The youth mental health crisis has been growing over many years. Recent studies show that the pandemic made things much worse because of its health and economic impacts on families, isolation, challenges with virtual schooling and ongoing stress and uncertainty.
And mental health care experts agree that the solution will involve investments in many sectors, including families, communities, and the health care system. However, schools are increasingly being recognized as central to solving the problem.
"We need to have a range of services that are offered to children [through schools]," says Miller, so that they can meet the range of needs that kids have.
"Some kids might just simply need to be more supported," he says. "Some kids might actually need to have more intensive counseling. Some kids might need to have access to social services that's going to allow their family additional benefits."
The report grades states based on how well they've developed eight different kinds of programs and services to improve school mental health.
These cover everything from mental health education for students, training for teachers and staff, to access to school counselors and psychologists, says Angela Kimball, senior vice president of policy and advocacy at Inseparable, one of the many advocacy groups involved in the poll. They also include getting funding from Medicaid for eligible kids, developing partnerships with community mental health professionals, and policies that foster a healthy school climate.
States like Colorado, California, Washington, Illinois and Nevada were highly rated in the report, says Kimball, because they've adopted a range of measures.
For example, she says, Colorado has leveraged Medicaid to cover school-based mental health care – including telehealth services – for all eligible students. The state has adopted anti-bullying and anti-discrimination legislation, which help create a more inclusive environment for marginalized students. (Studies show that discrimination and bullying are associated with a higher risk of mental health struggles.)
"They have a legislation that provides alternatives to exclusionary discipline like suspensions and and expulsions, which disproportionately harm students with mental health conditions, and as students of color," adds Kimball. "In addition, Colorado has also adopted mental health excused absences legislation and suicide prevention programs."
Some of the lowest rated states were Georgia, West Virginia, Missouri, New Mexico, Nebraska and South Dakota. These are places which have invested very little in mental health support in schools.
The good news, says Kimball, is that a growing number of states have adopted legislation to incorporate mental health in K-12 health curricula, so that students have the language to understand, talk about and seek help for their emotional health if necessary.
The report also highlights other states for their efforts. For example, New Jersey invested $1 million in 2021 to do regular wellness screenings, so that students who are struggling can be identified and connected to help before their symptoms escalate.
Similarly, Kansas was lauded for creating a School Mental Health Advisory Council, which brings together parents, providers, legislators and others to advise the state Board of Education on ways to address students' emotional health.
At the federal level, lawmakers are paying attention to this issue, and there is bipartisan support towards addressing it. A law passed in 2021 making funding available for school-based mental health services, and Senate leaders this year have pledged to put together a legislative package addressing mental health, including improving kids' access to care.
There have been several Congressional hearings on the issue recently, where both young people, providers and advocates have testified.
Earlier this week, Trace Terrell, a 17-year-old in Oregon, testified before the Senate Finance Committee about his own struggles with depression and suicide, as well as those of teens across the country.
Terrell, who now volunteers at Youthline, a free teen-to-teen crisis hotline, shared messages he's received from kids across the country recently, and urged lawmakers to make schools a focus in their efforts to address this crisis.
"From my experience and many of my peers, mental health efforts in schools are lacking," said Terrell. "Day after day, I hear my friends and those on the line voice about how inaccessible school counselors are due to being overworked and overloaded. This is an especially difficult challenge for the many teens who rely on school mental health professionals for crisis care."
He argued for investments to "create a streamlined approach to free mental health screenings and referrals."
"At my school, four out of every five referrals to external resources are not carried out," he said. "Let that sink in: 80% of referrals go nowhere. Someone who needs help, should receive help."
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