Meeting the Mental Health Challenge in School and at Home

This article is part of our Learning special report about how the pandemic has continued to change how we approach education.

Last year, Leticia Guerrero-Castaneda’s 11-year-old son, Isaiah, was struggling. He was in the fifth grade when the pandemic shutdown occurred, and his reaction was to shut himself down; he became pathologically afraid of germs and contamination.

“He wouldn’t come out of his room and became afraid of touching anything,” Ms. Guerrero-Castaneda recalled.

That led to depression and anxiety, which affected not only Isaiah, but his family. By the time he returned to the classroom, Isaiah was in seventh grade and, like many students, was experiencing behavior problems.

Seeking help, Ms. Guerrero-Castaneda attended two workshops run by CHAMP (Community Health Action Mental Perseverance) last spring at Norma Cooms Elementary School in Pasadena, Calif. Parents there wrote narratives of their experiences related to events that impacted their families — like Covid and school shootings — and processed those experiences with other parents.

“We came to see we were not alone,” Ms. Guerrero-Castaneda said. “We learned different coping mechanisms and were told not to ignore our feelings or our kids’ feelings. Most of us were worried about how our children will be affected in the long run. And there was a sense of great comfort in being able to talk about it with other parents.”

CHAMP was created by three faculty members at Pacific Oaks College in Pasadena: Camille Huggins and Cassandra Peel, professors of social work, and Giovanni Hortua, an adjunct professor of history and Latin American studies. Dr. Huggins said the workshops provided parents a tool kit for coping with grief and loss, for themselves and their children.

“This is a self-care exercise that gets them to reflect on their experience, to analyze and make sense of it,” she said.

Ms. Guerrero-Castaneda guided her son toward individual therapy and is emotionally supporting him as he works his way through his fears. “He started journaling and drawing as a way to express what he’s feeling,” she said. “And little by little, things are improving.”

CHAMP is one of many innovative programs and strategies schools nationwide have put in place to help students, many of whom are struggling with the toll the last two-and-a-half years has taken on their mental health. That toll has been cumulative, because distress among young people has been rising for a decade.

In 2019, the C.D.C. reported that the percentage of high school students with persistent feelings of sadness or hopelessness was nearly 40 percent, up from 26 percent in 2009, and almost 20 percent of students in 2019 had seriously considered suicide. Two years later, in 2021, 44 percent of high schoolers were feeling sad or hopeless. And suicide is now the second leading cause of death among children 10- to 14-years-old.

“The pandemic really just turned up the volume on a soundtrack that was already playing,” said Amber Childs, a clinical psychologist and an assistant professor of psychiatry at Yale School of Medicine. That soundtrack, she said, includes “racism, discrimination against L.G.B.T.Q. youth, a lack of gender-affirming care, the overturning of Roe v. Wade, school shootings, climate change.

“The pandemic happened among a groundswell of issues. And then you have children seeing adults at war with one another on social media and in the news,” Dr. Childs said. “I’ve had teenagers say, ‘Where are all the grown-ups? If they are fighting and can’t solve this, what does it mean for us?’ That can be terrifying for a kid.”

College students are also struggling. Emotional stress is one of the top reasons students consider dropping out of college, according to a report released in April from Gallup-Lumina, a private foundation that advocates for equity in higher education. Colleges and universities have lost nearly 1.3 million students since the pandemic began, according to the National Student Clearinghouse Research Center

The Connection Project, developed by Joseph Allen, a clinical psychologist and psychology professor at the University of Virginia, helps ease difficult developmental transitions, like the one from high school to college, and guides students toward forming authentic, meaningful friendships. (The high school version is known as the Teen Connection Project.) The program grew out of a study Dr. Allen conducted that followed 184 13-year-olds in Charlottesville, Va., for 25 years to learn about the friendships and social connections they formed.

The research showed that deep, early friendships enhanced a teen’s sense of belonging and reduced loneliness and depression, both in high school, college and beyond. The teen project consists of semester long weekly meetings of about eight to 10 students led by two trained and supervised student facilitators (in high schools, facilitators are trained adults).

“We know over the last 10 years that rates of loneliness and depression among young people has gone up more than 60 percent,” Dr. Allen said; data from a randomized trial of the Teen Connection Project published in May showed a reduction in loneliness and depressive symptoms. The project’s groups use specially designed exercises to help students connect with each other across social groups in a short period of time.

The program was developed in conjunction with Wyman, an organization based in St. Louis that develops evidence-based programs for teens. It’s now in seven high schools and the University of Virginia, where it began in 2018 as Hoos Connected and served 27 students; this year about 1,000 will participate.

