The toll of the COVID-19 pandemic on student and adult lives goes beyond the physical symptoms of the coronavirus. Life has been interrupted for everyone, and we’ve all experienced some form of loss. Daily routines were upended, graduations downsized, weddings postponed, and new babies greeted on video chat. And, for too many families, loved ones have been lost. 

All this loss adds up, and students and educators are carrying it with them to campus. ATPE spoke with several clinicians and public health professionals about the challenges of addressing mental health in schools during the pandemic. While there are many layers to the impact of the pandemic, the loss of connection—and striving to regain it—is a running theme. 

Vida Clinic Behavioral Health facilitates campus-based therapy through Austin ISD. Laura Johnson is a clinical therapist with Vida Clinic and works as a campus manager at a handful of AISD schools. Johnson says existing clients’ mental health conditions have worsened during the pandemic, but there’s also been an uptick in referrals for new patients as well as requests from administrators for presentations and workshops to help staff and students cope with the added stress of COVID-19. 

What does “help” look like when approaching mental health?
Johnson: When we’re working with a child, we also want to work with the parents and educators involved in their life so we can give them strategies on how to support the child. That’s one layer of the systemic care we provide, and the other layer we’re able to provide is therapeutic services directly to teachers and parents. It’s important for the adults in a child’s life to be well for the children during this time. Children look to us for how to react to stress, and we really need to check in with ourselves and think about how we can work to feel calm and regulated so we can then support students and have positive connections with them. 

How can adults identify potential warning signs in a child?
Johnson: Knowing risk factors is important. Are there preexisting mental health issues like anxiety and depression? Because if there are, and someone is going through COVID-19 and with our political climate, it’s likely going to exacerbate symptoms. If there’s already a mental health issue, trauma history, or family mental health history, that can put them at higher risk, as well as current family and stability changes or a loss in the family. Other things to look for are changes in mood, apathy, or low motivation. It might look like laziness, but it could actually be a stress response. [Other signs include] issues with sleep or eating, either too much or not enough; irritability; and increased conflict with family, peers, or teachers. Somatic or physical complaints, like headaches and stomachaches, especially in younger kids, could be a cue they’re struggling, as could poor concentration or doing poorly in school, acting-out behaviors like lying or stealing, or isolating or withdrawing. Of course, right now it’s difficult to socialize, but if kids are not wanting to communicate with anybody, [that’s a sign]. For younger children, regressing developmentally, such as more crying, clinginess, or frequent meltdowns. Then with more severe cases, suicidal ideation or thoughts of self-harm. These are all important to look out for because children don’t always have the words to tell us and make connections, so we need to look for some of these signs. It’s important that if these are coming up, a parent tries to connect the child with somebody who can do a thorough evaluation. Maybe everything’s fine and [can] be managed at home, but a lot of times, we’ll find out there’s more going on than parents or teachers know about. I think if there are any concerns, it would be really important to bring the student in. What we find sometimes with kids, too, is at times they do have the words, but they don’t share it because, right now, they see the adults in their life really stressed, too. Maybe the child doesn’t want to burden the adult, or they feel this responsibility to just take care of it themselves, and they can also feel some stigma or shame around it. Or, if you’re not in a school or community that has a lot of support, [and] if you put yourself out there and you don’t feel like somebody’s going to help you, then that’s another reason they might not communicate. 

If the child were acting out, the adult might view that as “They’re going through a phase.” Is there anything an adult could do to get a better read on the student?
Johnson: It can be hard for kids to open up, so there needs to be connection and trust. Educators and parents can always be working to build that so these conversations are easier and children are freer to talk. What that looks like is for kids to feel like they’re being heard, respected, listened to, and validated. Talking about mental health on an ongoing basis on different levels belongs in the school because we know addressing mental health concerns supports academics. We can share with children that during these times, we can feel scared, sad, angry, and anxious. [We can ask,] I wonder if these are things that you feel? These can be hard conversations, but they need to happen. It’s OK not to get it perfect, so just give it a go. Communicate in a straightforward manner, make sure your communication is developmentally appropriate, and have discussions when the child feels safe and comfortable. For teens, that might be in the car or being on a walk. 

How should educators and parents who are struggling to comfort their children approach current events?
Johnson: Provide kids with some basic and developmentally appropriate information, and then take their lead on any questions they have. If they don’t have any questions, follow that information up with a lot of reassurance, sending the message that the adults in their life are working to keep them safe. With the news going on, encourage them to look for the helpers and what everybody’s doing to try to help with these issues. For all of us, routines feel predictable and can help develop that sense of safety and control. Find ways for kids to feel control. For instance, with COVID-19, here are the actions you can take and ways we can help others, such as, “Wearing your mask is an act of compassion.” 

When I was younger, I’d look to my parents for bravery. Looking back, I’m sure they were stressed, too. What would you say to educators trying to put on a brave face?
Johnson: I think to take care of our kids we have to take care of ourselves, as the adults in their lives, including our well-being and mental health. I would encourage them to prioritize their own self-care and know it is OK to put that first because it helps all the people in their lives. It’s not selfish at all. 

