A group of masked fourth graders at Fall-Hamilton elementary school in Nashville, Tennessee sits in a circle on colorful yoga mats. Hands stretched across bellies, eyes closed, they are breathing deeply in quiet calm when teacher Kara Kennard breaks the silence. “Time for Mountain Pose!” she says. The children leap to life in their socked feet, stretching their hands down by their sides.  

“I am confident. I am proud!” they chant together.  

After yoga, students pass around the “breathing ball.” When the students catch it, they take a breath, exhale and give a name to how they’re feeling.  When she catches the ball, a girl named Zi’Keyah tells the group she feels grateful. “We were relaxing in here, and it was good,” she adds.

Fall Hamilton fourth-grade teacher Kara Kennard leads a yoga class for her students designed to help them relax and focus. Credit: Holly Korbey

In the wake of the COVID-19 pandemic, good feelings have been in short supply in the nation’s schools. No one really knows what the long-term mental health effects on young people will be, yet one thing is abundantly clear: more students are returning to classrooms with mental health challenges than before the pandemic began. 

During the pandemic year, mental health insurance claims for teens approximately doubled by spring, as did self-harm and substance abuse claims. During March 2020 overdose claims for teens jumped 119%. From February to March of this year emergency room visits related to suicide attempts by teens rose by 31%, compared with February 2019. A shortage of beds in psychiatric wards in states like Colorado led some hospitals to declare a “state of emergency” for children. 

Younger children have suffered as well. Some 29% of parents of kids between the ages of 5 and 12 reported mental and behavioral problems among their children due to the pandemic, according to a report by the Kaiser Family Foundation.

In that context, the stretches, breathing exercises and games at Fall-Hamilton are more than good fun: The kids are learning about emotional regulation, connection and mindfulness, all of which help create a feeling of security and safety that has been badly frayed by the pandemic. 

At the Nashville grade school, whose full name is Fall Hamilton Advanced Option School, games like tossing the “breathing ball” let children relax and focus on the present, which in turn can build coping skills to help deal with the isolation, stress, grief and loss they’ve experienced; in fact, daily routines and mindfulness exercises “can help children cope with uncomfortable and frightening feelings” linked to the pandemic, according to the American Academy of Pediatrics. 

It’s an example of school innovation in the face of an ongoing crisis. 

Mental health support for children has never been more important. Like millions of kids across the country, about half of Fall-Hamilton’s students haven’t seen the inside of a school building since the start of the pandemic in March of 2020. And while schools may not be sure what kinds of challenges kids are facing, they do know students will need extra help to learn and stay engaged.

“We are focused on the social-emotional health of our students,” said Fall-Hamilton’s principal, Mathew Portell, who added the yoga room this year to a battery of programs Fall-Hamilton already offers students and families. “We have to provide kids with the skills to navigate the adversity they may experience,” he says. “I hear all the time that ‘we don’t teach school like [we] used to.’ That’s because the experience of a student isn’t anything like it used to be—not just the crises of a pandemic, or police brutality, but having constant access to media coverage” in which the world’s horrors are omnipresent.

The combination of pandemic stresses has hit school-aged children hard, especially those in low-income communities and communities of color—like the neighborhood served by Fall-Hamilton. Many of the students at Fall-Hamilton were already dealing with the struggles that come with poverty, including adverse childhood experiences (ACEs), toxic stress and homelessness. Nationwide, as many as 43,000 children have lost one or more parents to COVID-19, according to a study from the University of Southern California. Since children who’ve lost a parent are at a higher risk of traumatic grief, depression, poor school outcomes, unintentional death and suicide, the study authors say “evidence-based interventions” should be made readily available. 

Young people themselves say their mental health is deteriorating. An analysis of 29 studies published in the Journal of the American Medical Association revealed that during 2020, one in four adolescents reported significant symptoms of anxiety and depression—double the-pre-pandemic rate. Researchers said that “covid stressors,” like school closures, social isolation, severe income loss, and/ or the loss of a family member, contributed to high rates of anxiety and depression beyond the normal emotional see-saw of adolescence.

