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Philip Schonebaum is not afraid to talk about the mental health issues he has faced with students in his tiny South Dakota school district.

“I make it a conversation piece,” says Schonebaum, superintendent of the 694-student Elk-Point Jefferson School District. “I talk to our students about my struggles and remind them they’re not alone, that they have to be sure to talk to someone. It’s a huge connector for kids to seek the services they need.”

Those conversations and connections, Schonebaum says, are critical for students and staff members as school districts grapple with a still-surging post-Covid youth mental health crisis. And it is especially true in small rural communities, where access to providers, treatment, technology, and transportation is limited, and schools are struggling to bridge those gaps.

“Rural communities are considered a mental health desert in this country,” says Susan Sheridan, director of the Nebraska Center for Research on Children, Youth, Families, and Schools. “Access to specialized resources in these communities is very challenging because you can’t just refer someone to a therapist down the street or to a mental health agency. Those services are just not there.”

Catherine Biddle, a rural education researcher and professor at the University of Maine, says the lack of access to outside mental health resources puts a bind on teachers and student services staff. The pressures they face, in turn, contributes to burnout and can put a strain on their mental health as well.

“Teachers are having to address student mental health needs on the fly without much training,” Biddle says. “School counselors are seeing more students with severe needs that need to be addressed right away, but these kids can’t get in to see an outside provider. It is a complex problem with no easy solution.”

But as Biddle, Sheridan, and others note, often it takes a crisis to get the general population to take notice of issues long shrouded in stigma. The collective trauma of the pandemic, and its effect on students’ social, emotional, and mental health, has forced districts to try new approaches and reach out in ways they haven’t done previously on a larger scale.

“For a long time, pre-Covid, we really didn’t talk about mental health, especially in rural communities,” says Marie Ward, superintendent of Ohio’s Fairfield County Education Service Center, which serves eight mostly rural school districts outside Columbus. “Now we’re talking about it in a different way. Instead of asking, ‘How do we help Johnny graduate,’ we’re asking, ‘How do we stabilize Johnny and address the mental health barriers that exist for him so he can graduate?’ That’s a much different way of looking at it.”

Taboo and stigma

Crystal Brewer grew up in a rural area in Mississippi and has been the only school counselor for 21 years at Simpson Central School, a grades K-8 campus about 40 minutes south of Jackson. Since the start of the pandemic, she has seen marked increases in anxiety, depression, and suicidal ideation among her students, more than 80% of whom receive free and reduced-price breakfast and lunch.

The county has a community mental health agency, and the state is looking at ways to give students access to online telehealth, but Brewer says many parents are not willing to seek help for their children.

“Mental health has always been a taboo thing in my community,” Brewer says. “People don’t talk about it, and some families may have had a bad experience with the agency in one form or another. Other families don’t have the resources and means to transport their children to somewhere that’s an hour away, so they just don’t do anything, and it’s the child who suffers.”

Like Schonebaum, Brewer tries to be transparent with parents, telling them that her children have gone to therapy. “It gives me credence,” she says. “I’m not just telling them, ‘Your kid needs to get help.’ I’m saying, “My child needed it and got help.’ And sometimes that works.”

In California’s Livingston Unified School District, school counseling coordinator Alma Lopez says the stigma around mental health “is not as big as it used to be,” but families still have trouble getting access to professionals outside the school setting. The district has a partnership with the county mental health department, but it has had no clinician for the past three years. Virtual opportunities in her largely immigrant community have not been successful due to language barriers and trust issues.

“We are fortunate here in Livingston that we have a school counselor in every school, and we are very intentional in how we offer these services,” Lopez says. “We do our best to give our families and our students what they need on a day-to-day basis, and we spend 80% of our time providing direct services to students. That’s not the reality for other counselors around our country, but it’s something we have to work toward as a profession, especially given the challenges our kids are facing.”

As schools look for ways to address youth mental health needs, Biddle cautions they often don’t seek opinions from the audience they’re trying to reach—the students themselves.

“Schools are very controlling places for children,” Biddle says. “They don’t get a lot of choices and their options are very constrained. They have to be in a classroom for a certain amount of time. They can’t get a break unless they are truly overwhelmed. So many things are dictated for them.”

Biddle says schools should ask if their approach to social and emotional learning (SEL) is “helping students develop in a healthy way.” Her belief is that schools should have a student-empowered approach to SEL.

“One of the challenges with a lot of social and emotional learning curriculum is that it is focused on the deficiencies in the students themselves and identifying the skills they lack,” she says. “While I think developing those skills is really important, kids are hardwired to do so when the environment is conducive to learning.”

