Even before the COVID-19 pandemic, the perceived expectations of schools around students’ many needs were dramatically on the rise. Educators responded to many of these by adding teachable moments for valued concepts such as social-emotional support, cultural awareness, and career readiness to their classroom operations. However, a larger challenge looms ahead – the growing expectation that schools must help solve the youth mental health crisis. The increasing prevalence of anxiety, depression, and behavioral challenges in children and young people was alarming in the years before, during, and after the pandemic[1]. Countries across the globe are grasping for solutions and many experience the same tremendous challenge – the availability of mental health treatment is severely limited.
Our study, involving 34 schools in Canada and the United States, explores the positive impact schools can make on students, including higher risk cohorts, through embedded preventive mental health measures. This approach may offer an impactful and practical role for schools to take in the effort to promote favorable student mental health.
Why is preventive mental health a good choice for schools?
Schools are not built to function as a wide-scale treatment center for youth mental health concerns. While counselors, social workers, and school psychologists can provide some brilliant moments of intervention for students, these specialists are few in numbers and typically overwhelmed. In one example, the National Association of School Psychologists in North America reports an average ratio of approximately 1100 students to 1 school psychologist[2]. Metrics for counselors and social workers in New Zealand and Australia are equally concerning[3]. Thus, these skilled providers are often treading water, metaphorically, instead of diving into lasting interventions with students. This means that schools need to consider strategies that provide mental health support in novel ways. Preventive efforts may be the better route to take.
What can preventive mental health look like in schools?
Too often, the supportive learning that takes place in schools is an afterthought. This diminishes its importance. Consider the following common examples:
- A guest speaker shares a brilliant presentation regarding the perils of substance abuse but fails to connect with students because she is not a known and trusted adult.
- Pausing a discussion in English class abruptly so the school counselor can frantically pop in and chat for 10 minutes about why bullying is harmful.
- Showing a YouTube video about the importance of diversity and inclusion, but rarely discussing it again for the rest of the year.
These examples may sound familiar. All these efforts are well-intentioned, but the connection with students and outcomes are not what is hoped for or needed.
Our study was designed to test the performance of preventive mental health in a different light, one that would be relevant for children and enjoyable for staff. As such, our team designed a curriculum that emphasised preventive mental health support by:
- Leveraging academic content (from daily lessons) into discussions and/or activities that supported self-esteem, promoted personal efficacy, and highlighted strategies that develop resilience. These were called Mental Health Moments (MHM).
- Mental Health Moments connected with the academic content of that class, increasing the relevance for students – most of whom were motivated by enjoyment of the course work, positive interactions with the teacher, and/or the desire for good grades.
- Mental Health Moments typically lasted between 8 – 12 minutes. There was minimal prep time, as they were already scaffolded for teachers and linked to the lesson content. Teachers provided at least three Mental Health Moments per week in their class.
The following is an example of a MHM:
Mental Health Moment for Day 2 of a Group Project (suggested time = 12 minutes):
At the beginning of class, ask students to pull out a timeline they created on Day 1 for their project, which includes the incremental steps needed for project success. Ask students if anyone has built in time for setbacks?
- Lead a discussion with students regarding the stress points and emotions that come with unexpected setbacks – especially when you are working with a finite amount of time and a deadline is not negotiable.
- Ask students if it’s possible to plan for unexpected challenges? What would this look like on their timeline? Will they focus on preventing the setbacks, allotting time to fix the setbacks, or both?
- Student small groups should now share their ideas. Highlight at least one good idea from each group. (TEACHER: consider sharing how you build in time for unexpected setbacks with lessons and how it helps mitigate stress).
How did this approach to embedded preventive mental health perform?
The study results we collected across 34 schools demonstrated quantitative improvement in adolescent self-esteem scores by 8.3% at the end of 14 weeks (measured by the Rosenberg Self-Esteem Scale). This boost in self-esteem was even more favorable in adolescent cohorts considered higher risk for mental health strain by the American CDC and the Youth Risk Behavior Survey:
- Black adolescents: +14.7%
- Hispanic/Latino adolescents: +9.03%
- Female adolescents: +12.7%
- LGBTQ+ adolescents: +39.3%
Next steps: how does this research translate into future practice?
The initial research project embedded preventive mental health support into scholarly gaming courses in secondary schools, which teach computer coding, digital skills, project management, and game design. One of the reasons our research team selected these classes was a genuine desire to help students who might be at risk for high screen time burdens, potential isolation from peers, and a failure to connect with traditional extracurricular options at school. After seeing the study’s statistically significant impact and publishing a paper in a medical journal, we quickly moved the research into practice. The second embedded preventive mental health curriculum is currently underway in schools. Through the help of dedicated educators, more than 700 students in social studies and civics classes across the United States are engaging with the second implementation. We hope for the same favorable results regarding student self-esteem.
As we wait for those performance metrics, I encourage you to consider how you might embed discussions and/or activities that support favorable self-esteem, personal efficacy, and practice with resilience. As someone who has seen the youth mental health crisis through the perspective of BOTH an emergency physician and a teacher, I believe this kind of support may be the greatest lesson you can teach. I thank you for your efforts and wish you and your students the best of luck.
Endnotes
[1] Goto, R., Piedvache, A., Hangai, M., et al. (2022). Time trends in emotional well-being and self-esteem in children and adolescents during the COVID-19 pandemic. Child Adolescent Psychiatry Mental Health, 16(1):89. doi: 10.1186/s13034-022-00525-3;
Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., et al. (2020). Suicidal ideation and behaviors among high school students – youth risk behavior survey, United States, 2019. MMWR Suppl, 69(1):47–55. doi: 10.15585/mmwr.su6901a6;
McCarthy, C. (2019). Anxiety in teens is rising: what’s going on? HealthyChildren.org. www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Anxiety-Disorders.aspx;
Frazee, G., & Morales, P. G. (2019). Suicide among teens and young adults reaches highest level since 2000. PBS. www.pbs.org/newshour/nation/suicide-among-teens-and-young-adults-reaches-highest-level-since-2000 .
[2] Shortage of school psychologists. National Association of School Psychologists. 2021, March 15. [accessed 2024-02-25]. https://www.nasponline.org/research-and-policy/policy-priorities/critical-policy-issues/shortage-of-school-psychologists
[3] Rose, T. Early Interventions “missed” as NSW struggles with a shortage of school counsellors”. The Guardian. 2022 Oct 8. [accessed 2024-02-23]. https://www.theguardian.com/australia-news/2022/oct/08/early-interventions-missed-as-nsw-struggles-with-shortage-of-school-counsellors#:~:text=%E2%80%9CWe%20have%20more%20than%202%2C000,one%20for%20every%20400%20students;
Gerritsen, John. School counsellors urgently need more help. Radio New Zealand. 2023 November 5. [accessed 2024-02-27] https://www.rnz.co.nz/news/national/501718/school-counsellors-urgently-need-more-help-association#:~:text=%22We’re%20looking%20to%20have,which%20is%20actually%20a%20risk.%22
