In a Nutshell:

• Increases in the number of school counselors, nurses, social workers, and psychologists, as well as school-based health centers, are long overdue.
• Schools should also support disease prevention and health promotion efforts to reduce students’ need for treatment.
• Small changes to school activities and environment may have large impacts on long-term health outcomes.

Attention to student mental health needs has taken on an almost unprecedented policy focus in recent months. My past research has supported policy strategies to bolster the supply of behavioral health providers in the state and increase the number of school counselors, nurses, social workers, and psychologists, as well as school-based and school-linked health centers.

To be sure, these policy efforts will be invaluable to address an ongoing and growing mental health crisis in our state.

While effective and equitable mechanisms for the diagnosis and treatment of illnesses and injuries are essential, policymakers and school leaders would be wise to invest equal attention to the creation of environments and supports that can mitigate or prevent the emergence of disease. Taking a public health approach to youth mental health means recognizing the interconnectedness of physical, mental, and social factors, and creating environments that foster healthy behaviors and support students’ well-being.

School Nutrition

Nutrition is a major risk factor for various mental health disorders, such as depression. School nurses, dieticians, and health education specialists may all play a role in educating students about the health benefits of quality nutrition.

Poor nutrition not only affects physical and mental health – it also has a negative impact on student performance. Efforts to teach students about nutrition and health must be matched by schools providing healthy food options in school cafeterias. Yet, for a variety of reasons, and despite decades of scrutiny, many school lunch options remain less than nutritious.

Student health and success would be greatly amplified by collaborative efforts between health professionals, educators, and school cafeterias to teach and reinforce healthy eating. It is also important to recognize that not all students have equal access to healthy food outside of school. Food insecure students have been found to struggle with school and have increased stressors related to food insecurity that impact their mental health.

When schools provide breakfasts and lunches to their students and make many of these meals free for families who need them, they are taking important steps to help students get through the day and focus on learning by lessening their food insecurity. The foods provided in breakfasts, lunches, and outside food support programs should ideally be healthy options in order to best support students in their nutrition and mental health, since unhealthy food can have an adverse impact on children’s health. There is certainly a difficult balance between student preference and food desirability on the one hand, and nutritional value and health impact on the other.

Ultimately, because students develop social and behavioral norms within schools, schools have an opportunity to help students develop healthy behaviors and make healthy food choices. At the very least, schools should ensure that choosing healthy food is the easiest choice for students to make, and that these healthy choices are available to all students regardless of ability to pay.

Physical Education and Sports

Like nutrition, physical activity is an essential part of mental and physical well-being. Physical education and health education are therefore inextricably linked, and some research supports the notion that gym class can reduce the probability of obesity.

While physical activity also decreases depression levels in teens, it should be recognized that depression symptoms often inhibit motivation for physical activity. Effective health programming must develop inclusive and supportive strategies to address this and other barriers to student engagement, such as the stigmatization and resulting self-esteem issues experienced by youth with larger body sizes.

Indeed, negative experiences of physical education may increase the likelihood of adult sedentary behavior. Weight stigma can also lead to self-exclusion from physical activity.

While formal activities, such as gym class, should develop a greater focus on inclusivity, not all physical activity need be formal. Making sure that there is adequate opportunity for voluntary physical activity and movement within the school day should also be considered at all levels. For younger children in particular, recess is integral to optimal child development. Older children also benefit from opportunities for stretching, walking, and other forms of movement.

Sports are a promising context for efforts to improve and support mental health for students who participate. Sports provide opportunities for students to develop healthy physical and social habits, such as regular exercise and the importance of teamwork. Conversely, the competitive context of sports can sometimes place students’ health at risk through overexertion, stress, social exclusion and, in extreme cases, abuse.

As schools increasingly offer mental health training to teachers and other school personnel, they should consider extending such training to all personnel (including volunteers) involved with school sports and athletics.

