The mental health decline of Black and multiracial school-age youth before and during COVID-19 is evident from numerous data sources, including Mental Health America (MHA), the Substance Abuse and Mental Health Administration, and the Congressional Black Caucus Emergency Task Force on Black Youth Suicide. The pandemic only added fuel to the fire—as seen from an alarming 2021 U.S. Surgeon General’s advisory on youth mental health and a Centers for Disease Control and Prevention survey showing that 44% of high school students reported feeling persistently sad or hopeless in the last year. Another startling statistic: More individuals in families that identify as Black, Indigenous, or people of color (BIPOC) and became sick and died from COVID-19 were turned away from emergency rooms and had poor access to health care systems.

While about half of lifetime cases of mental health conditions begin by age 14, fewer than 1 in 3 youth of all races with major depression receive consistent care. The percentage is worse for Black youth with depression.

What can we do to support this growing number of children in need of our attention?

The benefits of school-based mental health education, supports, and services are touted in report after report, and it is clear that providing increased access to mental health information and services through schools is a more equitable response than when only provided to families outside of school.

As we consider bringing these services into the school environment, it is important to note that:

  • Black families, including their school-age youth, are more likely to live in neighborhoods with higher violence, environmental hazards, and other factors that negatively impact health.
  • Behaviors of distress exhibited by Black students in the classroom are more often perceived as disruptive and result in disciplinary and juvenile justice-related responses rather than healing ones.
  • Suicide attempts are higher among Latina or Hispanic female teenagers than non-Hispanic white female and Hispanic male peers, with more than 1 in 4 Latina or Hispanic female high schoolers having suicidal thoughts.
  • Many Black/African American, Indigenous/Native American, Latino/Hispanic, Asian, Middle Eastern, and Pacific Islander families do not discuss mental health and mental illness because it is seen as a sign of weakness or believed to not exist at all.

Of students who successfully engage in mental health treatment, over 70% initiated services through school, according to the School-Based Health Alliance. Data also indicate that school-based mental health services reduce disparities in access to behavioral health care. Research shows that when basic needs are not met and students stay in distress (fight, flight, or freeze mode) over long periods of time, executive functioning skills necessary for academic achievement may decline.

When it comes to supporting students’ mental health, what can school leaders do?

Centering Lived Experience and Learning From Youth

Because they have the ear of state officials and school board members, school leaders are uniquely positioned to improve student mental health within schools and across school districts. The most effective way for school leaders to promote good mental health and support those with mental health conditions through a diversity, equity, and inclusion (DEI) lens is to center the lived experience of students from BIPOC families. This should happen when creating and designing policies and procedures to govern school operations that address student mental health and well-being concerns. The same method should also be used when considering youth who are LGBTQ+ and those who have experienced trauma, emotional/mental distress, and suicidality.

Centering BIPOC students with lived experience of emotional distress in designing policies, procedures, and practices—including multitiered support systems—allows these voices to speak out against any that are harmful and discriminatory, and instead support culturally and linguistically inclusive ones. By giving students a stake in the game, they will be more inclined to ensure the system works for them and their peers and provide feedback when a policy or practice is ineffective.

A Mental Health America report, “Youth and Young Adult Peer Support: Expanding Community-​Driven Mental Health Resources,” found that students—even before talking to an adult about what they experience or connecting to professional services—have a strong desire to problem-solve on their own. They want the skills, knowledge, and ability to manage their own mental health issues, and to help peers who are struggling.

New federal funding provides an important opportunity for school leaders to center lived experience and amplify the voices of youth with mental health conditions, including the voices of those from various racial and ethnic backgrounds, in planning and funding decisions. The Bipartisan Safer Communities Act, which President Biden signed into law June 25, 2022, provided $36 million in new funding for Project AWARE, $500 million for diversifying the pipeline of school mental health professionals, along with $1 billion for school climate improvements.

School districts are also allowed to bill Medicaid directly for eligible student services and may use new guidance from the Centers for Medicare and Medicaid Services on school-based services to navigate the policies. In considering new opportunities from federal laws and guidance, local leaders can benefit from the input of diverse students when looking for fresh opportunities, such as implementing youth peer support programs. Such programs can empower youth to increase self-help skills, reduce isolation, and build connectedness.

Promoting Mental Health Education

The goals of mental health education are to help individuals before a crisis occurs and equip them with the knowledge and skills to manage their own distress or reach out for professional help. Mental health education in New York State became law in 2018 for all K–12 students and has four objectives that other states could follow:

  1. To help school personnel and students understand mental health and mental illness and what contributes to both;
  2. To improve comfortability using terms to describe mental health and mental health conditions, including mood, anxiety, depression, psychosis, etc.;
  3. To encourage help-seeking behavior and knowledge of where and how to initiate care and support; and
  4. To increase understanding of treatment and support options.