Megan Turner, 21, a Hoos Connected facilitator and former group member, said Hoos Connected helped a great deal with her transition from high school to college. “For the first time I was surrounded by people where I felt I could share when I wasn’t doing well, and I received a lot of empathy and kindness.”

True North, a program at Boston College, began as a class for students participating in internships and evolved into a campuswide initiative. It was developed by Belle Liang, a clinical psychologist and psychology professor at the college, and Tim Klein, a licensed clinical social worker and lecturer there. True North’s structured exercises and discussions guide students toward determining their core values, skills, character strengths and the contribution they want to make in the world and connects that to life after college.

Dr. Liang’s research has shown that when students feel a sense of purpose in their work, they are buffered against academic and social stress. She and Mr. Klein are co-authors of the book, “How To Navigate Life: The New Science of Finding Your Way in School, Career and Beyond.”

The TRAILS (Transforming Research into Action to Improve the Lives of Students) program trains educators and school counselors to support students in grades K-12 by equipping them with coping skills to use when they feel anxious, stressed and depressed. That’s important because mental health crises have been rising for younger students, yet schools can’t find enough clinicians to help them.

TRAILS started as a program within the University of Michigan’s psychiatry department and the Eisenberg Family Depression Center. It grew so fast during Covid that in May it became an independent fiscally sponsored project of the Tides Center, a nonprofit that supports social change. TRAILS’ social and emotional learning curriculum focuses on teaching children how to recognize what they are feeling and strategies for coping.

“Kids usually sleep, listen to music and spend time on their phones, none of which, the evidence shows, makes them feel better,” said Elizabeth Koschmann, a psychologist and founder and executive director of TRAILS. Instead, students are taught skills grounded in cognitive behavioral and mindfulness practices, like reframing how they think about a situation or recognizing and stopping negative feelings and thoughts about themselves.

The program also offers professional development and coaching, a suicide risk management protocol and a library of resources teachers and counselors can use when working with students. About 750 schools have partnerships with TRAILS and about 8,000 teachers nationwide use its social and emotional learning curriculum. Materials in the program’s resource library are free for school mental health professionals and pulled from its website 2,500 times each day during the school year.

Students living in rural areas face significant challenges accessing mental health services, according to the Rural Health Information Hub, a national clearinghouse for information on rural health issues. Rural communities often lack local psychologists, psychiatrists or social workers and suicide among youth has historically been highest in rural areas.

The Rural Behavioral Health Institute, a nonprofit established in 2020, aims to reduce youth suicide in rural regions, starting with Montana, where young people commit suicide at more than twice the rate of young people nationwide, according to data from the Center for Children Families, and Workforce Development at the University of Montana.

In March 2021, the institute piloted its Screening Linked to Care program in one Montana high school to identify students at risk for suicide, quickly evaluate them and refer them to care. Janet Lindow, an associate professor of psychiatry at the University of Kansas Medical Center and executive director of the institute, has been a suicide researcher for six years.

“It used to be unheard-of to have a kid below age 12 being suicidal, but it is now not uncommon to have 10- and 11-year-olds,” she said.

This year, the program will offer psychiatric services, case management to help families connect to mental health providers and virtual group therapy for students in different schools with the same mental health needs. The institute screened 41 students in the 2020-21 academic year; last year, its program screened more than 1,000 children at 10 schools in five Montana counties. About 10 percent were identified as having a high risk of suicide, and about one-third needed mental health services.

Screening is critical because children who are suicidal are less likely to ask for help than other children and when they do, they usually ask a peer, Dr. Lindow said. “And their peers don’t know what to do.”

Many schools across the country have less formal approaches to helping students. Cumberland County School district in Fayetteville, N.C., created “calm corners” and “reset rooms” in every kindergarten through fifth-grade classroom with items like beanbag chairs, large pillows, art activities and fidget toys, which can help with focus and ease anxiety.

Reset rooms for sixth through 12th graders have an area where students can write in journals using prompts on the wall, punching bags, adult coloring books, Silly Putty, even illustrated instructions for breathing exercises and yoga (and yoga mats).

Dyann Wilson, who counsels sixth- through eighth-grade students at Brabham Middle School, part of Willis Independent School District in Willis, Texas, helps students build virtual “reflection rooms,” which they can visit when they feel their emotions are starting to affect their behavior.

“Students add things that make them feel better, calmer or ground them, like inspirational quotes, art, and links to music and games,” Ms. Wilson said, adding that these coping skills are crucial. “If we don’t help kids find proper ways to manage their emotions, we fail them.”

Eilene Zimmerman is a regular contributor to The New York Times and a former columnist for the Sunday Business section. She is the author of the book “Smacked: A Story of White-Collar Ambition, Addiction, and Tragedy” and a clinical social worker in Southern California.