Back to School Psychology - Mental Health Considerations for Parents
By Tim Weissman, Ph.D.
A fervent debate has developed in our country on whether schools should re-open. In deciding whether to send your child back to school, I feel it is important to weigh mental health issues in the overall assessment. Some school systems are offering the choice of in-person or online classes, and parents may be faced with a tough decision. In this article, we consider the ramifications on mental health of children. I understand there are countervailing issues, and that there are wide discrepancies between individuals regarding their ability to engage in or tolerate perceived and real risk. I also respect that there are mental health considerations for parents, teachers, administrators, and the community at large.
Mental Health in Children of the United States
According to the CDC, approximately 4.4 million children in the US are diagnosed with an anxiety disorder and 1.9 million with depression. Further, approximately 6.1 million have a diagnosis of ADHD and 4.5 million with a behavioral problem. Between the ages of 3-17, rates of anxiety and depression tend to increase. For children living 100% below the poverty line, the rates are even higher – 1 in 5 children in this category have a diagnosis of anxiety, depression or a behavioral disorder.
Researchers have shown how important early childhood social and emotional development is in predicting lifelong success.1 It is critical to address behavioral and emotional disorders when they first present, as early treatment tends to be more effective. Conversely, poorly treated or ignored childhood mental health disorders have far-ranging consequences for both the child and many related systems – family, school, community and juvenile justice. It is estimated that 70% of children in the juvenile justice system have a mental health disorder.2
Costs for mental health treatment are more than any other medical expenditure in children - $13.9 billion in 2012.3 Further adding to cost because of supply issues, there are well-documented shortages of child psychiatrists in the US, with many states having between 1 and 17 per 100,000 children.4 At the best, that would mean 1 child psychiatrist for every 5800 children. There are also documented shortages of other behavioral health professionals as well – social workers, therapists, psychologists, etc.5
Role of Schools in Mental Health
All the above paints a challenging picture of childhood mental health in the US. With such widespread difficulty regarding the prevalence of mental health disorders in children, and the costly access to care constraints, school systems naturally become a safety valve to relieve a good deal of the pressure. The social support of peers and the guidance of caring adults help children who otherwise receive little assistance with mental health issues. This is particularly true for poor students who do not have as many resources.
Teachers do not replace mental health professionals, but they are frequently the first ones to notice behavior or emotional problems in children. They have the benefit of seeing large numbers of children together and can recognize types of differences which are outside the norm. This becomes a backstop for children who might otherwise get lost in the shuffle of life at home, where behavior may be rationalized away or overlooked because a parent might not understand that is it outside the norm.
As schools are frequently the sites of the first clear indicators of mental health issues, they also provide many opportunities for growth and progress which tend to improve these very issues. Anxiety is the most common emotional disorder in children. Avoidance of anxiety never improves it. Thus, engaging with others and challenging the child to push forward against their anxiety can be helpful. Depression similarly can be mitigated by engagement with others – the type of social interaction which typically occurs in the school setting. It is also improved by having a routine schedule, physical exercise and a focus on goals and activities – all relevant within the school setting.
Staying Home – Significant Mental Health Costs
If your children are anything like mine, the lockdowns and school closings have not led to an improvement in their mental states. Before Covid-19, our country already had a significant issue with too much social media, too many screens, too much sitting on the couch. After Covid-19, it seems like these problems have only intensified. Social media and screens have become the main way to obtain connection with others – further reinforcing the obsession with devices and feelings of disconnection from people. On the one hand, being able to video call a friend is an amazing reprieve from being socially distanced for so long. But, when the lockdown does not end, it can also serve to remind us how separate we have become as well. There simply is no substitute for connecting with loved ones in person.
Research has begun to look more carefully at mental health results of lockdowns in response to the pandemic. Initial indications are significant increases in stress, depression, irritability, insomnia, fear, confusion, anger, frustration, boredom, substance abuse and potentially suicide rates. Children have not developed the same level of wisdom as adults, and typically have fewer coping skills. Will the emotional and behavioral effects of being locked down be more severe for them? It is reasonable to expect that children will carry these scars of the pandemic and lockdowns with them into adulthood. As parents we should consider these psychological impacts when we decide whether to send them back to school.
Toward a Fuller Perspective
Human health is a full range including physical, mental, and emotional. As a society we should take care to include all of these in our public policy debates. As parents we should include all of these in making decisions for our individual families and children. Lockdowns and the pandemic have clearly impacted this entire spectrum of health. To determine how we proceed with our children in mind, it is important that we do not forget their emotional and mental health.
In-person school and in-person social connection are critical to the development of children. Before Covid-19 our country already had significant challenges in recognizing and treating emotional and behavioral disorders in children. Lockdowns and school closings present added pressures in navigating mental health in children. Poor students are more at risk to the potential deleterious effects created by the lack of school.
When schools close, or parents decide to keep children home, the traditional mental health backstop provided by teachers will be absent while children are facing increased emotional turmoil. Also absent are the beneficial effects of social interaction, peer support, focus on challenging activities and goals. If parents decide to keep their children out of school, it is important for them to maintain a heightened awareness of the need to recognize and assist their children in addressing mental health disorders. Failure to do so could lead to long-lasting and significant problems in their children’s lives which weigh heavily on their success and happiness.
1 Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, eds. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Research Council and Institute of Medicine, National Academy Press; 2000.
2 Hammond S; National Conference of State Legislatures. Mental health needs of juvenile offenders. https://www.ncsl.org/print/cj/mentaljjneeds.pdf. Published June 2007. Accessed December 29, 2016.
3 Soni A. Top five most costly conditions among children, ages 0-17, 2012: estimates for the U.S. civilian noninstitutionalized population. Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey. Statistical Brief #472. April 2015
4 American Academy of Child & Adolescent Psychiatry. Workforce maps by state. https:// www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx. Published 2015. Accessed December 29, 2016.
5 Health Resources and Services Administration/National Center for Health Workforce Analysis; Substance Abuse and Mental Health Services Administration/Office of Policy, Planning, and Innovation. National Projections of Supply and Demand for Selected Behavioral Health Practitioners: 2013-2025. Rockville, MD: 2016.
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