Editor’s note: This article includes references to self-harm and this content may be triggering for some readers. If you or someone you know are considering harming yourself or themself, please reconsider and know that there is support available at S.A.F.E. (Self Abuse Finally Ends) Alternatives.

A pseudonym has been used in this article to protect the privacy of the student quoted.

Xavier is cutting himself with a knife on his arms and wrist.

The 16-year-old student lives with five family members in a one-room apartment. His mom is a house cleaner and dishwasher and speaks only Spanish. Xavier is the “parentified” family leader because his dad isn’t present. In response to his stress, Xavier has depression and anxiety and began cutting himself a few years ago.

“It’s a common form of self-harm, a maladaptive coping mechanism,” says his therapist, Joseph Gutierez, a former public school counselor in private practice in San Mateo County, CA, who assists clients referred by overloaded schools.

Xavier is among the 41 percent of U.S. students growing up in a low-income household. This group — often dealing with unstable housing, food insecurity, and violent neighborhoods — is associated with certain adverse mental health outcomes, such as a high rate of Posttraumatic Stress Disorder (PTSD). Middle- and upper-class students suffer equally, or even more, from mental distress, research from Columbia University suggests.

“In higher economic households, the absence of parents, plus no supervision, rules, or boundaries, but high expectations and academic pressure, creates mental instability,” Gutierez says. “Eating disorders, suicide ideation, and suicide attempts are prominent in this group.”

The mental health of high schoolers — from families that are wealthy, poor, and from every ethnic group — has plummeted since the 1970s, and continues to decline every year. Consider these woeful statistics:

Why are today’s teenagers experiencing so many mental issues? A survey by the Harris Poll revealed the top reasons to be school work, thinking about their future, pressure from their family, and social isolation.

Although one in four teenagers have mental health issues, 80 percent never receive help in high school because there’s an insufficient number of counselors. (In U.S. high schools, the average counselor-to-student ratio is 441 to 1.)

“A full-time counselor can see five students a day, at most,” explains Gutierez. “That’s 25 students a week. They need to see these students every week, but the counselor-student ratio isn’t 25 to 1 in California.” Instead, California has the worst ratio in the nation at 951 to 1.

Peg Johnson, a recently retired counselor from Chico High School in Chico, CA, said, “The ratio [of students to counselors] was 400 to 1. That would work if we were only working with academic guidance issues. But most of our days were filled with social/emotional issues, especially in the last eight years, when the level of anxiety was on the increase.”

7 ways understaffed high schools can help with the escalating mental health crises among teens

  1. Mental health education for everyone

    Three Virginia students from Monticello High, Western Albemarle High, and Albemarle High designed and helped pass a bill to provide mental health education in the state’s K-12 public schools in 2018. The reform was sponsored by state senator Creigh Deeds, who was stabbed multiple times in 2013 by his mentally ill son, who ended up killing himself. The instruction goals are to teach students how to maintain mental health, identify symptoms, seek help, and reduce the stigma.

    Texas law HB 18 requires all teacher certification programs to teach strategies to help students with mental health conditions. Certification curriculum in California also includes mental health. Damian Martin, a counselor at Woodland Senior High, notes, “Teachers are asking more questions now because they’ve been trained better to look for self-harm, abuse, and depression.”

  2. Counselors who care

    When student Sol Garcia had a panic attack at Jimmy Carter Early College High School in La Joya, TX, she said that “the counselor immediately went up to me. She helped me a lot.” Garcia praises her high school staff, describing them as “very caring. Their priority was, ‘Are you mentally healthy? What can we do to get you to feel better?’ That really helped me.”

    To provide students support at this useful, empathetic level, counselors need to be committed and informed. “The best technique I could offer is listening and encouragement through attentiveness,” says former counselor Peg Johnson. “I basically operated on motherly instinct and [with] a heart of compassion. I always tried to encourage the students to speak with their parents and to create a team of support.”

  3. Relax the teen mind

    Research indicates meditation helps adolescents reduce “self-harm thoughts, disruptive behavior, stress, anxiety, impulsivity, and psychological distress.”

    Paul Covey, principal of Valle Verde Early College High School in El Paso, TX, observed students’ “stressful anxiety and panic attacks.” To counteract this, his school started doing a schoolwide “Mindful Minute” of silent meditation or listening to nature sounds or soothing music each day to help the students clear their minds and relax. They also started a student club for yoga and meditation. “Some teachers like [the “Mindful Minute”] so much, they do it to start off every class,” Covey says.

