Girls Are in a Mental Health Crisis. What Can Schools Do?

Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode! 

Dan Gorenstein: Girls in the U.S. are in crisis.

News clip: This alarming new report from the CDC…
News clip: The CDC calling the findings of this report devastating and disturbing…
News clip: It’s girls in the U.S. that are engulfed in a growing wave of sadness, violence and trauma.

DG: That CDC report found that in 2021, almost 60% of girls felt persistent feelings of sadness or hopelessness. Nearly 20% had experienced sexual violence, and 1 in 4 made a suicide plan.

Kathleen Ethier: I don’t know a single parent of a teenage girl who is not incredibly worried about the state of their teenager’s mental health. 

DG: Clinicians, schools and policymakers are racing for solutions. But will Black and Latina girls be left behind?

Sheretta Butler-Barnes: There’s been this invisibility of black and brown girls in programming in school settings.

DG: Today, as kids kick off a new school year, what schools can do to help girls of color navigate this growing mental health crisis — and what’s getting in the way. From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein, this is Tradeoffs.

*******

DG: Shekinah Jackson walked into her first day of high school on Chicago’s South Side convinced she’d spend the next four years alone. 

Shekinah Jackson: I had been bullied about my weight, my skin complexion, the way I talked. I had been bullied all throughout elementary school.

DG: Shekinah still remembered in 7th grade when a classmate mocked her for asking a question in science.

SJ: This boy, he said, he was like, “Oh, you don’t know that? You’re slow.” And I looked at him and I was like, he really just said that. He said that I’m dumb in front of everyone.

DG: By the time she started her freshman year, Shekinah believed that boy — she was dumb. The bullies who called her ugly? She’d decided they were right too. Sadness and isolation shadowed Shekinah wherever she went. At school, she tried to disappear: sat in the back, kept her head down.

SJ: I truly felt like I would never be good enough for anyone.

DG: Ngozi Harris has worked with plenty of teenagers a lot like Shekinah.

Ngozi Harris: Young girls are suffering in silence. 

DG: Ngozi is one of the leaders of a group called Working on Womanhood. This school-based counseling and mentoring program was developed in Chicago by Black and Latina women to support Black and Latina girls. In her 12 years on the job, Ngozi’s met hundreds of girls living in some of Chicago’s roughest neighborhoods: Girls who’ve seen loved ones die in front of their eyes, girls who have been raped, girls who are hungry or homeless. A large body of research shows that trauma like this often leads to depression, addiction and suicide. And yet, Ngozi says people often ignore the link between trauma and mental distress especially for girls of color, with the boys seeming to get more of the attention. 

NH: The narrative for girls is they don’t need help because they’re getting straight A’s, so why are you trying to help them? Our boys, on the other hand, are acting out a lot, and they need more support. And for us, it is about making sure that everybody understands that just because she’s able to sit quietly doesn’t mean that she’s not going through something and needs support.

DG: Ngozi says the Working on Womanhood program — or WOW — launched in 2011 as a way to help Black and Brown girls in Chicago who were falling through the cracks. The girls coming to school and getting good grades, but who were still being exposed to staggering amounts of violence and trauma. Counselors from WOW meet with small groups of girls once a week during school. They use cognitive behavioral therapy and narrative therapy — techniques to help the girls learn about themselves and develop healthy coping skills — ultimately encouraging them to take more control of their lives. 

NH: Not only cope with, like, this society ain’t right, society ain’t set up for me, but saying this is how I’m planning on changing it. 

DG: When Shekinah Jackson joined WOW as a freshman, she was just excited to get out of class an hour every week.

SJ: I really hated English. Like I was so happy when WOW used to be on English.

DG: But about 10 sessions in, Shekinah’s counselor, Nora-Lisa Malloy, passed each girl a mirror. She said look at yourselves for one minute. Sixty seconds.

Nora-Lisa Malloy: When they looked in the mirror, they saw all these imperfections that are in their head. “I am ugly. I’m not good enough. People call me loud. People call me fat. I’m too skinny.” Those girls could not look themselves in the mirror. 

DG: The taunts that Shekinah had come to believe were true were now being spoken by the other six girls in the room. And maybe for the first time, Shekinah realized other people felt just like her.

SJ: It felt like weights being lifted off my shoulders. It just felt good that I wasn’t holding it in anymore, and I can come and talk to someone about this and that. I’m just not dealing with it all on my own. It made me want to ask for help more.

DG: Shekinah decided to act on her new insight in less than a week after that session.

SJ: I had a teacher. Her name was Miss Smith. Fourth period biology. I will never forget it.

DG: Shekinah was in her usual spot hidden in the back when Miss Smith handed out a worksheet. Shekinah saw she needed help.  But that boy’s comment from 7th grade still rang in her head. 

SJ: He said that I’m dumb in front of everyone.

DG: The hurt and shame –  still fresh. But so was that session with the mirror: helping her to listen to her feelings and trust herself, remembering other girls felt just like her. With the eyes of her classmates on her, Shekinah walked from her seat in the back to Miss Smith’s desk in the front.

