When we’re super-stressed, many of us grumble that we need to blow off work and take a “mental health day.” Sometimes we say it in jest, but other times we seriously long for a day or two when no one makes any demands on us. We may fantasize about a long bike ride on the local trail, a damn-the-calories lunch with a friend, or, as a former housemate of mine once put it, “some time to just sit and stare.”
Now, kids want some emotional breathing room, too. Spearheaded by high school students and supported by some influential adults, a movement is underway to mandate a limited number of mental health days as part of a public school’s official sick-day policy. In the last two years, state legislatures in Oregon and Utah have passed such bills, while lawmakers in California, Florida, New York, Colorado, and Washington state are considering statutes on emotional relief days for students. Until now, excused absences have typically been limited to a student’s or family member’s physical illness, a doctor or dentist appointment, or an emergency.
It sounds pretty reasonable: everyone needs occasional days to chill out and recharge, including kids. But are student mental health days really a good idea?
What we know for sure is that many young people today suffer serious emotional distress, and that the number of struggling children is rising steeply. In 2017, the National Survey of Drug Use and Health reported that 13 percent of teens had endured one or more episodes of depression in the past year, compared with eight percent in 2007. According to a recent survey conducted by the National Institute of Mental Health, 20 percent of adolescent boys and 30 percent of girls suffered an anxiety disorder. Most alarming, a recent survey by the Centers for Disease Control and Prevention found that between 2007 and 2017, the rate of suicide among those ages 10 to 24 jumped 56 percent, making suicide the second leading cause of death in that age group. Every day, 16 young people in our country kill themselves.
Experts cite numerous reasons for this epidemic of youth mental distress, including the rise of cyberbullying, the trauma of school shootings and everyday violence in neighborhoods, many more kids coming out as gender nonconforming and facing peer harassment, and the crushing pressure many teens feel to excel academically so they can get into top colleges. It’s clear that we need to work much harder and better to support our children’s emotional well-being. School seems a natural place to focus energies, and some child health specialists think mental health days are a good way to begin.
Of the measures enacted or under consideration, the 2019 Oregon statute has garnered the biggest share of media attention—in The New York Times, The Washington Post, CNN, NPR, and other leading outlets. One reason is that Oregon has one of the highest youth suicide rates in the country. Another is that the Oregon movement for student mental health days wasn’t initiated by concerned school administrations, PTAs or local mental health organizations. Instead, the charge has been led by students themselves.
A key architect of the measure is Hailey Hardcastle, a teenager in suburban Portland, who struggled with emotional issues and saw that many of her schoolmates were suffering, too. At a 2018 summer camp on school mental health run by the Oregon Association of Student Councils, Hardcastle, then 17, and other high school leaders brainstormed ways to support vulnerable students. They decided to push for state legislation to allow kids occasional time-outs from school.
The young activists formed an organization called Students for a Healthy Oregon and enlisted pro-bono lobbyists and psychologists to advise them. The students then drafted a bill in support of mental health days, persuaded several legislators to sponsor it, initiated a letter-writing campaign, and testified at the state capitol in Salem. On July 1, 2019, the students saw their bill signed into law.
Debbie Plotnick thinks the young Oregon activists are onto something. The vice president of state and federal advocacy for Mental Health America, she believes that mental health days “are essential” as a component of a comprehensive school mental health program. “It gives a student permission to say, ‘I’m being bullied’ or whatever the problem is, which lets parents and the school know that the child is suffering,” she says. This knowledge can then empower adults to support that individual student while also addressing larger, underlying mental health stressors in the school. Plotnick adds that brief breathers can help students attend to purely practical matters. For example, for those who are already in treatment, an excused day off could give them a chance to keep a therapy appointment or adjust to a new medication.
Not everyone thinks school mental health days are a useful strategy. One skeptic is Lynn Lyons, a Concord, New Hampshire psychotherapist who specializes in anxiety among children and adolescents. “It strikes me as feel-good legislation,” she says. “It makes lawmakers feel like they’re doing something progressive for kids’ mental health.” It makes perfect sense that students would be all for it, Lyons adds. Young people are so stressed that “if you offer them a day off, it’s like tossing a piece of bread to a starving person. They’re desperate for it. They’ll take it. But it’s not nearly enough.”
To really make a difference, she says, legislators and school systems need to allocate substantial resources for thoughtfully designed, comprehensive school mental health programs. In her view, and that of many other health advocates, priorities include hiring more guidance counselors, mandating training on youth mental health for school staff, education for parents, a more effective referral system to local therapists, and targeted antibullying and suicide prevention programs. Finally, every school must provide a robust mental health curriculum, both to help kids self-identify difficulties, and to give them tools to prevent problems in the first place.
This last component is vital, says Lyons. “There’s some good research that supplying emotional skill-building in schools makes a difference,” she says. “If we’re really concerned about the mental health of our kids—and we should be—they need to know how to manage their emotional lives. We need to talk openly with kids about how to deal with disappointment and mistakes, how to problem-solve, and how to get support.”
To some, mental health days aren’t just an inadequate response to a child’s emotional difficulties: they might actually be hazardous. Nancy Dever, a volunteer for the National Alliance on Mental Illness affiliate in suburban Philadelphia, facilitates a support group for parents of children who struggle with major mental illnesses. As the mother of a teen whose severe and escalating anxiety led to school refusal, Dever knows something about the perils of days off from school for vulnerable kids. “School was so frightening to my daughter that she couldn’t get out of bed in the morning,” Dever says. “The most important thing in my life became getting her into school every day. I saw firsthand that the more a child stays away from school, the worse things get.”
