According to the World Health Organization, when the United Nations released its 2030 Sustainable Development Goals, addressing mental health needs was directly referenced as a U.N. health priority for the first time. This is not surprising. The American Foundation for Suicide Prevention states that 1 in 5 Americans (more than 40 million people) have a mental health condition, but 56 percent of these people will never receive treatment. In the United States, 1.3 million adults have attempted suicide at least once. Medical institutions globally are attempting to improve their mental health departments to better address issues from severe depression to minor anxiety.
Many educational institutions have used holistic care as a potential solution to mental health issues. Holistic care is a comprehensive model of caring that is based on the concept of holism, which posits that the mind and spirit both affect the body. This means that biological, social, psychological, and spiritual aspects are all relevant to a person and thus relevant to academic success.
Delving Into the Data
High school students are experiencing unprecedented levels of stress, anxiety, and depression. Young adults struggling with mental health issues can often feel different, isolated, and powerless. Unfortunately, this isolation can lead to negative outcomes such as withdrawal from the community and severing ties with friends and family.
My school, West Islip High School (WIHS) in West Islip, NY, is no exception to the national and international trends. In October 2018, a questionnaire was sent to all students of WIHS. Of the approximately 1,400 students, 786 students responded. Students were asked to answer a variety of questions based on a five-point Likert Scale ranked from “strongly disagree” to “strongly agree.” The focus survey phrase was: There is at least one adult in the school who I can confide in. In answering that question, almost 46 percent said they “strongly agree,” 20 percent said they “agree,” 14 percent said they were neutral, while nearly 10 percent said they “disagree” and 10 percent said they “strongly disagree” with the statement. Over 34 percent—271 students—did not feel as though they could confide in an adult at the school.
A longitudinal study was conducted during the second semester of the 2018–19 school year. When a student entered the counseling office with a nonacademic issue, we recorded their presenting problem. According to the data gathered, 124 students entered the counseling office. Among those students, 70.5 percent reported feeling sad, anxious, worried, or depressed. These results were shocking and unacceptable to the committee compiling the results.
This data was presented to West Islip’s Child Study Team (CST), which comprises the director of counseling, all school counselors, psychologists, social workers, the nurse, the substance abuse counselor, and all school administration. Through collaborative discussions, we brainstormed a variety of possible solutions and responses. The team also sought student input while developing a plan. Through various methods of research and interviews with students, CST created the following multifaceted solution: the development of a welcoming student center, open to all students and devoted to their academic, social, and personal needs. We believe this center will provide an opportunity for increased clinicians’ accessibility, peer mentoring, and an alternative learning environment. Throughout the school day, a team of professionals—including staff and students—will be available to discuss academic and/or social-emotional concerns.
Identifying Key Obstacles to Care
As a result of the discussions with CST and students, we came to realize that the accessibility of school clinicians contributes to how we address students’ mental health. We identified various obstacles that appear while responding to mental health crises, including the counseling suite waiting room, the need for a pass, conversation with the secretary, and counselor availability.
By removing these identified obstacles, the accessibility of all clinicians will increase. The proposed student center will be staffed by school clinicians on a rotating basis so that someone will be available at any time during the day. During this time, students’ social-emotional, mental health, and personal needs will be addressed. Assigning a school clinician on a rotating basis increases the number of opportunities to create an alternative go-to person for students in need.
Research conducted by the Regional Research Institute for Human Services at Portland State University in Oregon concluded that adolescents challenged by mental health issues face an array of potentially overwhelming experiences that may manifest as sadness, anxiousness, worry, or depression. The data collected at WIHS coincide with the findings from Portland State University. In an effort to support WIHS students during overwhelming experiences, the student center implements peer mentors supervised by clinicians and staff familiar with adolescent mental health. These mentors are vetted student volunteers; each mentor provides academic and social-emotional assistance to students in need.
Adolescent peer mentors offer their firsthand experiences of living with and overcoming overwhelming experiences to support and assist other adolescents. The role of the peer mentor is someone a student in need can go to for advice on things such as course workload, relationships, and enrolling in college. According to Aspire Health Alliance in Massachusetts, peer mentoring increases connectedness with others in the school community, promotes the development of mindfulness techniques, and increases comfort and confidence to form social relationships.
During our study, we also monitored attendance for 104 school days, during which time we saw 159 students absent at least 10 days. According to the U.S. Department of Education, students who are chronically absent are at serious risk of falling behind in school. The New York State Department of Education defines chronic absenteeism as missing at least 10 percent of enrolled school days. Chronic absenteeism occurs for a variety of reasons. Christopher A. Kearney and Anne Marie Albano, authors of The Functional Profiles of School Refusal, reported that the most common diagnoses in a group of 143 children 5 to 17 years old with problematic school absenteeism were separation anxiety disorder, generalized anxiety disorder, social phobia, oppositional defiant disorder, and depression.
We observed this chronic absenteeism problem at WIHS. More than 10 percent of the student population is chronically absent. The established attendance committee at WIHS has identified the various causes of the chronic absenteeism and has implemented tiered interventions in response. One identified cause is students and families reporting chronic stomachaches, nausea, headaches, or diarrhea. The Anxiety and Depression Association of America (ADAA) describes these as symptoms related to anxiety, depression, sadness, or worry.
The ADAA suggests exposure to school in small degrees, increasing exposure slowly over time. Talking with the student about feelings and fears, arranging an informal meeting with a teacher away from the classroom, placing an emphasis on social relationships, and building relaxation and coping techniques through mindfulness exercises is essential to decreasing anxiety, depression, sadness, or worry related to school refusal and chronic absenteeism.
The student center will provide a room to transition back to school, overseen by clinicians and peer mentors. Requiring students to attend school during those hours will increase school-controlled influencers while decreasing parent-controlled influencers, e.g., video games or sleeping. The student center, under the guidance of a clinician, will provide an opportunity in school to increase classroom time and decrease alone time—while also providing an opportunity to work independently in an alternative learning environment. Charted transition time might look something like this: A student may start by spending one minute in class and 40 minutes in the student center, eventually reaching the goal of 41 minutes in class with free periods in the student center to be used as a support tool.
Anxiety, worry, sadness, and depression are temporary or chronic mental health conditions that plague adolescents and young adults. These conditions can present acute symptoms that can be quickly addressed through accessibility to a clinician or talking to a peer mentor, but these conditions can also present chronic symptoms that need to be addressed through an intensive team approach. No matter the cause or symptom, the data collected identifies that students at WIHS are reporting feeling sad, anxious, worried, or depressed. To address this concern, research supports the implementation of a student center.
We hope this center will provide an opportunity for access to a team of professionals, including staff and students, who will be available to discuss academic and/or social-emotional concerns. This center should reduce the number students reporting feeling sad, anxious, worried, or depressed while increasing the number of students agreeing with the statement “There is at least one adult in the school who I can confide in.”
Craig Gielarowski is the assistant principal at West Islip High School in West Islip, NY.