When three students in Virginia's Albemarle County Public Schools (ACPS) noticed how stress, anxiety, depression and other mental health issues were affecting many of their peers — and having an impact on their own lives — they didn’t just push through and wait for graduation.

The trio took their concerns to state lawmakers, who were among the first in the country to pass legislation requiring state-mandated mental health education in K-12 schools.  

“At each of our high schools, we had individuals who attempted suicide either at school or outside of school,” said Lucas Johnson, a graduate of Monticello High School in Charlottesville, Virginia, who worked with colleagues Alexander Moreno, a graduate of Western Albemarle High School, and Choetsow Tenzin, a graduate of Albemarle High School, to push for the bill.

The Virginia ­­­­­­­­­­­­law requires mental health education in the 9th and 10th grades. A proposal for implementing the new law extends the mandate to include kindergarten through the 10th grade and will be presented to the Virginia Board of Education next month, followed by a period for public comment and a final vote of approval slated for January 2020.

The proposed standards are designed to be incorporated into existing standards for social and emotional health, said Vanessa Wigand, coordinator for K-12 health education, driver education and physical education for the Virginia Department of Education.

They include age-appropriate instructional practices aimed at reducing stigma and teaching students how to obtain and maintain good mental health, understand mental health disorders, pick up on signs and symptoms of distress, and seek help.

At the 4th-grade level, for example, students will learn about healthy self-concepts, compassion and respecting differences, as well as verbal and nonverbal communication skills and how to understand and manage emotions related to loss, grief and stress.

“These are explicit health skills that the kids will have so they know it’s a good thing to seek help. We’re destigmatizing. We’re educating,” Wigand said.

Multiple approaches to mental health awareness 

Several states have either approved or have legislation in the works related to mental health education. Some of them are aimed at addressing concerns about additional workloads and teacher training.

A Colorado bill, for example, created a grant program to help with professional development related to crisis and suicide prevention. A new Texas law requires teacher preparation institutions to include mental health instruction in their certification programs, and a Nevada bill created a grant program for districts to contract with social workers or other mental health professionals.

Virginia, however, is one of only three states to mandate mental health education at the K-12 level. The latest to do so is Florida, where the state Board of Education approved a program in July that dovetails with the Hope for Healing Florida campaign, an initiative of First Lady Casey DeSantis that will create and disseminate materials about mental health and substance abuse issues throughout the state.

“We are going to reinvent school-based mental health awareness in Florida,” state Education Commissioner Richard Corcoran said in a statement.

Announcing details about the new measures, the Florida Department of Education released survey data showing that in 2017, 28% of the state’s high school students reported feeling sad or hopeless for two or more consecutive weeks, 14% said they had purposely hurt themselves without wanting to die, 14% said they seriously considered attempting suicide, 11% said they had made plans to commit suicide, and 8% said they tried to commit suicide.

National statistics show similar trends. According to the Centers for Disease Control and Prevention, suicide rates rose nearly 30% between 1999 and 2016, and suicide is now considered the second leading cause of death for Americans ages 10-34.

Johnson, Moreno and Tenzin attribute student distress to a wide range of factors — family and home-life issues, the high-stakes nature of academic life and college admissions standards, and the ripple effects of social media, among others.

Like many students, Moreno once struggled with the gap between his own life and those of his “friends” on social media. But now he said he has a more holistic approach toward social media, what it is and how it works.

“I’m wiser to it,” he said, “and I know that it’s more of a face you show to the world than what’s actually going on in your life.”

Based on their own experience, the trio from Virginia feel strongly that age-appropriate mental health education should be incorporated into the school day from the get-go.

“We really need to invest in the period from when an individual is born to when they graduate from high school,” said Johnson, who is working in several states to support legislative initiatives for mental health education at the K-12 level. Those states include Alaska, Arizona, Delaware, Indiana, Kentucky, Massachusetts and Pennsylvania.

“Those 18 years,” Johnson said, “are some of the most fundamental in ensuring that individuals will not develop a lifelong mental health illness and that they are well-suited to ensuring that their mental health and resiliency are at the highest level that they can be when going into their post-graduate life.”

'More of a carrot than a stick'

Their sentiments echo those of others who say mental health education has a pivotal role to play. By incorporating it into the school day and building successively on what children learn from kindergarten through the 12th grade, educators can destigmatize the issue and provide young people with the tools they need to pick up on early warning signs and get help for themselves or a friend, said John Richter, public policy director for the Mental Health Association in New York State (MANHYS).

New York was the first state to enact a law requiring mental health education in public schools. The state legislature subsequently allocated $1 million in 2018, and the state budget included $500,000 in 2019 to create the School Mental Health Resource and Training Center to support school efforts to comply with the new law, including curriculum-building resources provided by MANHYS.

“We thought that that was important,” Richter said, “to really make sure [the law] had life, because oftentimes when laws change, especially when you just insert the word mental health in the law, it can get forgotten about pretty quick. Our approach has been much more of a carrot than a stick.”

Embedded in that approach is the concept of sharing the burden, Richter said, making sure there are multiple options for imparting information about mental health education, whether it’s organizing mental health awareness days, using “The Scarlet Letter” to teach lessons about stigma, or including mental health awareness tips in the morning announcements.

“We’ve really tried to encourage schools to go even beyond teaching about mental health,” he said, “and try to create a climate and a culture in their schools of wellness.”

Amanda Fitzgerald, director of public policy for the American School Counselor Association (ASCA), said her organization is encouraged by the growing interest in mental health education, and she hopes the conversation will lead to more programs and policies that will improve upon the nation’s current student-to-counselor ratio of 455 to 1.

“We want to ensure there are no unintended consequences,” she said.

ASCA recommends a student-to-counselor ratio of 250 to 1, and only three states (New Hampshire, North Dakota and Vermont) are below that threshold. All other states surpass it, some exceedingly so, and the disparities tend to be greatest at the elementary and middle school levels.

While emphasizing the need for improvement, Fitzgerald also touted efforts underway in several states to bolster the ranks of school counselors and other support personnel.

The Arizona State Board of Education, for example, recently approved an additional $20 million for schools to hire counselors, social workers and police officers; the Virginia General Assembly approved an additional $12 million earlier this year to hire more counselors; and the Colorado School Counselor Corps has put $60 million into new hires and professional development since 2008.

“We want to ensure that the schools are well situated to handle any of the referrals that might come in,” she said, “and that schools have resources in place to get folks the help they need.”