Shea Wiedemeyer's depression crept in slowly.
The high school freshman had struggled with some anxiety before schools shut down abruptly in March, but in the isolation of the pandemic, cut off from daily interaction with friends and teachers at McCallum High School in Austin, the feelings snowballed.
“I feel stuck in this sort of in between age where I’m old enough to see current events that I’m able to understand their impact and have opinions on them, but I’m unable to really do anything about it,” the 14-year-old said. “It’s a very discouraging feeling and it leaves me feeling pretty hopeless about the future, both my own and that of the world.”
Wiedemeyer is part of a wave of students nationwide grappling with mental health issues spawned by the loneliness, fears and uncertainty of the COVID-19 pandemic. Texas counseling clinics and hospitals report large increases in students seeking help for anxiety, depression and thoughts of suicide. Students are wrestling with their loss of freedom, fears of contracting COVID-19 and grief for loved ones who died from the virus, experts say, and the state needs to step up its efforts to help them.
“It’s really the perfect storm for whatever causes a child anxiety,” Jessica Knudsen, CEO of the San Antonio-based Clarity Child Guidance Center, which offers in-person and outpatient services to children in South Texas. “It’s really created stressors, no matter what your trigger is.”
There are few hard numbers available on the pandemic's mental health effects on adolescents, but emerging information sheds light on disturbing trends.
Last month, a Centers for Disease Control and Prevention analysis found a significant increase in pediatric mental health-related emergency room visits, often the first point of care for children needing mental health care. Beginning in April, mental health-related visits to a large sampling of emergency rooms in 47 states increased 24% among children ages 5 to 11 and 31% for those 12 to 17 compared to 2019.
A June study of 3,300 U.S. high schoolers by America's Promise Alliance showed 30% of young people said they were feeling unhappy or depressed more often.
Emerging research from other countries, as well as long-term data on the effect of other community disasters and prior epidemics, "suggest that the mental health toll of COVID-19 and its associated burdens on youth will be significant and long lasting,” said Sharon Hoover, professor of child adolescent psychiatry and co-director of the National Center for School Mental Health at the University of Maryland School of Medicine. “We anticipate increases in depression, anxiety, trauma and grief, and more demand for an array of mental health services and supports for children and families."
Texas districts typically have school guidance counselors licensed and trained in trauma-informed practices, but they spend the bulk of their time on academics, juggling students’ schedules and keeping them on track for graduation. Students with mental health needs are often referred to therapists off campus. Few schools have campus-based licensed medical professionals who are equipped to provide long-term mental health care.
In the absence of such professionals, it often falls on teachers to identify students who are struggling. But teachers themselves wrestle with mental health issues, as they juggle greater workloads, teaching both in-person and virtual students, and risk exposure to the virus.
Texas may have been more prepared than other states to handle student mental health. State lawmakers in 2019 passed laws requiring schools to train teachers in addressing student trauma and developing ways to prevent substance abuse and suicide.
But experts say more students will need those services as the pandemic continues.
Cook Children’s Medical Center in Fort Worth, for example, admitted 37 youth following suicide attempts in September, the highest monthly count the hospital has seen since it began tracking the number in 2015, Dr. Kia Carter, the center's co-medical director of psychiatry, told the Texas Senate Committee on Health and Human Services earlier this month.
School-based intervention can play a key role in identifying and reaching out to students, experts said, and trained educators on alert for warning signs can make a big difference. For students learning at home, parents are often the first to sense that something is wrong.
Carl Hooker noticed his daughter's hesitancy while watching her take an online class. Already an introvert, the sixth grader at Bailey Middle School in Austin Independent School District sat quietly during her group project in English Literature.
She was terrified to start the conversation, Hooker said, and he tried prodding her to unmute and participate in the class. She previously wrestled occasionally with anxiety, but since schools closed her levels of angst have become troubling, he said.
“With the pandemic and the inability to socialize, it’s just been a struggle,” Hooker, an educational consultant and speaker, said. “She was pulling away and not participating in any of the breakout room chats, so much to the point that my wife and I were hovering over her trying to get her involved.”
On a recent morning, the family guinea pig was dying. Grieving, Hooker’s daughter reluctantly logged into her online class, but kept her camera off, holding the pet in a blanket on her chest.