Fall-Hamilton’s social worker, Lori Dunlap, said last year she also saw a big increase in urgent social needs, with 70 to 75 percent of the school’s families requesting help with everything from food and housing to keeping the lights and heat turned on. Parents and caregivers who were hospitalized with COVID-19 also needed places for their children to stay.

The overall effect for families was tremendous stress—something she is seeing kids still dealing with now that they’re back in class. “We are a month into the school year now, and I feel like I’m just starting to piece together some of the after-affects,” she said. “I’ve noticed a huge increase in anxiety. Headaches, stomachaches, feeling something in your body but not having the words to know what to say.” 

Nationally, Education Secretary Joseph Carbona has made it a priority to help kids through the trauma of the last year, along with protecting them from COVID-19 and accelerating student achievement.  “Students have suffered so much over the past 18 months,” he said in a recent talk. “We know it’s hard to process and heal, and we can’t unlock a student’s potential unless we also address the needs they bring with them to the classroom every day.” 

The federal government, in fact, is pledging $85 million in funding to schools for programming and teacher training around youth mental health issues and substance abuse. Schools and districts are using these funds to hire more counselors and psychologists, administering school-wide screenings for health and social needs and providing mental health programming to support students as they return to classrooms. 

“We anticipate that there is major inequity in the way the pandemic is going to impact the mental health and well-being of children long-term,” said psychologist Nicole Racine, one of the study’s authors. “But even in families where there were social and income resources, those adolescents still struggled. I think there will be lasting implications.” 

Prevention or the fire-truck approach?

Before the pandemic, support for students’ emotional and psychological needs varied widely. A 2017 survey found that classroom teachers in the US devoted 4.3 hours a week — roughly 8% of their time — to social-emotional learning, or SEL, an umbrella term for non-academic skills like managing emotions, forming healthy relationships, and encouraging traits like kindness and empathy: skills that are valuable in ordinary years, but especially so during the pandemic. Teaching social-emotional learning often fell to teachers as budget cuts eliminated the school counselors and psychologists tasked with providing SEL lessons focused on issues like bullying or substance abuse. 

Most American schools were already woefully understaffed with mental health professionals. Research shows that student access to school counselors and psychologists is connected to better mental health outcomes such as improved attendance and reduced disciplinary incidents, but schools rarely have enough.  The American School Counselor Association’s recommendation of one school counselor for every 250 students rarely gets met; the average load for counselors is double that. Twenty percent of students have no access to counselors at all.

When school mental health professionals are stretched thin, they’re often forced to take the “fire truck” approach, Eric Rossen, director of professional development at the National Association of School Psychologists, said in an interview. The average school psychologist serves more than 1200 students, which means they often bounce between several schools, putting out fires instead of coming up with plans for prevention.  

A proactive approach that provides all students with basic mental health support would be a much more effective approach, says Micere Keels, founding director of the Trauma Responsive Educational Practices (TREP) Project at the University of Chicago. Even though schools were moving to a stronger focus on mental health before the pandemic, she says, schools still tended to use a wait-and-see approach that only addressed mental health once children’s behaviors disrupted the classroom, or it became a crisis. She believes the pandemic has changed that thinking.

“A lot of schools need to assume that most kids are coping with low levels of emotional distress,” Keels said. “So how do we make sure our teachers know how to recognize signs and symptoms of distress, and are able to put in supports that are preventative and offer positive mental health and coping skills?” 

Together with the TREP Project staff, Keels helped develop the 30 Days of Mental Health Pledge for educators, a free curriculum to use at the beginning of the school year to heighten awareness of mental health for students. Each day, teachers cover topics like ‘what is stress?’ and ‘how to share your stress with an adult,’ using simple methods that are backed by research. 

“We don’t want teachers to wait for a crisis,” Keels said. “We want to ensure they have the knowledge and the tools to actually promote positive mental health.” 

Schools zero in on surveys, data and teacher training  

Of course, like families, each school district has suffered in its own way. Large urban districts that remained virtual all year, like Los Angeles Unified and New York City Public Schools, may have different considerations than districts across Florida, Texas and the Midwest, where school shutdowns were often shorter and the risk of COVID infection worse.