SJ: It was just me in the back of my head saying, “OK, you got this. Nobody’s going to say anything. It’s OK. You can go up there and ask for help.”

DG: Shekinah sat down next to her teacher who walked her through the worksheet. And when she got back to her seat, the other students at her table wanted Shekinah to help them.

SJ: I felt good. Like it felt like I had a breakthrough with asking that question.

DG: Nora-Lisa, Shekinah’s WOW counselor, noticed the change right away. It was in her body language. 

NLM: Her head was held high. She’s walking down the hallway with so much confidence she’s not worrying about what people are saying, what they’re doing.

DG: Nora-Lisa says this is what WOW does. Every year, she sees girls use the skills they learn to make real and positive changes in their lives. Program director Ngozi Harris says the 12-year old organization has long believed their program could be a national model helping Black and Brown girls address their trauma. But she said they also knew as powerful as individual stories like Shekinah’s may be, they needed more.

NH: We wanted to not only be able to say we are successful in this and we’re seeing impact in this. We wanted the data to show it as well.

DG: Working on Womanhood got its chance in 2017. WOW teamed up with the University of Chicago’s Education Lab to run a randomized controlled trial, the gold standard to test the program’s impact. The research was funded in part by Arnold Ventures, which also supports Tradeoffs. The study would measure two things: First, did WOW improve girls’ mental health — specifically anxiety, depression and post-traumatic stress disorder? Second, did WOW improve girls’ grades and school attendance? The researchers began by surveying girls in Chicago public high schools about their mental health.

Monica Bhatt: What we found was really sobering and striking.

DG: Monica Bhatt led the study. Monica says the survey results suggested the girls were experiencing – and witnessing – hard to believe levels of trauma and violence. 38% reported symptoms of post-traumatic stress disorder like negative thoughts and constantly being on guard.

MB: Candidly, when I started seeing those numbers come in, I thought there was something wrong in our measurement, and I thought we were doing the analysis wrong.

DG: Monica made her team double, triple check the results because if they were true, that would mean girls in these neighborhoods were reporting PTSD symptoms at twice the rate of returning Iraq and Afghanistan War veterans. The numbers were right.

MB: We asked the kids, are you all right? And they said, no, we are not.

DG: After the survey, researchers then compared girls who had access to normal services at school to about 1,200 randomly selected girls who received counseling and mentoring from WOW. They found that the number of girls with clinical mental health diagnoses stayed about the same, but the girls in WOW had their symptoms of anxiety drop 10%, depression 14%, PTSD 22%.

MB: As far as I know, this is one of the few programs where we have this kind of clinical evidence at scale to say this works – not just for a few students, not just for 10 students or 20 students, but for, you know, a thousand students. And that’s really heartening for us because it means that we actually have a potential solution at hand. I don’t think it’s the only solution but it’s the only one that we’ve got rigorous evidence about.

DG: At the same time, the study showed that WOW had no impact on the girls’ grades or attendance. And Monica says that made sense. Many of these girls were still coming to school, getting by, or even doing well in their classwork.  Plus, WOW’s mission is to address girls’ mental health, not boost grades. Monica says the findings challenge the notion that academic improvement should be required of a school-based mental health program.

MB: We’re forced to reckon with whether this is important, to mitigate these harms for girls who are showing up and doing what society expects them to but are carrying a really big load. Because left unchecked, these kinds of mental health challenges could have really outsized negative consequences. And so by intervening now, we’re making sure that those kinds of long term consequences don’t occur.

DG: For Shekinah Jackson, the skills she learned in WOW helped her navigate problems in her personal life and in the classroom throughout high school. They gave her the courage to take that long walk to her biology teacher’s desk. They gave her the fortitude to get her grades up at the end of senior year so she could walk at graduation. They gave her the strength to walk away from a toxic relationship. And now she’s made her longest walk yet: 180 miles to Eastern Illinois University where she’s a freshman. At 14, Shekinah was confident she would never be good enough. At 18, Shekinah is just confident.

SJ: Honestly, right now I’m not scared of anything. Like, I feel like I can overcome anything that’s being thrown at me.

DG: When we come back, we look at how schools in the rest of the country are trying to find their own solutions to the girls mental health crisis.

MIDROLL

DG: Welcome back. People who study and work with teens and mental health have known for at least 5 years that girls all over the country are struggling.

Kathleen Ethier: Back in 2017, 2018, we started seeing movement in the data that concerned us.

DG: Kathleen Ethier runs the CDC’s Division of Adolescent and School Health. But even a savvy, veteran policymaker like her was floored when the latest data came across her desk earlier this year: 6 in 10 girls experiencing symptoms of depression, 1 in 5 experiencing sexual violence, 1 in 4 making a suicide plan. And on almost every single measure, girls fared worse than boys.

KE: It’s, I mean, beyond concerning, it’s devastating. We’re sending teenage girls into their adulthood already in a traumatized place.

DG: The good news, Kathleen says, is that schools, clinicians and policymakers are more tuned in than ever. Federal officials, they’ve made it easier for Medicaid to pay for school-based mental health services. And federal and state lawmakers from both parties have poured at least $8.5 billion into school mental health in the last few years. And unlike some health crises, Kathleen says the research provides some pretty clear guidance on the best way for schools to invest that money.

