toward making students feel better.

In recent years, school leaders have highlighted that quality sleep is an important precondition for academic success, helping young people pay attention and retain material. In a 2019 effort to safeguard rest for teens, California pushed back school start times for middle and high school students statewide. But the mental benefits extend far beyond learning, experts say, emphasizing sleep as a key to healthy emotional regulation for young people.

By way of explanation, Pope offers a metaphor, which she credits to psychologist Lisa Demour.

“If you had sort of a magic pill that you could take that would help increase your mental health, increase your physical health, lower your stress, make you more efficient,” she says, most people would be itching for a dose.

Well, we do have that magic pill. “It’s called sleep,” says Pope.

But according to her research, teens are skimping on this vital resource, and the problem has only worsened with COVID-19.

In fall 2020, Pope’s Challenge Success team joined with NBC to on their well-being and academic engagement through the pandemic. They found that high schoolers were getting an average of 6.7 hours of sleep per night — well below the recommended nine-hour benchmark, which only 7 percent of students were hitting. Five percent of students regularly slept under four hours per night, the research team found.

Even though remote school eliminated commutes for many students, 43 percent of high schoolers reported that they were sleeping less since the pandemic struck, compared to only 23 who reported sleeping more. Anecdotal accounts indicate that quarantine spurred many teens to , and using naps as a coping mechanism when they started to spiral.

“My sleep schedule really went off the rails when the pandemic started,” Bridgette Adu-Wadier, now a senior at T.C. Williams High School in Alexandria, Virginia, told �鶹��Ʒ. During the day, on top of attending classes, she had to keep an eye on her two younger brothers, first- and second-graders who would constantly interrupt her with quarrels over toys, requests for help with schoolwork and messes to clean up in the kitchen.

Distracted days meant she frequently had to log late nights working to complete a never-ending stream of assignments. Sometimes, she would find herself nodding off while working. “It was just really hard managing my time with all the things that I had to juggle,” said Adu-Wadier.

The Virginia high schooler has not been alone. Students in a tricky AP course she’s enrolled in share a group chat, and on nights before assignments are due, messages buzz into the wee hours of the morning as peers scramble to finish. In the mornings, some of her friends can’t drag themselves out of bed for online class. Throughout this year, peers “definitely were in a similar boat,” says Adu-Wadier.

At the same time, isolation and worries for COVID-19 have exacerbated levels of teen stress and anxiety nationwide. Between April and October 2020, the share of mental health-related emergency department visits . Over 1 in 5 teenagers surveyed by EdWeek Research Center in April said , compared to less than 1 in 10 who said it went down.

Based on increased demand for behavioral health services over the past four months, Colorado Children’s Hospital on May 25 declared a . The hospital’s chief medical officer said the situation is more severe than anything he has seen in his 20 years of practice.

Though experts say it’s , parents of teens who took their own lives say that the circumstances of quarantine contributed to their children’s desperate condition.

Susanne Button, a clinical psychologist who directs high school programming for the Jed Foundation, an organization dedicated to preventing youth suicide, is especially worried for LGBTQ+ youth. Queer and trans teens struggled with high rates of suicidal ideation even before the pandemic, she says, and in the past year, many have been forced to .

Working with such students, Button emphasizes the importance of good sleep hygiene.

“You can’t sleep off some of these stressors, but you certainly can link sleep into resilience,” she told �鶹��Ʒ. “Adequate sleep for teenagers stabilizes mood and reduces irritability and depression.”

“Adolescents who don’t have enough sleep tend to actually engage in more high-risk behavior when they don’t feel mentally calm or happy,” continued Button. “Adolescents who get enough sleep tend to make better decisions and be less impulsive around risk-taking when they’re feeling stressed or distressed.”

But for students like Adu-Wadier, budgeting time to rest can be a challenge. She knows her well-being and mental health took a hit through much of the past year — she sometimes lacked patience, felt irritable and snapped at family members because she was over-tired — but it can be hard to find time to snooze when assignments are piling up, she says.

“[Sleep] ends up taking a backseat.” For many peers, she explained, the choice is a simple cost-benefit calculus: “They’ll feel tired, but at least they won’t be failing a class.”

In such cases, Pope of Challenge Success suggests a compromise. Every week, try to push bedtime just a few minutes earlier.

“Don’t let yourself look at that extra TikTok video, don’t stay up for the news, whatever it is. Just try to move that needle by 15 minutes at a time.”

Screen use before bed is something parents ought to monitor, Pope says. A mother herself, she’s had to institute a no-devices-at-night rule for her kids.

“Parenting needs to change as technology changes,” Pope says.

Of course, many youth live in conditions where it can be tricky to cultivate friendly sleeping conditions. Perhaps they’re staying with relatives or in a homeless shelter. Still, even small changes can help, says Pope, who recommends earplugs and sleep masks to mute outside stimuli.

