Every day should be a mental health day at school, says Dr. Gene Beresin, a child psychiatrist.
The growing number of school districts and states that are allowing students to take mental health days off when they are struggling emotionally are taking a positive step. But the practice won’t solve the wider mental health crisis that K-12 leaders are confronting, say Beresin and other child psychiatrists and pediatricians.
“For the first time, we’re realizing psychiatric problems—which are more common than strep throat—need to be part of the general framework in which we look at ourselves and our kids,” says Beresin, the executive director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital. “But five mental health days are not going to take care of the problem.”
Destigmatizing mental health care
When students at Oak Park and River Forest High School near Chicago take a mental health day, student services staff will follow up to check on that student’s wellbeing. In the coming school year, the team will get a weekly report of students who have cited mental wellness as their reason for being absent.
The staff will make a priority of reaching out to students who take multiple mental health day, district spokesperson Karin Sullivan says.
Of course, educators across the nation were seeing anxiety, depression, stress, loneliness, and suicidal thoughts worsening in their classrooms long before COVID. Students are struggling with layer upon layer of compounding pressures, from family financial troubles to mass shootings to social media, overscheduling and the pressure to excel academically. A mental health day may only “recharge a kid’s batteries” for about 24 hours, says Beresin.
A big positive is that health days go a long way in destigmatizing the act of asking for help, adds Dr. David Kaye, a professor of psychiatry at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.
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“The worrisome side to this is that it can promote avoidance for kids,” says Kaye, who also directs Project Teach, a New York State Office of Mental Health-funded program that provides mental health education and consultation for pediatric and maternal health practitioners. “A huge problem with COVID is the many, many kids who do not want to go back to school. And we know the longer you avoid something you’re anxious about, the more difficult it gets to face.”
Support beyond mental health days
Educators, parents and other stakeholders hoping to ease the mental health crisis must consider redesigning school in several ways, Beresin says. Students in Finland, for instance, get several breaks during the school day. They also collaborate extensively and often on projects and are subjected to very few high-stakes exams.
What is the mental health role of school nurses?
When a student is feeling physically ill, they go to the school nurse. A student in emotional distress who seeks help is likely to the same thing—rather than visit a counselor, says Linda Mendonça, the president of the National Association of School Nurses.
“Mental health days are certainly something school nurses would support and be on board with,” Mendonça says.
Though school nurses may not be trained in behavioral psychology, school nurses can act as mental health “sentinels.” They spend much of the day assessing students and can refer them to school counselors or to outside providers for more extensive mental health care. They could also suggest that the student goes home.
In the decision-making process around allowing mental health days, administrators can rely on the expertise of school nurses—many of whom are trained in disaster preparedness. “If a student has an injury in PE, we immediately call rescue service,” she says. “But if a student has a mental health issue, it’s been so much more challenging.”
With many schools now using COVID relief funds to hire more counselors, Beresin says the nation also needs to expand its workforce of child psychiatrists and psychologists. Another part of the solution is ensuring that parents, teachers, administrators, and other educators have a better grasp of the scope—and the warning signs—of the current “mental health emergency.”
If you the ask average parent, teacher, principal, administrator or coach what teenage depression is, they probably couldn’t tell you,” he adds.
Understanding the “3 W’s”—what to look for, when to worry and what to do—leads to more meaningful conversations with students, which paves the way for prevention and early intervention, Beresin says.
Also, there is no risk in asking young people if they are depressed considering suicide. “Kids are relieved when you ask them if they are thinking about hurting or killing themselves,” Beresin says.
‘Preventative maintenance’
Now that individual schools, districts and states are offering mental health days, it’s time for policymakers—such as the U.S Department of Education—to develop standards and best practices for K-12 social-emotional support services, says Kaye, at the University of Buffalo.
For example, a handful of states have passed laws requiring mental health days but have not addressed the lack of access to mental health care. Many policies also don’t specify how the problem will be solved, says Kaye.
“I haven’t seen coherent statements about the rationale for mental health days and how they address a problem,” says Kaye. “I do think there are positives to these laws but am quite concerned about how this will play out.”
There is a risk of creating more conflict between students, parents, and schools if students begin to see mental health days as a way out of difficult or challenging situations. “Mental health days are best thought of as preventative maintenance rather than something to be used routinely for kids who are having long-term mental health issues,” he says. “When kids miss more school, they get further behind academically and social-emotionally, and it becomes a bigger hill to climb to get back.”
Risks of overreacting
Pediatricians should be consulted as educators and families allow students to take mental health days, says Dr. Sten H. Vermund, a professor of pediatrics at the Yale School of Public Health.
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“It’s hard to generalize,” Vermund says. “Parents, pediatricians, and teachers can all help guide the way for when mental health days can be used effectively and when they should not be deployed.”
If a child is bullied, for instance, taking a day off from school may not be as effective a solution as confronting the problem with school administrators. Or, taking a mental health day may be appropriate for one child when a grandparent passes away, while another student in the same situation might benefit from returning to school as quickly as possible.
“Childhood is not easy, and childhood does have its emotional and psychological challenges,” Vermund says. “If a parent overreacts to those, then the result may be absenteeism that could exacerbate the mental health challenge.”
