By Mallory Matthys BSN, RN, CPN, North Carolina pediatric nurse and Ph.D. Student at the University of Texas, Tyler
From mental health crises to suicide attempts, pediatric nurses are seeing their hospitals being flooded with patients newly diagnosed with mental health conditions. Often, parents are confused and have limited resources to help their child. As a pediatric nurse, I have witnessed first-hand the declining mental health of children and the lack of resources for families.
North Carolina is experiencing a worsening mental health crisis among its school-aged children. According to the Youth Risk Behavior Survey, in 2021, 43.4% of high schoolers in North Carolina reported feeling sad or hopeless almost every day for more than 2 weeks. In 2019, 36.3% of high schoolers indicated that they felt sad or hopeless for more than 2 weeks. Suicide rates are also increasing, with 11 more teenagers aged 15 to 17 dying by suicide in 2023 as compared to 2018 in the state.
While there are resources for mental health concerns in North Carolina, the system is overrun with patients having to wait months for even an initial appointment. Schools are in a unique position to aid the mental health of their students. The North Carolina General Assembly recognized that schools could be integral in improving the mental health of their students and passed Session Law 2020-7, requiring schools to provide mental health training to staff and create a system for staff to report students believed to be at risk for suicide. Despite this law, the mental health of students continued to decline.
Again, the General Assembly has elected to take action by proposing the Suicide, Safety, and Violence Education (SAVE) Students Act. This act would require schools to provide mental health training directly to students in grades 6 through 12. However, what if students need more help than the generalized training given to everyone? How can school staff better identify students who are at risk?
Normally, schools only conduct targeted mental health screening of students whom staff think are at risk of suicide, but targeted screening can allow many children to fall through the cracks. Universal screening is the method of providing evidence-based screening questionnaires to each student to identify those who are at risk for mental health issues and those who need immediate help. It has been shown to identify more students who need help that would not normally have been selected through targeted screening, like minority students and those in rural areas.
While I endorse the addition of universal screening to the SAVE Students Act, key stakeholders have pointed out concerns that universal screening will place an even bigger burden on a mental health system that is already at capacity. Like the community, schools in North Carolina have a lack of mental health workers, with a ratio of 1 school psychologist to 1,928 students and 1 social worker to 995 students. This is well above the national standard of a 1:500 ratio for school psychologists and a 1:250 ratio for school social workers. By identifying more students who need assistance, schools could also be overrun with mental health referrals.
Again, the North Carolina General Assembly is in a position to aid in increasing the number of school psychologists and social workers. Several methods have been proposed to encourage mental health professionals to choose school settings. The legislature can provide funding for loan forgiveness programs for social workers or school psychologist who agree to work in the school system for a pre-determined number of years, grants to school staff going back to college to become social workers or school psychologists, or set up state-run programs between universities and school districts to provide internships for graduate students to inspire them to work in a school setting.
I encourage the North Carolina General Assembly to consider adding universal screening and methods to increase the number of school mental health workers to the SAVE Students Act. The mental health of students is continuing to decline, and under the existing circumstances, the mental health system will continue to be overburdened. Now is the time to take action.