There does not have to be severe mental health issues occurring for someone to benefit from therapeutic support. Any caregiver or educator could likely benefit from seeking support with stressors during these difficult times. Anything that keeps you from connecting with the children in your life and staying calm and regulated [is] enough to seek additional support. Educators and parents can also practice regular self-care, acknowledge emotions that come up, and set helpful routines and boundaries. Teachers are often going back and forth between virtual and not, so they could benefit from a space for work time and home time and creating boundaries around their work area and time. [We also need to evaluate] expectations because we know for children, these basic needs have to be met in order for learning to even happen. We don’t want to [put] our focus on the learning part if they’re not feeling internally safe or connected to us.  The best thing that we can do now to safeguard them against trauma and for learning to happen in the future is to put that focus on relationships and kids feeling connected.

I think the biggest [stressor] for [school staff] is how much they’re worried about their kids, and then all the unknown. “I don’t know what tomorrow’s going to look like, if I’m going to be at home and need to reformat everything virtual or for the classroom.” Then there’s this fear with COVID-19 and going into the classroom and feeling isolated. We need to figure out, as a system, how we’re going to support teachers. We can’t just leave it all to them. 

To learn more about the importance of mental health in schools and how Texas school districts—no matter their size—can provide resources to students and staff, ATPE spoke with Alexandra Copeland, Austin ISD’s health services director, and Kim Eerkes, the department’s mental health coordinator. AISD’s health services department includes 15 licensed mental health professionals (LMHPs) and a school mental health center that supports students, staff, and families. 

Why do you think it’s important for school-based mental health services to expand across Texas?
Eerkes: I’m passionate about mental health in schools because it’s where children spend most of their time and where we have an opportunity to educate kids about their mental health. We can really open the avenue for reducing the stigma around it, and it gives us the opportunity to identify kids early on who may be struggling and provide them resources and support. Not only does that impact the mental and social and emotional well-being, but also the educational outcome.

Copeland: Resources are readily available. They are there for people to access, and by increasing access to care and support, you don’t have to go outside the school system to initiate the process. Of course, we defer to community resources, too, but as a district, it’s so important to have that readily available and have staff across the board educated to recognize those who need more support. 

What would you say to educators who may be struggling but want to put their students first?
Eerkes: When we’re working with parents whose children may be struggling, we say you have to focus on your own wealth before you can share it with others. It is imperative the adults in
children’s lives take care of their well-being so they can continue to be present and be available for their students or children.

Copeland: A lot of people might not know [that many] districts have an employee assistance program (EAP). I know that with our EAP services, people are able to get counseling sessions through district insurance. I would encourage them to reach out to their HR department to see what options they have and to participate in those programs as a part of self-care. 

If a school is interested in doing more with school-based mental health, do you have any advice?
Copeland: With smaller districts, try to partner with community organizations. When I have visitors from smaller districts, a lot of organizations that focus on mental health are eager to help in any way they can. Sometimes the idea just needs to pop up. There are some districts that might have an opportunity to partner with universities and colleges close by that have mental health programs and students who need opportunities to finalize their degree course. And for districts that may not have a lot of resources, sometimes those are prime settings to apply for grants. I know the grant process is a lot, but there are a lot of mental health startup grants, and there are federal and local grants that can help. 

What’s one thing you want our readers to know?
Eerkes: I can’t stress enough the importance of connection and taking the time to talk and listen to each other. Take note and take notice of what is happening around you. Engage in the conversation, and offer support. Support one another, and reach out for assistance. Talk about it, be open to it, and be available for each other.

Copeland: I know COVID-19 has been the focus now, but I think sometimes when there’s so much going on, and COVID-19 is a prime example, people talk about mental health, but I don’t know if everybody realizes that mental health is just as important in the grand scheme of things. It needs just as much attention, and it needs just as much highlighting, marketing, collaboration, support, engagement, and conversation around it. I think we tend to meet critical needs, but in my experience, mental health is also a basic need that needs to be met and put on the same level as everything else we address in the school system to be able support the whole child. 

Interviews have been edited and condensed for clarity. 

Student Mental Health by the Numbers 
In the 2019 High School Youth Risk Behavior Survey of ninth through 12th graders in Texas, during the 12 months before the survey:

• 12% were electronically bullied, including through texting, Instagram, and Facebook.
• 14% were bullied on school property.
• 38% felt sad or hopeless almost every day for two or more weeks, thus stopped doing some usual activities.
• 19% seriously considered attempting suicide.
• 15% made a plan about how they would attempt suicide.
• 10% actually attempted suicide one or more times.
• 3% of those suicide attempts resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse.

In the 2020 State of Mental Health in America report on Texas youths ages 12–17:

• 12% had at least one major depressive episode* (MDE) in the past year.
• 9% had a severe MDE.
• 65% who experienced an MDE did not receive mental health services.
• 24% who experienced a severe MDE received some consistent treatment.

*A major depressive episode is generally defined as a period of at least two weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities, and had a majority of specified symptoms, such as problems with sleep, eating, energy, concentration, or self-worth.