KE: We have a program that’s called What Works in Schools.
DG: The name of the program is What Works…
KE: The name of the program is What Works in Schools. We thought that was apt.

DG: Arguably too on the nose name aside, Kathleen says the program offers schools effectively a menu of options the CDC endorses to help schools support the mental health of all students, not just girls. Strategies fall into three simple buckets: educate kids about mental health, connect kids in need to mental health professionals, and make school environments as safe and supportive as possible.

KE: All of this is around increasing the sense of connectedness so that young people are less likely to engage in violence, perpetuate violence, experience trauma, or if something happens to them, they have an adult right there. 

DG: Research shows that kids who feel connected to the adults in their school are less likely to report poor mental health, illegal drug use, suicidal ideation and sexual violence. So solutions exist, and policymakers are more interested than ever in funding them. But significant barriers to schools actually implementing them remain. The biggest, Kathleen says, is too few therapists and counselors.

KE: If 60% of the girls in a high school are experiencing depressive symptoms, there is no possible way that we can have enough mental health professionals in that school to handle those needs.

DG: 1 in 5 schools had unfilled jobs for mental health workers as of last September, with few districts meeting the recommended ratios of student to school psychologist or school counselor. And while state and federal lawmakers have invested in more workforce training and some schools have turned to telehealth, Kathleen says this is all going to take time.

KE: The building of that workforce takes years. And we need to do things like incentivize young professionals for wanting to do this work and wanting to work in schools.

DG: In spite of the recent funding increases, money remains a barrier to better services. Heidi Sipe has been the superintendent of the predominantly Hispanic Umatilla School District in northern Oregon for 17 years. She says schools know the critical role they play in addressing girls’ mental health, especially for kids who might otherwise struggle to get care. But schools, she says, juggle a lot: teacher shortages, learning loss. And academics is always going to top mental health.

Heidi Sipe: I could never to this day prioritize our mental health services over reasonable class sizes and textbooks and curriculum and all of that. 

DG: Another challenge? Making sure that programs are a good fit for the students they’re trying to help. Sheretta Butler-Barnes is a developmental psychologist at Washington University in St. Louis. She studies how race and gender impact the mental health and academic achievement of Black girls.

Sheretta Butler-Barnes: It’s about context. And whether we want to talk about it or not, we are in a society where the race, gender, class experiences and where we live geographically matters. And sometimes more general programs can leave out histories or experiences of people of color.

DG: Sheretta says if schools want to help Black and Latina girls, they should look for interventions that are specifically designed for them.

SBB: That means they’re bringing in the shared history of these groups, the role of how race and stress might play within these communities. They’re focused on the reduction of violence and the reduction of trauma from that, but also while empowering that youth as well.

DG: Those kinds of programs are rare, Sheretta says, and few of them have gotten the kind of rigorous evaluation that schools want. That’s why she’s thrilled about the study on Chicago’s Working on Womanhood program. But even if a school has enough money to hire enough counselors and finds a program that’s a cultural fit, there’s still a major barrier, says Superintendent Heidi Sipe.

HS: Unfortunately, like many issues in education, it has become very politicized and I think full of a lot of false narrative.

DG: Heidi says school-based mental health has gotten swept up in the larger political battle over what parents think should be taught to their kids in schools.

HS: I think parents are in some cases feeling like they’ve lost their voice and that they don’t have the same amount of influence on their children as they should.

DG: Heidi also has talked with some parents who worry their kids could be taken away if they get mental health services at school or that they could be forced to pay for care they can’t afford. Heidi counters these concerns by explaining what the district is trying to do.

HS: Because I do want parents to be able to make the right choices for their individual child. I do respect the role of a parent. But if we’re not providing a wide variety of services, and if we’re not attempting to have that dialogue with the naysayers, then we’re failing students.

DG: Heidi says when she has that dialogue, parents usually come around. But Heidi has colleagues around the country who have lost that fight and been unable to add new mental health services.

DG: As this long list of barriers makes clear, putting a dent in the girls mental health crisis is hard. But for the CDC’s Kathleen Ethier, hard is no excuse.

KE: No kid, no girl, no LGBTQ kid, no boy should exist in a place where they don’t want to live. And when more girls don’t want to live, when more girls are feeling so hopeless that they don’t want to do anything and we have the means to try to fix that for them? There is not much that I can think of that is more important than that.

DG: Kathleen takes solace knowing that solutions do exist. She’s excited to see evidence-based programs like Working on Womanhood get bigger. From just 11 schools in Chicago, WOW is now in more than 60 schools across Illinois, Boston, Dallas and Kansas City serving about 3,500 girls. Girls like Shekinah Jackson. 

SJ: I learned that it’s OK to reach out and ask for help. And it’s OK to not be OK sometimes. Like it’s OK to cry. But I don’t have to sit there and suffer.

DG: Shekinah says she’s thinking of studying psychology.

I’m Dan Gorenstein, this is Tradeoffs.

If you or someone you know is in crisis, please call, text or chat with the Suicide and Crisis Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.