Under Pressure: Student Mental Health

Rising toll of student stress, anxiety and depression adds to urgency of schools’ risk-mitigation practices.

May 6, 2019

From the May/June 2019 Net Assets Magazine.


Article by Donna Davis

Junior and senior year are filled with college admission preparations — fine-tuning essays, submitting applications and waiting for a “yes” from that dream school.

At Lake Highland Preparatory School in Orlando, Florida, it’s also time to roll out the yoga mats, lounge in a deck chair along the lake shore or take part in a mindfulness and meditation session. These activities are designed to counter the stress and anxiety students face around the increasingly competitive college admission process. “It’s hard to separate that college piece from other stressors in their lives,” said Lynn Stewart, dean of college counseling and guidance at Lake Highland, a preschool-12th-grade day school with 2,000 students.

Stewart is on the front lines of a growing challenge that many of her independent school colleagues also are experiencing — an increasing number of students who are chronically stressed, which can contribute not only to health problems but also mental disorders including anxiety and depression. No age group is immune, although diagnoses of depression and anxiety increase with age. The Centers for Disease Control and Prevention, citing research published in the Journal of Pediatrics in 2018, found that 7.1 percent of children between 3 and 17 (approximately 4.4 million) have diagnosed anxiety, and 3.2 percent have diagnosed depression. Among those with depression, nearly 74 percent also have anxiety.

A 2019 report from the Pew Research Center found that 70 percent of teens say anxiety and depression are a major problem among people their age in their communities. Perhaps most concerning is an increase in serious depression. In the last 10 to 12 years, rates of depression, psychological distress and suicide-related thoughts or actions rose significantly among people 26 and younger, according to a study published in March in the American Psychological Association’s Journal of Abnormal Psychology. Some of the highest increases have been among women and people at higher income levels.

A variety of factors can contribute to these conditions, including problems at home and in relationships, but one of the top contributors to chronic stress among private school students is the pressure to achieve academically, mainly in order to boost the chances of admission to a top-tier college or university, according to research from Frontiers in Psychology, a multidisciplinary psychology journal. Several years ago, the American Psychological Association found that during the school year, teenage students’ stress levels exceed those of adults.

Managing the Risks

Addressing mental health issues has become an important part of risk management for independent schools. “One of the things that has become a real concern with the mental health of students are the school shooting incidents,” said Anita Pittman, director of human resources at Oak Hall School in Gainesville, Florida.

The 800-student preschool-grade 12 school is located just about two hours from Parkland High School, scene of the 2018 shootings that left 17 students dead, and the tragedy sparked conversations at Oak Hall about how to enhance not only safety measures, but also student well-being measures.

Making those investments can be difficult at a time when schools face increasing FTE expenses, but NBOA President and CEO Jeffrey Shields called them “almost not a choice.”

Among those changes is a revamping of the advisory program. Advisors are receiving additional training in recognizing warning signs that students need help with academic or social challenges. “We want the new program to be a strong resource for our students that helps guide them in developing the skills they need to de-stress and manage their lives, so that they don’t reach a tipping point,” Pittman said.

The school initiated other changes too — including conducting a threat assessment, hiring a full-time campus protection officer, providing safety and security training for faculty and staff, and establishing a threat assessment management team. The financial investments are necessary for student safety as well as sustainability, Pittman said. “We did a survey recently, and we asked parents what are the reasons that you spend money to send children to Oak Hall School — the number-one answer was that they are safe.”

Making those investments can be difficult at a time when schools face increasing FTE expenses, but NBOA President and CEO Jeffrey Shields called them “almost not a choice.” He likens them to the commitments independent schools have made to human resources staffing to meet increasingly complex compliance and risk requirements. “It’s an investment not only in fulfilling our mission to support students to be successful, but also in our efforts to manage and mitigate risk in our school communities.”

Providing More Services

Demand for mental health services on independent school campuses — and new types of services — has been rising as well. “We are seeing increased services and counseling both on and off campuses, in practitioners both full- and part-time and in referrals at nearly every boarding school in the country, and we are seeing more serious diagnoses, certainly in the last five years,” said Douglas Dickson, the assistant head for student life at Episcopal High School in Alexandria, Virginia, and a 38-year veteran of boarding school administration.

A similar scenario is playing out in day schools. Gone are the days of the school nurse in the infirmary tending to all needs. “Non-residential schools always had guidance and college counselors, but now more are introducing counseling services for mental health issues — whether they are employees or independent contractors,” said David Wolowitz, director and co-chair of McLane Middleton’s Education Law Group, who consults with schools on student health and safety issues.

Those services vary widely, reflecting the mission, philosophy and resources of a particular school, among other factors. A boarding school, for example, might have a psychiatrist on staff or on call. A day school might opt for a psychologist or choose to provide only counselors. And those counselors may not provide counseling — only diagnosis and referrals to third-party mental health providers, Wolowitz said.

“There are different models for provision of services, but one thing that is consistent is that the demand for services is higher than ever,” Wolowitz said. “Schools are realizing that they need this resource because they can’t ignore the anxiety and depression of these kids, and they are highly alert to suicidality and aggressive behavior.”

Another factor in increased demand is the willingness of students to ask for help. “There is a lack of stigma that applies to mental health counseling in the younger generation,” Wolowitz said. “There used to be a stigma around having a diagnosis, but now parents want a diagnosis.”

Studies done in higher education have shown counseling has benefits, especially in student academic success and retention. One survey from the Association for University and Counseling Center Directors found that about two-thirds of students who received counseling reported it helped with their academic performance and helped them stay enrolled.

