A blog post by Jennifer Greif Green
A few weeks ago, one of my kids told me she had a sore throat. “Oh no, here we go,” I thought, since there were students in her class who recently had COVID-19. But at the same time, friends had come down with strep, a family member had the flu, and there was a lot of pollen outside. So I found myself wondering how worried to be about COVID, whether it might be something else, or if I should just wait and see if things got better on their own.
This experience is one that many of us have had frequently in the past two years. But weighing these decisions gets even more complicated when it comes to kids’ mental health. We ask ourselves questions like: When should we be concerned? When should we seek help? And if we want help, where can we go? Unfortunately, there are no swabs that can give us an answer when a child is struggling with their mental health, leaving many families to worry and wonder.
May is Mental Health Awareness Month, and this year, it comes on the heels of a recent study from the Centers for Disease Control (CDC) finding that 37% of adolescents reported having poor mental health during the pandemic and almost 20% seriously considered suicide in the past year. More concerning is the finding that even before the pandemic, only about one-third to one-half of children with a diagnosable mental health problem received treatment—and those receiving treatment disproportionately identified as non-Latinx white.
While healthcare systems are far from perfect, mental healthcare systems are even more fragmented, complicated, and inequitable. Preventive care that could lead to early identification of mental health problems is nonexistent for many children and families. And, when families do access mental health services, the associated stigma leads many to hide that they are receiving care, making it more difficult for others to find recommended and trusted providers. As a result, families may wait until problems are so severe or chronic that they require emergency care.
So what do schools have to do with this? Quite a lot! Most children in the U.S. who receive mental health services receive them in schools—not on a leather couch in a wood-paneled office, as movies would have us believe. And services that occur in schools are accessible to youth who are less likely to access services in the community – including Black and Latinx youth, decreasing some of the well-documented racial and ethnic disparities in mental health service access.
When I teach BU Wheelock teachers, I say that they have an important role to play. When a student shows signs of a mental health problem, teachers are often the ones who will determine whether students go to the counselor’s office. And, if teachers misinterpret those signs, students may wind up in the school nurse’s office or the principal’s office—or getting no care at all. How can teachers embrace this role and do it well? One first step is through increased awareness of mental health and its impact on youth and families.
However, most teachers receive little or no training on how to identify and understand mental health problems. As a result, most say that they do not feel prepared to address the mental health needs of their students. In a study conducted by our research team, we found that the most common signal that teachers rely on to identify mental health problems is poor academic performance. However, some students with mental health problems actually do quite well in school and are missed as a result. (Here is a list of recommended signs for seeking help.)
In another study, we gave middle and high school teachers vignettes describing students with mental health problems and asked the teachers if they would refer the student for mental health services. We hoped that teachers’ decisions would be made based on the severity of the mental health problems described, but what we found is that this was only one of the factors they considered. Other factors in their decisions included both characteristics of the teacher and qualities of the school where they work.
What we’ve learned is that to increase access to mental health services and decrease inequities, there is a need to train teachers and also to pay attention to the resources available and contexts in which they work. Teacher preparation programs like ours at BU Wheelock can prepare teachers to conceptualize supporting student mental health and well-being as part of their professional role. This includes at the secondary level as adolescence is when depression and suicidality spikes.
For many of us, the pandemic has taught us to be more aware of our physical health, to look for signs of illness, and to act on those signs. Now, let’s figure out how to do the same for our children’s mental health.
Jennifer Greif Green is an associate professor in special education and a child clinical psychologist at BU Wheelock College of Education & Human Development. Her research focuses on supporting students with emotional/behavioral disorders and bullying prevention.