As for Adu-Wadier, the long hours she logged studying for high-level courses have paid off. This spring, she earned admission to study at Northwestern University on a full scholarship.

On the night she got the good news, the college-bound senior didn’t stay up late celebrating. Instead, she tucked herself in at 10:30 p.m.

“I just went straight to bed,” Adu-Wadier remembers. “I didn’t spend a ton of time trying to do assignments or work on college applications because I didn’t need to do any more college applications. So I just attempted to go to sleep.”

Whether it was the news from Northwestern or a full night’s rest, the next day had a certain shine to it.

“I woke up feeling a lot different,” said Adu-Wadier. “It’s a very great feeling.”

As vaccine distribution picks up pace across the country and governors join President Joe Biden’s push for schools to return to in-person instruction by May, leaders are moving quickly to ensure that reopenings happen safely. The School Superintendents Association, AASA, estimates that the average district will spend more than $1.7 million on safety protocols, such as facility improvements and personal protective equipment — much of it allowable expenses under the new $1.9 trillion stimulus package.

But physical health precautions shouldn’t be the only considerations for defining a “safe” school reopening. While young people, on the whole, have fared better physically than adults during the pandemic, researchers say isolation — such as that caused by school closures and quarantining — is leading to a “.” In a recent survey, two-thirds of parents said their child had experienced mental or emotional challenges, including anxiety, depression, and suicidal thoughts, in the last month.

Unfortunately, this was a problem long before COVID-19. About 20 percent of students need mental health services, with the onset of half of cases , and only a small portion will access appropriate care. Early intervention, however, can mitigate long-term consequences of mental illness. Yet the infrastructure for students to receive mental health services at school is woefully underdeveloped. Only obtains needed mental health services through school.

Nearly half of public school students are enrolled in a school without a psychologist on staff, and less than 3 percent of schools nationwide meet the recommended social worker-to-student ratio.

Classroom teachers and staff are often the first adults outside the family to interact with students experiencing psychological distress. Thankfully, the recent stimulus packages allow schools to allocate funds toward mental health-related services, which could include professional development to train teachers and staff members to recognize signs that students are struggling. With the appropriate training, teachers and other school staff can learn to manage conversations with students to help them navigate challenges and, if necessary, connect them with mental health support services.

Here are four ways schools can prioritize mental health as part of a safe reopening plan:

1 Prepare teachers and staff to recognize signs of distress among students

signs of psychological distress in students can’t rest entirely on school counselors and psychologists. Every adult member of a school community should be the eyes and ears for students who are struggling. Professional development programs can empower school employees to recognize emotional and behavioral cues that might point to more serious mental health concerns. That identification, as well as the skills to approach, talk to and, if necessary, refer students in psychological distress, is integral to supporting school mental health initiatives. As teachers and staff members become more adept at recognizing the signs, the safety net expands, providing a safer and more trusting environment, so learning can move forward. Employees equipped with these skills provide a strong, sustainable foundation for promoting wellness and school safety.

2 Increase availability of mental health services and resources.

When asked about providing mental health services to students, 75 percent of surveyed public school principals cited as a barrier, as well as access to mental health professionals and community support. Allowing local education agencies to use stimulus funding for these services is a good start. But district leaders must prioritize school-based mental health services. Access to mental health resources should be as important a component of school safety as pandemic-related protocols like social distancing, wearing masks and disinfecting classrooms.

3 Address stigma through mental health literacy.

A simple approach for schools looking to promote mental health is to encourage conversations that normalize the topic and propagate positive attitudes. Minimizing the shame and guilt students experience as a result of mental health concerns is a critical component in eliminating stigmas that prevent students from seeking help. When administrators, teachers and staff have the resources and skills to support students who are struggling, the culture shifts. Fostering positive student-teacher relationships also helps prevent teacher stress and burnout, increasing job satisfaction. A nurturing school climate provides a safe place for students to seek mental health support services, which ultimately will strengthen learning and academic success.

4 Teach students to manage feelings through social-emotional learning.

Social-emotional learning helps students regulate their emotions and behaviors. An analysis of programs that focus on emotions, relationships and decisionmaking revealed , all of which contribute to school safety. Through social-emotional instruction, students learn to identify their feelings, form positive relationships, set achievable goals and demonstrate empathy toward peers and adults. School districts can train teachers to incorporate lessons on social-emotional skills into their curriculum, then give students an opportunity to put those skills into practice.

