MENTAL HEALTH CRISIS

IN SCHOOLS
HOW TO ADDRESS ADOLESCENT MENTAL HEALTH

Shreya Rupesh

ENGL 138T, Sec. 004

Professor Babcock

04/15/2023
 Rupesh 1

INTRODUCTION

Mental health has been a trending topic the past few years. Primarily due to the recent

COVID-19 pandemic, students and parents alike have been worrying about emotional well-being

and how to manage this throughout quarantine. People on social media sites like Instagram and

TikTok posted colorful, vibrant infographics on normalizing and spreading awareness of various

mental health struggles.

Mental health differs significantly from mental illness. The definition of mental health is

cognitive, behavioral, and emotional wellbeing while mental illnesses are mental health disorders

that affect a person’s thinking, feeling, mood

or behavior2. This difference is important to

understand. A person can have mental health

issues while not being diagnosed with a

mental illness. Thus, mental wellness is a

1
Figure 1. Mental Health, Wellness, and Illness
spectrum and people range from one end to

the other. Many people generally fall somewhere in the middle, usually having good health, but

having the occasional mental health struggle.

The need to address mental health started long before the pandemic. According to the Center

for Disease Control and Prevention, more than 50% of people will be diagnosed with a mental

illness or disorder at some point in their lifetime3. More specifically, adolescents are

experiencing a rise in mental illnesses such as depression, anxiety, and other behavioral

disorders4. Many of these health conditions go unrecognized and untreated. Thus, the need for

action on mental health is urgent and necessary. There must be strategies in place to promote and

support mental health issues in the school system as well as in the community.
 Rupesh 2

HISTORY OF MENTAL HEALTH

For most of history, mental illness was seen as the work of evil spirits. It was some sort of

possession of the human body that caused this ‘madness.’ In the 19th century, this theory was

quickly replaced with an inaccurate but more scientific theory5. Mental illness was now thought

to stem from a diseased or defective brain. No one understood precisely where the ‘defects’ came

from, but many theorized that it was genetically passed down, from germs, or simply through

bad luck. Treatments at this time included brain surgery, different elixirs, exorcism, and

institutionalization.

Mental struggles were first portrayed as issues that needed treatment in the 1840s by

American nurse, Dorothea Dix. She realized that the

mentally ill were being treated inhumanely- like criminals

and placed into asylums without proper care. This is when

the need for proper treatment began. Clifford Beers,

considered the founder of the mental hygiene movement,

wrote a memoir titled ‘A Mind That Found Itself7.’ This

book discusses Beers’ own trouble with psychosis and the

treatments he was given. His condition was deemed as

‘insanity’ and he was put into the mental hospital. Thus, Figure 2. Dorothea Dix Portrait6

he called for the creation of mental hygiene societies, programs, and destigmatization of mental

health through his organization Mental Health America. In 1933, the first International Congress

on Mental Hygiene convened. The members discussed determining the best way to care for and

treat the mentally sick. Since then, various studies have been launched to determine and treat

different mental illnesses.

 Rupesh 3

Sigmund Freud was also pivotal in the discussion of mental health. He separated the

mind from the brain and offered various explanations of

mental illnesses and mental health issues9. He even coined

the “talking cure” of therapy that is most widely known

today, where patients sit on a couch and talk about their

feelings, moods, and issues. This idea of ‘therapy’ helped

destigmatize mental health as a whole. By the mid-20th

century, Freud’s ideas of psychoanalysis were widely

accepted. More researchers and scientists began studying

mental health and how to effectively treat it10.

Figure 3. Sigmund Freud Portrait8
Around this same time, schools realized the

importance of mental health services for students in the early 1900s. Princeton University was

the first educational institution to develop a mental health service. Following this, discussions

arose about whether schools should support mental health along with their physical health

services. In 1920, the American Student Health Association decided that ‘mental hygiene’

support services were critical for college campuses11. However, it took around 40 years for these

services to become common on every college campus. The American College Health Association

formed a separate section for Mental Health in 1957, and today all colleges and universities have

some sort of support for their students12. Slowly, people started realizing the importance of

adolescent mental health.