Watching Out for Liabilities

While counseling and other mental health services can allow schools to manage risks and help students cope, litigation resulting from how students’ needs are handled is on the rise. “We have 40 to 50 mental health cases per year,” said Sara Schwartz, founder and president of Schwartz Hannum PC, an education law firm representing more than 200 independent schools. “Those are just the ones that land on my desk, so the volume of mental health cases in private schools is staggering — much more than five, 10 or 20 years ago.”

The “fundamental” reason for the increase "is the impact of social media and stress on students today,” said Schwartz, echoing both statistics and the experience of independent school administrators.

Schwartz groups the cases into three types: threats of violence from students, threats that escalate into suicidality or violence against self or others, and requests for accommodation under the Americans with Disabilities Act. Examples of those requests include emotional support animals, different class schedules and test-taking accommodations.

No matter how many [practitioners] you have at your school, there are going to be issues that you need to refer out. For that, you need a robust catalogue of providers.

Douglas Dickson
Episcopal High School

Having a sophisticated compliance infrastructure in place helps lessen the risk of legal issues for schools, Schwartz said. That includes an up-to-date student handbook that spells out the school’s policies regarding issues such as ADA compliance, service and emotional support animals, and medical leave for mental health issues. A good time to do that update is in the spring, before staff members take summer leave. “Those conversations will trigger questions about whether we are handling mental health issues the right way,” Schwartz said.

Conducting periodic assessments of the school’s mental health center — if it has one — or of services and providers is essential. “Look at what you think is an appropriate level of staffing and the appropriate level of practitioners providing the services,” Dickson said. “Identify areas where you might have gaps in services and find resources in your area.”

And, Dickson added, recognize that “no matter how many [practitioners] you have at your school, there are going to be issues that you need to refer out. For that, you need a robust catalogue of providers.” Community mental health agencies or local health care agencies that provide mental and behavioral health services can be a resource.

Wolowitz recommends a three-pronged approach to determine whether the school is being protective and operating within the standard of care:

  • Decide what services the school wants to provide, and then decide whether those practitioners will be licensed or unlicensed. Every state has different licensing laws, and some do not require licensing. Wolowitz has worked with schools that have some practitioners who are licensed and others who are not — or that are unaware of licensing status. His preference is for hiring licensed practitioners because the standard of care that they must adhere to is higher.
  • Decide on the scope of services. “Most schools try to limit what they provide and distance themselves from the private practice model,” Wolowitz said. “If someone needs extensive counseling, they are referred out. The school does only short-term, situational, fairly routine counseling. That’s to mitigate legal risk, and it’s also a cost factor.”
  • Decide on a way to share information that affects the health and safety of students and the larger community. “Information siloing by licensed professionals is a big area of risk,” Wolowitz said. He recommends requiring parents to sign a confidentiality waiver that authorizes counselors to share information to protect the health, safety or welfare of the child — a precaution that some practitioners may challenge as unethical. “It’s not, because the waiver is in the hands of the parents not the child, who is a minor, and parents do this in other cases such as [physical] health issues,” he said. Parents expect counselors to alert them and the school to issues that might affect their children, he added.

Setting up the programs and protocols needed to handle mental health services properly involves a few thousand dollars of an initial financial investment, but it could save schools money and intangible costs in the future, Schwartz said. “Hopefully you can avoid court, but if you do get into court over an issue, [such programs] can help you prevail.”

More than Counseling

Schools also are providing students with alternative ways to manage stress. Examples include mindfulness and meditation, sound healing, deep-tissue and foot massages, lectures on time management and healthy eating, switching to later start times to allow students (especially upper-school teens) to get more sleep, and block periods so students have fewer classes per day and less homework each night. Many are also concerned about what Dickson calls “the elephant in the room” — technology. “We’re beginning to see a trend toward limiting the amount of time students are allowed to be on their devices,” he said. “We are realizing the importance of face-to-face communication in creating relationships.”

At Lake Highland Prep, administrators have been implementing programs designed to help students relax and regroup. The school is not limiting its focus to older students. For example, it has introduced yoga in preschool through sixth-grade classes, and students start each day with a meeting that often has a few minutes for a deep-breathing “centering” designed to get them ready to learn. But the main emphasis in the younger grades is activity, such as biking and jogging. “We believe that getting kids moving is an important part of staying less stressed,” Jakubisin said.

This year, Lake Highland Prep also began offering mindfulness sessions on Thursdays to upper-school students as an alternative to study hall. In the dome atop the school’s main administrative and classroom building (the Rex Building), teacher Brenda Hack guides the teens through sessions focused on yoga nidra (deep relaxation) and meditation. “They can get a moment of calm,” she said. “They all have grins on their faces when we’re done.” Moreover, the sessions were “jampacked” by the end of the semester.

Hack also leads yoga for the women’s basketball and men’s cross-country teams, and the school plans to add an upper-school course on mindfulness next year. It also educates parents about mental health by bringing in experts for talks. Topics have ranged from reconceptualizing anxiety to helping students handle the pressures of technology and social media.

For Episcopal High School, a boarding school for 440 9th-12th-grade students, “our number-one priority is to provide the safest, most healthy environment possible for students — that is a form of risk management,” Dickson said. Also important, he said, is providing a rich array of social and emotional activities that students can enjoy as a way to achieve a balanced life, such as volunteering in the community and attending theater performances.

Even with all these alternative programs, however, nothing is more beneficial than building relationships, according to sources. “The key is what has been key in independent schools all along, and that is the relationship between students and teachers,” Jakubisin said. “We are constantly talking among ourselves about whether there are kids who need more support, does every kid have an adult to talk with.”

And that may be the one thing every school can do. “Being aware of how students are feeling doesn’t cost anything,” as Pittman noted. “But it can make all the difference in their lives and it’s everyone’s job.”

Donna Davis is a freelance writer based in Boulder, Colorado. A contributor to Net Assets since 2008, she specializes in education.

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