Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. Office of the Surgeon General. Published online December 6, 2021
What Educators, School Staff, and School Districts Can Do The experiences children and young people have at school have a major impact on their mental health. At school, children can learn new knowledge and skills, develop close relationships with peers and supportive adults, and find a sense of purpose, fulfillment, and belonging. They can also find help to manage mental health challenges. On the other hand, children can also have highly negative experiences at school, such as being bullied, facing academic stress, or missing out on educational opportunities (for example, due to under-resourced schools). Mental health challenges can reveal themselves in a variety of ways at school, such as in a student having trouble concentrating in class, being withdrawn, acting out, or struggling to make friends. In light of these factors, below are recommendations for how schools, educators, and staff can support the mental health of all students:
Create positive, safe, and affirming school environments. This could include developing and enforcing anti-bullying policies, training students and staff on how to prevent harm (e.g., implementing bystander interventions for staff and students), being proactive about talking to students and families about mental health, and using inclusive language and behaviors. Where feasible, school districts should also consider structural changes, such as a later start to the school day, that support students’ wellbeing.
Expand social and emotional learning programs and other evidence-based approaches that promote healthy development. Examples of social, emotional, and behavioral learning programs include Sources of Strength, The Good Behavior Game, Life Skills Training, Check-In/Check-Out, and PATHS. Examples of other approaches include positive behavioral interventions and supports and digital media literacy education.
Learn how to recognize signs of changes in mental and physical health among students, including trauma and behavior changes. Take appropriate action when needed. Educators are often the first to notice if a student is struggling or behaving differently than usual (for example, withdrawing from normal activities or acting out). And educators are well-positioned to connect students to school counselors, nurses, or administrators who can further support students, including by providing or connecting students with services.
Provide a continuum of supports to meet student mental health needs, including evidence-based prevention practices and trauma-informed mental health care. Tiered supports should include coordination mechanisms to get students the right care at the right time. For example, the Project AWARE (Advancing Wellness and Resilience in Education) program provides funds for state, local, and tribal governments to build school-provider partnerships and coordinate resources to support prevention, screening, early intervention, and mental health treatment for youth in school-based settings. School districts could also improve the sharing of knowledge and best practices.
For example, districts could dedicate staff at the district level to implementing evidence-based programs across multiple schools). Districts could also implement mental health literacy training for school personnel (e.g., Mental Health Awareness Training, QPR training).
Expand the school-based mental health workforce. This includes using federal, state, and local resources to hire and train additional staff, such as school counselors, nurses, social workers, and school psychologists, including dedicated staff to support students with disabilities. For example, a lack of school counselors makes it harder to support children experiencing mental health challenges. The American School Counselor Association (ASCA) recommends 1 counselor for every 250 students, compared to a national average of 1 counselor for every 424 students (with significant variation by state). The American Rescue Plan’s Elementary and Secondary School Emergency Relief funds can be used for this purpose and for other strategies outlined in this document.
Support the mental health of all school personnel. Opportunities include establishing realistic workloads and student-to-staff ratios, providing competitive wages and benefits (including health insurance with affordable mental health coverage), regularly assessing staff wellbeing, and integrating wellness into professional development. In addition to directly benefiting school staff, these measures will also help school personnel maintain their own empathy, compassion, and ability to create positive environments for students.
Promote enrolling and retaining eligible children in Medicaid, CHIP, or a Marketplace plan, so that children have health coverage that includes behavioral health services. The Connecting Kids to Coverage National Campaign also has outreach resources for schools, providers, and community-based organizations to use to encourage parents and caregivers to enroll in Medicaid and CHIP to access important mental health benefits. Families can be directed to HealthCare.gov or InsureKidsNow.gov. Schools can use Medicaid funds to support enrollment activities and mental health services.
Protect and prioritize students with higher needs and those at higher risk of mental health challenges, such as students with disabilities, personal or family mental health challenges, or other risk factors (e.g., adverse childhood experiences, trauma, poverty).