Today, drug therapy and counseling are at the forefront of treatments for mental health

issues. While the stigma around mental health still exists today, it is not as prevalent due to the
 Rupesh 4

rising levels of mental health issues in children and adults. However, efforts still need to be made

to increase mental health support nationwide.

IMPORTANCE + MENTAL HEALTH TODAY

14
Currently, it is estimated that one in five adults experienced a mental illness at least once in

their lives. And millions of American students

suffer from mental health problems. The

prevalence of mental health problems in

American students continues to grow. In fact,

more recently during the COVID-19 Pandemic,

the American Academy of Pediatrics declared a Figure 4. Advantis Medical Data13

National Emergency in Child and Adolescent

Mental Health15. The pandemic exacerbated the mental health crisis that was already present

before.

Mental health for adults is discussed more often than adolescent mental health. Thus, there

are many more options for treatments for adults. However, for children, despite all the efforts

that schools put in, it has not been enough. Historically, most states failed to meet national

standards for the number of students served by mental health professionals. The national

standard is a ratio of one professional for 250 students16. Some states, like Georgia, have only

one psychologist for every 6,390 students at their schools, which is unacceptable. Students are

not getting the mental health support that they need, which can provide dangerous results.
 Rupesh 5

It is unacceptable that the mental health

crisis continues to grow at an

unparalleled rate. In a study done in 2018

by the National Association of

Elementary School Principals, 65.6% of

principals identified student mental

health issues as an area of extreme

Figure 5. NAESP Data, 201817 concern. So, even staff members identify

and understand that mental health is an important issue.

Even more, most of the afflicted students will not get the help they need. According to the

American Journal of Psychiatry, approximately 80 percent of the nearly 5 million affected

students won’t receive counseling,

therapy, or medication19. In fact, they

won’t get any treatment at all. It is

imperative that solutions are found to

help students that struggle with these

issues. Untreated mental health issues

can significantly deteriorate a person’s

overall health. Mental health issues, like

depression, are often linked to long

lasting physical health problems like

Figure 6. The Pew Charitable Trusts, 202218
diabetes, heart disease, and stroke20. And
 Rupesh 6

as of last year, more than 60% of children who experience depressive episodes do not receive

treatment21.

CURRENT LEGISLATION

Presently, there is legislation that addresses mental health support in schools nationwide.

However, each state is taking their own steps to address mental health on a smaller scale. In

2021, 38 states enacted nearly 100 laws addressing mental health support in schools22. This was

a direct response to the COVID-19 pandemic and the rise in mental health issues that it caused.

This legislation provided funding for improved support services, a strategic plan, and training

and resources for teachers and students. The Bipartisan Safer Communities Act of 2022 invested

one million dollars in improving school mental health for five years, which included funding to

increase the number of mental health providers that schools had access to23. The COVID-19 laws

that were enacted targeted a wide variety of upgrades to school mental health resources, aiming

towards arriving at a comprehensive solution. Some states used the money towards research and

screening tests, while others used it to create new mental health curricula.

While there are many laws that provide grants and funding for schools, some schools still

do not have the proper budget for these services. So as school budgets shrink, staff members are

forced to prioritize programs over others, and mental health support is usually at the bottom of

that list. By prioritizing programs deemed as ‘valuable’ like STEM education and athletic

programs, schools disregard actual important programs like counseling and mental health

support. Schools that have a larger budget might still prioritize other programs and give much

less funding towards their mental health resources. Thus, these resources might not be the best

quality.
 Rupesh 7

Ultimately, the efforts that are made today are all necessary solutions; however, nothing

is standardized. Every school is attempting to tackle this issue in several different ways.

Furthermore, many of these attempts are not comprehensive, meaning they do not tackle every

aspect of support that a student might need. While all these laws are steps towards a solution,

they need to be much improved, as schools still have too little funding and too few mental health

providers and services to fill the rising demand of support.

