School Nurses and the Student Mental Health Crisis

By Courtney Suciu

The numbers are staggering – researchers estimate about a quarter of all school-age children and adolescents struggle with mental health issues like anxiety and depression. And yet most children – nearly 80 percent – who need mental health services won't get them¹. Schools are not always equipped to deal with students’ emotional needs, and parents often lack the awareness or resources to get help for their young ones.

As a result, some children and adolescents are left to suffer in silence. Others lash out, inflicting harm on themselves or others. Young people might self-medicate with drugs and alcohol. Often, academic performance is negatively impacted.

However, at the forefront of this crisis, school nurses are in a unique position to spot signs of mental health issues among students and help those who are in need. With that in mind, let’s take a closer look at the important role of school nursing staffs in helping students who struggle with anxiety and depression.

But first, what are the challenges in providing care to children?

According to research published in the Spring/Summer 2018 School Community Journal¹, “approximately 25% of youth ages 5-18 have experienced a mental health disorder during the past year and more than 30% of children and adolescents are expected to experience at least one mental health condition during the course of their lifetime.”

This study by Danielle Swick and Joelle D. Powers focused on an innovative partnership in North Carolina to create a “school-based support program” that would provide mental health services to students.

The program was developed in response to the high number of students struggling with conditions like depression and anxiety who are not receiving treatment. Swick and Powers noted a variety of obstacles that prevent families from accessing mental health services. Working parents might not be able to take time away from their jobs for appointments, or they might not have reliable transportation. Some parents are unaware of where to seek services. Then there is the cost of services – according to one report cited by researchers 25% of parents with children with mental health concerns said they did not seek care for them because of the expense.

“Lack of adequate treatment to mental health needs can have serious implications for children, including greater difficulty in academic performance and increased vulnerability to various negative school outcomes,” according to the researchers.

Additionally, consequences of “untreated early onset mental health problems include greater risk of initiating substance use, sexual activity, and violence,” they added. “These risky behaviors in adolescence and young adulthood can result in poor outcomes in overall health, socioeconomic status, employment and social adjustment.”

The evolving role of school nurses in mental health services

Barriers to mental healthcare result in serious immediate and long-term disadvantages for young people. School-based programs can alleviate many of these challenges. This puts the school nurse in a critical position to assess and diagnose students with mental health problems, as well as provide care and advocacy for them.

A study in The Journal of School Nursing² delves deeper into the role of nurses in providing services to students with mental health disorders. “Students often report to the school nurse with somatic complaints, which are physical symptoms for which no medical cause can be identified,” researchers noted, adding: “Symptoms of anxiety and depression are common in children with somatic complaints.”

Additionally, “school nurses who have mental health training as part of their nursing education can explain the role biophysiology plays in mental health to students, parents and staff, and may help lessen the stigma associated with mental health conditions,” the researchers continued.

The effectiveness of screening tools used by school nurses to identify anxiety and depression in selected urban schools were examined by the authors of this journal article who found that these efforts improved students’ access to treatment for symptoms of anxiety and depression.

Nurses are committed advocates of children’s success and well-being

So, how are nurses responding to their expanded role in providing mental health services to the students they serve?

In 2014, the National Association of School Nurses³ published an inspiring, detailed position statement (excerpted below) on the “Mental Health of Students” in strong support of nurses’ contributions to mental health care for students in school settings:

[School nurses] serve a vital role in the school community by promoting positive mental health outcome in students through school/community evidence-based programs and curricula. As members of interdisciplinary teams, school nurses collaborate with school personnel, community health care professionals, students and families in the assessment, identification, intervention, referral and follow-up of children in need of mental health services…In addition, school nurses serve as advocates, facilitators, and counselors of mental health services both within the school environment and in the community…

School nurses also offer themselves as a resource to learn and strategize with staff to prevent bullying and promote a safe learning environment for the student body…

School nurses are uniquely positioned between policymakers and the student body as caregivers, advocates, and experts. This vantage point affords the school nurse the ability to identify and intervene with at-risk adolescents as well as lead in developing prevention policy…

Mental health is a key component in children’s healthy development; children need to be healthy in order to learn, grow, and lead productive lives.

Resources to support school nurses in providing mental health care

As school nurses continue to play an increasingly vital role in providing mental health services to children and adolescents, access to training, continuing education and the latest relevant research is crucial.

Nursing and Mental Health in Video features over 240 videos of the most common mental health disorders nurses may encounter – whether in a school setting, primary care setting, emergency room, medical, psychiatric or other. Mental health disorders featured include anxiety, depression, suicide ideation, and substance abuse assessment. Curated by nursing experts, many “patient cases” include:

Director’s Cut – features moment-by-moment analysis of the case provided by a psychiatric mental health nurse.

Key takeaways – includes a psychiatric mental health nurse’s opinion on what is most important in the video.

Future treatment options – includes recommendations on next steps in providing patient treatment.

Health Research Premium Collection is a single point of access to many types of content, including more than 4,500 full text health and medical journals (such as The New England Journal of Medicine, The Lancet, The BMJ and Nature), instructional videos, grey literature, and 40,000 full-text dissertations on nursing, psychology, and health management.

Nursing Education in Video is a collection of video created specifically for the education and training of nurses, nursing assistants, and other healthcare workers. All of the videos in the collection have been created by Medcom-Trainex, and are regularly reviewed for accuracy, currency, and compliance with US Federal regulations from agencies such as OSHA and CMS.

Notes:

1. 1. Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. The American Journal of Psychiatry, 159(9), 1548-1555. Available from PsycINFO.
   2. Swick, D., & Powers, J. D. (2018). Increasing access to care by delivering mental health services in schools: The school-based support program. School Community Journal, 28(1), 129-144. Available from ProQuest Central, Health Research Premium Collection and Social Science Premium Collection.
   3. Allison, V. L., Nativio, D. G., Mitchell, A. M., Ren, D., & Yuhasz, J. (2014). Identifying symptoms of depression and anxiety in students in the school setting. The Journal of School Nursing: The Official Publication of the National Association of School Nurses, 30(3), 165-172. Available from Health Research Premium Collection and SciTech Premium Collection.
   4. Blackborow, M., Tuck, C., Lambert, P., Disney, J., Porter, J., & Jordan, A. (2014). Mental Health of Students: Position statement. NASN School Nurse (Print), 29(6), 323-326. Health Research Premium Collection and SciTech Premium Collection.

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Courtney Suciu is ProQuest’s lead blog writer. Her loves include libraries, literacy and researching extraordinary stories related to the arts and humanities. She has a Master’s Degree in English literature and a background in teaching, journalism and marketing. Follow her @QuirkySuciu