The COVID-19 pandemic has amplified the mental health struggles that were already proliferating among young people. Many schools are trying to expand their rosters of adult specialists who can provide support. But some are tapping an additional source, too: the students themselves.
School districts are training teenagers to spot early signs of mental health problems in their peers and connect them with adults who can help.
The practice isn’t new: It has its roots in longstanding work to prevent suicide and school shootings and foster emotional and physical safety at school. But training young people to help spot trouble, in close partnership with adults, is being embraced anew as the pandemic ladles unprecedented demands onto school psychologists, social workers, and counselors.
Sofia Mendoza is one of the students who’s trained to play this role for her classmates. She does her work as part of a “Hope Squad” run by her school, Hilliard Davidson High, outside Columbus, Ohio. Sofia said it’s rewarding to serve as such an important resource for her peers.
“Some students won’t get help because they’re just afraid to ask for it,” said Sofia, a senior at Davidson. “But if a peer knows, and if their struggle is seen and heard, then they’re able to say, OK, yes, I do need the help. And we can get them to go to an adult themselves.”
Students as eyes and ears on the ground
In the Hilliard City district, dozens of students are trained to serve on Hope Squads in each building that serves students in 6th through 12th grades. They watch for signs like social isolation or feelings of hopelessness, and persuade those students to get help from trusted adults in the school. They also learn to monitor their own emotions and take care of themselves, seeking support from adults when they need it. Each squad gets guidance from a team of trained adults, said Mike Abraham, the district’s director of student well-being.
The district began the Hope Squad work four years ago, along with an array of other social and emotional support programs, when its leaders saw a spike in suicides, depression, and anxiety, Abraham said. The squads have provided important support during the pandemic.
Hilliard refers far more students to a nearby children’s hospital for psychiatric support than other nearby districts of its size, a statistic Abraham cites with pride. “It means they’re getting the help they need,” he said.
Nationally, one of the best-known programs that trains people to spot mental health struggles, Mental Health First Aid USA, has seen a spike in demand for its programs during the pandemic. Millions of adults—from firefighters and hospital staff to former first lady Michelle Obama—have taken its courses, which were designed 20 years ago by Australian researchers and adapted in the United States by the National Council on Mental Wellbeing.
I realized that they’re having these conversations with their peers on a daily basis. In the absence of formal training, they very much carry the weight on their shoulders that they have to fix their friends’ problems.
Suzanna Davis, vice president of operations and programs at Grant Us Hope
More than 550,000 K-12 staff members have taken its 6- to 8-hour courses, which focus on noticing signs of mental illness or substance abuse in other adults or in young people, and more than 125,000 teenagers have taken the “teen” training, said Tramaine EL-Amin, who leads MHFA USA’s strategic initiatives.
Trainees learn to use what’s known as the “ALGEE” protocol—Assess for risk of suicide or harm, Listen nonjudgmentally, Give reassurance and information, Encourage professional help, and Encourage self-help and other support strategies.
Research on these early-spotter programs generally focuses on how the training affects those who take it. Studies find that the programs can improve trainees’ ability to recognize mental illness and build their confidence in helping those who need support. In a study set for publication this year, Johns Hopkins University researchers found that more than two-thirds of the students who take the MHFA teen training report that they use the skills to manage their own stress and to help peers who are in need, EL-Amin said.
Asking students to notice the signs: an undue burden?
Research is thinner on how much the trainees’ intervention helps those in distress. One 2018 analysis, conducted by researchers who collaborate with the Australian founders of Mental Health First Aid, found a “small improvement” in the amount of help provided to those with a mental health problem. A 2018 study on the Hope Squad program found that more than one-quarter of students who sought help from their counselors for suicidal feelings had been referred by Hope Squad members.
Some administrators express doubt about the wisdom of involving students in identifying young people with mental health struggles. The Paterson, N.J., schools have been stepping up their early-warning-signs training of adults in the last few years: More than 600 staff members have been trained, said Cheryl Coy, the district’s assistant superintendent for special education and services. But she wouldn’t extend the training to students just yet.
“I think it’s too much of an additional layer to add on,” she said. “Many students don’t realize the level of stress they’re under right now. It’s like a soda bottle: Shake it up, and when you take the cap off, it explodes.”
Suzanna Davis, the vice president of operations and programs at Grant Us Hope, which partners with Hope Squad to provide training to 175 schools in Ohio and Indiana, said she had the same hesitation when she was a high school principal and was considering adopting the program.
“I asked students, is this too much to take on?” she said. “But I realized that they’re having these conversations with their peers on a daily basis. In the absence of formal training, they very much carry the weight on their shoulders that they have to fix their friends’ problems. If we’re not engaging them and giving them the right tools and training to engage in those conversations, we’re missing the boat.”
Strong adult support: key to program success
Experts, and district leaders who have opted to train teenagers, caution that key conditions must be in place to ensure the programs provide appropriate support for everyone involved.
Schools must make sure there are enough trained adults to provide a skilled, supportive team for students to lean on. Schools that wish to use MHFA’s training for teenagers must commit to training 10 percent of their adult staff, EL-Amin said. To do Hope Squad training, schools must partner with a mental health provider in their community, Davis said.
Staffing shortages currently plaguing schools during the pandemic can complicate that picture. The ratios of mental-health specialists to students were already insufficient before the pandemic. On average, there is only one school psychologist for every 1,200 students, far from the 1-to-500 ratio recommended by the National Association of School Psychologists. There are currently 427 school counselors for every student, but the American School Counselor Association recommends one per every 250 children.
Ratios like those, while many mental-health vacancies in schools are also going unfilled, don’t bode well. They suggest that schools risk relying on insufficiently trained adults to provide support for children in distress and to supervise teenage student mental-health trainees, said Kelly Vaillancourt, the NASP’s director of policy and advocacy.
The community mental health groups that partner with districts are strained past capacity too, noted Kelly Davis, the associate vice president of peer and youth advocacy for Mental Health America. So while there’s been a big upsurge in the need for services, and in interest in youth-training programs, there is a danger that children who are struggling “could be referred to nothing,” she said. Policymakers must redouble efforts to staff schools and feed the pipeline of trainees for mental health professions, she said.
Abraham, from the Hilliard district, urged districts to pair teen training with the purchase of an after-hours notification system. At night or on weekends, if his teenage spotters need to report a friend in serious trouble, or frightening comments from a peer on social media, they know to call the Safe School Helpline, which connects them with appointed employees in their district who can take swift action.
In Collier County, Fla., the district operates a suite of interlocking programs designed to support students emotionally. Some are exclusively carried out by adults, who form communication webs about students’ attendance and well-being. In others, the students lead, with teams of adults backing them up.
One program trains elementary students to be “friendship ambassadors” who check specially painted “buddy benches” in their playgrounds for kids who seem to need a companion. Another taps middle school students to ensure that no one’s eating alone in the cafeteria. These students aren’t trained to spot early signs of mental illness, but their work aims to build connections that can help when a student is in distress.
“Sometimes we forget how our students can help” complete the picture of support at their own schools, said Kamela Patton, Collier County’s superintendent of schools.