VIABLE SOLUTIONS

There are a wide range of solutions to address the mental health crisis. While there are

many laws right now, it is not enough. Adolescents continue to struggle with mental health

issues. Furthermore, many of these laws vary from state-to-state and school-to-school. For topics

as pivotal as this, legislation should be more homogeneous for every school across the nation.

Whatever solution is implemented should be common for every school, and grants should be

given to every school to do so. Some homogeneous solutions include mental health days, a new

mental health curriculum, or new tiered systems of support.

The five main necessities that school

needs to have been illustrated in this

infographic. The first is discussion.

There must be open discussion about

mental health issues. Students need

to be reassured and understand that it

is normal and okay to be struggling.

This is the only way that students

Figure 7. Student Behavior Blog24
will be okay to ask for help. Next,
 Rupesh 8

staff members need to be trained well to identify and respond to signs of mental health issues.

Third, mental health must be part of school curricula. It must be addressed in class syllabi, and

different aspects of mental health should be taught both to students and staff. There also must be

accessible support systems for students that ask for help, whether that be through the school or

community based. Finally, teachers need to be supported and taken care of as well. It is not only

the students that.

MENTAL HEALTH DAYS AND BREAKS

There are several options on how to address the mental health crisis in schools today. The

simplest solution is to give students more breaks. Especially for high school and college-aged

students, the stress of academics affects students’ mental health. But mental health also affects

students’ academics. Thus, a vicious cycle is born. Schools cannot change or individualize the

level of academic rigor they give students. So, it is important to find a support system to counter

this stressor.

A mental health day is a day where students can stay home from school and take part in

self-care activities to relieve anxiety that arises due to the mental and social impacts of school.

Some of the benefits of mental health days include reduced feelings of burnout, improved

attitude, stronger resiliency, increased productivity, and an overall improved physical health 25.

77% of parents that have been letting their children take a mental health day felt that it had a

positive impact on them, according to a study by Verywell Mind and Parents26.

 Rupesh 9

Currently 36 states have not addressed and have not proposed laws regarding mental

health days. However, the states and schools

that have addressed it have been seeing

positive results. In 2022, Northeastern

University came up with the idea of

“Wellness Days” for their undergraduate

students. This program gave all students two

excused absences per semester to prioritize

self-care and mental health28. Northeastern Figure 8. Verywell Mind and Parents27

University has embraced this program and it has been receiving positive feedback.

Previously, the university had a ‘Care Day’ where class was cancelled on a selected two

days per semester. However, this was criticized because mental health crises are always

random—not on a select day. “Wellness Days” gave students the opportunity to choose when

they wanted a break.

IMPROVED MENTAL HEALTH LITERACY

Another simple solution is to improve the mental health curriculum for both staff and

students. One of the main issues with schools is that they do not identify risk behaviors early on.

If these behaviors were identified, then students could get the care they needed.

Researchers at the Norwegian University of Science and Technology in Trondheim,

Norway studied the relationship between positive mental health literacy and mental well-being in

adolescents29. They concluded that an adequate mental health curriculum is positively associated

with mental wellbeing. Thus, educating students on topics such as stress management, body
 Rupesh 10

image, and self-esteem are crucial to mental wellbeing. This could mean hosting open

discussions, classroom seminars, and even small-group discussions between staff members,

nurses and counselors, and students.

The University of California Irvine hired a pedagogical wellness specialist to help

improve their mental health literacy30. This specialist helped train professors and staff to address

wellness in their class policies and procedures, created workshops, consulted with professors,

and conducted research on staff and students. Ultimately, she implemented a ‘flexibility with

guardrails’ approach for the school, which gave students autonomy in their coursework, but

within certain classroom boundaries. The specialist then created different workshops for staff

members to teach about different mental health issues, like trauma-based mental health issues,

school-based stress, and anxiety, and many more31.

COMPREHENSIVE SCHOOL MENTAL HEALTH SYSTEM (CSMHS)

This multitiered approach was founded by the Substance Abuse and Mental Health

Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services

(CMS)32. This solution includes evidence-based universal prevention efforts, training for staff,

students, and community members to identify and respond to early signs of mental health

struggles, and targeted prevention and intervention programs. While this is merely an extension

to currently existing programs, it could possibly be pivotal in aiding with the mental health crisis.

