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Earlier this month, we brought together a first-of-its-kind brain trust of leaders across education, healthcare, government, research, and policy — including Superintendents and Chief Medical Officers from the largest school districts in the country, health plan CEOs, congressmen, the Deputy Secretary of the U.S. Department of Education, and even the Head of Behavioral Health for the Kansas City Chiefs! — to talk about how we can work together to preserve our country’s most precious resource: the mental health of our children.
We dove into the biggest questions facing educators and public health leaders today, like:
- What is the role of the school in addressing the youth mental health crisis?
- How can we transform schools into access points for physical and mental healthcare? And what kinds of public/private/philanthropic partnerships are needed to enable this transformation?
- How do we move from a model of crisis intervention to crisis prevention?
- A pandemic-era surge in federal funds (e.g., ESSER) enabled schools to stand up new services and systems to support student mental health. How do we not only preserve, but scale, what’s working, as the funding dries up?
Seven key themes emerged, collectively reflecting the complex interplay of factors and stakeholders that impact a student’s health and well-being.
1. Aiming for “recovery” from the pandemic’s impact on youth mental health is a worthy milestone, but it cannot be our end goal.
As educators know all too well, the mental health of kids and teens has been in a state of crisis for over a decade; the pandemic just made it impossible for the public to continue to ignore. CDC data from 2019 estimated that 20% of all children had a mental health disorder, and that feelings of persistent sadness and hopelessness (as well as suicidal thoughts and behaviors) increased by 40% among young people in the 10 years leading up to the first COVID-19 infection. That the pandemic made these numbers even worse does not mean they're a reality we should accept for our children.
2. Early intervention is the highest-impact lever we have to improve a student’s health and academic trajectory — and the only real way to reverse the youth mental health crisis.
Fifty percent of mental disorders emerge by age 14 — yet, impacted children typically don't get care until adulthood (the median delay from first onset of a mental disorder to first treatment contact is 11 years!). Without sufficient intervention during this critical developmental window, early symptoms can progress in severity and evolve into entrenched clinical disorders that are less responsive to treatment. The good news is that there’s another side to this coin: the same neurodevelopmental factors (e.g., higher brain sensitivity and elasticity) that make young children more vulnerable to developing mental health issues also make early treatment more effective. The sooner we intervene, the more we can affect a child's life trajectory.
3. Universal promotion and prevention benefits the well-being of all children — not just those at risk of developing a mental health condition.
From the moment a child is born, we focus intently on the state of their physical health — measuring their development to the centimeter to ensure any potential problems are caught early. We teach children the importance of good nutrition and hygiene, of wearing a helmet and seatbelt — all with the goal of keeping their bodies healthy and safe as they grow. What if we approached mental and emotional health development in the same way? Imagine if, from a young age, every single child was taught the language to communicate their emotions; trained in healthy coping skills; equipped with the tools to navigate setbacks and resolve conflict productively. The world would likely be a very different place.
“Mental health is not just about helping kids in crisis. It is a big spectrum that starts when kids are little, when we teach them to use their words … that is how we teach our kids to be well, is teaching them to resolve conflict.” — Ashley Chohlis (Superintendent, Uvalde Consolidated Independent School District)
4. Schools should serve as a central point of access for healthcare, including mental health services — but the responsibility to provide services can't fall on schools alone.
Ninety-five percent of kids spend most of their waking hours at school. That makes schools the most effective and accessible point of care — especially for students whose families may not have the resources, language, or know-how to navigate our byzantine healthcare system.
“Where is that one place where we can address the whole child? — the physical child, the mental child, the academic needs, the nutrition, the enrichment, the exposure to music and arts? It's not at home … school is the place. School is the place where you detect abuse, where you provide comfort, where you build joy, where you provide physical health, mental health support, social and emotional support. ” — Alberto Carvalho (Superintendent, Los Angeles Unified School District)
But most educators are not trained as clinicians or care coordinators — and they shouldn’t have to be. While the school can act as a front door, it is the collective responsibility of school districts, the local/state/federal government, health plans, providers, community organizations, and health departments to build programs that transform schools into the go-to access point for any care a student needs to thrive.
“We have to partner — communities, families, and Departments of Health. We have to be solution-oriented because their public health issues are our public health issues. What they're facing in the community, we're facing in the school.” — TaShunda Green (Deputy Chief Medical Officer, Chicago Public Schools)
5. The U.S. is more diverse than ever — and every community within it has unique healthcare needs. We must meet students and communities where they are, with the resources they need, in a language that makes sense for them.
