(WASHINGTON) — Ten-year-old Sarah Craig banged at the side door of Granny Lin-Lin’s Louisville, Kentucky, home last December.
Through the window, Craig saw shattered glass, spilled coffee and her granny — unresponsive — slouched on the kitchen floor.
“I kept saying, ‘Granny, wake up, please’,” she told ABC News. “I just kept calling her name.”
At first, Craig thought Granny Lin-Lin had passed out, but then realized the situation was much worse.
She never woke up. Granny Lin-Lin had died from chronic obstructive pulmonary disease (COPD), asthma and emphysema.
“When I lost her, I almost felt like my whole heart had almost crushed into pieces – because like I was really, really, really, close to her,” Craig said.
Granny Lin-Lin’s death was one of several traumatic events that have taken a heavy toll on Craig since the pandemic began. But, according to the Centers for Disease Control and Prevention, even before the pandemic, mental health challenges were the leading cause of disability and poor life outcomes for young people.
Then, the Journal of American Medical Association Pediatrics found depressive and anxiety symptoms doubled during the pandemic.
Even before coronavirus crisis, young people were experiencing mental health challenges on an increased scale, according to CDC data. Persistent feelings of sadness and hopelessness increased 40% among U.S. high school students from 2009 to 2019, according to the most recent CDC Youth Risk Behavior Survey, with 36.7% reporting those symptoms in 2019. Data released by the CDC earlier this year showed 44% reported feeling sadness or hopelessness during the past year, and 37% of high school students reported poor mental health during the COVID-19 pandemic.
U.S. Surgeon General Dr. Vivek Murthy’s 2021 Youth Mental Health Advisory emphasized how today’s youth are facing an “urgent” public health challenge that needs to be addressed with immediate awareness and action.
Murthy, the nation’s top public health official, wrote experiencing trauma is a contributing factor to youth mental health symptoms during the pandemic. His advisory also warned of the increased pressure on the mental health of young people, particularly when it comes to the effects of disruptions in traditional schooling.
After more than two years of a pandemic that has interrupted the lives of millions of children — many who have experienced loss and increased social isolation — the Biden administration is prioritizing the mental health crisis on the nation’s youth. It is using funds allocated from the Bipartisan Safer Communities Act (BSCA), an anti-gun violence law passed this summer by Congress and signed by the President Joe Biden in June, to add more mental health services to schools.
The administration’s “historic funding” includes $1 billion to increase the number of school-based health professionals — and ABC News first reported the Department of Education is granting more than $280 million in competitive grants to schools to beef up mental health staffing and recruitment programs.
Education Department Assistant Secretary for Planning, Evaluation, and Policy Development, Roberto Rodríguez, told ABC News there’s never been an effort of this magnitude by the federal government to distribute mental health professionals to schools. The recent spending also helps President Biden inch closer to his goal of “doubling” school-based mental health practitioners.
“We are making a big bet on supporting, attracting, developing and retaining our school psychologists, social workers, [and] counselors to really work in support of our students,” Rodríguez said.
Practitioner shortage
Efforts by the Biden administration to curb the youth mental health crisis are needed now more than ever, advocates say. A recent National Center for Education Statistics (NCES) report found that school leaders say mental health professionals are one of the top five most understaffed positions.
“There’s a shortage of mental health professionals writ large in the country, whether it’s community or school-based,” Kathy Cowan, director of communications for the National Association of School Psychologists (NASP), told ABC News. “There is a long term shortage of school-employed, mental health professionals.”
The current national average student to psychologist ratio is 1,162:1, according to NASP. Cowan explained the federal government has just begun collecting this data in the last two years. NASP’s recommended ratio is 500:1.
Cowan explained that each of the different mental health professionals that can be found on a school staff plays a slightly different role, but that having a school psychologist on staff gives students more access to “multi-tiered systems of support.”
School counselors are typically trained teachers and have the ability to provide academic as well as social and emotional support to students, according to Cowan. She explained they are generally employed by one school, and can provide assistance with wellness promotion, social skills and even group counseling sessions for students who struggle with grief, but they cannot provide individualized clinical support.
School psychologists are able to offer those social and emotional services, in addition to individual counseling and intervention for students who need mental health support. They often serve multiple schools at once and thus, are not always on campus. School social workers similarly often work with more than one school, and are able to connect students with community resources they may need for their mental health, Cowan explained.
“In the ideal world, school systems have all three of those professionals working as a tandem and supporting not just the students in the building, but the adult systems necessary to make sure kids are getting the supports that they need,” Cowan said. “That doesn’t happen very often.”
Deputy Education Secretary Cindy Marten favors embedding school social workers into the community and underscores that they should not be left behind in addition to psychologists and counselors.
But during the early stages of the pandemic, like most education professionals, social worker numbers dipped, according to School Social Work Association of America (SSWAA) Executive Director Rebecca Oliver. Coupled with the nationwide teacher shortage, Oliver says most schools aren’t close to meeting the needs of its students because social workers are overworked and have stretched themselves thin due to increased caseloads during the shortage.
Based on data from the National Association of Social Workers (NASW), Oliver and SSWAA recommend a 1:250 social worker to student ratio. In some years the national average was 1:2106, according to the ACLU’s Cops and No Counselors report, which is considerably behind the recommended ratio for mental health practitioners.
Community response
“People underestimate the value of the school environment [for young people’s mental health],” Dr. Tami D. Benton, psychiatrist-in-chief at Children’s Hospital of Philadelphia and president-elect of the American Academy of Child and Adolescent Psychiatry, said.
