Without daily, in person interaction with teachers and peers, flagging mental health issues in students is increasingly difficult. In the move to virtual classes, schools say they can no longer depend on teachers to notice warning signs and refer students to mental health services.
Now districts are turning to new ways of screening children for mental health issues, along with continuing to use existing frameworks from before the pandemic.
“This time has called for us to really relook at how we provide services to families,” said Lateshia Woodley, executive director of student support services at Kansas City, Missouri, Public Schools, a district that serves 15,568 children in grades K-12.
Even before the pandemic, mental illness and suicide in young people was on the rise. The three-year-average suicide rate in young people ages 10 to 24 increased by over 60% in both Missouri and Kansas between 2007-2009 and 2016-2018, according to a report released by the Centers for Disease Control and Prevention. Missouri’s rate increase was the fourth highest in the nation.
Some factors leading to suicide — like isolation — have increased during the pandemic, according to Alexandria Wagner, manager of community-based clinical services at PACES, part of the Wyandot Behavioral Health Network. PACES provides mental health services for children and teenagers, and is the safety net clinic for Wyandotte County.
“In the beginning, it was almost a fun step away from school, but the isolation is really starting to catch up to these young people,” Wagner said.
She said she noticed the children she works with having more depression and anxiety around returning to school last fall and the uncertainty of their futures, as well as an increase in social anxiety.
Nationally, the proportion of mental health-related emergency department visits by children ages 5-11 increased 24% from mid-March through mid-October 2020 compared to a year before.
But Wagner said she had fewer referrals for care from teachers during the fall back-to-school season, when she usually would see an uptick, which she attributes to more children being in virtual schooling.
How to virtually monitor mental health
The isolation of virtual schooling contributing to mental health issues in students also makes it more difficult to provide mental health services to them, school officials say.
In Missouri, all school districts are required to have a suicide awareness and prevention plan and in Kansas, all school district staff are required to undergo suicide prevention training.
But schools didn’t create these plans with a pandemic in mind.
Woodley said the Kansas City school district moved to implement telehealth and virtual tools to help screen students and provide services to them.
KCPS provides laptops to all of its students and is using a software that monitors their Google searches. The software, called Relay, gives mental health professionals at the school district an alert if a student searches anything related to topics like depression, self-harm or suicide.
“We have seen a rise in the numbers of students that are searching things like death and violence over the course of this pandemic,” Woodley said.
KCPS addressed over 100 safety alerts from the software just in the month of October — in 60 of those alerts, the software said there was a risk of harm to the student.
The school district uses other digital resources to identify changes in student behavior. It tracks whether students attend their virtual classes, if they actively participate in classes and if there are changes in their grades.
KCPS also started a phone hotline program for families to directly contact clinicians and schedule counseling sessions if they have concerns about their children. Each school has its own hotline.
Telehealth is available, which Woodley says solves some problems that existed before, like parents being unable to get off of work or having to drive students to appointments. Telehealth allows families to access clinicians remotely using technology such as video calling from a laptop or smartphone.
“I think it’s something that is going to be really utilized post-COVID,” Woodley said. “Some (parents) can’t get off of work, so we had students that pre-COVID were missing appointments. I’m excited for what the telehealth movement has done to reduce some barriers for our families.”
But even though all students have laptops, telehealth can’t reach every student, especially because some live in digital deserts with unreliable internet.
“We had to understand that it was not a one-size-fits-all model,” Woodley said.
KCPS also does wellness checks where a professional goes out to a home to meet with a student and their family. It also has counseling available over the phone for people who are unable to use video calling.
Proactive tools already in place
Schools have made large changes in their efforts to address mental illness during the pandemic.
But some of the most effective tools for mental health intervention at schools are ones that were already in place before the pandemic.
In 2018, the Neosho School District in southwest Missouri had a crisis: There were an average of two student suicides each year, with at least eight students dying by suicide during the 2017-2018 school year. The most common group was sixth-graders.
“Our suicide rates were appalling,” said Tracy Clements, director of counseling services for the Neosho School District. “No one wanted to believe it was a real problem.”
Since then, the school implemented a mental health program Clements said has helped their students during the pandemic. The school district currently has children attending school both virtually and in person.
Part of why their suicide prevention program is successful is because the focus is to build resilience and help children be healthier, rather than just responding to mental illness, Clements said. Each teacher uses Sanford Harmony in their classroom. The program teaches children about resolving conflicts, forming relationships, managing emotions, forming empathy and collaborating with people who have different experiences.
All of the staff goes though suicide prevention training, and students complete suicide prevention training at three different grade levels. Children who are assessed as having a high or mild risk for suicide are referred to mental health services. Therapists are able to see students at school and have been able to maintain teletherapy with students throughout the pandemic.
Clements said she expected students coming back to school to have more issues related to the pandemic, but results from a survey showed most students feel like they are doing OK with coping with the stress of today’s world.
“It’s going much better than I anticipated,” Clements said. “Our kids are managing quite well, under the circumstances.”
“Hopefully, there are enough safeguards in place to get through this without any suicides.”