Her teacher noticed the withdrawal, asked her to join him in a one-on-one breakout room, away from both the in-person and online students in their class. He complimented her on her work and checked in on her pet, asking if she was OK.
“The guinea pig had almost passed but that one minute of action on his part will not,” Hooker said.
Many students who have or will be returning to in-person schooling also are battling “crippling anxiety” either because of socialization after being out of school for months or fear of the virus and risk of exposure, said Knudsen, of the San Antonio-based Clarity Child Guidance Center, among a handful of collaborative partners providing mental health services to students of the South San Antonio Independent School District.
Carter, of Cook Children’s, said the stress of the pandemic, virtual schooling and limited or no access to mental health services are contributing to the upward trend of suicide attempts and ideation.
“Our kids have been isolated from their activities, their peer groups, their teachers who are strong support systems for them, their school counselors,” Carter told the committee members. “So we’re seeing a lot of kids coming in feeling hopeless due to the level of isolation and not being able to do the normal things that they do.”
Students also are affected by the stress their parents and teachers are experiencing. Many parents now are unemployed, and thousands of teachers across the state are experiencing burnout and leaving the profession in the middle of the school year.
“One of the most important messages right now is that as we think about student mental health, we have to also think about educator mental health,” Hoover said. “That doesn’t just mean telling educators to take better care of themselves, but really thinking about what are the structural or organizational factors that need to be adjusted and put in place so teachers can be well … Our teacher well-being will impact our student well-being so we have to be attentive to both.”
School districts that offer campus-based therapy to students and their families also have their doors open to their teachers, but many educators are left to find help on their own.
Since March, the therapists with Vida Clinic Behavioral Health, which operates out of 45 Austin district schools and now also provides counseling to students online, have seen nearly 4,000 students and 2,000 teachers and parents.
The top issues the group’s staff have encountered are anxiety, psychological trauma, family conflict and depression, said Elizabeth Minne, a licensed psychologist who founded the Vida Clinic. Suicidal ideation also is on the rise, she said.
“This year, the demands are just really huge,” she said.
Interventions can be as simple as teacher or counselor check-ins with students to ensure they are okay, particularly if educators notice a decline in participation or change in behavior.
“There are definitely things schools can do to help mitigate those effects that aren’t what we would consider a mental health intervention,” said Josette Saxton, director of mental health policy for Texans Care for Children. “But they can help address those lower level issues that if unaddressed could lead to something that requires mental health treatment.”
They also can include more robust social and emotional learning, which teaches skills to help children manage their emotions, control behaviors and cope with life’s pressures and in-house counseling and therapy.
More districts are attending more to social emotional health as part of the day-to-day operations of school and are devoting a chunk of what would be learning time to well-being checks, screenings and discussions about the effects of stress.
“We’ve been really heartened by the efforts of so many districts and schools and student mental health staff and the hoops they’re jumping through to make sure their students not only are accessing distance learning but also receiving school emotional supports along the way,” Hoover said.
Districts also are creating new or increasing partnerships with community behavioral health providers and bringing them into school buildings, which helps remove the stigma for seeking help, mental health experts said.
Just four months before the pandemic hit Texas schools, 8,700-student South San Antonio ISD launched the South San Mobile Wellness partnership, a group of six agencies, including Clarity, which provides free, on-campus counseling and therapy for students, their families and staff members. The collaborative was born after a yearslong effort by a group of high school students advocating for more mental health resources.
“The services were there when we needed it,” said Marc Mendiola, one of South San Antonio High School spring graduates who advocated for increased mental health resources. “Students would have struggled more. It is something to make it easier during the pandemic.”
Other districts across the state also have similar clinics. The 52,000-student Lewisville district opened a free counseling center more than a decade ago to students and their families. And the 76,000-student Austin school district launched campus-based therapy for students eight years ago and expanded services to about one-third of its schools, as well as online counseling.
The counselors with Vida Clinic connect with the student’s teacher and parents to provide holistic care. Such interventions generally have resulted in improved grades, attendance and school performance “because our care goes beyond the walls of the therapy room,” Minne said.
“We’re surrounding that child with a system of care,” Minne said. “That’s where we move the needle.”