Equal access to services

“Rural schools” is a catch-all phrase for any district not directly tied to a metropolitan city or suburb. According to the Rural School and Community Trust, approximately one in five students —about 9.3 million in all—attends a rural school. But most rural districts are small—median enrollment was only 494 students in 2018-19—and enrollment has declined in many states since Covid. That means fewer dollars and resources for the students who remain.

Janessa Graves, an associate professor in the College of Nursing at Washington State University, lives in a town of 2,000, about an hour north of Spokane. She became interested in rural mental health issues pre-Covid, when three youths in her community died by suicide within a month. In a study published in the October 2022 American Journal of Preventative Medicine, she found that rural schools were “significantly less likely to offer mental health services” when compared to their urban and suburban counterparts.

“Rural youth are not getting the same equal access to services in schools,” Graves says. “This is not a surprise, but the data confirmed it, and it serves as a springboard to help us apply for grants and funding to provide telehealth services to rural school districts in our state. It’s not perfect. It’s not ideal. But we have to start to address these issues somewhere.”

Washington and Ohio are two of 10 states that have regional service centers, which provide a broad array of programs that serve multiple school districts. In Fairfield County, for example, Ward’s organization serves eight districts with enrollment ranging from less than 500 to more than 12,000 students.

Fairfield County runs an alternative high school as well as a K-8 program for students with significant social, emotional, and behavioral issues and contracts with local mental health agencies for licensed practitioners and crisis response. The practitioners serve children individually and in group sessions.

Ward says her service center is taking a “multipronged approach” to address student needs by offering free webinars to families, teachers, and practitioners on mental and behavioral health. Working with the Cook Center for Human Connection, a foundation that focuses on suicide prevention support for children, families, and schools, the service center also is providing professional development to teachers to help them engage with students on mental health and academic issues.

“Communities have to come together and recognize that mental health is no different than any other health issue—diabetes, high cholesterol, cancer,” she says. “If we do not have kids who are regulated, safe, and feeling as though they’re heard, we’re never going to start addressing the academic achievement piece.”

One way to do that, Sheridan believes, is through the Teachers and Parents as Partners (TAPP) program that she started in Nebraska and now is expanding to other states. The program, which is funded with a grant from the federal Institute of Education Sciences, is designed to train school-based practitioners on social and emotional learning, wellness, and other youth mental mental health issues.

“Our intent is to give these services away by doing online, virtual professional development for educators, specialists, and schools so they can work together with families to develop meaningful ways to help students who are struggling,” Sheridan says. “We’re working to tailor these experiences to start wherever these groups are at and help them develop skills that can bring families and schools together. I am hopeful that by increasing and improving the dialogue between educators and families that we can further normalize the issues around mental health and make it OK for them to seek help.”

Normalize mental health care

That’s what Schonebaum has tried to do for much of his 11-year career in education: Normalize mental health. He started talking about his struggles while working in Henry, South Dakota, which has a single pre-K-12 school that serves 180 students, first as a math teacher, then as principal, and finally as superintendent.

“I just think you need to be open, especially now,” he says.

His wife, Danielle, had been a school counselor for eight years at another pre-K-12 school in Waverly-South Shore when the couple decided to move in June 2020 to the Lyman School District, which has three campuses and 369 students. More than 40% of the students are Native Americans who live on the Lower Brule Reservation.

Danielle, who worked with Lyman’s grades six to 12 students, was the only mental health professional within 60 miles of the district. “The students you would typically refer out you couldn’t because there was no one there to help,” she says. “For the families, transportation is limited, finances are limited. We had telemental health, but most of that was at school because families did not have computers or internet access.”

Working with families and teachers, Danielle spends a lot of time helping them to understand the broad spectrum of mental health issues that can affect student performance. “Mental health issues are more than just depression and suicide. It encompasses so many things — anxiety, ADD, ADHD — and helping parents to understand how these things also affect their child’s ability to perform in the classroom. A student needs to be able to process what’s happening so they can learn what is being taught.”

After two years, the Schonebaums left Lyman. They now work in different school districts about 15 miles apart. He is in Elk Point; she is working at a 350-student elementary school in Vermillion.

“This is a different district with different demographics and socioeconomics,” Philip says of Elk Point, which has only 18% of its students eligible to receive free or reduced-price meals. “But you still see many of the same things I saw in my other two districts. We’re still looking for ways to help kids channel their energy in a positive way.”

He continues: “I encourage our principals and teachers to let the kids know that it’s normal to have to deal with your mental health. It’s something they need to talk about. Make it a conversation piece. If you’re struggling that day, don’t be afraid to say so. Don’t allow students to be chastised if they’re having a bad day, or if they need to go to the counselor’s office. It’s normal. It’s a part of life.”