Historically, there has been a need for schools to prioritize mental wellness — not only for students, but for teachers as well. The pandemic has shined a spotlight on the need for a broader definition of school safety, one that considers the social and emotional needs of the school community. Let’s seize upon this era of increased awareness to focus on emotional well-being and ensuring that schools can provide students with a safe, supportive environment where learning can thrive. For that to happen, school leaders and policymakers must be ready to prioritize prevention through a mental health lens.

is a clinical psychologist and co-founder and director of research at Kognito, which uses evidence-based simulations to harness the power of role-play to help educators and mental health professionals improve social, emotional and physical health.

Yet amid growing concern that the pandemic and its widespread disruptions to schools could have a devastating, long-lasting toll on students’ mental health, the new offers some optimism. While the survey offered critical insight into the challenges youth have experienced over the last year, it also pointed to a remarkable amount of resilience among young people. In fact, just a third of parents said their child’s emotional health is worse than it was before the COVID-19 outbreak. More than half of parents said their child’s mental health is the same as it was before the pandemic, and 16 percent said that it has actually improved.

That finding caught Sara Gorman, JED’s director of research and knowledge dissemination, off guard. While the survey findings make clear that schools must prioritize youth mental health as students return to classrooms, they weren’t nearly as worrisome as she had predicted. JED, a nonprofit, is focused on the mental health of teens and young adults, working with schools and colleges on youth suicide prevention.

“What we were expecting to see was something much more significant,” she said. “That really spurs for us an interest in studying further how this resilience develops and what methods these students have been using to keep themselves mentally afloat.”

The new data come amid a pitched debate about whether to reopen schools during the pandemic — a move the Centers for Disease Control and Prevention has endorsed in places with low to moderate spread of COVID-19 so long as students wear masks and follow other public health recommendations. Preventing a potential uptick in youth suicide rates has also been pitched as a reason to reopen schools quickly.

Such a reality played out in Las Vegas, Nevada, where officials as motivation to reopen campuses. But mental health experts say a delay in comprehensive, real-time mortality data has hindered officials’ ability to get a clear picture of the problem. Suicide, the second leading cause of death for youth 10 to 24 years old, was already on the rise before the pandemic.

Lisa Horowitz, a staff scientist and clinical psychologist at the National Institute of Mental Health, called the country’s youth suicide rate “an incredible public health crisis,” but the pandemic’s effect remains unclear, though there are reasons to be concerned.

“The truth is that we don’t have suicide statistics yet for 2020,” she said during a recent webinar. Yet many of the pandemic’s effects, like social isolation and the loss of in-person connections, “can exacerbate a lot of the risk factors for suicide.”

In the JED survey, 3 percent of student respondents said they’ve had suicidal thoughts in the past month. Meanwhile, 28 percent said they experienced anxiety, 20 percent experienced social isolation or loneliness and 14 percent experienced depression.

Students were far more likely to report having mental health challenges during the pandemic if a family member or friend had contracted the virus, or if a parent lost work because of the unstable economy. Meanwhile, the parents of students in middle school were most likely to observe mental health issues in their children, a finding Gorman theorized was the result of social deprivation.

“The brain development at that time makes them want to be more social, and a lot of development happens over those couple of years,” she said. “Part of the reason they’re struggling more, they’re basically getting a signal from their brain that they’re supposed to be with other people their age.”

The online survey included a national sample of 2,075 parents and 899 teens 13 to 18 years old, two-thirds of whom were not attending school in-person full time. The survey was conducted in September and October, early in the current school year and shortly before the presidential election.

As the national infection rate drops, schools begin to reopen and millions receive the vaccine, Gorman said students’ mental health has likely improved some, but she warned that the effects could be long-lasting. For some, the “fallout” of pandemic-induced trauma could manifest even after the current crisis ends.

The survey results offer important lessons for policymakers, Gorman said. Previously, “people were just kind of assuming that mental health must be really bad during the pandemic and that we have to get students back to school as quickly as possible,” she said.

But the results suggest that the pandemic itself is more to blame for students’ mental health issues than its havoc to schools. While 88 percent of students said they were concerned about how long the pandemic would last and 78 percent were concerned about contracting the virus, 67 percent of teens said they worried about falling behind academically and 61 reported concern about their mental health.

These findings, Gorman said, suggest that young people have been resilient during the crisis “because if students were really distressed, they might be focused on their own mental health and they were really more focused on the global situation.”

Still, as students return to schools in many cities, Gorman said it’s important that educators assess young people’s mental health and act swiftly when youth are in crisis. To help guide that work, JED has partnered with more than a dozen schools across the country to implement that aims to identify students at risk and provide mental health care to those who are struggling. Looking beyond this past year, the pandemic won’t be the last crisis that students experience in their lives.

“We can’t prevent any of those things from happening in many cases,” she said, but schools can teach kids how to regulate their emotions during times of intense stress. “We hope that schools see more and more how important that is because that’s what’s going to really help students when these kinds of things inevitably recur.”

