Schools Can Help Address Youth Mental Health and Substance Use

Today’s young people are facing unprecedented mental health and substance use issues—no matter where they live throughout the country. And youth ages 12 to 17 are experiencing growing rates of anxiety, suicide, and more. Despite slight declines in 2023, drug overdose death rates among young people have increased substantially in recent years, and about 9% of youth ages 12 to 17 have a substance use disorder. Further, in 2023, more than 20% of high school students seriously considered suicide and almost 10% made an attempt. And suicide was the third-leading cause of death for youth ages 14 to 18.

Amid these challenges, many experts say that turning this trend around depends on offering support where kids spend most of their time: in the classroom.

Sharon Hoover, a clinical psychologist and professor emeritus at the University of Maryland School of Medicine, knows this firsthand, having spent her career visiting schools and speaking with students navigating mental health challenges. Most recently, she co-directed the university’s National Center for School Mental Health, which seeks to improve standards for mental health care in academic settings.

This interview, originally featured in Pew’s “After the Fact” podcast, was edited for length and clarity.

Q: What’s the state of youth mental health today?

A. Anxiety, depression, post-traumatic stress, and disruptive behaviors have been increasing in young people for some time. Things got worse during the COVID-19 pandemic, which brought new burdens on families, loss of life, isolation, and the disruption of social activities. Many of these trends continue today. We’re still seeing kids who are experiencing higher rates of depression, anxiety, and suicidality.

Q: Has this trend affected academic performance?

A: Yes. As students started coming back into schools post-pandemic, we found that they not only had tremendous learning loss, but also disruption to mental health.

Q: Do we know what’s behind this increase?

A: Data shows that the introduction of cellphones and social media platforms was one of the largest contributors, even pre-pandemic. Many families are also facing economic strain, and we know that when there's a burden on families, it affects students’ mental health. Finally, today’s generation of kids face growing demands, such as increased pressures around academics and extracurricular activities, with less time for play and unstructured activity.

Q: What do mental health challenges look like in young people?

A: Parents or teachers often ask, how do I know if my kid is depressed or just experiencing teen moodiness? It's an important question. Most kids have worries or experience nervousness in new situations. We get concerned when these feelings start to impair a child’s ability to engage in typical standard developmental activities such as play, school, or family interactions.

Q: And what about youth substance use?

A: While many still think of substance use as separate from mental health, they’re deeply intertwined. We know that students experiencing mental health issues are much more likely to also struggle with substance use issues and vice versa, so we need to approach these together.

Q: How can schools help?

A: Because young people spend much of their lives at school, it’s an opportune place to positively affect mental health. From kindergarten through 12th grade, young people spend about 15,000 hours in school. Data shows that when we bring mental health supports into school buildings, young people are much more likely to access them and to follow through with intervention. There’s also lots of data suggesting that schools are the best place for substance use prevention, screening, and intervention.

Q: Are schools already implementing mental health practices?

A: Every school in the country would tell you they have some degree of mental health services. Most school administrators not only see the need for mental health services, they want to prioritize them. Yet more than half of administrators say they don't have sufficient financing or staffing to provide resources.

Q: Why is that?

A: Our systems aren’t built to provide mental health support in schools. We don't have adequate funding at the local, state, or federal level for some of this work. And unfortunately, schools are often under-resourced, so administrators make difficult budget decisions in order to supply mental health resources.

Q: How can we improve these programs?

A: The National Center for School Mental Health has identified national performance standards for the ideal comprehensive school mental health system. Ultimately, mental health needs to be embedded into the educational ecosystem.

Q: What does this look like in practice?

A: It means embedding social and emotional competencies into the curriculum. It includes teaching mental health literacy and having measures that support positive relationships among students and teachers. Schools should also offer higher tiers of support for students who need it, such as interventions and onsite mental health treatment and crisis services. Additionally, it’s critical to have adequate staffing from the school and community partners who can provide mental health supports to students in the building.

Q: You mention community partners. Do local health systems work with schools?

A: The most effective school mental health systems are those with really solid relationships between the school’s system and the community’s behavioral health systems. This ensures that our students’ mental health doesn't fall solely on the shoulders of our schools, or our behavioral health agencies, or families. It's a partnership.

Q: And improved mental health leads to better grades?

A: That's correct, the two go hand in hand. When students feel better, they're usually able to perform better, and this often translates to grades. One priority for schools is that students perform academically. We also need to ensure that the mental health interventions we’re implementing have positive academic consequences too.

Q: What insights do you hear from students?

A: When we visit schools, students tell us they enjoy when mental health and well-being is acknowledged during the school day. They want to feel well, and they want to feel connected. When we act like the only thing that matters is whether they’re reading, writing, or doing arithmetic, it doesn't work. And students don't want to have to wait until a crisis to go see somebody for support—they want opportunities for regular check-ins, which some schools are adopting.

Q: Final thoughts?

A: I'm optimistic because young people are driving the future. They’re talking about mental health and asking for resources in school and at home. We're also seeing a shift from reactive systems to preventive ones; schools are embedding mental health promotion and literacy early on. If we help kids build social skills and emotional competencies, we can help them learn how to be well in their daily lives.