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Schools Still Have A Mental Health Epidemic

COVID can help us end it.

There was an epidemic before the pandemic. An epidemic that targeted our children and was spreading with deadly speed. It was an epidemic unresponsive to masks and accelerated with social distancing. It was an epidemic that we could all see, but as parents, as schools, and as a society, we continued to do the things that fueled the transmission of the disease. The cure seemed to be more frightening than the problem.

Even before COVID, US children were suffering from an escalating mental health crisis. Our response to the pandemic can either intensify the mental health epidemic or disarm it.

Life was painful for many children pre-pandemic and this last generation of children felt pain more acute than those before them. Between 2009 and 2018, rates of depression rose by 60% among 7–17-year-olds. Between 2007 and 2015, the number of children and teenagers who were seen in emergency rooms with suicidal thoughts or attempts increased by 200%. The suicide rate for children is two times higher when school is in session whereas for adults, it’s higher in the summer. School stress is toxic for many of our children. And, the higher-achieving the school district, the higher the risk.

In September of 2019, the Washington Post reported on a confluence of studies that led to the same conclusion. Students in high-achieving schools are at significantly greater risk of mental health problems. “The Robert Wood Johnson Foundation named the top environmental conditions harming adolescent wellness — among them were poverty, trauma, discrimination and ‘excessive pressure to excel,’ often, but not exclusively, occurring in affluent communities. It may sound counterintuitive, even perverse, to put relatively affluent kids in the same category as our country’s most vulnerable youths. While the stressors are markedly different, researchers are finding that both are ‘at risk’ for elevated levels of chronic stress that can affect health and well-being.” Despite the affluence and unlimited resources, high-achieving schools are not protecting children from severe mental health problems. Ironically, these schools are creating this increased risk.

Researcher Suniya Luthar reviewed three decades' worth of research findings and found that adolescents at high-achieving schools suffer from symptoms of clinical depression and anxiety at rates three to seven times higher than national norms for children their age. The research indicates that “the pressure to excel in multiple academic and extracurricular pursuits” is causing this emotional suffering. The Washington Post article references Luther’s research when they write, “when a child’s sense of self-worth is dependent on what they achieve, it can lead to anxiety and depression. Anxiety can come from worrying about keeping up with or outshining peers, while depression can be caused by a failure to achieve.”

The pressure that we put on our children is, for many, overwhelming. As income inequity in our country increases and colleges become more selective, the idea that our children will not catch the train to prosperity and happiness has infected our parenting and our schooling. It has found a host in the emotional lives of our children. And, it is a myth. Even Forbes reports that “money doesn’t buy happiness over $75,000.” And Frank Bruni’s book, “Where You Go Is Not Who You Will Be” takes a sledge hammer to the common wisdom that people who attend highly selective schools are happier and more successful.

Imagine if the water in our schools was contaminated. We would close our schools, demand that we not reopen until the water was safe. We would pour whatever money or resources were necessary to ensure the safety of our children. But, in the face of the data about the impact of achievement-based stress on our children’s mental health, we do the opposite. Believing that high performance is the secret ingredient to our children’s success, we intensify the pressure to achieve at home, at school, in the orchestra, and in the locker room. Many of our children never get a break, and it is breaking them.

Ironically, COVID may be the one thing that can reverse this epidemic.

Something unexpected happened in the spring of 2020. At the heart of the pandemic, some children’s mental health began to improve. Luthar’s research found that “as classes and exams were canceled, grading moved to pass/fail and extracurricular activity ceased, they reported lower levels of stress, anxiety, and depression compared with 2019.” The pandemic ground everything to a halt, and for many children, that was a good thing.

Of course, these are broad statistics. Although these changes relieved the pressure on many students, they had a devastating impact on other students. Data from this time reveal a complex picture. In many ways, COVID was an accelerant, placing students already at high risk at even greater risk. Students of color, children living in poverty, and students from unstable homes were most vulnerable. In normal years, the suicide rates of whites far exceed the suicide rates of people of color. This was reversed during COVID. Suicide rates for white people dropped by 5.6% but in many states, the suicide rate for people of color more than doubled. Susan Borja from the National Institute of Mental Health stated that Black and Hispanic students “suffered from the pandemic the worst and are likely to have the longest tail.” The same is true for students living in poverty and in emotionally unstable homes. Overall, the strongest predictor of student functioning was how their parents coped with the stress of COVID.

