Children’s mental health is in crisis (2023)

As the United States approaches 2 full years of the COVID-19 pandemic, mental illness and the demand for psychological services are at all-time highs—­especially among children. While some children benefited from changes like remote learning, others are facing a mental health crisis. Prior to COVID-19, Centers for Disease Control and Prevention (CDC) data found 1 in 5 children had a mental disorder, but only about 20% of those children received care from a mental health provider. Whether kids are facing trauma because of child abuse or loss of a family member or everyday anxiety about the virus and unpredictable routines, they need even more support now—all amid a more significant shortage of children’s mental health resources.

In a 2020 survey of 1,000 parents around the country facilitated by the Ann & Robert H. Lurie Children’s Hospital of Chicago, 71% of parents said the pandemic had taken a toll on their child’s mental health, and 69% said the pandemic was the worst thing to happen to their child. A national survey of 3,300 high schoolers conducted in spring 2020 found close to a third of students felt unhappy and depressed much more than usual.

Mental health crises are also on the rise. From March 2020 to October 2020, mental health–related emergency department visits increased 24% for children ages 5 to 11 and 31% for those ages 12 to 17 compared with 2019 emergency department visits, according to CDC data (Leeb, R. T., et al., Morbidity and Mortality Weekly Report, Vol. 69, No. 45, 2020).

Emergency visits could be mitigated with more widespread outpatient care, but even before the pandemic, kids often had to wait months for appointments (Cama, S., et al., International Journal of Health Services, Vol. 47, No. 4, 2017). Only 4,000 out of more than 100,000 U.S. clinical psychologists are child and adolescent clinicians, according to APA data. School psychologists are also in short supply, leaving kids without enough support at school. The National Association of School Psychologists (NASP) recommends a ratio of 1 school psychologist per 500 students; current NASP data estimate a ratio of 1 per 1,211 students.

The pandemic has also exacerbated existing disparities in mental health services. A 2020 technical report from the University of Massachusetts Boston and University of Massachusetts Amherst found that students who needed access to school-based services the most, particularly those with lower socioeconomic backgrounds, had lower rates of counselors and school psychologists in their districts.

While federal funding has provided schools with money to support students’ well-being, psychologists have been seeking additional long-term solutions to address the mental health problems revealed and exacerbated by the pandemic, from building mental health into school curricula to training teachers in prevention strategies to support students based on psychological science.

Here are some of the most notable ways psychologists have worked to address students’ mental health and what’s ahead.

Bringing mental health into the classroom. The American Rescue Plan Act, passed in March 2021, included $170 billion for school funding, and many schools used the funding to hire mental health workers, including psychologists. Other federal and state funding is being allocated toward training more psychologists. For example, in Nevada, which has historically ranked last in U.S. mental health, the University of Nevada, Las Vegas, received a grant to train school clinicians in urban diversity and social justice, and Nevada State College received funding to create a new program to train school mental health clinicians, including psychologists.

While the field of psychology recognizes a shortage of mental health services for kids, addressing those needs may not be a realistic solution until the workforce grows. Relying on temporary funding to hire permanent staff isn’t financially sustainable for lower-income districts, said Kenneth Polishchuk, APA’s senior director for congressional and federal relations. As a result, Polishchuk said, many schools are hiring mental health providers on a short-term basis, as well as taking a preventative approach focused on training teachers in psychological principles.

Psychologists in some districts are training teachers in basic social and emotional skills to help students cope with stress and anxiety in real time, said Kathryn H. Howell, PhD, an associate professor of child and family psychology at the University of Memphis and chair-elect of APA’s Committee on Children, Youth and Families. Howell said equipping kids with coping skills in the classroom can prevent strain on school psychologists while also improving students’ ability to learn.

“As psychologists, we don’t just want to bring in interventions that only we as experts can deliver,” Howell said. “We need to make it sustainable by teaching those on the front lines how to equip kids with the skills they need to thrive.”

Some teachers are incorporating formal mental health lessons into their curriculum with help from psychologists. New York state requires basic mental health education in health classes, and Peter Faustino, PsyD, a school psychologist in Scarsdale, New York, said he’s been receiving requests from teachers for help incorporating pandemic-relevant topics like anxiety, trauma, and warning signs of suicide into their classes. Other schools, he said, are investing in social and emotional health training programs for staff, such as Yale University’s RULER program, which teaches school leaders and teachers how to equip students with emotional intelligence skills.

