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We already know how to prevent pandemics
John Nwosu, a school counselor outside Atlanta, says counselors need to be more intentional and active in their work because students don’t always seek out help when they are learning from home. (Chanelle Joseph-Nwosu)

More than 10 months into the pandemic, mental health is a simmering crisis for many of the nation’s schoolchildren, partly hidden by isolation but increasingly evident in the distress of parents, the worries of counselors and an early body of research.

Holed up at home, students dwell in the glare of computer screens, missing friends and teachers. Some are failing classes. Some are depressed. Some are part of families reeling with lost jobs, gaps in child care or bills that can’t be paid.

Some students care for, or grieve, relatives with covid-19, the disease caused by the coronavirus, which has claimed more than 400,000 lives in the United States.

Mental health problems account for a growing proportion of children’s visits to hospital emergency rooms, according to the Centers for Disease Control and Prevention. From March, when the pandemic was declared, to October, the figure was up 31 percent for those 12 to 17 years old and 24 percent for children ages 5 to 11 compared with the same period in 2019.

Others suggest the fallout of the pandemic could reverberate far beyond the time of masks and quarantines.

“Students are struggling across the board,” said Jennifer Rothman, senior manager for youth and young adult services at the nonprofit National Alliance on Mental Illness. “It’s the social isolation, the loneliness, the changes in their routines.”

“Students who might never have had a symptom of a mental health condition before the pandemic now have symptoms,” Rothman said.

Lily Villa, 16, a junior at Mabton High School in Washington state, said she struggled with anxiety before the pandemic, but it is worse. Adding another layer is the cultural taboo, she said: Mental health issues are not widely discussed in her Latino community.

“A lot of the time it is just the uncertainty of school,” she said. “When am I going to be able to go back? How are my grades going to be affected not only because I am doing online school but because of my mental health?”

“My peers have struggled the same way — some of them even worse,” she said.

In Maryland, Melissa George’s middle-schooler has grown increasingly depressed amid the pandemic, she said — unable to focus on school-by-screen, failing classes, missing classmates and friends.

There have been visits to a psychiatrist, trips to the emergency room and a three-week stay in a psychiatric facility. They are a family of two, and George works in health care. Her teenager had difficulties before, but now it is much worse, she said.

“I’m scared this sets her down a dark path that may have been avoidable if she had more opportunities with friends, teachers and peers,” she said. “I don’t know what else I can do. I feel devastated.”

A growing number of studies examining the impact of covid-19 show mental health problems on the rise in children and adolescents, said Sharon Hoover, a professor of child and adolescent psychiatry at University of Maryland School of Medicine and co-director of the Center for School Mental Health.

“Many school kids are suffering,” she said. “There’s no doubt about it.”

Students who are most vulnerable are often most affected — tending to have greater family disruption and economic hardship, less access to mental health services and fewer devices for connecting to school.

Experts point out that students can have very different experiences of isolating at home. Some are doing better academically — free from social anxieties, peer pressures and distractions, and getting more sleep. Some have bonded more with their families.

But others are visibly struggling: kids who don’t get out of bed, who stop eating, who harm themselves or withdraw from families and friends. Kids who fail their courses or no longer want to plug in.

“It’s hard to see your child hurt so much,” said one mother in Silver Spring, Md., who said her teenage daughter abruptly stopped eating and doing schoolwork midway through fall. “It’s a total 180 [degrees] from the way she was.”

Her elementary-schooler, who struggled before the pandemic, has needed “serious academic and medical interventions,” said the mother, who spoke on the condition of anonymity to protect her children’s privacy.

“We were a high-achieving household that expected good grades,” she said. “Now it’s just: ‘Pass and be well.’ Grades really don’t matter at all.”

Under the radar

With so many students learning remotely, problems can be harder to spot. Often, teachers and counselors don’t see the faces of their students during Zoom sessions. Teenagers in particular don’t turn their laptop video cameras on — not wanting to show their homes in the background or feeling awkward about showing themselves.

“It’s even more difficult to build trust and see a student’s nonverbals if all you’re seeing is a black screen on Zoom,” said John Nwosu, a school counselor in the Atlanta area.

While Nwosu does use Zoom, he finds students more receptive when they see him in person. He sometimes walks a loop with them around the school building, social distancing but connecting “wherever they are.”

“It’s difficult for them to get the mental health support they need,” Nwosu said. “We have to be more intentional and active.”