These varied statistics are not inconsistent. Rather they tell different stories about how our schools and our parenting place our children at risk for mental health issues in different ways. The pandemic as an accelerant put these differences in stark relief. The children most at risk in our achievement-focused culture are both the highest achieving and our most vulnerable students. The children from chaotic homes with little connection to school became further disconnected. The students who were in the pressure cooker of achievement-focused communities got a break from the stress and benefitted.

And then we blew it. According to Luthar, “these improvements were short-lived. Beginning in the fall of 2020, as schoolwork ramped back up, the mental health of adolescents returned to pre-pandemic levels or worse.” We had had enough. Worries about lost instruction from the spring fueled educators and parents to get back to normal as quickly as possible. We asked children to attend all of their classes online, for six hours a day with only 5-minute breaks between classes. And, we gave them homework, ensuring that they would be on their screens in the evenings. Our panic that our children had fallen behind pushed us to not only get back on pace, but to move faster, to catch up to where they would have been without the pandemic.

Similarly, the disconnected students became further disconnected and alienated from school. As the demands increased, they fell further and farther behind, their chaotic home lives making it impossible to log on and engage for hours at a time.

And our children began to get sick again.

As we plan for the return to school in the fall filled with the worry that children have “lost instruction”, we are at risk of doubling down on those practices that are least healthy for our children and, ironically disrupt their ability to learn. In our effort to catch up, learning is likely to become more passive, seated, competitive, indoors, overscheduled, intense, and teacher-paced than ever before. Students who struggle with learning in a high-achieving school culture will fall farther behind and experience the shame, discipline, and exclusion that poison their experience of learning. Equally tragic is the impact that it will have on the students who can keep up with the pace required for high achievement, who will have those pressures to achieve intensified and ignited by the fear that they have fallen behind. As parents and educators, we need to be careful that our anxiety about the educational impact of lost instruction isn’t transmitted to our children. Luthar states that “the strongest predictor of depression among these students was perceived parental criticism and unreachable standards.” This risk of anxiety and depression is a risk we have created. It is a fire that we continue to stoke.

I often wonder what we would say to our spouse if they woke up at 6 am, practiced with their garage band for an hour before work, missed lunch, played basketball after school in a pickup league, grabbed something to eat before going into the study, closing the door, and working until midnight or 1 a.m. We would call them a workaholic. We would say that they need more time with their family. We might consider divorce. And yet, many parents worry if their children don’t have a schedule like this. Many complain when there is no homework, believing that their children are not experiencing the rigor that they need to prepare them for life. Could you imagine calling your spouse’s boss, complaining that they didn’t have enough work to do at night? When our children want to quit the team or the instrument, we say that they need to learn perseverance. And we wonder why they become depressed, anxious, or use substances to cope. The environment we have created for our children is toxic and we are all complicit.

“There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning, boys, how’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?” This parable was shared by David Foster Wallace in his commencement address to the students of Kenyon College, warning them of the trappings of the adult world they were stepping into. In high-achieving school districts, everyone is steeped in the myth that achievement leads to success and happiness. Parents, children, teachers, and school administrators all swim in this water, not realizing that it is poisoned. COVID-19 took us, momentarily, out of the water. It allowed us to experience, briefly, what it was like to breathe before we plunged back in.

Google an image of a 1920’s classroom. Despite the innovations in all aspects of our society in the past century, the black and white image looks remarkably similar to a 2020 classroom. Students sit in desks in rows facing a teacher who is lecturing to them. Children still attend school for about six hours a day for 180 days that are divided into 45 minute periods with nearly identical subject areas. Although our educational system has remained surprisingly unchanged, the pressure on our children to succeed has skyrocketed, especially in the last decade as we have all bought into the myth that academic achievement leads to happiness and success in life. The pressure of this myth, as felt by children, parents, and educators, continues to intensify.

The disruption of COVID-19 provides us with an opportunity to change this. As we prepare for post-COVID life, we can, once again, lift our heads from the water, realize that we are the ones poisoning it, and begin the hard but essential process of change. As Winston Churchill famously said, “Never let a good crisis go to waste.” In that spirit, let’s look carefully at some of the things we did differently during the disruption of COVID. What have we learned?

Grading: The Illinois State Board of Education adopted a grading system in the spring of 2020 of “do no harm.” Grades do an interesting thing. In addition to indicating mastery over a concept or skill, they are an index of social comparison that is a driver of anxiety and depression for children.