School Music/Arts Programs

Much like the penny-wise, pound-foolish elimination of school health personnel that has occurred in past decades, school art and music programs are common targets when it comes time for budget cuts. While school arts programs may seem like low-hanging fruit to administrators when seeking to reduce expenditures (without engaging in the difficult process of systemic operational and/or budgetary reforms), these cuts have a wide-ranging impact that encompasses not only students’ academic success and enrichment, but also emotional and social well-being.

Substantial research has demonstrated an association between school arts and both students’ academic achievement and social and emotional development. A large scale, randomized-controlled trial in Houston found that an increase in arts education improved standardized writing scores, reduced disciplinary infractions, and increased student compassion for others. Art and music classes are also ideal settings for incorporating social and emotional learning (SEL).

There are also many evidence-based interventions in art and music therapy proven to reduce stress levels and improve mental health symptoms. The benefits of art and music therapy are not only psychologically based, but also demonstrated from a neurobiological basis (e.g., by measuring impact on brain activity or cortisol levels).

Schools would be wise to invest in art and music programs to improve student achievement and wellbeing. State standards guaranteeing greater access to arts education are also needed.

School Libraries

Much like school nurses, social workers, and psychologists, school librarians have faced massive elimination of positions in recent decades. Even though library media specialists can provide essential support to both teachers and students, and increase student success (such as improving literacy and reading ability), Michigan has just one library media specialist for every 3,343 students.

Trained and certified masters-level professionals in library and information science may also be an important component of improving student health and well-being. The CDC identifies libraries as important partners in health literacy efforts. Libraries can partner with health professionals and/or school-based health centers to disseminate health information and enhance health education efforts and strategies.

Beyond vital health literacy efforts, school libraries can also be a source of various mental health resources, as well as direct bibliotherapeutic practices (i.e., reading for pleasure).

Building Support in the Classroom and Budget

Schools are in a position to have conversations with students regarding stigmatization and discrimination, to provide education about various health issues, and to foster empathy. For instance, anti-stigma interventions in schools have been shown to increase positive attitudes about mental illness and tolerance of mental illness. Similarly, programs aimed at mental health education have been shown to improve attitudes towards mental health concerns and seeking help.

Social changes in school environment, such as changing the ways that teachers and staff talk about health, promoting classroom communication about students’ wellbeing, and making sure to combat misinformation, can also provide buffers against the stigmatization faced by those with mental health concerns, developmental delays, obesity, or other health issues. Indeed, incorporating destigmatization into school environments is, perhaps, the most fundamental way that schools can aid in improving the health of their students and communities. Successful implementation hinges on both educator training and the presence of school health personnel.

Another important facet is the work to create safe and respectful environments in schools that promote positive social interactions between students and their peers (as well as students and staff). While supported by research, it is also self-evident that positive and inclusive school social environments promote better mental health, whereas environments rife with discrimination, bullying, and other forms of victimization are related to negative mental health outcomes (for both perpetrators and victims).

It would be naïve to think that changes to school environment will solve all students’ health problems, and yet, it would conversely be foolish to disregard the potential aggregate impact of making the many small changes suggested above. Certainly, schools cannot fulfill every one of an endless supply of student wants and needs, but, when it comes to activities already occurring during (or around the school day) – lunch, recess, music class, gym, etc. – small changes in perspective and practice may yield large improvements in students’ health and wellbeing.

Many of the areas for intervention outlined above are frequently the target of cost-reduction measures; however, this approach to budgeting ignores the multidimensional benefits that (for instance) school music programs or libraries can provide. A local budgeting process that gives more weight to the health and psychosocial benefits of school activities might help change the tenor of discussions. State policies and standards provide an alternative, top-down means of enhancing school environments, particularly when these enhancements are tied to revenue distribution.

State and local education policymakers must recognize that meaningful outcomes and indicators of school quality (such as student health and wellbeing) are not necessarily the easiest to measure (i.e., by standardized test), but are nonetheless worthy of investment and prioritization. Promoting student health and well-being is essential to give students the opportunity to achieve individual and collective academic success.