    At Woodland Senior High, counselor Damian Martin helps anxious students by “talking them into listening to music conducive to relaxation, as a coping mechanism. I recommend slower-paced music. I encourage them to find their own songs that put them in a positive mood.”

  4. Supportive social groups

    Woodland Senior High provides “personal power groups specifically for students with mental health struggles,” counselor Damian Martin says. “We offer the group ‘My Strength’ to boys and ‘Be Strong’ for girls,”
    Martin says. “They help self-conscious teenagers open up and talk about their issues.”

    Atherton High School in Louisville, KY, provides social clubs to enhance student mental health. “We have internal groups that allow African-American students to have a sense of community,” explains Principal Thomas Alberli. Studies indicate gay-straight alliances can have mental health benefits for students participants and racial anxiety can be alleviated when cross-group meetings seek friendship between kids of different ethnicities. A study in California high schools found that student-initiated clubs reduce stigma around mental health issues and that homerooms can provide stability to anxious teens if they can depend on the teacher for counseling and advice.

  5. Time off and text therapy

    Hailey Hardcastle had a panic attack in her classroom at Sherwood High School in Sherwood, OR during her junior year. The experience motivated her to work with three fellow students and two pro bono lobbyists to draft House Bill 2191, which was signed into law in 2019. The reform allows students to take mental health days off from school, similar to sick days. Utah offered the same benefit a year earlier when it included mental illness in its re-definition of excused absences.

    Desert Hills High in Saint George, UT pioneered “text counseling” four years ago when it adopted SchoolPulse, a platform offering simple, fast, comfortable communication with students. The technology’s goals are to promote mental wellness, improve suicide prevention, and empower students to speak up about their feelings.

  6. Extra help on- and off-campus

    Crockett High School in Austin, TX, was the location of the first Vida Clinic, launched in 2012 as an on-campus mental health center. Its goal was to prove “accessible, trauma-informed mental health care can significantly aid students struggling with depression, anxiety and a host of trauma-induced conditions.” In only a few months, student clients improved “in their grades, behavior, and overall happiness.” Vida Clinic’s next goal is to be embedded in all of Austin’s 130 public schools.

    Many states like Arizona and Tennessee allocate funds for high schools to hire extra counselors and social workers, and referrals to outside counselors are the norm. Joseph Gutierez helps both adolescents and their parents, noting, “most of these clients have MediCal to pay for their services, but undocumented individuals aren’t able to get MediCal. For them I offer a sliding scale, starting as low as $5 an hour.”

  7. Extra care and connection

    Teen mental health is enhanced by social-emotional support from caring adults. The resulting self-esteem helps prevent depression. The American School Counselors Association (ASCA) suggests counselors build positive relations with students by attending their extracurricular events, like sports and performing arts, and offering them regular encouragement, even something as simple as letting them know, “You did a great job!”

    Students living with poverty might also be hungry. ASCA’s advice is to help them with weekend food bags, as well as connecting them to community services and fee waivers for SAT, ACT, and college applications. Students from low-income families also transfer schools frequently as their parents seek employment. These “new kids in school” endure loneliness and stress that can be alleviated if counselors help them integrate into campus life via introductions to classmates with similar interests, or campus clubs they might enjoy.

Tips to promote mental health support for high schoolers

For parents

For educators and administrators

  • Provide support groups for students with mental health struggles by working with agencies such as NAMI (National Alliance of Mental Illness) .
  • Teens who are physically and verbally harassed and subjected to cruelty by fellow students suffer long-term mental health challenges. Educators and administrators can increase empathy on campus by working with anti-bullying nonprofits.
  • Help teachers recognize students’ emotional struggles by providing them with training courses like Mental Health First Aid.
  • Offer student classes in mindfulness and other relaxation techniques, like yoga, guided imagery, and tai chi. Here’s eight tips from an experienced instructor.
  • Use technology. Apps are available to decrease stress, elevate mood, and help with multiple mental health challenges. Circulate this list to students.

This article is part of our Transforming High School series, a collection of stories, videos, and podcasts exploring the practices that prepare students for success in college and beyond.