But Pew Research Center found through the 2019-2020 school year, roughly half of U.S. schools offered mental health assessments, and elementary schools saw the least assessments with just four in ten public schools offering treatment for mental health disorders.
Benton said that there’s an “undersupply” among all mental health providers right now, and that one of the challenges is figuring out how to “move the knowledge without expanding the workforce,” to make mental healthcare more accessible.
Within schools, part of that progress has been teachers and school workers learning mental health first aid and how to identify when one of their students is struggling.
“Pediatricians and school counselors are the best ones to give you that kind of support,” Benton explained.
The Department of Health and Human Services (HHS) is also awarding nearly $27 million for a pediatric mental health access program for emergency department providers. Health Resources and Services Administration (HRSA) Administrator Carole Johnson told ABC News that pediatric primary health care providers will, with this new money, receive support and training in analyzing mental health conditions.
“If your school nurse is better able to identify early issues with mental health concerns and get that child referred to the right place, that’ll make a big difference for children,” she said.
Craig, the Louisville fifth-grader, sees the on-site mental health practitioner at Lincoln Performing Arts School about her grieving. She says speaking to a specialist during weekly healing sessions has been vital. According to Craig, the practitioner handed her a jar with blue “coping cards” last year to keep her busy and manage her feelings of sadness from years of trauma and social isolation.
“She was there for me, helping me and – like – supporting me,” Craig told ABC News. “I think we should just have, like, more people in the building to help students.”
Kentucky’s Jefferson County school district said Lincoln has two on-site mental health practitioners — the average number of mental health specialists in the district’s elementary school system. However, experts also told ABC News that school communities must think holistically about mental health concerns.
“SAMHSA works to address the mental health needs of children and youth across the country by developing and implementing grant programs that promote mental wellness, create opportunities to identify mental health concerns and intervene as early as possible, and provide treatment and recovery services,” said Dr. Miriam E. Delphin-Rittmon, HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “One of the most important ways we do this is through our school-based programs, which seek to support children, youth and families with the right service, at the right time and place, so that they get what they need to flourish.”
According to NCES’ School Pulse Panel, just 45% of K-12 public schools utilized a “community school” or “wraparound services” model. Of these schools, the study found, 85% stated mental health services were available to the community through their school’s existing partnerships for 2022-23.
Deputy Secretary Marten stressed the importance of creating a continuum of support for students with these services and partnering with outside organizations to bring specialists into schools. She believes it’s critical to have “mental health centers” with psychologists and trained counselors on school grounds.
“I don’t think I fully understood what the phrase ‘it takes a village’ meant until this crisis,” Benton, the child psychologist said, echoing how a community-based response can be helpful for the mental health struggles we see in young people, particularly as mental health professionals are in short supply.
Meeting students’ ongoing needs
Through roughly $314 million worth of new mental health funding via awards and grants for health professionals in schools and in emergency departments, the education department and HHS intend to help create healthier and safer learning environments for children.
As Deputy Secretary Marten explained, people should not be alarmed by the White House emphasis on supporting youth with mental health services. The career educator told ABC News this has been an ongoing issue.
“This is not a new need that we have in education,” Marten said. “It’s a consistent need. It’s always there and teachers know when you’re trying to give students what they need, when they need it, in the way that they need it. Sometimes you need additional support.”
Sarah Craig’s pandemic-related trauma not only stems from Granny Lin-Lin’s death but also includes her granny’s husband, who died earlier in 2021 due to complications from COVID-19.
Craig lost her half-brother, who was shot and killed this past spring, as well. Black youth were more likely to lose a parent or caregiver during the pandemic — losing granny devastated her.
“It just shocked me because I was the one who found her like that and if I didn’t — I mean I might have been okay, but I wasn’t okay,” Craig said.
“It’s the grief, the chronic stress and the trauma [from the COVID-19 pandemic] that the Biden administration is concerned about and want to make sure that, if needed, children and their families have access to good mental health services,” a Substance Abuse and Mental Health Services Administration (SAMHSA) official told ABC News.
Benton told ABC News this is not “the same group” of kids that left [school] before the pandemic. But even prior to the pandemic, young people experienced “worrying rates of anxiety and depression,” Benton said. She also explained that before the pandemic, many children were receiving their mental health support at school.
Meanwhile, Oliver is encouraged by President Biden’s focus on addressing the dearth of school-based services moving forward.
“Our youth deserve access to professionals like school social workers to meet their social, emotional, and mental health needs,” she wrote in a statement to ABC News.
Quinn Flowers, the 2021 School Social Worker of the Year, says mental health professionals have not only been an asset to students but social workers in particular have a unique role on school grounds. The Washington, D.C., specialist believes their versatility makes them deserving of being at the center of this conversation, from administering home therapy sessions to continuing education classes for students’ parents.
Through more than 10 years as a social worker, Flowers says she deals with crisis and behavioral intervention of all kinds and no day is like the next.
“Social workers do it all,” Flowers said. “When you’re talking about being able to provide these services in school, it is absolutely 100% essential. You have to make sure that our students are able to manage their emotions, manage their feelings, everything that they deal with, everything that they struggle with, so that they can be present and fully present in the classroom.”
A lack of school mental health professionals means less access to needed care for students, Cowan explained, but it’s also problematic at the district level because it puts schools in a reactive position, rather than being able to focus on prevention services.
“All of these things become a system-wide problem where, in essence, the school is on its back foot, not its forward foot, and it also means that when something big does happen, like a major crisis, there’s no capacity for the system to respond,” Cowan said, adding, “An ounce of prevention is worth 10 pounds of cure in this.”
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