This blueprint also considers community-based support systems. Schools can collaborate

with health care providers, government agencies, mental health and treatment providers, and

local businesses. Sometimes, the school support system might not be enough for students. Thus,
 Rupesh 11

reinforcement from the community will provide a necessary backbone as an expansion of these

school support systems.

MULTITIERED SYSTEM OF SUPPORTS (MTSS)

Along similar lines, a multi-tiered system of support in schools may help identify students

that are struggling more efficiently. As the name suggests, this approach requires multiple levels

of support, ranging from general to specific33. The first tier would be the baseline, which is more

general support for all students. As the tiers increase, the intensity and necessity of care increases

as well. This solution is entirely need-based and dependent on how efficiently the school can

identify the afflicted students.

Tier 1 should be universally offered, and it should include basic resources like a guidance

counselor, screening tests, and basic mental health literacy for staff and students. The next tier

should be specifically for students that have been identified with risk factors. This is a grey area

where students should be monitored and possibly screened. If early signs of mental health

problems can be found, the faster it can be taken care of. Finally, the last tier could specifically

be for students that are struggling with mental health or substance-related difficulties. This tier

should offer individualized school or community provided treatment. Of course, for both the

previous solutions, there must be grants given to schools to make these possibilities.

CONCLUSION

The mental health crisis in adolescents is often overlooked. Many schools do not have the

proper tools and funding to create a system of support for students, and the schools that have

funding often use it elsewhere. Failure to address mental health issues and illnesses for

adolescents can lead to many long-term issues that can impair students’ social, emotional, and
 Rupesh 12

physical lives in the long term. Thus, adolescent mental health should be a priority in all schools,

and it is time to invest money and time into making it one.

1
The Mindful Company. (2021, January 9). Defining mental health, illness, and Wellness. The
Mindful Company. Retrieved April 18, 2023, from https://mindful-
company.com/blogs/news/defining-mental-health-illness-and-wellness
2
Centers for Disease Control and Prevention. (2021, June 28). About mental health. Centers for
Disease Control and Prevention. Retrieved April 18, 2023, from
https://www.cdc.gov/mentalhealth/learn/index.htm
3
Centers for Disease Control and Prevention. About Mental Health.
4
World Health Organization. (n.d.). Mental health of adolescents. World Health Organization.
Retrieved April 18, 2023, from https://www.who.int/news-room/fact-
sheets/detail/adolescent-mental-health
5
Parkway. (2020, December 3). CMHC #14- Sigmund freud- the man who transformed mental
health. Parkway UCC. Retrieved April 18, 2023, from https://parkwayucc.org/2020/cmhc-
14-sigmund-freud-the-man-who-transformed-mental-health/
6
Dorothea Dix. Who2. (n.d.). Retrieved April 18, 2023, from
https://www.who2.com/bio/dorothea-dix/dorotheadixportrait/
7
Origins of mental health. Johns Hopkins Bloomberg School of Public Health. (n.d.). Retrieved
April 18, 2023, from https://publichealth.jhu.edu/departments/mental-health/about/origins-
of-mental-health
8
Sigmund Freud, historical novelist? by Vanora Bennett. The History Girls. (n.d.). Retrieved
April 18, 2023, from http://the-history-girls.blogspot.com/2015/11/sigmund-freud-
historical-novelist-by.html
9
WebMD. (n.d.). Psychoanalysis: Freud, therapy, and more. WebMD. Retrieved April 18,
2023, from https://www.webmd.com/mental-health/what-is-psychoanalysis
10
The History & Evolution of Mental Health & Treatment: Sunrise. Sunrise House. (2022,
November 28). Retrieved April 18, 2023, from https://sunrisehouse.com/addiction-
info/history-evolution-mental-health-treatment/
11
DP;, K. (n.d.). One Hundred Years of college mental health. Journal of American college
health : J of ACH. Retrieved April 18, 2023, from
https://pubmed.ncbi.nlm.nih.gov/21660801/
12
DP;, K. (n.d.). One Hundred Years
 Rupesh 13