In Southern Maryland, Jake Heibel, principal of Great Mills High School, said the distance created by the pandemic makes the true picture on mental health unclear.

“I’m very concerned that we don’t know even the half of it and that we’re going to spend months and years digging out,” he said. “We don’t know what we don’t know.”

But some find a way. Jan Desmarais-Morse, a middle-school counselor in Goshen, Ind., recalled a child who typed to a teacher on Zoom: “I don’t feel safe in my house.”

“We don’t know the trauma students are experiencing,” she said.

Many child-welfare workers say they wish students would come forward. Reports of child abuse have fallen markedly — not because there is less harm to children, but because so much goes unreported, experts say.

Based on the trend over 20 years of tracking cases, tens of thousands of abused children have not come to the attention of authorities during the pandemic, said Teresa Huizar, executive director of the National Children’s Alliance, an accrediting body for the country’s 900 children’s advocacy centers.

Teachers are among the frequent reporters of potential abuse, a role mandated by law.

“There are vulnerable kids in America who are trapped at home in unsafe circumstances,” Huizar said. “Even if a child wanted to disclose something, it would be very difficult right now.”

Worsening issues

Mental health problems were on the rise for young people before the pandemic. Suicide had reached a record high, the second-leading cause of death for people ages 10 to 24. Last year saw many more high school students reporting persistent feelings of sadness or hopelessness than a decade ago, according to CDC data.

Looking for a cause, experts have explored the effects of home and school stresses, social media, cellphones, disconnection and lack of sleep.

The pandemic has worsened existing mental health issues for some students, while bringing on new problems for others.

For Mekeala Watkins, a junior at Redan High School in Stone Mountain, Ga., the toll of the pandemic has worsened over time. Online learning means a pile of work every day.

“Some days I completely shut down and my mind and body refuses to do anything, which is harmful to my grades and isn’t fair to my dog or family,” she said. “I’ve had so many panic attacks in these last few months while trying to get everything completed.”

Her school created a team of teachers and administrators to support students. But she has not sought them out.

“It’s hard to just come out and explicitly ask for help or ask for a break,” she said.

For students of color, the pandemic has taken on another dimension because it hit harder in Black and Hispanic communities. And then George Floyd was killed, focusing the country’s attention on its history of systemic racism.

“They are trying to manage both of those things . . . and grief,” said Erlanger Turner, a psychologist and assistant professor at Pepperdine University.

Some have reeled, too, over the Jan. 6 storming of the U.S. Capitol by pro-Trump extremists — and the differences in police response between the riot and the Black Lives Matter protests.

Parents lament what their children are experiencing — and many struggle with their own anguish.

Kirsi Chavez, a mother of three children in Alexandria City Public Schools in Virginia, said she recently picked up her 9-year-old daughter at a recreation center and was told by the staff that the child had threatened to jump off a balcony.

“She feels sad, depressed, abandoned,” said Chavez, who works and said she has tried unsuccessfully to get a position online so that she could be with her children each day.

Chavez found a therapist for an emergency visit but is now struggling to find more help.

“They have to open the schools,” she said. “This is about mental health. Students cannot stay home this long.”

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Amber Boykin, a school psychologist in north Louisiana, said her school system has done more threat assessments for suicidal ideation in the first half of this school year than it did across all of 2019-2020.

Hopelessness and disconnection are especially problematic, she said. School connection is a protective factor for students — “a buffer for stress,” she said.

“I’m worried about it,” she said. “I think this is something we’re going to be dealing with for years to come.”

A newly published review of dozens of studies about the effects of social isolation and loneliness on the mental health of previously healthy children and adolescents found that they increased the risk of depression and possibly anxiety for up to nine years.

The review, published in November in the Journal of the American Academy of Child & Adolescent Psychiatry, looked at 63 relevant studies — including 51,576 children — between 1946 and 2020, including a retrospective investigation after an earlier pandemic.

Marian Earls, a North Carolina pediatrician who heads a mental health work group at the American Academy of Pediatrics, said it is important to remember that students not only suffer from the separation and disruption, but also are affected by their parents’ stress.

“This really is a two-generational concern,” she said.

Several psychologists say fatigue is widespread, and the cold-weather months keep families even more cooped up.

In the Washington area, psychologist Jonathan Dalton, director of the Center for Anxiety and Behavioral Change, described many of his practice’s young patients as overwhelmed, anxious or depressed.

The waiting list for treatment extends three to four months, he said. Families keep calling.

