Students Face Worsening Mental Health, But How Will Schools Handle It?

Ginny*, 15, had been trying to tell her mom how bad her mental health was, but her mom just wasn’t getting it — she would tell Ginny that all teenagers are hormonal and that her life was good compared to others so she shouldn’t be sad. It wasn’t until a friend’s mother found text messages detailing Ginny’s recent self-harm and told Ginny’s mom that she realized just how precarious Ginny’s mental health really was.

Ginny is one of the many people experiencing the widespread mental health ramifications of the COVID-19 pandemic. More than a year of uncertainty marked by social upheaval, rampant unemployment, extreme isolation, and a pandemic that has left over 618,000 Americans dead has, according to multiple studies, worsened Americans’ mental health. But teenagers appear to have been especially affected: One poll found that nearly half of parents they surveyed reported their children's mental health worsened during the pandemic, and the Centers for Disease Control and Prevention found that emergency room visits in February and March of this year for suspected suicide attempts among girls ages 12-17 rose 50% from the same period in 2019.

Now, vaccine access has resulted in loosening restrictions and a return to certain pre-pandemic behaviors. But as the Delta variant spreads rapidly and vaccination rates are still insufficient in many areas of the country, many students will return to school with unclear guidance on mask wearing and in-person learning — continuing the fear and uncertainty that’s lingered since March 2020. The question of what safety precautions students in schools will have to take looms large, but so does the question of how schools will handle not just the physical threats the pandemic brings, but the increasing mental health crisis among young people.

“I was just looking at myself in the mirror like what’s wrong with me? And looking at other people like ‘what are they doing that I’m not?’”

Ginny started high school in 2020, though she said she felt like she was still in middle school since most of her high school life has been online. When hybrid school (a combination of online and in-person learning) became an option, she tried it out because she missed being around her peers. But even when she was physically in the school building, she had to join Google meetings to attend class and avoid talking to anyone in the hallways to attempt to reduce the risk of COVID transmission — which left her feeling just as isolated as she had at home. She returned to her bedroom, which she started to call her depression room, and felt herself enter an unending cycle of worsening mental health. She started missing school assignments, which led to worse grades, which led to worse mental health, and on and on.

Ginny said she was “pretty mad” when her friend's mom told her own mother about her self-harm, but she doesn’t think she would’ve gotten help if that hadn’t happened. As a result, Ginny started seeing a therapist and psychiatrist, and took a medical leave of absence from school to enroll in an outpatient mental health center, where she was treated for several hours each day. Still, she said her teachers weren't understanding about her situation, even giving her zeroes for assignments she was excused for.

“I feel like they tried to make it seem like I was just regularly absent and skipping classes,” she said. “They didn’t really care... how it could negatively affect my recovery by giving me a bunch of work to do.”

For those not going back to school this year, a whole different set of mental health concerns arise.

Now, Ginny says she’s doing better. Though she’s worried about going back to school in-person, she thinks it’ll be best for her mental health. Without the effects of isolation, she doesn’t think her mental health would have deteriorated as far as it did.

Tiffany Yip, Ph.D, a psychology professor at Fordham University, told Teen Vogue, “there is no doubt that the pandemic sheds light on existing mental health challenges, and it also created new mental health concerns. The pandemic forced us into a global ‘pause.’ When we pause, we have more time to stop and observe, we start to notice things that were drowned out by our prior ‘busy-ness.’”

In the extended pause of the pandemic, Claire, a 15-year-old from Indiana, spent more time criticizing herself. “When you’re left alone with yourself that long, you tend to pick at yourself,” she said. “I was just looking at myself in the mirror like what’s wrong with me? And looking at other people like ‘what are they doing that I’m not?’” She found herself falling into what she called a “shame spiral” where she would tell herself “you have so much time in this pandemic [but] you’re going to come out on the other end the same person you were. You wasted a year of your life.”

Claire, who has ADHD and anxiety, relies on structured schedules to keep her symptoms at bay. When school went online and she lost that much-needed structure, she said it was difficult to care about her work. “It was like, they’re just sending me worksheets. Why do I have to do them? It was a general feeling of existential dread.”

While Claire had been in treatment for mental health for years, she found it hard to be honest with her care team during the pandemic. She said she felt guilty that her usual coping mechanisms weren’t working and was worried about wasting her therapist’s time. Things got better for Claire when she went back to in-person school.

“I was happy that I got to return to things that brought me joy pre-pandemic,” she said. “It gave me a lot to look forward to.” Looking back, Claire said, there just wasn’t understanding from adults about how challenging it is to work on schoolwork alone at home.

“It was hard for people to get back into the swing of things and there wasn’t much grace allotted for that.”

Haniya Raza, DO, MPH, a psychiatrist at the National Institute of Mental Health, said that adolescents who had existing mental health conditions, like anxiety or depression, were “particularly vulnerable to an exacerbation of their illness during this pandemic period.”

Whether students dealt with new mental health issues during the pandemic, or experienced the worsening of pre-existing ones, Raza said schools have a crucial role to play as students transition back to the classroom.

Students returning to school are anxious, frustrated, and uncertain about what the fall semester will bring.

“What grown-ups can do is be aware of their students and check in and make an environment where [students] can talk with trusted adults and teachers,” Raza said. “The biggest problem is teens feeling misunderstood.”

For Claire, that was a big problem. As she felt mounting pressure to return to “normal” once she was back in school, she said there was little room for readjustment.

“It was hard for people to get back into the swing of things and there wasn’t much grace allotted for that," she said.