Connection: Many teachers found it more difficult to connect with their students online and, as a result, created online conferences with students. This one-on-one time was valuable for everyone, even if it meant that instructional plans had to change. Research indicates that our brains grow faster when we are connected to our teachers. Swapping instructional time for individual student conferences and independent learning may, paradoxically, lead to even greater academic gains.

Parents: Parents and teachers needed to collaborate like never before. They saw into each other’s homes and partnered in new ways. There was newfound respect and appreciation for one another. Just as researchers from different labs collaborated to create a vaccine, if we are to address the mental health epidemic, the collaboration between parents and schools is more essential than ever before.

Asynchronous Learning. Asynchronous has become a four-letter word in education because of our fear of losing control of student learning. However, for many students, it opened up the possibilities for more independent learning. Often, asynchronous learning was student-paced and student-directed — two keys for academic engagement.

We Went Outside. Not confined by the walls of the school building, children could participate in class on their phones, walking the dog, sitting in the park or in their yard. Without the demands of homework, they could be outside in the afternoons and evenings. When we returned to in-person instruction, schools put up tents for outdoor classrooms. Research is teeming with the educational and mental health benefits of being outdoors and when we were forced outside, we were finally able to experience those benefits.

Sleep: As part of my daughter’s high school statistics class, each year students throughout her high school are surveyed about how much they sleep each night. During COVID, students were getting 7.8 hours of sleep while in past years, students were reporting sleeping an average of 7 hours. Do .8 hours of sleep make much of a difference? Again, the research is clear: children who sleep an hour less at night have a higher incidence of ADHD, behavior problems, and obesity. They also have greater academic and social skills deficits. Over time, pre-pandemic, as demands on children have increased, their sleep has decreased. Children across America are getting one less hour of sleep today, on average, than they were in 1980. Another contributing factor to our children’s mental health crisis.

Homework: Because all of the learning was online all day, homework was rarely assigned. Evenings became family time. Parents and children were more relaxed. Many families in my private practice said that while they hated online learning, they did not miss the homework battles at night. And, with a break from academic stress at home, their brains are more ready to engage academically when they walk into school the next morning.

Scheduling: Everything stopped. It was heartbreaking to see children who had worked so hard at their craft have sports, music, and theater cancelled. But there was an upside. Travel teams didn’t take families out of town. Play rehearsals didn’t keep children out late only to come home and have hours of homework to do before falling asleep. Family members were no longer ships that passed in the night. They were reconnecting. They were having dinner, playing games, and watching shows together.

While school for many students triggers anxiety that shuts down learning and development, each of these changes enhances learning, consistent with how we have learned throughout evolution. Formal education has only been around for the last 150 years, but we have been learning as a species for tens of thousands of years. And, more and more, we are departing from what we know enhances learning. Relationships. Fresh air. Movement. Lower stress. More sleep. Greater autonomy. Despite the use of screens during remote learning, many of our practices were more consistent with our biology than our educational practices when we are in school. And, whenever we fight our biology, we lose.

If all of this makes you anxious, there is a model for how this can work. Finland has it figured out. They do not assign homework and emphasize time outdoors and invest in relationships. “Finnish people believe that besides homework, there are many more things that can improve a child’s performance in school, such as having dinner with their families, exercising or getting a good night’s sleep.” Finland is ranked third in the world education rankings. The US is ranked 26th.

Was it a lost year or a year of discovery? Antoine de Saint-Exupery wrote, “a rock pile ceases to be a rock pile the moment a single person contemplates it, bearing within them the image of a cathedral.” COVID-19 shattered our world. It caused suffering and disruption at a scale that we have not seen for generations. There are two truths that we have discovered during COVID-19. The suffering is real. As is the opportunity. During COVID, we have learned that we can adapt as parents and schools in extraordinary ways to stare down a lethal threat to our society’s well-being. We can do the same with the lethal threat of the childhood mental health epidemic if we have the courage to heed the cries of our children, set aside our anxiety about their achievement, and create communities that embrace educational and parenting practices consistent with our biology. The COVID-19 pandemic has been an effective teacher. If we listen, we can use those lessons to disarm the epidemic that has gripped our children for the past several decades. Let’s make our schools into cathedrals.

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Doug Bolton

Doug Bolton

Doug Bolton, Ph.D. is a Clinical Psychologist and former K-12 Principal who provides school consultation with Formative Psychological Services, Northbrook IL.