Like other schools in the Washington, D.C. area, Achievement Preparatory Academy is following guidance from local health officials and government agencies and conducting its classes 100 percent virtually. We have incorporated lessons learned from the spring semester and are providing a mix of live and pre-recorded instruction as well as computers and school supplies for all scholars and training for families to support them in the virtual learning environment.

But regardless of how or when students return to their classrooms, there’s a troubling new issue we cannot ignore: the mental health of young students traumatized by the ongoing coronavirus pandemic, worldwide protests calling for racial justice, and fear students and their parents may be feeling around high unemployment and an economic crisis that will largely impact poor and underserved communities more than others.

The fact is that nearly everyone’s mental health has been impacted by these events. Even in families where no one contracted COVID-19, there have been countless changes to what “normal life” looked like. Team sports and practices have stopped. Contact with friends has abruptly ended. Entire families have been cooped up at home trying to work and learn in the same space. And vacations, birthday parties, and holiday celebrations have been canceled. For too many families, the pandemic has also meant deep concerns about bills and food insecurity.

All this against the backdrop of constant news stories chronicling the increasing COVID-19 death toll, mounting job losses, and civil unrest stoke grave insecurities in children and their families.

Psychologists and sociologists are advising that teachers are likely to see – both in scholars and themselves – conditions including trauma, post-traumatic stress disorder (PTSD), agoraphobia, hypochondria, and obsessive-compulsive behavior, as well as an increase in incidents of anxiety. Recess won’t be 100 kids running around playing tag on the playground and then coming into the cafeteria to have lunch together, side-by-side. The fact that “back to physical classrooms” won’t be back to what we thought of as “normal,” means that for any school environment, there will be mental stressors on scholars and staff.

Many scholars, parents, and teachers can be expected to feel scared or anxious. They will need to be reassured that those feelings are normal. Since many children, especially young children, may not know how to express their emotions, teachers, parents, and staff need training and coping strategies to ease stress. They will also need those skills for themselves.

“Teachers will usually be the first ones to see changes in behavior since they are on the front line with scholars,” notes Michele Swinson, CEO of AprilMay Company, a pediatric organization serving the mental health needs of children in the Washington, D.C. community and the city’s public and charter schools. “Undoubtedly, teachers will also need social and emotional support, and cannot be the only resource for students.”

Teachers and staff need to be taught to recognize the signs of mental health disturbances, and how and when to get scholars the right support they need. While it is impossible to accurately diagnose a mental health disorder without some one-on-one discussions with the person, there are some behaviors that may signal that someone needs help. These include anger (which can be a sign of depression), lack of regard for things the person used to enjoy, changes in sleep patterns (sleeping much more or much less), engaging in high-risk activities without regard to the person’s own health, and the inability to concentrate.

“A child who is acting out might be doing that based on anxiety or fear. Parents and teachers need to know how to recognize where emotions are coming from so they can help,” Swinson adds.

One essential feature will be trauma-informed classrooms, which give students space to show their emotions without feeling that something is wrong. These classrooms include quiet spaces for scholars who are feeling overwhelmed and teachers who establish clear and predictable schedules that provide a sense of security.

One of the biggest challenges in a post-COVID (or continuing-COVID) school environment that is also affected by racial and economic concerns will be how to socialize in a way that is safe. School is such an enormously important space for children to learn social skills while interacting with others. Losing the experience of a busy lunchroom or groups of kids outside at recess means opportunities to socialize will be limited.

It will be equally important for staff to talk with students, especially younger ones, about why the school culture has changed and ask them for ideas about how to connect and interact while still following new rules. While they may not have a lot of words to describe how they are feeling, kids know what they like and what they don’t like. Inviting them to help with solutions to be “safely social” will get their buy-in, ease some fears and probably result in creative ideas that adults may have overlooked.

Schools will also want to consider using recess time or breaks in online instruction more actively for emotional development. This may include conversations in small groups to talk about how they are feeling, what they are scared about, or one good thing that happened to them that day.

The resources available to help scholars with their mental health will vary greatly depending on the school’s own programs, partners, and local agencies. At Achievement Prep, we are fortunate to have a strong in-house team, as well as a partnership with AprilMay, who has increased the mental health services it is providing not only to our scholars but also to staff and families.

As schools build their new cultures, it is vital that the process remains collaborative. Input from parents, teachers, administrators, and students must be heard and respected. That, in turn, will build consensus, increase acceptance of the new plans, and lessen anxiety around the changes.

There is no doubt that what school looks like now is very different and more challenging than anything we have seen before. But it also gives us a chance to integrate mental health into classrooms as never before. And that could be the start of something great for our children and ourselves.

Steaven R. Hamlin, Jr. is the director of scholar support at Achievement Preparatory Academy, a Washington, DC-based public charter school that serves Ward 8 in Southeast D.C.