School-Based Strategies are Crucial to Supporting Adolescent Girls’ Mental Health

December 02, 2022 | Lexa Giragosian

According to a recent CDC report, the COVID-19 pandemic has had a particularly negative impact on the mental health of adolescent girls. While there was 31% increase in Emergency Department (ED) visits for mental health conditions for all children aged 12-17 from March through October 2020, the number of adolescent girls seen in EDs for mental health disorders (e.g., depression, eating disorders, anxiety, and trauma) increased significantly during the 2020-2022 period. School closures, isolation from peers, and normal-life disruptions contributed to increased prevalence of eating disorders, tic disorders, anxiety, depression, trauma/stressor disorders and obsessive-compulsive disorders.

Adolescent girls can be strongly influenced by social media, causing many of them to internalize the thin ideal which contributes to body comparison, body dissatisfaction, disordered eating—all leading to poorer mental health outcomes. In particular, greater social media usage during the 2020 school closures further increased body dissatisfaction among this group.

Adolescent girls' mental health is also influenced by social factors, including discrimination and inequalities based on factors such as sex, gender, and race. Internalized gender discrimination impacts mental health as it is a risk factor commonly present during adolescent development. Black adolescent girls’ mental health is disproportionately negatively affected, especially through experiences with racial microaggressions socially and in school.

Supporting adolescent girls’ mental, emotional, and social needs may significantly improve population health outcomes later in life. Focusing on school-based mental health systems offers the best opportunity to improve adolescent mental health. States have also been addressing school-based mental health through legislation enacted since the beginning of the COVID-19 pandemic.

Updating Health Education Curricula

Over the past few years, states have passed legislation including mental health education in curriculums or expanding the current mental health materials, allowing students to learn more about mental health and promote health-seeking behavior.

• In 2021, Arizona enacted SB 1376 requiring mental health education be part of the school-based health curriculum; the curriculum must include input from mental health experts and advocates and articulate how mental health impacts multiple aspects of overall health. The state Department of Education issued related recommendations.
• Illinois enacted SB 4028 in 2022, which amends the comprehensive health education program to include how and where to find mental health resources in the state. The bill also created an advisory council of members aged 14-25 that advises the Children’s Mental Health Partnership about barriers to youth mental health treatment access and how to improve and destigmatize mental health.
• In 2022, Louisiana enacted HB 440 requiring schools to provide age-appropriate education to sixth grade students and above about eating disorders and how to prevent them. This information must also be incorporated into current health education, physical education, or another related course.
• California enacted AB 748, requiring every public and charter school serving students in grades six – through twelve to create an age-appropriate and culturally relevant poster that shares common indicators for those struggling with mental health as well as mental health resources and positive and negative coping strategies.
• Delaware enacted HB 301, requiring the state Board of Education to establish and implement an age-appropriate statewide mental health educational program for all public and charter schools that covers the relationship between physical and mental health and is taught by certified teachers or mental health providers.

Building School Staff Capacity to Meet Mental Health Needs

By increasing their capacity to address student mental health, schools can improve treatment availability and increase student and family referrals to mental health services.

• In 2020, Virginia enacted HB 1508 which required local school boards to employ one full-time school counselor per 325 students in grades K-12 beginning with the 2021-2022 school year. HB 829, passed in 2022, allowed schools increased flexibility in filling school counselor positions (e.g., with professional counselors in the school counselor licensure process, or contracted services).
• Kentucky enacted SB 102 in 2022 requiring school districts to annually report the number of school-based mental health providers, including level of licensure, to the department of education.
• Alabama enacted HB 123 in 2022, which requires each school system to employ a mental health service coordinator. Each school system will also be required to conduct a resource and capacity needs assessment.
• West Virginia enacted HB 4074 in 2022 requiring the state board to propose a legislative rule to establish training requirements for all public-school employees to recognize students’ self-harm behaviors and eating disorders. These trainings must support the healthy development of students “by learning how to appropriately respond to or refer a student who exhibits warning signs of self-harm or eating disorders.”

Improving Mental Health Screenings and Treatment in Schools

States also focused on advancing mental health screening and treatment in schools to best determine the status of student mental health and provide interventions accordingly.

• Washington enacted SB 5030 in 2021 requiring public schools to develop and implement comprehensive counseling programs within their schools by the 2022-2023 school year.  The plan must provide a process for identifying student needs, explain how services are delivered, and establish an annual review process.
• Vermont enacted S 197 in 2022, which directs the department of education and department of mental health to establish a two-year program to provide children and youth-tiered support by providing grants to school-based counseling services and mental health and wellness focused afterschool programs in underserved communities.

Looking Forward

State health officials and their agencies can support adolescent girls’ mental health by working collaboratively with cross-sector partners and stakeholders such as community organizations, students, their families, and mental health professionals to develop and implement effective mental health campaigns and services tailored to adolescent girls. Public health leaders can also use a health equity framework when developing health program funding announcements as well as focus on upstream actions to reduce or mitigate adverse childhood experiences and other risk factors specific to adolescent girls. Overall, leadership can concentrate their efforts on improving adolescent mental health through school-based strategies.

ASTHO will continue to monitor this important public health issue and provide relevant updates.