There is a mental health crisis among young people today. The U.S. Surgeon General has issued advisories and there was a National State of Emergency in Child and Adolescent Health issued in 2021.
Large percentages of teens report sadness and hopelessness; drug overdoses have spiked; and suicides are the second leading cause of death for this group.
At the same time, mental health has become something everyone talks about in childhood and young adulthood. Kids talk about it in group chats and online. Schools have made preventative measures like teaching emotional awareness and mindfulness part of their missions.
But now, as The New York Times has reported, some researchers are asking a relatively controversial question: Are we talking about mental health too much?
Some studies have shown limited or even negative results from school-based mental health interventions, and some are concerned that all of this talk is leading kids to label themselves as someone who has anxiety or depression when they might just be experiencing the normal kinds of bumps and bruises of being a teen.
The Show spoke more about it with Matt Moix, past president of the Arizona Association of School Psychologists and coordinator of psychological services for Gilbert Public Schools. He’s been working in school psychology in Arizona for 25 years — from elementary all the way up to high school. And he told The Show, there’s a balance here we need to meet.
Full conversation
MATT MOIX: It's actually really interesting and it's not just mental health, what people think of in terms of mental health. They're probably thinking of our high school students that are experiencing tons of anxiety and depression. But it shows up much earlier than that with our elementary school students who show up either not ready for school or some sort of traumatic experience prior to showing up for school.
And they exhibit a lot of significant behavioral challenges as well as emotional difficulties. So at the elementary level, it looks like acting out and school refusal and noncompliance and aggression. And so it could be really intense and, and scary for lack of a better word. And I think that's really taxing for teachers as well as mental health professionals in the schools.
When you get into junior high and high school, it looks a little different, a lot less externalizing behavior, we call it, they're not necessarily throwing desks and chairs. But they are breaking down in class or they're refusing to come to school or they're asking you to come to the counseling office or to see the school psychologist or the school social worker depending on who's available. Because the thought of being in school or in the classroom is just overwhelming for them at that moment.
LAUREN GILGER: So, it's gotten worse. It's gotten harder.
MOIX: Oh, absolutely. Over the last, well, 2.5 decades, we've definitely seen an increase and, and to be, I know everybody talks about COVID and we're all sick of talking about the impact of COVID. But since COVID, since we returned to school it's been exponentially worse, we were seeing increases in all of these things prior to COVID. But I think COVID just exacerbated that for, for everyone.
And why that is, whether it was the social isolation, whether it just threw us into the lack of providers, whatever the case may be, we've just seen a sharp increase since we've returned several years ago.
GILGER: What about suicide? Sort of the worst case scenario here?
MOIX: We definitely have seen an increase in reports of suicidal ideation, whether they're talking about having thoughts of killing themselves or whether they're making plans. We've seen definitely increases in attempts unfortunately and have completed suicides unfortunately, are also on the rise. One in 15 high school students nationwide will attempt suicide. So it's, it's really kind of the worst case scenario. As you said, it's increase in all those things that are happening.
GILGER: OK. So tell us what programming looks like in the Gilbert school district and in schools that you, that you work in when it comes to mental health, there's a lot of mindfulness training in schools now, a lot of sort of training about identifying feelings and emotions and coping and things like that. What do you do?
MOIX: So, in Gilbert, we're very lucky in that we have school social workers, school mental health counselors, as well as school psychologists who serve as members of our behavioral health teams on every campus along with the school nurse and the school administrator. Part of the behavioral health team's role isn't to do SEL curriculum or go in classrooms and do those lessons.
GILGER: That social emotional learning, yeah.
MOIX: Right, social emotional learning. Social workers will do that as part of that, we try to integrate, best practice would be no matter where you are, that's, that's kind of just part of your daily experience. And it's kind of a buzzword has some negative connotations, social emotional learning does. And that in some communities, it's seen as we're trying to brainwash students.
And really, it's just how to get along, how to solve problems, how to deal with difficult things is really what we try to focus on. Students that express some concerns or we start to have concerns about how they're functioning, their behavior concerns their social emotional concerns. That's when the behavioral health team might design interventions. Obviously in conjunction with the parent and talk with them about whether we provide group counseling support or individual counseling support with the social work services or with the school psychologist or the school counselor. We might work with the family to identify outside resources that they might be able to access to help their student make progress.
And then obviously the, the highest level is when we've got some pretty significant needs and we need to be working with that family to identify all of those outside resources, as well as the things we're doing in school in terms of putting plans in place and doing risk assessments and threat assessments and those kinds of things.
GILGER: So let me pose something to you that is a little counterintuitive here. There are some researchers who are now kind of questioning the mass of mental health prevention training that we've seen in schools. A little different maybe than what you're talking about. But a lot of this kind of language, right? And it's not a political thing. Like this is research showing that we might be like overdoing it, for lack of a better phrase. That mental health awareness campaigns will help some young people who have serious problems and need help. But that for others, it seems to, to lead them to sort of overinterpret relatively mild symptoms or like self-label themselves when they're really not as bad off as they might think. What do you make of that?
MOIX: So it's definitely interesting research and I think what I've seen has every bit of research I've read about, it has indicated we need to do further research and try to identify exactly what's going on. But I think anyone who's worked in schools or any parent who's got a teenage child has dealt with this at, at one time or another where, let's say your, your adolescent comes home and says my friend has depression and I think I might have it, too.
I'm using the word contagion. That's not the good word for it, but that's kind of what it is that it seems like they want to over-label everything and every thing they encounter needs a label. And we've got somehow identify that symptom as a problem that needs treatment as opposed to something that maybe we just need to work through.
Whether, I mean, we all experience things in our lives that are challenging, that give us a little bit of anxiety, doesn't mean we have an anxiety disorder. Sometimes we get sad and we need to find a way to, to not be sad or to work through that, but it doesn't mean we have depression. And I think one of the concerns of that research that might have some validity is that if we talk too much about it, it does lead to that symptom identification and over diagnosis.
GILGER: Do you think social media plays into that?
MOIX: I think social media does two things. Well, it does a lot of things but two things that it does is one, it does lead into that, that the influencers talk about depression and anxiety and students identify with that and they start to label themselves as having that. But I think students also, social media, when you're invested in it and you're spending so much time looking at social media and interacting on social media, it inhibits your ability to have real meaningful relationships and decreases your ability to develop coping skills and resiliency that is what you need to be able to get through those times when you're facing something that's anxiety-provoking or something that makes you sad.
GILGER: Yeah, it's touchy, right? Like because we don't want to forget that and many in the mental health world will say this like the broad consensus is that the bigger problem is a lack of mental health treatment available for kids who really need it. Do you see that side of it, too?
MOIX: Absolutely, 75% to 80% of students that need mental health supports and mental health treatments aren't able to access it. And the vast majority of students, their first line of defense is a school. That's where they're able to get some sort of not necessarily treatment, but access to a mental health provider who could provide support and guidance.
And the fear with citing that research about us over-identifying is that if we shut it all off, then the kids who really do need it, they aren't going to be able to access it. So I think that's the bigger issue, is I think the the solution would be to not spend all of your time and your, your social emotional lessons identifying feelings and identifying disorders. It would be more about teaching coping skills and resiliency and things like that.
If you or someone you know may be considering suicide, there is help. Contact the 988 Suicide & Crisis Lifeline by calling or texting 988 (en Español, llame al 988, prensa 2; for Deaf and Hard of Hearing, dial 711 then 988). You may also contact the Crisis Text Line by texting HOME to 741741.