“The demand is as high as we’ve ever seen,” Dalton said.

A heartbreaking fact

Jesus Jara, superintendent of schools in Clark County, Nev., says the pandemic’s toll is amplified by one heartbreaking fact: In the first semester of the year, his system — fifth-largest in the nation — lost 10 students and two 2020 graduates to suicide.

That is compared with nine students for the full school year in 2019-2020 — most of whom died after the pandemic closed schools in March, according to officials in the school system, which includes Las Vegas.

“It was really disheartening, it was really troubling for this community, that about two-and-a-half weeks ago I lost a 9-year-old,” Jara said in an interview. In one case, he said, a student left behind a note saying there was “nothing to look forward to since school’s been closed.”

Data from the county coroner’s office — kept by calendar year, without school status — shows a one-year jump in suicide but an uneven trend. Twenty-four people ages 18 and younger died by suicide this year, compared with 16 last year, 23 in 2018 and 17 in 2017 and 2016.

Jara points out the pandemic has been economically devastating for Las Vegas, and many parents are out of work. “Our number one industry is tourism, and right now that’s very limited,” he said.

His school system has been all-virtual since March, and as Jara sees it, mental health should now be factored into the calculus about reopening schools. He is anticipating an early February return to in-person classes, starting with prekindergarten to third grade.

Colleen Neely, a high school counselor in Clark County, said she has seen mental health problems among students worsen each of the 15 years she has been on the job.

Two months into the pandemic, Neely lost a student who stopped in her office every day. He had struggles over the years but was turning a corner and about to be awarded the state’s top diploma, she said.

“He was one of those kids I thought I’d be in touch with his entire life,” she said.

Since his death in May, another student at her Las Vegas high school died by suicide.

'A tidal wave of need'

Since the pandemic, school districts and states have tried to beef up resources for young people in myriad ways — though nowhere do officials say what they are doing is enough.

Some counselors and psychologists show up at school meal or technology distribution sites to connect with families, said Kelly Vaillancourt Strobach, director of policy and advocacy at the National Association of School Psychologists. “Psychologists are getting a lot more creative in how to reach families,” Strobach said.

School systems include information about mental health resources in messages to parents and incorporate wellness activities into their reopening plans.

In Nevada, the school system is using a computer program that alerts educators and police 24/7 when students search online for information that may suggest self-harm, officials said. Monitoring continues overnight and on weekends, wellness checks have been expanded, and mental health teams are active at each school.

“I think everyone is trying,” said Bob Farrace, chief communications officer of the National Association of Secondary School Principals. “But there is a tidal wave of need.”

Many school districts have long fallen short over the years on hiring counselors, social workers and psychologists, according to standards set by professional groups. The American School Counselor Association, for example, recommends 1 counselor for every 250 students. The national average: 1 to 430.

The national average is for school-based psychologists is 1 to nearly 1,400 students, almost three times the recommendation.

In many areas, the pandemic has been another wake-up call.

In New York, city and school officials announced a mental health initiative that will target 27 neighborhoods most affected by covid-19, with a first phase focused on roughly 380,000 students in 830 schools. Plans include student mental health screenings and the hiring of 150 additional social workers. “You can’t succeed academically if you’re struggling internally,” a tweet from the mayor’s office said.

In Palm Beach County, Fla., school system leaders point to multiple ways they are trying to help. June Eassa, assistant superintendent in charge of student wellness, has hired “school-based health professionals” to support students.

Some are licensed therapists; others know how to coordinate resources and find necessary specialists. Separate mental health crisis teams respond to emergencies.

When the pandemic closed schools in the spring, the district set up a hotline for students, teachers and parents who were having trouble at home and needed help.

“We were worried we couldn’t keep a pulse on all of our kids,” she said. About 100 calls have come in so far from students and parents — with issues running the gamut from needing help with homework to calls about abuse.

In the classroom, teachers have also made changes to ramp down the stress.

Susan Barber, an Advanced Placement literature teacher at Grady High School in Atlanta, asks students every Monday to talk about one thing they did for their mental health over the weekend.

She has incorporated mental health check-ins and community building activities into daily lessons.

“While this has meant less time for academics, the trade-off in the small loss of instructional time has been well worth it,” she said.

For the winter break, Barber’s assignments include taking a respite from technology, spending time with family, eating good food, reading a book for fun, getting outside and performing a random act of kindness.

The idea, she said, is giving her students “intentional activities to get away from the computer and do something for their own mental health.”

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