Responding to the youth mental health crisis in schools

By Bethany Bray

July 2022

Late last year, U.S. Surgeon General Vivek Murthy issued an advisory to call attention to what he described as a “youth mental health crisis.” Depression, suicidality and other mental health challenges have been on the rise among American youth in the past decade, but Murthy believes the stressors and isolation of the COVID-19 pandemic exacerbated an already alarming situation.

In a June interview with ABC News, Murthy acknowledged that the crisis is ongoing, saying, “Ultimately, we will know when we’ve reached the finish line when they’re [American youth] doing well and they tell us they’re doing well and when data tells us that as well.”

Murthy’s advisory called attention to a concerning situation that school-based counselors continue to witness firsthand. American students are experiencing an increasing severity and prevalence of mental health challenges that range from self-harm and disordered eating to underdeveloped social and emotional regulation skills.

Students are trying to learn among a multitude of storms. America continues to struggle with the ongoing dual crises of racial injustice and the lingering COVID-19 pandemic. And on top of that, divisive issues related to schools have been making news headlines lately, including laws created to target transgender youth, arguments about critical race theory and school curriculum, and despair and finger-pointing after the deadly school shooting in Uvalde, Texas, which claimed the lives of 19 elementary school students and two teachers. 

It all adds up and is affecting the day-to-day lives of children and families. 

With a problem so large, it’s going to take more than school-based counselors to reverse the concerning trends in youth mental health. School counselors are on the front lines of this storm, but they also need buy-in, support and collaboration from school administration and staff, parents, community mental health professionals and the community at large.

Distress in students

Jennifer Akins, a licensed professional counselor (LPC) and president of the Texas School Counselor Association, noted that schools across her state are seeing both increased prevalence and severity of depression, anxiety, self-harm, suicidality and eating disorders among students. This has prompted statewide agencies to collect and track data on student mental health, including self-harm, to inform interventions and programs to be deployed in the public schools, Akins says.

“These are not new issues for us, but the thing is the numbers are so much greater,” says Akins, the senior director of guidance and counseling for the McKinney, Texas, public schools. “A huge area of need right now is emotional regulation. They [students] are just not as skilled right now at managing strong feelings. … Students who are experiencing thoughts about self-harm are more often advancing those thoughts into action. They now have thoughts, plus a plan, plus action.”

Texas school counselors are also reporting an increase in self-harm in young students at the elementary level, Akins adds.

Akins is far from alone in what she is seeing. The school-based counselors interviewed for this article report similar rises in self-harm, depression and other mental health challenges among their student populations. Many of these issues were present before the pandemic, but the isolation and lack of social interaction the students experienced while learning remotely during the first years of the pandemic weakened students’ social skills and their ability to regulate their emotions and cope with distress. According to several of the school counselors interviewed for this article, students’ social media use is also a factor that often makes these issues worse.

Jessica Henry has been a high school counselor for 15 years in the Akron, Ohio, area, and she says she’s never seen so many students struggling with suicidal ideation, self-harm, depression, anxiety and panic attacks.

Students are experiencing a lack of resilience and continue to struggle to adjust to in-person school, and for some, this includes developing unhealthy coping mechanisms such as self-harm, Henry says. Small problems that could otherwise be overcome often spiral into “the end of the world” for students, adds Henry, a licensed school counselor in a seventh through 12th grade school in Ashland, Ohio.

For some students, home can be a tumultuous atmosphere and a source of stress, so school functions as a safe place, which they lost when schools switched to at-home learning during the pandemic, notes Henry, a licensed professional clinical counselor and supervisor.

Jessica Holt, an LPC and counselor at a middle school in metro Atlanta, has noticed that in addition to self-harm, depression and anxiety, interpersonal problems, such as bullying and conflict with peers, have become more prevalent recently. Her school has seen an increase in the number of students requesting one-on-one counseling on their own, as well as referrals from teachers and school staff for students who need someone to talk to. There has also been an increase of students who are struggling with sexuality or gender identity issues or who feel like they don’t fit in, she says.

Even though most schools have returned to in-person instruction, the effects of being out of the school environment continue to affect students’ mental health, particularly their self-esteem, social skills and anxiety, says Holt, a member of the American Counseling Association. They are still out of practice with navigating classroom dynamics and making friends.

In Holt’s experience, many parents overcompensated and became more involved in their children’s lessons while they were at home for virtual learning. Parents would log in during virtual learning and check their child’s grades, monitor their work and send messages to teachers. As a result, Holt has noticed that students are struggling with autonomy and self-esteem now that they have returned to in-person classes. Parents are more likely to be the one to message the school when a student is failing, she notes, rather than the student being proactive and asking to make up missed assignments or for extra help.

