Mental health first aid and more: How schools can soften the pandemic’s emotional toll

By Jillian Cohan Martin
March 18, 2021
wearing masks in school

As we pass the one-year mark of the coronavirus pandemic, schools across the West are reopening.

Using guidance from the CDC to inform their choices, educators are deciding on the safest number of students in each classroom, the optimal airflow for school buildings, the best cleaning protocols and more, all to prevent COVID-19.

But along with the virus, there’s a shadow danger for kids.

The mental health toll of the pandemic is a companion crisis — one that experts say needs just as much attention, planning and funding.

These concerns will stay with us beyond reopening. The good news is that there’s a lot we can do to counteract them. And now’s the time to act.

Warning signs

Researchers tracking emotional and behavioral health have already noticed a rise in youth mental health concerns such as depression, anxiety and suicide attempts in the last 12 months. And that’s in a year when people delayed care during lockdowns.

In February, the American Academy of Pediatrics launched a campaign to raise awareness of these issues. “What began as a public health emergency is turning into a mental health crisis among our nation’s children and adolescents,” AAP President Dr. Lee Beers says.

Expert panel

Tyrone Burton, Ed.D., author, education leadership consultant

Tyrone Burton

Bonnie Harris, M.S.Ed., author, parenting and child behavior specialist

Bonnie Harris

Kyle Johnson, M.D., professor of psychiatry, director of child and adolescent psychiatry consultation-liaison service, Oregon Health & Science University

Kyle Johnson

Hossam Mahmoud, M.D., M.P.H., behavioral health medical director, Regence

Hossam Mahmoud

“The duration of the pandemic, isolation from friends and family, effects of parental stress and economic hardship, and loss of loved ones are all taking their toll on children’s mental health. Now is the time for us to step up and invest in a broad-scale, comprehensive approach to prevention, early intervention and treatment.”

As children return to classrooms, schools can play a big role. Regence recently spoke to psychiatrists, psychologists, educators and parenting experts about mental health in the COVID era. Here’s where they say schools could focus their efforts to have a lasting impact.

Boost training in/awareness of mental health issues

When you know how to identify the earliest warning signs that someone is struggling, it’s much easier to address the issue before it becomes a serious mental health condition, says Dr. Hossam Mahmoud, Regence’s medical director of behavioral health.

Mahmoud recommends mental health first aid for everyone who works in schools. Like CPR or first-aid training, mental health first aid courses teach people to recognize very early signs of emotional strain.

“It is meant to help educators and other school staff identify signs that there is trouble early on,” Mahmoud says. “And that would be an opportunity to engage with the kids, engage with the family, and to start the conversation as to how these challenges can be addressed.”

It’s also important for schools to be aware of the impact this year has had on teachers’ mental health, notes educational leadership consultant Tyrone Burton.

Burton’s recent book, The Reframing of American Education: A Framework for Understanding American Education Post COVID-19, includes guidance for reopening schools with an eye toward righting systemic imbalances.

“I can’t think if a more empathetic group of people than teachers,” he says.

“We should apologize, because we asked them to get to work — in the context of a pandemic that’s killing people — with very little instructional guidance and very little guidance in regard to health. And they did it willingly, because that’s what teachers do.”

In effect, we now have a nation of educators who have given so much to their students that they’re at an emotional deficit themselves, Burton says. He’s started offering training with school staff to help them identify when they’re under strain and to find ways to tend to their mental health before they’re stretched too thin.

Add staff with expertise in mental health

As part of its school-reopening recommendations, the AAP notes that schools serve as a vital resource for the mental health needs of young people. In order to reopen responsibly, the association says, school districts need to increase funding for mental health services.

Money itself won’t address the need, of course. But if they had the resources, schools could create mental health safety nets by increasing the number of staff who know how to care for children’s emotional needs.

Elementary schools, for instance, currently may have a school counselor who can help with general social, emotional or academic concerns. But many schools do not have regular access to a psychologist or a social worker with more extensive training, as these professionals often share responsibility for more than one school.

Each school should have a full-time staff person with expertise in mental health, Mahmoud says. “Preferably, this would be a social worker who could assess the severity and need for treatment, help triage cases, and connect with the students’ families when need be.”

Burton imagines an even more robust framework, especially for schools in underserved communities. Oftentimes, he says, a school district might have a full cadre of services: psychologists, social workers, counselors, behavior interventionists and parent involvement specialists.

These types of support are called “wraparound services,” because they’re intended to support children in all aspects of their lives — at home, at school and in the community.

But in most cases, if an individual school wants to access wraparound services, they need to ask the district to provide resources. Given our needs today, “it really needs to be at the site level,” Burton says. “That’s the game changer.”

Be proactive with kids and teens

In an effort to respect young people’s boundaries, adults sometimes wait to express their concerns until children are really hurting. Now is not the time to hesitate, says Dr. Kyle Johnson, a child and adolescent psychiatrist and professor at Oregon Health & Science University.

Johnson’s research shows that emergency-room visits for children’s mental health issues dropped during Oregon’s stay-at-home orders in the initial months of the pandemic, making it harder for health care providers to understand how kids and teens were really doing.

For some young people, mental health issues play out in visible ways. But others turn inward, making it hard to identify what they need. That means schools may have to be proactive about identifying and working with students who need support.

If a student is highly anxious about the return to in-person learning, for example, Johnson suggests letting them come to campus when school isn’t in session to get the lay of the land, see the counselor and meet their teacher.

“You may have heard school staff say ‘if you’re struggling, let us know. Reach out to us,’ ” Johnson says. “But we have to assume all of them are struggling. And we as adults need to be reaching out to them to make sense of it.”

Connect with families

When kids struggle, it’s not happening in a vacuum. “I would be willing to bet that it has to do with the anxiety, and the depression, and the isolation of the child’s parents,” says child behavior specialist Bonnie Harris. “Whether kids have been more neglected, or more criticized, the general flavor of this whole pandemic has been more intensity of anything that’s already there.”

Harris, who hosts the podcast “Tell Me About Your Kids,” says that tending to parents’ mental health can ease pressure at home that might otherwise have a greater impact in children’s lives. Schools that have wraparound services that support parents, as Mahmoud and Burton recommend, may be able to help families become more resilient as we head back into the classroom.

Commit to long-term change

For decades, our mental health care system has suffered from provider shortages and other challenges that made it hard for people to access services. But there may already be signs of change.

“I'm hoping this crisis will inspire medical students to consider a career in in psychiatry and undergraduates to consider a career in mental health care,” Johnson says.

Mahmoud, whose research includes an examination of virtual visits for mental health care during COVID-19 shutdowns, notes that “the pandemic also showed us that telehealth technology can make care much more accessible.”

Widespread use of telehealth isn’t likely to disappear once COVID recedes, he says. Similarly, if we add robust mental health supports in schools now, they are likely to stay in place and benefit kids for years to come.

“We’ve really been slogging through the muck of this,” Harris says of the pandemic. But with vaccines becoming more available and case counts dropping, “now there’s a light at the end of the tunnel.”

“We can choose how to come out of that tunnel, and plenty of people are going to need a lot of help doing that.”

Children’s mental health resources


Jillian Cohan Martin is a journalist and content strategist based in Portland, Oregon.