Topeka, Kansas, public schools welcomed back students sooner than most, but they still had to address the emotional damage wrought by the pandemic. Superintendent Tiffany Anderson of the Topeka Unified School District said in an interview that the district’s comprehensive student mental health program — which included community partnerships with mental health providers and social workers — continued to operate during the temporary closures of last year. Schools provided mental health checkups when families came to school to pick up meals. They switched routine home visits to “porch visits,” so social workers could check on families at a safe distance. When school was in session, educators took time to ask how students were doing and pay close attention to the answers. 

Now that school is back in session,  principals are planning to use mental health survey data they collect at the start of each year to ensure no students fall through the cracks. 

Weekly and monthly “data consult” meetings give Topeka principals, counselors, social workers and educators a chance to look at screening results together and connect numbers to actual students. “We pull up the data together and see which students have been highlighted because of some red flags, or overlapping issues, or attendance,” Anderson said. “Then we can figure out who is going to support that student. We can talk about kids, not numbers.” 

In California, Mountain View Elementary District, a district forty miles from downtown Los Angeles, anticipated that more students arriving at school this fall would have mental health challenges. 

So over the summer, Mountain View encouraged teachers, principals, support staff, kitchen staff and even bus drivers to get training in Youth Mental Health First Aid, said Superintendent Douglas Moss. In afternoon sessions, adults who work with kids find out the signs of a student who might be emotionally distressed or experiencing the onset of a mental illness. They also learn how to assess risk for suicide and what to do next. 

“I wanted people to get the training so we could get specific and direct tools to meet students where they are,” Moss told MindSite News. “Know what you know, know what you don’t know, and know when to refer—that’s what we’re hoping for.”

Whether it’s survey data, mindfulness exercises or training staff to assess suicide risk, many schools realize they are now playing a critical part in supporting students through one of the toughest moments of their lives. 

“What the pandemic highlighted is how central schools are to families,” Anderson said. “We always kind of knew that, but in the absence of families not having access to their schools, we came to realize how critical schools are. They are the hinge point.” 

Putting mental health at the heart of school’s mission 

At Fall-Hamilton, “improving student mental health” per se isn’t really the goal, says Portell, who has been principal for six years. Instead, he views the school’s counselors and social workers, its engagement and deep breathing practices as part of a more holistic approach, a way to give students a chance at a stable, fulfilling life. 

“We want kids to come out of here who can self-regulate, who can identify their emotions and meet their academic potential,” Portell said.  

Fall-Hamilton students still face a variety of challenges, and academic achievement, while improving, hasn’t yet reached its mark, Portell says. But the school has done everything in its power to transform the school into a place where positive mental health—a way to deal with life’s anxieties—is both at the heart of the school’s mission and a sustainable goal.

At the end of the third day of school, Portell turns philosophical. He is annoyed that the pandemic has turned words like “resilient” into buzzwords and worries that a rush to focus on kids’ mental health might cause some administrators to treat schools like therapy or emergency rooms instead of gateways to a better life. Schools can be therapeutic, he said, without being therapy.

He points to research conducted by psychiatrist Bruce Perry, an author and expert on child trauma, showing that positive “micro-interactions” with adults in high dosages had a greater effect on student mental health than a 50-minute therapy session. 

With that research in mind, teachers at Fall-Hamilton began opening car doors for students every morning and greeting them by name, saying things like, ”How are you? I’m so glad you’re here! Today is a new day. I love you.” 

“We know that those small interactions can have a huge outcome when given in high dosages,” Portell said. After a devastatingly hard year and a half, they’re a high-dosage human connection to start the day. 

Learn more

Fall-Hamilton Elementary:  Transitioning to Trauma-Informed Practices to Support Learning. Meet principal Matthew Portell and others in this video, part of a series by the California-based nonprofit Edutopia.

How Children Learn. An excellent video series from Edutopia on the importance of social-emotional learning (SEL) in dealing with students’ adversity and helping them flourish.

Reimagine and Rebuild: Restarting Schools with Equity at the Center. Created by California-based family and student engagement organizations in response to the COVID-19 pandemic.

School Mental Health First Aid. A “first aid” kit for help preventing student suicides from the National Council for Mental Well-Being.