13
The importance of mental health awareness in schools. Hey Teach! (2021, September 8).
Retrieved April 18, 2023, from https://www.wgu.edu/heyteach/article/importance-mental-
health-awareness-
schools1810.html#:~:text=Because%20teens%20spend%20most%20of,get%20the%20hel
p%20they%20need.
14
The importance of mental health awareness in schools. Hey Teach! (2021, September 8).
Retrieved April 18, 2023, from https://www.wgu.edu/heyteach/article/importance-mental-
health-awareness-
schools1810.html#:~:text=Because%20teens%20spend%20most%20of,get%20the%20hel
p%20they%20need.
15
Aap-AACAP-Cha Declaration of a national emergency in child and Adolescent Mental Health.
Home. (n.d.). Retrieved April 18, 2023, from https://www.aap.org/en/advocacy/child-and-
adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-
emergency-in-child-and-adolescent-mental-health/
16
Vestal, C. (2022, April 18). As teen mental health worsens, schools learn how to help. The
Pew Charitable Trusts. Retrieved April 18, 2023, from
https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/04/18/as-teen-
mental-health-worsens-schools-learn-how-to-help
17
Mental Health and School Safety. NAESP. (2021, March 31). Retrieved April 18, 2023, from
https://www.naesp.org/advocacy/issue-areas/mental-health-school-safety/
18
Vestal, C. (2022, April 18). As teen mental health worsens.
19
NPR. (n.d.). A silent epidemic: The Mental Health Crisis in our schools. NPR. Retrieved April
18, 2023, from https://apps.npr.org/mental-health/
20
Centers for Disease Control and Prevention. About Mental Health.
21
NPR. (n.d.). A silent epidemic.
22
Olivia Randi, Z. G. (2023, January 20). States take action to address children's mental health
in Schools. NASHP. Retrieved April 18, 2023, from https://nashp.org/states-take-action-to-
address-childrens-mental-health-in-schools/
23
American Psychological Association. (n.d.). New legislation will boost school mental health
services. Monitor on Psychology. Retrieved April 18, 2023, from
https://www.apa.org/monitor/2023/04/boosting-school-mental-health-services
24
Park, Y., & Nakamura, J. (n.d.). How can we incorporate mental health education into
schools? consider the 5 T's. Student Behavior Blog. Retrieved April 18, 2023, from
https://studentbehaviorblog.org/how-can-we-incorporate-mental-health-education-into-
schools/
 Rupesh 14

25
Angela Theisen, L. C. S. W. (2022, October 4). Recharge with a mental health day. Mayo
Clinic Health System. Retrieved April 18, 2023, from
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/recharge-
with-planned-mental-health-
day#:~:text=Mental%20health%20days%20can%20help,to%20help%20with%20future%2
0stress.&text=Often%2C%20people%20who%20feel%20burned,feeling%20more%20isol
ated%20and%20lonelier.
26
Iamreneeonque. (2022, August 26). 74% of parents think schools should allow mental health
days-these 12 states already do. CNBC. Retrieved April 18, 2023, from
https://www.cnbc.com/2022/08/23/12-states-that-allow-mental-health-days-for-kids-in-
schools.html
27
Nelson, K., & England, A. (2022, August 22). These are the US states allowing Student
Mental Health Days. Verywell Mind. Retrieved April 18, 2023, from
https://www.verywellmind.com/us-states-allowing-student-mental-health-days-
5270047#citation-12
28
Roberts-Grmela, J. (2023, February 3). Students say mental-health breaks from class help
them succeed. here's how colleges are responding. The Chronicle of Higher Education.
Retrieved April 18, 2023, from https://www.chronicle.com/article/students-say-mental-
health-breaks-from-class-help-them-succeed-heres-how-colleges-are-responding
29
Mental Health Education for youth: Focus on Mental Wellness. Psychiatry.org - Mental
Health Education for Youth: Focus on Mental Wellness. (2019, July 18). Retrieved April
18, 2023, from https://www.psychiatry.org/News-room/APA-Blogs/mental-health-
education-for-youth-mental-wellness
30
Roberts-Grmela, J. (2023, February 3). Students say mental-health.
31
Pedagogical wellness. UCI Division of Teaching Excellence and Innovation. (n.d.). Retrieved
April 18, 2023, from https://dtei.uci.edu/initiatives/pedagogical-wellness/
32
Advancing Comprehensive School Mental Health Systems. SAMHSA. (n.d.). Retrieved April
18, 2023, from https://www.samhsa.gov/resource/ebp/advancing-comprehensive-school-
mental-health-systems
33
Multi-tiered system of supports. Texas School Mental Health. (2021, September 29). Retrieved
April 18, 2023, from https://schoolmentalhealthtx.org/multi-tiered-system-of-
supports/#:~:text=An%20MTSS%20includes%20strategies%20to,needs%20to%20evidenc
e%2Dbased%20interventions
 Rupesh 15