Training teachers to address trauma. Along with more minor mental and behavioral health concerns, teachers are facing an unprecedented number of students with trauma, said Laurie McGarry Klose, PhD, president of NASP and director of the School Psychology Program at Trinity University in San Antonio, Texas. And many teachers don’t feel equipped to handle their students’ struggles: A 2020 survey by the New York Life Foundation and American Federation of Teachers found that only 15% of educators said they felt comfortable addressing grief or trauma tied to the pandemic.

As a result, psychologists are finding new ways to share their expertise with school personnel. For example, Samuel Song, PhD, a professor of school psychology at the University of Nevada, Las Vegas, and president of APA’s Div. 16 (School Psychology), is working on a grant with colleagues to deliver a four-part web-based curriculum on trauma-informed practices. Such programs can help teachers identify signs of trauma in students and also cope with their own trauma, which Klose says are equally important. Teachers are more likely to dismiss trauma-driven behaviors as belligerence when they’re under strain, so with proper resources and training, they can better identify kids who are struggling and route them to appropriate support services within the school system.

Mental Health Primers, developed by the Coalition for Psychology in Schools and Education, also provide information for teachers to identify behaviors in the classroom that are symptomatic of mental health and other psychological issues, with the goal of directing teachers to appropriate resources for their students.

“We know one-on-one therapy won’t be possible for every kid who’s struggling, so we need a multipronged approach to help build the capacity of teachers and staff to support kids in the classroom setting,” said Melissa Pearrow, PhD, a professor of counseling and school psychology at the University of Massachusetts Boston.

Resilience is built outside the classroom, too. Howell said psychologists and graduate students from her department at the University of Memphis are also working with local community centers to train leaders in emotional health principles. “We want to help provide mentors that can be present in kids’ lives beyond their parents, who are already dealing with a lot,” she said. “We have the expertise and scientific background, and they have expertise in working directly with families and systems, so how can we pair our expertise and learn from each other?”

Ensuring long-term resilience. While short-term crisis funding has helped many communities and schools hire mental health professionals and develop related programs, psychologists and policymakers continue to advocate for more permanent solutions. In a September 2021 address to the House Energy and Commerce Subcommittee on Oversight and Investigations, APA CEO Arthur C. Evans Jr., PhD, encouraged Congress to consider long-term investments in states’ and school systems’ mental health workforces and infrastructures. In October 2021, the Biden administration and U.S. Department of Education released new guidance for schools to better help students’ mental health needs.

Several bills could help protect kids’ mental health in the long term. President Biden proposed an additional billion dollars to procure health care professionals—including mental health professionals—in schools. As of November 2021, the bill has passed in the House and will soon go before the Senate.

Also as of November 2021, bipartisan lawmakers are working to pass the Student Mental Health Helpline Act, which would create a grant program to support existing and promote new statewide student mental health and safety helplines. The Comprehensive Mental Health in Schools Pilot Program Act, a bill referred to the House Committee on Education and Labor in May 2021, would provide resources for low-income schools to integrate social and emotional learning and evidence-based, trauma-informed practices into all aspects of the school environment. Also in May 2021, the House passed the bipartisan Mental Health Services for Students Act, which would build partnerships between schools and community-based organizations to provide school-based mental health care for students. It now awaits consideration by the Senate.

Until new laws go into effect, psychologists are committed to finding new ways to address children’s mental health, not only for their own well-being but for the common good. “It’s not only the right thing to do to make sure people can have as full a life as they possibly can,” said Alan Leshner, PhD, the former director of the National Institute on Drug Abuse and former deputy and acting director of the National Institute of Mental Health, who has recently turned his attention to student mental health as a member of the National Academies of Sciences, Engineering, and Medicine Committee on Mental Health, Substance Use, and Wellbeing in STEMM Undergraduate and Graduate Education. “Young people are critical to the future of society, so it’s in society’s interest to make sure we don’t lose the talent youth could contribute to a set of problems that can be alleviated.”