The history of health education in schools is as long as the history of modern medicine itself. While Edward Jenner was discovering smallpox vaccination and Louis Pasteur was inventing pasteurization, even before Robert Koch laid out his famous postulates, reformers like Horace Mann and William Alcott were advocating for the inclusion of health education in school curricula. Throughout the 20th century, calls to reform health education and create comprehensive standards became louder and louder until today it is practically a given that schools should include health-related education. From diet and exercise to drug and alcohol prevention to injury prevention and safety to sexual health (in at least some form), health education is ubiquitous in U.S. schools today.
The same cannot be said for mental health — in which standards, education, and enthusiasm all remain uneven at best and completely non-existent at worst.
In the last decade, this lack of comprehensive mental health education has risen from a notable shortcoming to a full-blown crisis as adolescent mental health has worsened, particularly in the wake of the Covid pandemic. In short, now more than ever, mental health education is sorely needed.
The Centers for Disease Control, mental health professionals, the Surgeon General’s Office and systematic reviews of the evidence all agree that mental health education is important and that school-based mental health interventions improve mental health literacy among students.
And yet, our experience at Letters to Strangers, a global youth-run, youth-focused nonprofit seeking to destigmatize mental illness and increase access to affordable, quality treatment, has been one of frequent disappointment. Educators are occasionally hesitant (or more simply, poorly equipped) to openly discuss mental health with their students, offer proper resources and materials to students, or include any binding mental health education standards in their curricula. Administrators, in particular, are often actively hostile to our efforts.
Administrators we have spoken to are often concerned that talking and teaching about mental health will, in and of itself, worsen students’ mental wellbeing. To put it bluntly, the thing that many administrators seem to be most concerned about is that they may be left holding the bag if anything bad happens after they open what they see as a can of worms. We can empathize with this concern, but despite this fear, there is no empirical evidence that this is the case. And, in any event, ignoring mental health’s existence does not mean it has actually ceased existing,
This reluctance to engage with mental health education is particularly troubling because, at a policy level, school-based interventions are the most accessible venue for promoting mental wellbeing. Of course, we would prefer that every family talk about mental health as openly as they talk about physical health, and that society at large no longer treat mental illness with the stigma that is attached to it. However, in the absence of the magical ability to reach into every living room, break room, board room and ballroom, and have them see things our way, the classroom will have to suffice.
To effectively address the pressing mental health challenges facing students today, it’s imperative that we move beyond merely acknowledging the problem and toward actionable solutions. This requires a comprehensive, multi-faceted approach that integrates mental health education, support services and a shift in cultural attitudes within our schools.
But what does a mental health forward school environment truly mean?
First and foremost, it means requiring schools to provide mental health resources and education from qualified instructors. Letters to Strangers’ groundbreaking partnership with the Sambhavya Foundation in Nepal, our first-of-its-kind Mental Health Guidebook, and California’s Senate Bill 224 can serve as models in this regard. SB 224 in particular is a great example of how Mental Health education can be implemented here in the U.S. It requires all school districts that offer health classes to include mental health as part of the curriculum and this academic year will be the first full school year in which districts are required to include this material.
Crucially, this legislation goes beyond talking about mental health in general and vague terms. It specifies that students learn about more serious conditions like schizophrenia, post-traumatic stress disorder, disordered eating, obsessive compulsive disorder, and depression and bipolar disorders. The new standards also include explorations of the causes, symptoms and potential treatments of mental health disorders.
In short, California has gone from being, quite frankly, a bit of a wasteland when it comes to mental health education to having some of the most robust standards in the nation. Other states, and the Department of Education at the national level, should learn from California’s experience and craft similar standards of their own.
Putting our schools’ mental health forward also means treating mental health in the same way that we treat physical health. There has been movement on this front in some areas. Mental health parity laws, for instance, require insurers to cover mental health treatment just as they do physical health treatment. (Though enforcement of this has been negligible.) However, the same cannot be said for the way we treat mental health in our schools.
Take excused absences as an example. No one objects to students taking time away from school (and being excused for it) when those students have a cold, the flu or Covid. In fact, staying home when sick is the expectation. It is the responsible choice. Yet, excused mental health days are anathema to many. Even the suggestion of mental health days retains a stigma that students are faking it or that they should be able to power through it in a way that we simply do not expect when it comes to physical health. It isn’t complicated: students are able to get excused absences for physical illnesses, mental health problems should be no different.
Similarly, access to counselors remains sorely lacking, even relative to the also lacking access that students have to school nurses. As of 2022, LA Unified School District had 57 counselors covering 14 wellness centers accepting referrals from schools covering more than 430,000 K-12 students — one counselor for roughly every 7,500 students in the district. The end result is that students often wait months for a slot to open up. Creating a mental health forward school environment means ameliorating that shortage.
Above all perhaps, building a mental health forward environment requires making mental health normal. It requires removing the stigma from mental health. Teaching about mental health, treating it like physical health and providing access to treatment undeniably help. But, at the end of the day, the only way to make mental health normal is for us to stop shying away from it, to talk about it openly and honestly in all aspects of our lives.
With my own students at UCLA, for example, I always begin our first section with an open invitation for students to come to me if they are having mental health challenges and highlighting the University’s counseling services. I want it to be clear to my students that I recognize the challenges they may face while I am their instructor, and that they can rely on me to treat them with the respect and dignity they deserve.
It is ultimately up to all of us to do the same.