“Kids don’t have problem-solving skills because things have been done for them. They don’t know how to cope when they are in distress,” Holt says. “One thing that has come out of the pandemic is [problems with] accountability. Students are not taking responsibility because their parents have taken everything on. … That self-advocacy piece is not there for a lot of students.”

Early intervention

Derek Francis, manager of counseling services for the Minneapolis Public Schools, says that his district will be doubling the number of elementary school counselors this fall. Counseling staff at the elementary, middle and high school levels in Minneapolis have also been leading more small groups for students to focus on social-emotional learning, managing stress, anxiety and other mental health challenges.

Minneapolis students are struggling not only with self-esteem, peer conflict, anxiety and other mental health issues but also with discrimination and bias based on racial, sexual and other identities, including negative interactions on social media, says Francis, who co-authored a chapter on proactively addressing racial incidents in schools in the ACA-published book Antiracist Counseling in Schools and Communities. In response, Francis’ school district has enhanced counseling services (including small groups) and weaved mental health discussions with a cross-cultural focus into classroom lessons across grade levels. It’s powerful when students hear that their peers are feeling some of the same anxiety and distress they are experiencing and are able to talk about it openly, says Francis, who works in the Minneapolis Public Schools’ Department of College and Career Readiness.

The Minneapolis schools are also taking an early intervention approach to mental health. Recent years have shown that elementary students can benefit from learning coping skills that help them regulate and calm themselves and deal with strong emotions, Francis says. So the district has been teaching young students how to identify when they’re becoming overwhelmed, name their feelings and use skills to calm themselves, such as breathing techniques, as well as letting them know whom they should contact within the school for additional help.

Self-regulation in a young student can mean the difference between moving on from a negative interaction with a peer on the playground or remaining upset the entire day, says Francis, an ACA member. Teaching young students these skills during elementary school may keep them from carrying over or forming difficult or unhealthy behaviors, such as skipping class, into middle or high school.

“The younger we can help kids know how to regulate their emotions and talk about their feelings, the better,” he stresses.

As manager of all the school counselors in the Minneapolis Public Schools, Francis often goes into classrooms to speak with students. During a recent session on “the power of words” with third, fourth and fifth graders, he sparked discussion by asking students for examples of incidents when they’d heard an “ouch” (hurtful) word and ways to respond when they are the recipient of or witness to an ouch word. The students had plenty of experiences with ouch words, including one kid who had been ridiculed for his lisp.

Francis then focused the conversation on social skills, empathy and ways to connect with people who come from different backgrounds. His overarching message to the students was that school should be an inclusive place, says Francis, a professional development specialist with Hatching Results, a company that provides training and continuing education for school counselors, administrators and school districts.

Francis says his district intentionally approaches hate and bias incidents in the same way they treat fire drills: It’s something for staff, students and parents to prepare for. That way, when something does happen, everyone knows how to talk about it, respond and connect with resources. 

The Minneapolis schools have also focused on the negative implications that social media use can have on student mental health. It’s become clear that students are saying hurtful things to each other online, not only on social media platforms such as TikTok and Snapchat but also via the chat feature on video games, group text messages and other avenues, Francis notes.

Adults don’t often realize how much of students’ lives are spent in the digital world, he says, and parents and students alike are not often aware of the connection between social media use and how a person feels about themselves. Many students do not have a parent or adult who monitors their dialogue on social media or helps them know when to log off or disregard negative comments, he adds.

“[Students’] brains are not developed yet to know how their words impact other people. It’s an area that needs a lot more development after the pandemic,” Francis continues. “The [effects of the] isolation of the pandemic, when paired with the negativity of social media, can really distract them from seeing positive things about themselves. We have to be mindful of the impact of screen time on students’ mental health. … It really impacts the school environment when it’s unaddressed.”

Forging connection

Holt and the other school counselors at her Atlanta-area middle school coordinate their schedules so they can visit and speak to the classrooms each fall. These visits serve as an opportunity to survey students on their mental health needs, and they also allow students to meet the counselors and learn more about the schools’ counseling programming.

The survey data they collect during these classroom visits informs the counselors’ focus for the year (e.g., the need for small groups to help students with anger, parental separation, grief or other issues) and also helps them identify and connect with individual students who are at risk, Holt explains.

Tracking student concerns and tailoring an appropriate counseling response are even more vital as mental health difficulties are on the rise.

