It's been a school year like no other in recent memory -- combining the challenge of remote and hybrid learning for millions with the agony and strain of a pandemic that has killed more than 600,000.
Mental health has taken a toll on many students and staff alike.
One Ohio school district will welcome back students with more counselors and social workers on hand. Hilliard City Schools in Columbus has added seven new school counselors, up to 42, and 10 more social workers, for 15 total, Director of Student Well-Being Mike Abraham told ABC News.
"Anxiety has always been high with this generation," Abraham said. "With the pandemic, some students have become very comfortable with isolation, not having to deal with the anxiety that school might bring or their peers bring. That's what all districts are dealing with coming back now that these kids are together -- giving them strategies to be able to deal with their anxiety, to deal with whatever mental health issues that they're struggling with."
The school district, which has nearly 17,000 students, is tapping into federal relief money earmarked for K-12 public schools to pay for the new positions.
Last month, Iowa officials announced the state is launching a new pre-K-12 school mental health center that would expand training and resources that support mental health needs in schools.
The Iowa Department of Education is putting $20 million in federal pandemic relief toward the center, which aims to "address the impact pandemic-related disruptions have had on students and will focus on strengthening mental health support moving forward," Iowa Department of Education Director Ann Lebo said in a statement.
And the Miami-Dade County school district is exploring using federal relief funds to hire more mental health clinicians as most of the district's 334,000 students are expected to return to in-person learning this fall, the Miami Herald reported last month.
Other initiatives targeting school culture include adding mental health as an excused absence. That will be the case for Montgomery County Public Schools, Maryland's largest school district, starting in the fall, Board of Education member Patricia O’Neill told ABC News Washington, DC, affiliate WJLA.
"I think coming off the pandemic this year, adults and students recognize the challenges that mental health has brought about," O’Neill told the station. "We had to figure out how to make this change and elevate the importance of mental health, as it may be a barrier to learning."
Range of mental health concerns
The full impact of the pandemic on students will take time to understand, Kelly Vaillancourt Strobach, director of policy and advocacy for the National Association of School Psychologists and a school psychologist, told ABC News. One area of concern is emergency department visits for attempted suicide or suicide ideation, she said.
In 2020, mental health-related emergency department visits among those aged 12 to 17 increased 31% compared to 2019, according to the Centers for Disease Control and Prevention. Visits for suspected suicide attempts in girls that age from Feb. 21 to March 20, 2021, were 50.6% higher than the same period in 2019, the agency reported.
A report published in Pediatrics also found "significant increases" in the number of emergency department visits for suicide ideation and attempts in youth for certain months in 2020 when compared to the previous year.
Isolation due to remote learning is another concern. A recent report from a team of researchers at the Graduate Center, City University of New York found that 91% of New York City parents surveyed agreed there should be "increased mental health supports for students due to social isolation from COVID-19."
Meanwhile, some students may not have experienced any toll on their mental health, and may have even thrived virtually, Vaillancourt Strobach said.
"We don't know the level of trauma that individual students have had. We don't know their family situation, if they lost somebody, if parents have lost jobs," she said. "So what we are encouraging schools to do is really in those first couple of weeks, just infuse a lot of social-emotional learning, give kids the opportunity to talk about what's happened over the last year."
"There's a lot of focus and attention on learning loss, or lost instructional time. Certainly it's important that we address student's academic needs, but if we don't have a handle on their social-emotional learning and their mental health needs, the academics are never going to come," she added.
'All about adjustment'
Summer to fall can often be a tough transition for students in general, Janine Domingues, a clinical psychologist at the Child Mind Institute and the manager of curriculum development and professional training for its school and community programs, noted.
"That first month of school is all about adjustment," she told ABC News. "Now, even more so, it's a whole different ball game."
Students may experience anxiety and stress while getting acclimated to the classroom and a new routine, she said.
When Centennial High School in Corona, California, welcomed back students on campus for their last quarter this past school year, it was an adjustment for some students returning for in-person learning, Josh Godinez, a counselor at the school and chair of the board of the California Association of School Counselors, told ABC News.
"It was almost like the isolation allowed them to create almost somewhat of a fantasy of what they remembered about school. And then showing up to the social distancing partitions, only half their class being there, everybody in masks, it wasn't that picture that they had created," he said. "Things start to get back to normal, but aren't really back to normal."
As a counselor, Godinez said he worked with students on an individual level to address any anxiety, apprehension, grief or fears students had.
"There was no one response when they came back to school," he said.
A call for lasting change
Come the fall, Centennial High School, which has about 3,300 students, will have brought on a new counselor, focusing on English learners, bringing them to nine total, Godinez said.
The pandemic has helped bring more attention to the importance of mental health support in school, particularly as districts have an infusion of federal funding that could be put toward more staffing or training, and how schools can foster a healing-centered environment "focusing on social-emotional well-being," Domingues said.
"This year has kind of really helped propel that mission forward," she said.
The attention and funding come as schools nationally are largely understaffed when it comes to support staff like social workers and psychologists, experts said.
The National Association of School Psychologists recommends a ratio of no more than 500 students per school psychologist. In the 2019-2020 school year, the national ratio was estimated to be more than double, and only one state met the recommended ratio, the organization said.
The National Association of Social Workers and American School Counselor Association both recommend a ratio of 250 students per social worker and counselor, which most states also fail to meet, according to a 2019 ACLU report.
"We've had 100,000 traumatized school communities in this country," Robert Boyd, president of the School-Based Health Alliance, which promotes school-based health centers in the U.S., told ABC News. "We're coming into this with not enough school behavioral health specialists. … We didn't have it before the pandemic."
The pandemic relief funds could help bring those ratios down, the experts ABC News spoke with said, though noted more rural areas often face a staffing shortage. Boyd's organization is also focused on diversifying school support staff, which tends to be white women, he said.
Some schools may need to lean on community providers, Vaillancourt Strobach said. Trained grief counselors, for instance, may include pastors and morticians, Boyd noted.
Beyond dealing with staffing shortages, districts may build up their programs, only to not be able to sustain them in the long term.
"Are we going to make a lot of really good progress because there's been so much attention paid to the importance of school mental health, and then with the American Rescue Plan dollars hit their limit, are we going to be back at square one?" Vaillancourt Strobach said.
Mental health professionals hope this spotlight leads to lasting change and funding support, beyond the pandemic.
"We don't need to focus on student mental health just because of COVID," Vaillancourt Strobach said. "The need has always been there; as a nation, we are finally paying attention to it."