Resources for Educators, School Staff, and School Districts Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs (Dept. of Education): Guidance for schools, school districts, and education departments
National Center for School Mental Health: Resources to promote a positive school climate
StopBullying.gov: Learn about what bullying is, who is at risk, and how you can help Turnaround for Children Toolbox: Tools to drive change towards a more equitable, whole- child approach to school
Design Principles for Schools: Framework for redesigning schools with a focus on supporting students’ learning and social and emotional development
Safe Schools Fit Toolkit (National Center for Healthy Safe Children): Resources and guides to build safe and healthy schools
Mental Health Technology Transfer Center Network: School mental health resource
New National Survey of School Board Members (Source: Mental Health First Aid USA press release January 25, 2023)
School board members nationwide consider student mental health the most pressing issue facing schools and students today, according to a new national survey of school board members commissioned by Mental Health First Aid USA® (MHFA).
Student mental health was the No. 1 concern for school board members: 86% reported being either “extremely concerned” (56%) or “very concerned” (30%), a higher level of extreme concern than was expressed for school funding (51%), staffing challenges (48%) and school safety (46%).
[T}he nation continues to grapple with a youth mental health crisis. Not only is suicide the third-leading cause of death for youth ages 15–19, but one in four adolescents age 12 to 17 have had a substance use disorder or a major depressive episode in the past year.
School board members see family and home life (66%), social media (57%) and bullying (44%) as the top three issues that most affect student mental health — more than disruptions caused by the COVID-19 pandemic (23%).
The National Association of School Psychologists has reported that:
Nearly one-third of the middle school and high school students surveyed reported having bullied, being bullied, or both. These findings were based on a representative sample of 15,686 students in grades 6 to 10 who were enrolled in public or private schools throughout the United States. According to Viadero, studies conducted in recent years have produced “strikingly similar conclusions that offer useful lessons for educators ” regarding both the prevalence and severity of the problem.
One major finding is that teachers and principals consistently underestimate the amount of bullying that takes place under their radar–on playgrounds, in hallways, even in classrooms. Virtually all studies on the subject show a wide gap between the amount of bullying students say they experience and the amount their teachers see. Part of the reason for the gap is that most bullying takes place when there is little adult supervision.
Some adults see bullying as normal–“kids being kids”–and something all kids must just learn to handle. But researchers say the problem is too pervasive and damaging for educators to ignore. “You’re talking about 10, 11, 12 percent of kids saying their lives are miserable in school,” says John Hoover, an education professor quoted in Viadero’s article. “I don’t think that’s something that kids need to go through.”
Students who are targets of bullying experience immediate sadness, fear, anger, pain, loneliness, and humiliation. They can develop such internal expressions as depression and eating disorders, or such external expressions as aggression and violence. Finally, rarely but tragically, bullying and victimization have been associated with suicidal ideation and suicide attempts. As reported very recently by Hinduja and Patchin, youth who experienced traditional bullying or cyberbullying had more suicidal thoughts and were more likely to attempt suicide than those who had not experienced such forms of peer aggression.
The disturbing relationship between bullying and school violence was underscored in a review of research on school bullying by Espelage and Swearer. The authors describe the “startling finding” of a Secret Service investigation of 41 school shooters between 1974 and 2000:
Carla Garrity (co-author of Bully-Proofing Your School) cites the lessons learned from a Canadian study, where researchers placed a hidden camera on a playground and recorded 120 hours of how students treated each other when the adults weren’t looking. Here’s what the study revealed:
Bullying typically takes place in the context of other peers. Bystanders are typically part of the problem, as many students either just watch or even instigate aggression, without reporting the situation to an adult or intervening to help the target child. However, bystanders can be motivated and taught to become part of the solution.
The message from research on bullying prevention is both loud and clear. Bullying is indeed a serious and pervasive problem. However, for schools that are willing to commit resources, time and personnel to comprehensive bullying prevention programs, it is possible to reduce bullying significantly and provide students and teachers with a safe and supportive learning community.