Three students at Holt’s middle school have taken their own lives in the past five years. Part of the district’s response to the suicides, as well as to the overall increase of mental health needs, has been to establish a program that installs school-based therapists to provide long-term therapy for students. This year, Holt’s district has increased the number of school-based therapists to meet  the demand.

Holt’s school has also adopted several peer-based programs, including one that pairs established students with peers who are new to the district and another that trains students in suicide prevention and how to respond and connect a peer to appropriate help when they notice suicidal ideation (e.g., observing evidence of cutting in a peer as they change clothes for physical education classes).

The peer programming, counselor classroom visits and other recent initiatives are aimed at preventing students from falling through the cracks and help the counselors keep their finger on the pulse of the school, Holt explains. And it’s had a positive impact on school culture.

Like Holt, Henry feels that counseling staff need to be more visible and involved in their schools to respond to the recent rise in mental health needs. Now more than ever, school counselors need to get creative and set an example for other school staff by taking the first steps to forge connection with students, Henry says.

Long hours and heavy workloads leave teachers and counselors prone to burnout, but students also suffer when teachers and school staff focus on just getting through the school day and lose sight of the emotions and issues that students are dealing with beyond academics, stresses Henry, who is co-author of the 2019 book Mental Health in Our Schools: An Applied Collaborative Approach to Working With Students and Families. School staff who don’t take the time to connect with students, she says, risk not being able to recognize when a student is having an “off” day or exhibiting uncharacteristic behavior that indicates they need extra support.

School counselors can take steps to prevent this by encouraging teachers to spend time bonding with students at the start of the year, rather than diving into rigid topics such as classroom rules and expectations, Henry says. She notes that icebreaker activities, such playing bingo or prompting discussions about students’ favorite television shows or rides at a local amusement park, can make a big difference in fostering connection.

“And with that [activity] comes so much more dialogue,” she adds.

Henry also encourages counselors to be proactive and make their services known during team meetings and trainings among school staff. By emphasizing that their “door is always open” for collaboration when a student is struggling behaviorally or academically, counselors can help remind teachers that they are an important resource that can help address the underlying reasons for disruptive behavior or failing grades, such as anxiety, self-esteem issues or food insecurity at home. 

Henry says that improving student mental health and school culture is about school counselors “being present, being around [the] teachers and being around students as much as possible,” including in the hallways and at lunch. “And invite teachers to collaborate with you when a student seems ‘off,’” she adds. “When an adult reaches out, little things like that can change a kid’s life and make them feel like someone does care.”

Henry often offers to serve as a mediator between a teacher and a student when behavioral issues or conflict arises in the classroom. “I sometimes meet with a teacher behind the scenes to say, ‘Have you tried this?’ or ‘When I worked with this student, here’s what worked, here’s what he responded to,’” she explains. “It’s just like a [counseling] treatment plan; if something is not working, we move on and try something else.”

It’s easy for school staff to focus on what a student is doing wrong, she notes, but it’s more helpful to focus on what they’re doing right and emphasize their strengths. Offering students creative options beyond discipline and exploring the reasons why they’re struggling is key.

“We need to meet kids where they are,” says Henry, who counsels individual clients part-time at a private practice in addition to working as a school counselor. “Some of these kids just want to be heard. Just listening to what they have to say and not judging them makes a big difference. They need to feel like people [school staff] care.”

Barriers to behavioral health care 

School counselors are often the first mental health professional a student who is struggling with mental illness comes in contact with, notes Stephen Sharp, a school counselor at a middle school and coordinator for K-12 school counseling services in the Hempfield School District in the suburbs of Lancaster, Pennsylvania.

However, many students need long-term outpatient therapy that would not be appropriate or feasible for school counselors to offer. When students and families face barriers to access behavioral health care, it only adds to the increasing student mental health needs that schools are facing, notes Sharp, a member of the American School Counselor Association (ASCA) board of directors. 

The issue that Sharp says he finds most challenging is that for many of his students, all of their mental health support “begins and ends at the school walls.”

Sharp says he’s seen students go months without needed treatment because they were put on a waiting list for an appointment with a local mental health provider or they lack insurance or the ability to pay for treatment not covered by insurance. In some cases, undertreatment or lack of preventive treatment has led to student hospitalizations, he adds.

“The biggest need for my students is access to ongoing behavioral health services,” he says. “The reality is that it [the gap in services] creates a disproportionate burden on the schools. Not just on school counselors but teaching staff as well.”

Sharp’s school district has a strong partnership with a local behavioral health provider who provides school-based services for students. However, he says that many students are not able to take advantage of the service. Both lack of insurance and limited coverage are barriers to treatment for students, he notes, but the latter is more pervasive. Students may have health insurance, but their plan may not cover certain services such as school-based therapy or virtual therapy, he explains.

