key: cord-0941115-pb0figs6
authors: Weisbrot, Deborah M.; Ryst, Erika
title: Debate: Student mental health matters – the heightened need for school‐based mental health in the era of COVID‐19
date: 2020-10-07
journal: Child Adolesc Ment Health
DOI: 10.1111/camh.12427
sha: 5513c57f03a779bbcba31866b44d3c8855e8613e
doc_id: 941115
cord_uid: pb0figs6

The COVID‐19 pandemic has highlighted existing gaps in school‐based mental health services and created new and urgent needs to address student mental health. Evidence from early in the pandemic already suggests that preexisting educational and mental health disparities have increased under the stress of the current health crisis. School mental health professionals are essential to help address anxiety, to promote social adjustment in the 'new normal', and to address trauma, grief, and loss. Schools will also need to creatively support teachers during this unprecedented time. Such efforts will require adequate funding and advocacy for the inclusion of school‐based mental health supports within governmental COVID‐19 aid packages.

Child and adolescent psychiatrists are taught from day 1 of training to always place the child's best interest first. However, children can only do well when their caregivers and communities are similarly well supported. In considering the complex challenges of the COVID-19 crisis, the best interests of children can only be met by simultaneously considering the best interests of parents, families, teachers, and school staff.

As schools open, in whatever shape or form, mental health practitioners who work in schools will be busier than ever. Even before this COVID-19 apocalypse began, schools were already ill equipped to meet students' mental health needs. It has been estimated that more than seven million children in the United States have a mental health disorder; less than half of those diagnosed actually receive treatment, and of those who do receive treatment, over 75% receive this treatment at schools (McKay, Lynn, & Bannon, 2005; Merikangas et al., 2011) . Whether schools open, stay closed, or work semivirtually, the existing challenges will multiply and vary according to the specific solutions developed. Just as hospitals faced a crisis when the pandemic began, now school administrators, families, students, and school staff face similar distress, uncertainty, and confusion about how to return to school given the new realities of COVID-19. The solutions will necessarily vary by community, level of COVID infection, school size, and resources. Surprisingly, in all that has been written about returning to school, very little has been targeted toward meeting the mental health needs of students, teachers, and other school staff.

Mental health contributes to overall health, and students must be healthy enough to learn. We know our children should return to school, but to do that they need a safe, secure, and supportive learning environment with professionals who also feel safe and cared about. If the stress and illness burden is not too great, we hope that the resilience of youth will prevail. However, those children already burdened by mental health challenges may suffer more. Mental health and educational disparities will widen the pandemic's negative impact in marginalized and under-resourced communities. Evidence from two U.S. national surveys conducted by the Edweek Research Center in Spring of 2020 already confirm vast disparities, with schools located in lower socioeconomic communities less able to provide access to technology, to reach all students, or to provide 'live' distance learning instruction (Herold B, April 2020) . Fairness and equity require that those bearing a disproportionate impact of the pandemic be provided sufficient access to equipment, services, and technology, and mental health support to address systemic cultural disadvantages in education and mental health worsened by COVID-19.

Decisions related to school reopening must be datadriven, relying on the best available medical understanding and public health guidance. In addition, different populations, such as children receiving special education, children in foster care, or non-English-language learners, may require approaches that differ from the general approach. Children at different developmental stages will have specific needs. What is good for some students and their families will not necessarily be good for others.

Multiple potential mental health consequences arise from school closures related to COVID-19. Lost learning opportunities during school closures result in possible regression of educational and emotional coping skills, particularly in children with special education needs. For some children, the pandemic may produce heightened fear, anxiety, and depression, leading to further difficulty in emotion regulation and behavior, learning, and interpersonal relationships. The fears of school staff will also need to be recognized and discussed, as these will impact the students in their care.

School mental health professionals will be essential in helping to shape messages to students and families about school re-entry, to address anxiety, to promote social adjustment to the 'new normal', and to address other unanticipated mental health concerns that are sure to arise during this national trauma experience. Teachers and school personnel should receive training on how to talk with and support children during a pandemic. Intentional strategies to help students adapt to new school environments should be developed. Schools will also need to creatively support teachers in their efforts during this unprecedented time. Addressing the grief of those who have suffered loss will also be critical. Fortunately, many great resources to assist in this effort have already been developed. For example, the National Center for School Mental Health (http://www.schoolme ntalhealth.org/COVID-19/) and the Mental Health Technology Transfer Center Network (https://mhttcnet work.org/centers/global-mhttc/responding-covid-19-school-mental-health-resources) have both developed school mental health resource pages for dealing with COVID-19.

It is hard to imagine how children can return to school safely without providing additional (and substantial) financial support. Added to the costs of the physical needs created by the pandemic will be the increased costs necessary to bolster a full continuum of educational AND mental health supports. Funding of schoolbased mental health supports will be necessary for prevention of staff burnout and trauma effects, as well as early identification and intervention of mental health problems in the increased numbers of students at high risk for adverse outcomes.

Child mental health organizations should be advocating to ensure that mental health programs, specifically children's mental health, are included in governmental aid packages. Solidarity with other mental health organizations is essential to ensure that such provisions are included in any governmental COVID-19 relief packages. Provisions should include increasing funding for existing and new mental health programs. The American Academy of Child and Adolescent Psychiatry (AACAP) Schools Committee, which cowrote this editorial, is especially concerned with ensuring that the best information on school mental health is available as it is developed. Toward that end, a recently published 'Children and Schools Resource Center' is available on the AACAP website: https://www.aacap.org/AACAP/Fami lies_and_Youth/Resource_Centers/Schools_Resource_ Center/Home.aspx.

As child and adolescent psychiatrists, mental health is definitely 'our lane'. Every student, every family, and every school staff member will have a COVID-19 story. We need to do our best to hear them all and respond when help is needed.

The Disparities in Remote Learning Under Coronavirus (in Charts)

Understanding inner city child mental health need and trauma exposure: implications for preparing urban service providers

Service utilization for lifetime mental disorders in US adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCS-A)

Accepted for publication: 9 September 2020