Experts seem to agree that schools should be patient as students re-enter, looking out for worsening mental health. The American School Counselor Association (ASCA) has advised members to be prepared for students' mental health needs upon returning to school, noting that some may have lost loved ones, witnessed violence, or be afraid of catching COVID-19 once back in school. “School counselors are first responders,” their website reminds readers. And, in 2020, the American Psychological Association advised that all school staff have heightened awareness about students' mental health upon return to in-person learning, advising a screening system for anxiety and depression, and a plan of care in place for students who are found to be experiencing mental health concerns.

But with mounting need, there are, in many places, fewer resources.

In-school mental health services serve as the only form of treatment for a lot of students, so being out of school meant being away from that lifeline. According to a March 2020 survey from YoungMinds in the UK, 26% of respondents said they couldn’t access mental health help when they were out of school during the pandemic. Upon returning to school, 23% said there were fewer mental health resources than before, according to a follow up survey. For schools still grappling with evolving COVID restrictions and a worsening shortage of both qualified educators and mental health professionals, tending to students’ mental health along with their education is a tedious but important balance.

To address that balance, the California Association of School Counselors and Wisconsin School Counselors Association teamed up and created a resource guide for school counselors. And, the ASCA is offering discounted courses on helping students with mental health issues and trauma to members. But helping students adjust after the pandemic is an all-hands-on-deck type of job.

“Being a teenager is hard enough without a pandemic," Yip told Teen Vogue. "It is that much harder with one. We need to prioritize the mental health needs of our young people before we aim to address any ‘learning loss’ that may have accumulated over the past year and a half.”

Yip said that recognizing the range of experiences teens have had in the pandemic – from flourishing to losing loved ones to watching people they love get sick – will be critical for educators and community members. And just like there’s a wide range of pandemic experiences, there are an equally wide range of reactions to this transition period. Some teens, Yip said, will be ready to jump right back in. Others will need more time to ease back – and it’s important to communicate that this entire range of reactions is normal.

“It’s really hard to look forward to your future when your present is such a disaster.”

For some, however, the lack of resources isn’t necessarily the problem — it’s a lack of understanding.

Anya*, a 17-year-old first-generation American living in Texas, said the option to process the mental health toll of the pandemic through therapy was locked behind the stigma of mental illness in her immigrant community.

“Therapy wasn’t even a talking point,” Anya said. She has spent the pandemic at home because her high-risk grandmother lives with her family. When she logged onto online school, she could hear her peers participating in person and she felt like while her world had come to a screeching halt, people were continuing on without her. She remembered walking up the stairs at 2 a.m. to go to bed and sitting down for a moment to cry in the middle of the staircase. After she cried, she got up and kept walking like nothing had happened. Her mom even had a term for the moments when Anya would get overwhelmed many evenings: the midnight blues.

Anya was anxious before the pandemic, notably about her school performance. She said she faces pressure from her immigrant parents’ high expectations of her and that she’s been burnt out since sixth grade – and when the pandemic impacted her junior year, which is known as the most important year for college-bound high schoolers, she was completely overwhelmed. She wants to be a doctor but during the ongoing isolation, she started questioning her skills as a student. Her mother would ask how she thought she would get through years of college and medical school if she was already having a difficult time keeping up with school. Usually, Anya said she was able to laugh comments like that off, but during the pandemic, they stuck with her. “It’s really hard to look forward to your future when your present is such a disaster,” she said.

"That’s just an overwhelming [feeling], having that grief and yet having to go on.”

Like so many teens in 2020, Charlotte, a 17-year-old from South Carolina, found herself in a gauntlet of online learning and teletherapy when trying to cope with her mental health. She was screened for, diagnosed with, and treated for an anxiety disorder entirely online. Although she started the process of mental health treatment before the pandemic took the world in its grasp, her initial appointment wasn’t until July of 2020, when most doctor’s appointments were held virtually. Even now, almost a year after her first appointment, Charlotte hasn’t met her therapist in person.

Through virtual appointments, Charlotte was diagnosed with anxiety and prescribed medication. She is of two minds when it comes to tele-mental health: on one hand, it was convenient to be able to see her psychiatrist online instead of driving across town for an appointment. On the other, she found it hard to communicate her feelings and gauge her response to medication over video. She said she felt both more and less vulnerable when talking to her therapist. “I’ve never met her in person,” Charlotte said. “Which helps to be a little bit more honest… because she’s just a head on a screen. But also I didn’t really get to have as much personal trust.”

Charlotte, who just finished her senior year of high school and is college-bound in the fall, said returning to in-person school was overwhelming after being online for so long. “It was very draining to be in person but almost not in person because I couldn’t hug my friends or sit next to people at lunch,” she said. “I had to be six feet away while I was eating and the social areas in my school were blocked off so people couldn’t congregate and spread COVID.” On top of the continued isolation of the pandemic, every school activity Charlotte had been looking forward to during her senior year was either cancelled or changed beyond recognition. She was also waiting for word on her college applications and felt adrift between not having a normal senior year and not knowing where she would be going to school in the fall.

By the time graduation rolled around and Charlotte had received her college acceptances, her mental health was better than it had been. But when she was listening to graduation speakers wax poetic about the resilience of the class of 2021, she was frustrated. Yes, she and her peers had been resilient – but they shouldn’t have had to have been. “There hasn’t been time to collectively grieve all the experiences and all the people we’ve lost," Charlotte said. "That’s just an overwhelming [feeling], having that grief and yet having to go on.”

*Indicates name has been changed for privacy.

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Originally Appeared on Teen Vogue