There is also a shortage of behavioral health care providers just at a time when there is an increased demand for services. Sharp says that his school struggled this year to find a qualified school-based therapist to hire in addition to school counseling staff.

Sharp’s district is not alone in this phenomenon. Francis says that community mental health agencies in Minneapolis are also full and have waiting lists. In Texas, community resources that would otherwise provide support for families outside of schools, such as social service organizations, civic centers and nonprofit programs, are declining — and in some areas are nonexistent, Akins notes.

The pandemic revealed the cracks and flaws not only of our education system but also the health care and mental health care systems, Sharp notes.

“We are in a behavioral health care crisis, not just in the state of Pennsylvania but nationally as well, and it leads to a lack of access to care. Certain areas (e.g., rural) have always had a lack of care, but it’s gotten so much worse,” Sharp says. “All of this is really disheartening and challenging, but it’s also something that we absolutely as a profession and a society need to be talking about. What level of advocacy and coordination are we going to do to address these concerns?”

Sharp says the past year has been the hardest year yet for him professionally. But at the same time, he sees opportunity ahead.

One of the lessons gleaned from Hurricane Katrina, Sharp notes, is that a coordinated response works best in times of crisis, especially when there are financial strains and staffing limitations. There is an opportunity for national-level organizations such as ACA and ASCA to offer guidelines, training and other programming to address the rise inyouth mental health concerns, he says. And there is also opportunity for multidisciplinary collaboration. For example, the Pennsylvania School Counselors Association (PSCA) is working with the Pennsylvania chapter of the American Academy of Pediatrics to address the barriers to care in their state, he notes.

Support from professional organizations as well as collaboration among and across helping professionals at the local, state and national levels “makes things better but also makes us [individual counselors] feel like we’re not the only ones pushing against a brick wall,” says Sharp, a past president of PSCA. “The more innovative that we can get and share stories of success, those are the types of things that will lead to something better after this.”

All hands on deck

As a school counselor, Holt says that she sometimes thinks of her role as a “connector” between students and families and wraparound resources that can help meet their needs outside of school, including mental health services. However, she advises school counselors to only share resources that they are familiar with and have vetted to ensure that they offer quality services.

It’s helpful, Holt says, when a professional counselor contacts her school to let them know they offer group or individual services that are well-matched to their student population. She also recommends counselors have a list of local providers that they can offer to teachers and school staff who, like counselors, sometimes find themselves overwhelmed and in need professional support.

Holt encourages community counselors to connect with their local school counselors, and vice versa. “Having that connection from community mental health to the schools is very important,” Holt says. “The more resources that we [school counselors] know about, the more referrals we can do for our parents and students. If we don’t have connections in the community, it makes it harder. Being able to know that we have partners in the community and knowing what’s available is helpful.”

Akins agrees that partnerships between school and community resources will be key in addressing the recent increase in youth mental health needs. However, community counselors need to recognize that establishing helpful collaboration takes time and patience.

There are a lot of practical components that have to fall into place before a school can adopt a new program or resource, Akins notes. “Instructional minutes are very precious,” she says, so school officials cannot always justify using class time for mental health programming.

Akins suggests that community counselors get to know the unique needs of their local school district, as well as what has and hasn’t worked for other schools, before contacting their school to offer help.

In times of crisis, “sometimes people who are coming from the [nonschool] mental health community think ‘we don’t have time to waste.’ That’s true, but processes are in place for a reason (i.e., student safety),” Akins says. “Taking the time to really connect with your district and plan and develop a formal partnership will be a lot more successful than emailing a principal to ask, ‘Can I come in and do XYZ?’”

Sandi Logan-McKibben, a clinical assistant professor and school counseling program director at Sacred Heart University in Connecticut, asserts that counselors have an ethical responsibility to know what mental health and other wraparound resources are available in their area for clients and students.

She believes in this idea so strongly that she assigns her school counseling students a community mapping project each year. The students are charged with finding resources within the school district where they are working as a counseling intern and then overlaying those resources on a Google Maps image of the area. Students’ maps include not only mental health services but also after-school, tutoring and mentorship programs; organizations that help with food insecurity, homelessness or immigration services; nonprofit or faith-based organizations; and other institutions. 

This mapping project can be helpful for community and school-based counselors, whether they are students or not, adds Logan-McKibben, an ACA member.