Dever acknowledges that it’s not a black-and-white issue. “I think if you have a truly healthy student, an occasional mental health day is okay,” she says. “But if a child has major issues, it’s a slippery slope. Mental health days can become an escape hatch.”
Perhaps the most worrisome aspect of the mental health day movement is its potential to isolate kids. If a student takes a day off, she or he is likely to spend it alone, since friends and siblings are apt to be at school, and the majority of U.S. parents work full-time. Some kids may use the time to get some badly needed sleep or unwind with a favorite TV series. But if a student is already emotionally vulnerable, a day off from school could arguably exacerbate symptoms rather than relieve them. A day at home, after all, provides ample space and time to ruminate on one’s distress and possibly spiral more deeply into depression, anxiety, and shame. Unsupervised, some kids may self-medicate with alcohol or drugs, with little risk of detection.
Breaking the Silence
Rather than hiding out at home, professionals advocate the exact opposite—coming to school and seeking connection. Any successful school mental health program must include a peer-support element, which can be a powerful antidote to the shame and stigma that keeps kids from seeking help. “I don’t think mental health days will reduce the stigma,” says Nancy Dever. “We reduce stigma by talking about mental health in classes and forming clubs that encourage kids to talk about it, so they feel permission to share their pain.” Hearing from people who’ve struggled and since recovered is also crucial, says Dever. She cites a nearby high school that recently invited a young adult to tell classes about his own battles with mental illness and addiction, and—importantly—how he’d gotten help and reclaimed his life. “The result,” Dever says, “was a huge line at the school counselor’s door.”
Debbie Plotnick of Mental Health America concurs. She’s observed that for students of all ages, as well as their distressed parents, “peer support is the single most important thing to help them navigate difficulties. The connection comes from others who’ve been in the place they are. It gives people hope.”
One program that demonstrates the power of peer support is Mental Health 101, a Tennessee-based school curriculum for middle- and high-schoolers. Initiated by Ben Harrington, CEO of the Mental Health Association of East Tennessee, the state-funded program started in 2000 in two local schools and has expanded to 108 schools in 28 counties, now serving 34,000 students per year. Trained health educators teach kids stress management in sixth grade, coping with depression in seventh grade, and suicide prevention in eighth grade. High school seniors can’t graduate until they’re completed a course called “Lifetime Wellness,” which gives them tools to cope with emotional challenges at every stage of adulthood.
“Our message is that it’s okay to have problems, but it’s not okay to engage in poor coping strategies,” says Harrington, who has won an American Psychiatric Association achievement award for his work. In his view, student-to-student support is a vital element of the program’s success. “Students really become their brother’s or sister’s keeper,” he says. “They learn to have conversations with each other that go something like this: ‘Hey, this is what I’m noticing about you.’ Then, ‘I’m worried about you. What’s going on?’” If the problem seems serious, the student initiating the conversation would encourage the schoolmate to talk with a trusted adult.
The good news is that programs like Mental Health 101 are beginning to multiply. A number of nonprofit advocacy groups have established multidimensional programs promoting and providing student services, among them the National Center for School Mental Health, the National Alliance on Mental Illness, the National Alliance to Advance Adolescent Health, and Mental Health America. Numerous local governments, school districts, and community collaboratives have gotten on board, too. Meanwhile, Hailey Hardcastle and her coactivists, the original champions of mental health days, have widened their lens to encompass early identification, and are now pushing the Oregon legislature to establish annual mental health assessments for all K-12 students.
Still, the work has just begun. Of the 50 million children enrolled in U.S. public schools, only a tiny fraction attend schools that offer comprehensive mental health services. To date, only nine states mandate mental health curricula. And among students who have been diagnosed with serious emotional problems, few are receiving help via school-based Individual Education Programs, ranging from 28 percent of struggling children in Vermont to just 2 percent in Alabama.
Margaret McManus, president of the National Alliance to Advance Adolescent Health, sketches a bigger picture. While she applauds the growth of school-based mental health programs, she remains concerned about the multifaceted unmet needs of low-income children. “We need to look upstream, at the larger systems that affect students,” she says. “What if a child is homeless? What if a child needs help but has no access to a mental health professional? How can we reduce the multiple traumas that many kids face at a young age?” She pauses, and then says, “I don’t have the answers, but I know these kids need more than mindfulness classes in school.”
And, of course, they need much more than mental health days.
A Wake-Up Call
So what are we to make of school mental health days? Clearly, such a stand-alone measure barely begins to address the needs of millions of emotionally vulnerable young people in our country. Yet there may be a plus side. This extensively publicized, student-led movement is bringing widespread public attention to a seriously overlooked crisis. For legislators, parents, teachers, school administrators, youth activists, and therapists, it can be an opportunity to look more thoughtfully at the multiple mental health needs of youngsters growing up in a high-pressure, confusing, and sometimes unkind world.
And we need to start early in a child’s life. National surveys show that fully half of mental illnesses show up by age 14—and, astonishingly, the majority of kids don’t get help for another decade. “It’s sickening and ludicrous to let a young person develop mental health problems with no adult helping them for years,” Ben Harrington says. “A teen who’s developing depression or anxiety may become a young adult who can’t hold down a job, can’t be a productive adult in society. It’s not acceptable. We need to press the gas pedal hard and intervene early.”
So let’s keep talking about mental health days. If legislated breathing room from school spurs a broader and deeper conversation about meeting the full range of kids’ mental health needs—with action backing it up—then this movement might make a genuine difference. And the clock is ticking. As Harrington says, “It’s 2020. We can’t continue to be in denial.”
photo © istock/muralinath
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