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Schools Struggle to Provide Mental Health Resources During Coronavirus Crisis

Illustration: Student popping out of computer screen looks across chasm at a dark computer screen
(Illustrations: Julie Elman)

*This story by Alexis Angelus and Stacey Dec is part of a collaborative project by the University of Richmond Department of Journalism and the Virginia Center for Investigative Journalism.
Virginia school administrators say they are struggling to provide mental health services during the coronavirus pandemic, even as vulnerable students continue with online studies away from regular counseling and support.

As school systems move to virtual learning, school counseling resources, deemed critical to student wellness by the U.S. Department of Education, are unable to provide in-person therapy for high-risk students. The alternative treatments -- online sessions or new therapists from community services boards -- could fall short in continuing care and supporting students during the pandemic, mental health professionals say.

The global crisis has brought added stress and anxiety to students and their families. More than 100,000 children and teens suffer from mental illness in Virginia, according to the state chapter of the National Alliance on Mental Illness.
The pandemic “is going to exacerbate some of those kids' symptoms -- even the kids that have outside providers,” said Nicolo Porto, a high school social worker in Northern Virginia. “The biggest thing that we’re still working through is we can’t provide mental health services to kids.”

For many students, access to trusted adults and mental health resources were suddenly cut off on March 23, when Gov. Ralph Northam officially closed schools throughout Virginia for the rest of the academic year. Several other local school boards had made the decision weeks earlier.

“I was genuinely devastated,” said one student from Chesterfield, Va., who had been regularly meeting with her school’s resource officer and relied on support from three teachers. The 18-year-old student, who wished to remain anonymous, said her resources at school were like family to her.

“Those four people were my rock. They were the sole reason why I would get out of bed in the morning,” the Chesterfield teen said. “I never got to say a goodbye or anything. One day they were 3 feet away from me and next they were gone -- like someone just turned the light off. I still get emotional thinking about it.”
Universal efforts are being made across school divisions to help children transition, Maribel Saimre, director of student services at the Virginia Department of Education, wrote in an email. Although schools are providing students and their parents with coping strategies during virtual learning, consistency of care is not guaranteed, she said.
“Resources vary by community,” Saimre said. “Crisis intervention is available across all community service boards, but other services are going to vary depending on the locality and providers.”
While some school districts are embracing telehealth, others are hesitant to use it as a replacement for in-person treatment. 

Virtual counseling poses privacy concerns, and can produce lower quality care, Porto said.

Porto, who specializes in crisis intervention and trauma, said his role as a school social worker abruptly shifted to an administrative role when the COVID-19 pandemic hit Virginia. Porto had been working regularly with several students when his school district suddenly closed schools. Since his school closed, he has had no contact or time to make contingency plans with any of his students due to legal and ethical concerns.

Each school district has its own guidelines for how or if counselors can contact their students. For example, some districts allow counselors to send emails to students to check in, but others require specific signed permission for outside-of-school contact related to privacy practices and counseling confidentiality.
School social workers and psychologists in Virginia are not required to complete telehealth training as it isn’t necessary in typical school environments. Even with training, Porto said the quality of virtual healthcare is diminished because counselors cannot analyze body language.
Mental health professionals also cannot guarantee a confidential environment over a virtual platform. “There’s no way to be sure that their parent isn’t sitting off camera,” Porto said.

Porto also said that because some families do not believe in mental health treatment, their children lose all of their mental health resources when schools close. Other students who don’t typically seek resources may find themselves in need during social distancing and continued isolation.

School psychologists and social workers are left to focus on providing online resources and communicating with parents, who frequently must initiate contact.
To cope with concerns over treatment gaps, administrators are also referring students to providers outside of the school system. Saimre said some Virginia localities are using an out-of-office voicemail system to refer students to community resources.
“The double-edged sword is that there are actually a lot of places for mental health, but very few of them actually take insurance, and even then it can still be expensive,” Porto said.

Even if students want to have online therapy sessions, many cannot. In 17 Virginia counties,  less than half of the population has access to broadband internet, according to Broadband Now, an advocacy group.

“The well-off kids have access to that, but many, many kids don’t have access to it, so they are caught in a situation where they are deprived,” said Bob Trestman, chair of psychiatry and behavioral health at the Carilion Clinic in Roanoke. “I have no doubt that there are many children who previously were receiving care who now, either no longer have access or, because of the nature of their problems, no longer have the support to continue their care.”

Some districts throughout the state have tried to combat digital inequity by providing computers, tablets or internet hotspots. However, some districts can’t afford it.

“It could have an outsized impact on kids who are not able to connect in person or to connect electronically,” said Lloyd English, a school psychologist for Norfolk Public Schools where hotspots have been distributed to those in need. He expected the extended period of isolation to be difficult for everyone.

The economic collapse caused by the pandemic has left many families in financial distress. Over 410,000 Virginians applied for unemployment benefits during the first four weeks of the crisis. A parent’s stress is often felt by their children. 

“As parents, we transmit all of those anxieties to our kids, no matter how hard we try not to,” English said. “Our students definitely feel that pressure, even for the younger ones.”

With mounting financial concerns, children might find it harder to ask for help.

“We’re already starting to see some of our families that may not ordinarily need to access the meal services, coming to the meal service line to get food,” Porto said. “If your basic needs aren’t even met, you can’t begin to think about your health or your mental health. They’re not going to be in an environment that they can do self care because they’re just trying to survive.”
Most school-provided mental health resources will likely remain limited until students are back in classrooms and able to return to in-person counseling.
Porto said he believes there will be an uptick in students needing mental health services in the fall due to COVID-19, whether the student was personally affected by the disease or other stresses related to the pandemic.
Porto has turned to providing online resources for students and families. He created the Mental Health, Wellness and Community Resources for Families, which lists places students and families can turn to in order to cope with COVID-19.

“When we come back, it’s going to hit me like a freight train, how little I was able to do,” Porto said. “I [will] have to put on my work hat and deal with that in the moment because that’s what these kids need from us.”
Emergency Mental Health Resources:
National Suicide Prevention Hotline: 1-800-273-TALK (8255)
Text “NAMI” to 741741 if you are having suicidal thoughts or urges.

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