She also recommends counselors find and help fill gaps in needed services. This can include anything from advocating for funding at a school board meeting or partnering with an existing nonprofit to expand services to contracting with a local university to offer pro bono counseling services for school students.

“It only takes one person to enact something and prompt change,” says Logan-McKibben, a former school counselor who lives in Florida and teaches virtually at Sacred Heart. “Find out what the actual needs of your community are. Don’t make assumptions. You don’t know unless you reach out.”

Counselors in all settings have a common skill — resourcefulness — and they need to draw on that skill to meet students’ needs in this time of crisis, Logan-McKibben says. This calls for counselors to work with a preventive, proactive and collaborative focus.

“The most important thing for all professional counselors to know is that we’re all in this together. Any kind of school crisis is really a community crisis,” she says.

Sharp agrees that counselors have a role to play in advocating for support for mental health care “both in and beyond the walls of the school.” This is a time to be concerned, he admits, but it’s also a time for meaningful work to be done.

“We also need to acknowledge the work that is being done and was done before [the situation became a crisis]. That work mattered before, and it matters now,” Sharp says. “Whether it’s school counseling or clinical counseling work we’re doing, it’s a sensitive time for the profession, … but [it’s] also a time to be mindful and reflective of victories and lessons learned. Also, [counselors should] take the time to celebrate. Celebrate the work our clients and students have done and use that to make the profession better.”

The influence of social and political issues on youth mental health 

Adults have been making a lot of decisions lately that not only create news headlines but also affect youth mental health, including a law aimed at making it easier for teachers to carry firearms in Ohio schools and the controversial Florida law — dubbed “Don’t Say Gay” by its opponents — that banned classroom instruction about sexual orientation or gender identity.

For school counselors, these issues are more than soundbites on news programs. They affect their students and families and add to the already complicated work school counselors are doing to combat a rise in suicidality and other mental health concerns in American youth.

Jessica Henry, a high school counselor in the Akron, Ohio, area, says she’s had coworkers who have refused to use a student’s preferred pronouns. “Not only is that unethical and has legal ramifications, it’s [also] very difficult to hear when a teacher says, ‘I’m not doing that,’” she says.

Henry, a licensed professional clinical counselor, feels that schools (and school counselors) should take a proactive role to address controversial issues rather than avoiding them. Students, parents and educators need to hear about topics such as racial injustice and LGBTQ+ inclusion, she says.

“We have to address the bigger picture of what is going on in our world. It’s about getting your administrators and superintendent to understand that inclusivity is vital — and in turn, will affect academics,” Henry explains. “It goes back to [asking], ‘Does every kid feel safe in their school?’ ‘Does every kid feel like themselves in their school?’ If even one student says ‘no,’ we’ve got work to do.”

Part of this work also involves the need for counselors to have the humility to recognize their biases, says Derek Francis, manager of counseling services for the Minneapolis Public Schools’ Department of College and Career Readiness. The majority of the counseling profession is white, yet the majority of many school populations are not, he notes.

“We need to be mindful of our biases. … It takes laying down your privilege and learning, open listening and connecting,” says Francis. “Ultimately, we’re trying to build trust when we’re doing counseling. We want all people to know that we have positive regard for them, and we need to come in [with] the right [unbiased] mindset to help the person in front of us.”

The growing polarization of political and social issues in America has also led to distrust of public institutions such as schools, says Jennifer Akins, a licensed professional counselor and president of the Texas School Counselor Association. She’s seen this mistrust spiral into parents equating terms such as “social-emotional learning” with critical race theory.

“We [school counselors] have been working on mental health issues and school safety for a long time, and many districts have integrated mental health and social-emotional learning [into the curriculum]. There is a segment of the public that has developed a mistrust even of those words, ‘social-emotional.’ They feel that things like mental health don’t really have a place in public education or are inappropriate. That stigma adds to some of the [mental health] needs we’re seeing in students. It’s disheartening,” says Akins, the senior director of guidance and counseling for the McKinney, Texas, public schools. “There’s very little disagreement that parents want to send their child somewhere where they’re cared about and where they’re safe. But the initiatives and programs that help enhance those things are the very things that they are scared into thinking are harmful and terrible.”

One way to reduce these patterns, Akins says, is for school counselors to make transparency and communication with parents about programming a priority, as well as involving parents in the creation of programs as much as possible.

She suggests that school counselors focus on messaging that emphasizes common ground: We all want children to feel connected, to belong and to feel safe, she notes, so open communication about what a school is doing for student mental health — and why you’re doing it — can be helpful. “It’s just a matter of peeling back some of the layers of misinformation,” Akins says.

  ***** Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org. **** Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.