Supports are accommodations, such as mental health sick days or extensions on assignments, that help the student manage a condition. School leaders may want to explore curricula that further mental health literacy to ensure that all students are aware of the signs and symptoms of mental distress and how to seek help.

Increasing Access to Community-Based Mental Health Providers in School Settings

Building partnerships with community-based providers in schools eliminate barriers to services, such as the need for transportation, parents taking off work, and wait times. Black and Latino/Hispanic youth are more likely to complete treatment in schools compared to other settings.

For instance, in Kansas, the Mental Health Intervention Team pilot program provided resources for school-based mental health liaisons to work with case managers and therapists at community mental health centers. The local education authority and the community mental health centers entered into memorandums of agreement, and the Kansas State Department of Education created the payment mechanism and the database to track outcomes. Following implementation, about two-thirds of students improved their attendance, over half improved their internalized behaviors (e.g., mood, depression, social withdrawal, and avoidance), roughly 60% improved in academic performance, and approximately 70% improved their external behaviors (e.g., physical or verbal aggression, threats to self, and elopement—when a student leaves an assigned area). Students provided positive feedback about their experiences, and teachers and other school staff reported fewer disruptions and an improved school climate.

In Minnesota, a second state to link schools and community mental health providers, the state’s Department of Human Services—not the education agency—distributes grant funds to local community mental health agencies to “offer mental health services in schools, including assessment, treatment and care coordination, teacher consultation, and schoolwide trainings.” These community mental health agencies bill both public and private insurers for clinical services, leaving grant funds for students who do not have health coverage or are underinsured.

Funds can also be used to pay for the services that health plans do not typically reimburse, such as in-service training, outreach to families, and setting up a telemental health platform. Almost half of the children enrolled had not received mental health services before they were provided care under the school-linked program. For children of color, the figure was higher, with 58% never receiving any mental health services before participating in the program. School-linked mental health programs can begin to narrow the access gaps for mental health care for underserved BIPOC students.

Other Key Considerations for School Leaders

Leaders should work to build up evidence-informed services and supports, which are more inclusive than evidence-based practices, and take into account the cultural and lived experience of individuals. Being evidence-informed encourages innovation and offers better outcomes for those being served.

For instance, in a study published in the June 2022 Journal of the American Academy of Child & Adolescent Psychiatry, the evidence-based practice of psychotherapy was less effective for Black youth when the general population in their geographic location held higher levels of anti-Black cultural racist attitudes. Therefore, in geographic locations where higher anti-Black attitudes are held, coupling psychotherapy with other culturally based practices may be more effective.

Cultural rituals and traditions used in BIPOC communities, such as healing circles, prayer circles, storytelling, honoring kinship systems, or other forms of community care, are beneficial to the well-being of BIPOC communities. But these pillars may have missed out on funding because they are not considered “evidence-based.” While many federal grants are required to be used for evidence-based activities like assessment and psychotherapy, remember that there are other useful options for student mental health.

Educators should also reexamine existing mental health and counseling resources within the school community to determine efficacy and reach. There should be collaboration with school-based leadership and student leadership to assess student mental health needs. From this, an action-oriented plan can be designed that delivers tiered mental health and counseling services to all students in need of such supports.

School leaders may also work with state officials to ensure adult caregivers in the school system have adequate access to mental health supports and services through health insurance plans. Many health plans are not meeting requirements for network adequacy, and adults must wait long periods of time for mental health care. Lack of access to mental health care by adults on campus will indeed impact student well-being. Oftentimes the difference between two students with adverse circumstances—when one flourishes and another flounders—is a reliable caregiving adult figure in their life.

So let us listen to BIPOC students with lived experience of mental health issues and create programs around these voices; design schools as places that help fill the gaps of need with mental health education, services, and supports; and ensure a broad framework that considers the well-being of adults on campus and brings in community partners. By opening our minds to and for these young people, we can better serve the mental health of our children.

Caren Howard is the director of policy and advocacy for Mental Health America where she advises policy priorities and strategy on a wide range of issues including health care, education, and criminal justice.

References

Centers for Disease Control and Prevention. (2022). Risk for COVID-19 infection, hospitalization, and death by race/ethnicity. cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. (2019). Ring the alarm: The crisis of Black youth suicide in America. watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf
Mental Health America. (2021). COVID-19 and mental health: A growing crisis. mhanational.org/sites/default/files/Spotlight%202021%20-%20COVID-19%20and%20Mental%20Health.pdf
Mental Health America. (2021). Strength in Communities: 2021 Bebe Moore Campbell National Minority Mental Health Awareness Month Toolkit. mhanational.org/sites/default/files/BIPOC-MHM-Toolkit-2021_Final_03_0.pdf
The Mental Health Literacy Library. (2021). In-class curriculum. Chad’s Legacy Project and the University of Washington SMART Center. mentalhealthinstruction.org/curriculum