As we each create new playbooks and systems for school-based healthcare, we must keep in mind that a one-size-fits-all approach will not work — and what’s successful for one community may not be successful for another. The care we provide — and the way we deliver it — must be responsive to a vast spectrum of needs and preferences, from a clinical, cultural, and geographic perspective. While telehealth as a care delivery mechanism helps us (quite literally) meet communities where they are from a geographic perspective, we must also remove less obvious barriers to care by tailoring our services to be linguistically, culturally, and developmentally appropriate. For example, 1 in 5 Americans speak a language other than English at home. This adds yet another layer of hurdles to access mental healthcare — try finding a licensed therapist who practices in your language, and takes your insurance, and has appointment times you can make work with your schedule.
In short, providing students truly equitable access to healthcare requires us to remove not only the tangible barriers to access (e.g., financial, logistical), but the hidden ones (e.g., cultural, linguistic), too — by providing culturally responsive support available in multiple languages, and sensitive to the circumstances of each student’s and community’s unique background and lived experience. We at Hazel employ a provider force that reflects the diverse communities we serve — 50% of our providers identify as BIPOC, and 40% are bilingual, speaking over 19 languages! — which we believe is core to our ability to drive equitable engagement and outcomes among groups who have historically faced the highest barriers to care.
“Remember that these digital interventions were dropped down from the sky … We need better digital community integration strategies … to make sure people have culturally relevant onramps into our products. …They want to know that the care that they're receiving is designed for them … incorporates their voices and talks about mental health in the ways that they want to have it talked about.” - Dr. Wizdom Powell (Chief Purpose Officer, Headspace)
6. “Our children are not problems to solve, but wonders to behold.” The youth mental health crisis does not mean the kids are broken; it means the system of adults around them is.
In many ways, it’s a relief that the nation has finally realized that the kids are in fact not alright. Bleak as it is, the relentless barrage of headlines — warning of skyrocketing rates of depression, anxiety, and suicidal behaviors; of the long-term impact of the pandemic on academic and social-emotional health; and so on — has driven unprecedent surges of public and private investment in youth mental health support.
But as we come to terms with these hard realities, we must be careful not to lose sight of the most important reality of all: Our children are not problems to be solved, but wonders to behold (as Dr. Wizdom Powell so eloquently put it). Children are born deeply curious, engaged, enthusiastic, creative, and empathetic. That they are struggling to thrive in our current system means that the adults around them are failing to create the spaces they need to bloom.
“I'll bring to you some wisdom from young people. And what they've said to us over and over again is, ‘Stop fixing us. Fix yourself.’ Students recognize that if all the fish in the water are dying or sick, it's probably something in the water. And they're calling us to a higher level of moral responsibility, not just to do no harm, but to create spaces where children can thrive.” — Dr. Wizdom Powell (Chief Purpose Officer, Headspace)
7. We cannot let the specter of future funding cliffs stop us from building and scaling what our students need, today.
We’ve learned the hard way that for our children to get back on track and succeed socially and academically, that they must first feel physically and psychologically healthy and safe. The good news is that after a few years of bold innovation and experimentation — made possible by the massive surge in federal funding for Covid recovery (e.g., ESSER) — we know a lot more about how to accomplish this: converting schools into a central access point for healthcare, integrating mental health into our academic development frameworks, moving from an approach of crisis intervention to crisis prevention.
But let’s address the elephant in the room: we’re about to hit a federal funding cliff. One-time Covid recovery dollars like ESSER are drying up, forcing many districts to ask: how will we find the funding to continue the programs that are working? Should we really invest in expanding these programs if we might have to sunset them later?
Here’s advice straight from two folks who’ve worked at the federal level in The U.S. Department of Education: “Spend the money you have now, because the students you have now need this help. But keep the data, keep the receipts — tell the story of how you leveraged these dollars to improve student mental health and well-being that ultimately led to academic outcomes. If you have the receipts to show this worked, your community is not going to want it to stop … if you show how the child benefitted, I do believe people will continue to invest in our children.”
“Are there funding cliffs? Will things run out? Yeah — but that always happens in education. Build while you can for the need that’s in front of you, today.” — Cindy Marten (Deputy Secretary, U.S. Department of Education)
We’ve made real strides in the past few years. That much became clear, seeing the incredible results of bold student health and well-being initiatives co-championed by education and healthcare leaders in communities across Los Angeles, San Antonio, St. Louis, Miami, Chicago, and more. But the mission is not accomplished. While the lack of consistent funding presents a huge hurdle, it can’t stop us from pushing these solutions forward when our kids are the ones who pay the price. It is our moral responsibility to bring what we know improves student mental health to all of our children. We can’t afford not to.
"We have the answers — let’s just get it done.” – Cindy Marten (Deputy Secretary, U.S. Department of Education)