Schools Brace For Pandemic-Fueled Mental Health Needs

September 2, 2021

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Kids are returning to in-person school this fall with increased rates of depression, anxiety and other pandemic-fueled mental health challenges, and schools are leaning on billions in new federal funding to meet the growing need.

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The Basics: Youth Mental Health

Even before the pandemic, young people in the U.S. were increasingly struggling with mental health. Rates of youth depression, anxiety and suicide have all gone up over the last decade, and kids of color were less likely to access mental health services than their white peers.

While we don’t yet have definitive national data on how the pandemic has impacted youth mental health, the evidence we do have strongly suggests it has exacerbated the problem as kids deal with isolation, economic and family instability, fear of getting sick, and grief over lost loved ones. Data from the CDC show emergency department (ED) visits for mental health and suicide for kids have gone up, and research suggests rates for anxiety and depression have too.

+ 0 %
proportion of total pediatric (<18) ED visits for mental health from 2019 to 2020¹ (see chart)
+ 0 %
ED visits for suspected suicide attempts among adolescent (12-17) girls from 2019 to 2021²
0 %
of parents report their child's mental health got worse during the pandemic³

Back-to-School: Opportunities and Challenges for School Mental Health

Schools have long played a key role in providing mental health services to America’s youth, and a large body of research finds that school-based mental health care can lead to increased access to care (especially for low-income and minority students), improved treatment adherence, better outcomes, decreased stigma and improved academic performance.

Nearly 4 million kids between 12 and 17 got mental health services in an educational setting in 2019 (roughly the same number who saw a specialist outside of school), and an oft-cited study from 2000 suggests as many as 80% of kids who receive mental health services get them at school. This includes students who see a school counselor, social worker or psychologist, as well as those who use school-based health centers, which are usually operated by a community health center or local hospital and located on school grounds.

With so many kids returning to classrooms with mental health needs this fall, many states and school districts are using some of the more than $190 billion of COVID-19 relief money Congress has set aside for K-12 education to increase their mental health services.

Hire More Staff

Many schools are trying to hire badly needed school counselors, psychologists and social workers. Some states, including Michigan and California, have set aside state funds for increased hiring too. But experts say there are not enough qualified candidates to fill the openings, especially in rural districts. In those cases, schools are turning to telehealth and community providers to fill the gap.

School-Based Health Centers

Communities in several states including Connecticut, Delaware and Tennessee are using COVID-19 relief funds to build school-based health centers, according to Robert Boyd, president and CEO of the School-Based Health Alliance. These centers can provide physical and mental health services on school grounds.

New Curriculum

Many districts are investing in training their teachers in social emotional learning (SEL) and mental health literacy curricula. SEL teaches students to manage their emotions, develop healthy relationships, and has been shown to improve student mental health, social skills and academic performance. Mental health literacy teaches students how to maintain good mental health, as well as identify and respond to mental health problems.

Staff Well-Being

Sharon Hoover, director of the National Center for School Mental Health, says some districts are directing relief funds to create support systems for staff mental health, including assessments, trainings and even gym memberships for teachers. "Districts are recognizing that student well-being depends on staff well-being," Hoover says.

Michigan as a Model of Sustainability

Many experts fear the one-time influx of COVID-19 relief funds going to school mental health will end with schools having to fire newly hired staff or discontinue new services or curricula. Sharon Hoover points to Michigan as an example of how states can more sustainably invest in supporting school mental health.

In 2019, Michigan allocated $31 million for schools to hire additional mental health professionals. That funding has been renewed each year since and increased to more than $50 million in the most recent state budget.

The state also started allowing school districts to bill Medicaid for services provided to any Medicaid-enrolled students by school health professionals. (Previously, schools could only do this for some special education students.) Being able to get reimbursed like any other provider creates a stable, ongoing funding source to support mental health staff and services in schools, even if state or federal support goes away.

Since enacting these two policies, the number of mental health professionals in schools has nearly doubled, according to the Michigan Department of Health and Human Services.

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Episode Resources

Select Reporting and Research on School Mental Health:

Kids Head Back to School—and Bring Covid-19’s Mental-Health Scars With Them (Andrea Petersen, Wall Street Journal, 8/30/2021)

American Rescue Plan Act Presents Opportunities for States to Support School Mental Health Systems (Olivia Randi, National Academy for State Health Policy, 8/2/2021)

8-Year-Olds in Despair: The Mental Health Crisis Is Getting Younger (Christina Caron, New York Times, 6/28/2021)

Nation’s skeletal school mental health network will be severely tested (Kate Rix, The Hechinger Report, 5/30/2021)

Solutions & Challenges for Children’s Mental Health in the COVID-19 Pandemic (NIHCM Foundation, 5/20/2021)

Child and Adolescent Mental Health During the COVID-19 Pandemic (National Association of School Psychologists, 4/15/2021)

The Impact of COVID-19 on Pediatric Mental Health (FAIR Health, 3/2/2021)

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R. (Benedict Carey, New York Times, 2/23/2021)

Schools As a Vital Component of the Child and Adolescent Mental Health System (Sharon Hoover and Jeff Bostic, Psychiatry Services, 11/3/2020)

Cops and No Counselors: How the Lack of School Mental Health Staff is Harming Students (Amir Whitaker, Sylvia Torres-Guillén, Michelle Morton, Harold Jordan, Stefanie Coyle, Angela Mann and Wei-Ling Sun; ACLU; March 2019)

Episode Credits


Kyron Harvell, Principal, Vivian Riddle Elementary School; Lansing, Michigan

Sharon Hoover, PhD, Co-Director, National Center for School Mental Health, University of Maryland School of Medicine

The Tradeoffs theme song was composed by Ty Citerman, with additional music this episode by Blue Dot Sessions.

This episode was reported and produced by Ryan Levi.

Special thanks to:

Elizabeth Koschmann and Lauren Kazee with TRAILS and Robert Boyd with the School-Based Health Alliance

Additional thanks to:

Karen VanLandeghem, Olivia Randi, Nicholas Affrunti, Mark Masselli, Maryjane Puffer, Rebecca Oliver, Nichole Bobo, Elizabeth Clark, John Crocker, Todd Barlass, Kayla Jackson, Nick Jaskiw, Kevin Bauer, Neal Perry, the Tradeoffs Advisory Board and our stellar staff!