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Aap-AACAP-Cha Declaration of a national emergency in child and Adolescent Mental Health. Home.

(n.d.). Retrieved April 18, 2023, from https://www.aap.org/en/advocacy/child-and-adolescent-

healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-

adolescent-mental-health/

Advancing Comprehensive School Mental Health Systems. SAMHSA. (n.d.). Retrieved April 18, 2023,

from https://www.samhsa.gov/resource/ebp/advancing-comprehensive-school-mental-health-

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American Psychological Association. (n.d.). New legislation will boost school mental health services.

Monitor on Psychology. Retrieved April 18, 2023, from

https://www.apa.org/monitor/2023/04/boosting-school-mental-health-services

Angela Theisen, L. C. S. W. (2022, October 4). Recharge with a mental health day. Mayo Clinic Health

System. Retrieved April 18, 2023, from https://www.mayoclinichealthsystem.org/hometown-

health/speaking-of-health/recharge-with-planned-mental-health-

day#:~:text=Mental%20health%20days%20can%20help,to%20help%20with%20future%20stress

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Centers for Disease Control and Prevention. (2021, June 28). About mental health. Centers for Disease

Control and Prevention. Retrieved April 18, 2023, from

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Dorothea Dix. Who2. (n.d.). Retrieved April 18, 2023, from https://www.who2.com/bio/dorothea-

dix/dorotheadixportrait/

DP;, K. (n.d.). One Hundred Years of college mental health. Journal of American college health: J of

ACH. Retrieved April 18, 2023, from https://pubmed.ncbi.nlm.nih.gov/21660801/

 Rupesh 16

The History & Evolution of Mental Health & Treatment: Sunrise. Sunrise House. (2022, November 28).

Retrieved April 18, 2023, from https://sunrisehouse.com/addiction-info/history-evolution-mental-

health-treatment/

Iamreneeonque. (2022, August 26). 74% of parents think schools should allow mental health days-these

12 states already do. CNBC. Retrieved April 18, 2023, from

https://www.cnbc.com/2022/08/23/12-states-that-allow-mental-health-days-for-kids-in-

schools.html

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schools1810.html#:~:text=Because%20teens%20spend%20most%20of,get%20the%20help%20th

ey%20need.

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supports/#:~:text=An%20MTSS%20includes%20strategies%20to,needs%20to%20evidence%2D

based%20interventions
 Rupesh 17

Nelson, K., & England, A. (2022, August 22). These are the US states allowing Student Mental Health

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https://studentbehaviorblog.org/how-can-we-incorporate-mental-health-education-into-schools/

Parkway. (2020, December 3). CMHC #14- Sigmund freud- the man who transformed mental health.

Parkway UCC. Retrieved April 18, 2023, from https://parkwayucc.org/2020/cmhc-14-sigmund-

freud-the-man-who-transformed-mental-health/

Pedagogical wellness. UCI Division of Teaching Excellence and Innovation. (n.d.). Retrieved April 18,

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