A Call to Action: Addressing the Mental Health Crisis in Schools

Background

The mental health crisis among children in the United States is growing more urgent and complex. In 2021, The American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association declared a national emergency in children’s mental health following the COVID-19 pandemic, and this crisis continues to warrant attention (American Academy of Child and Adolescent Psychiatry [AACAP], 2025).

Suicide is the second leading cause of death in children ages 10 to 18 (Centers for Disease Control and Prevention [CDC], 2023a). The 2023 Youth Risk Behavior Survey (YRBS) found that 40% of U.S. high school students reported persistent feelings of sadness or hopelessness, 20.4% had seriously considered attempting suicide, and 9.5% had attempted suicide in the past year (Verlenden et al., 2024). Rates were substantially higher among female students (53% sadness/hopelessness; 27% seriously considered suicide) and among LGBTQ+ students, who reported suicide attempts at more than triple the rate of their heterosexual peers.

The rising prevalence of childhood and adolescent mental health conditions may be attributed to a complex interplay of genetic predisposition and environmental influences, including pandemic-related disruptions, increased screen exposure, academic pressures, and changes in family and social structures (Meade, 2021). These influences are thought to contribute to the increasing rates of several distinct, though sometimes co-occurring, clinical diagnoses, including anxiety disorders, depression, ADHD, and ASD.

Anxiety disorders have shown a marked increase in pediatric populations, with recent estimates indicating that approximately 9.4% of children aged 3 to 17 have a current diagnosis of anxiety, up from earlier prevalence estimates (Bitsko et al., 2022). Depression has followed a similar upward trajectory; the YRBS survey reported that 42% of high school students experienced persistent feelings of sadness or hopelessness, and 21% described their mental health over the past 30 days as not good most or all of the time (CDC, 2023b). ADHD prevalence among U.S. children has also climbed, now affecting roughly 11.4% of children aged 3 to 17 (Danielson et al., 2024), while ASD diagnoses have risen to approximately 1 in 36 children, according to recent CDC surveillance data (Maenner et al., 2023). Parents have likewise reported worsening behavioral health in their children since the pandemic, including increases in self-harm behaviors among adolescents (Meade, 2021), underscoring the need to distinguish observable behavioral changes from formal diagnostic categories when interpreting these trends.

Approximately 15% of U.S. boys aged 5 to 17 have been diagnosed with ADHD (CDC, 2024; Danielson et al., 2024), and autism rates have increased significantly in recent years (Shaw et al., 2025). While rates of both ADHD and autism are undeniably increasing, the reason for this remains unclear and are likely complex, involving both modifiable (environmental) and unmodifiable (genetic) contributing factors (Han et al., 2026; National Institute of Mental Health, 2024).

Both genetics and lifestyles may affect students’ mental health. Excessive screen time has been implicated in children’s worsening mental and physical health by disrupting sleep, reducing exercise, and cutting down on face-to-face social time, all of which are known protective factors against depression and anxiety (Devi & Singh, 2023; Oerther, 2023; Twenge et al., 2018; U.S. Office of the Surgeon General, 2023). Author and social psychologist Jonathan Haidt offers guidelines to address cellphone and social media use for children, including no smartphones before high school, no social media before age 16, and “bell-to-bell” cellphone bans in schools (Haidt, 2024). Restrictions and rigid bans on cell phone and social media use for youths have gained popularity and political traction, yet some researchers argue the reasoning fueling this lacks evidence by assuming causality, overestimating the impact, and even ignoring potential benefits to social connection (Li et al., 2025; Nagata et al., 2025; Odgers, 2024; Orben & Przybylski, 2019). Effects of youth’s screen, social media, and cellphone use in our current society appear to be more nuanced.

Researchers have found that academic pressure now begins early, with more focus on standardized tests and less time for free play and recess. Increasing academic demands leave students more open to stress and mental health problems (Morford, 2021; Murray et al., 2026). For instance, researchers found that policy changes, such as increased testing and the No Child Left Behind Act (NCLB), are connected to more ADHD diagnoses, especially in low-income children (Fulton et al., 2015; Hinshaw & Scheffler, 2014). Although NCLB was succeeded by Every Student Succeeds Act in 2015, federally driven accountability testing and its downstream pressure on classrooms have persisted under the new framework (Heys, 2025; Kim et al., 2024).

School nurses can help influence school policies so that educational demands better match children’s developmental needs. Their direct knowledge of students’ families, school communities, and the social determinants of health impacting them positions school nurses to make meaningful, evidence-informed recommendations to policy makers. As leaders, nurses can work with school administrators to focus on well-being and social-emotional health. By leading efforts to improve school environments and policies, school nurses help address the root causes of the mental health crisis, while making sure students receive the appropriate support they need.

National Level: Federal Responses and Advocacy

At the federal level, the U.S. Department of Health and Human Services’ 2025 MAHA report calls for improving children’s mental health through better diets, less screen time, and less dependence on medication (U.S. Department of Health and Human Services, 2025). Nurses can work with school administrators to implement these recommendations by offering nutrition education and encouraging activities that reduce screen use, fostering school environments that are more supportive of student well-being. Additionally, in Illinois, all students now receive mental health screenings, which help identify students who need early interventions (Illinois General Assembly, 2025). School nurses are key in these screenings, making sure students who require extra support receive the correct interventions.

Groups such as Challenge Success work with schools to make sure teaching methods align with children’s developmental needs (Pope & Miles, 2022). However, broader national conversation about mental health has yet to fully address the role of schools as a potential source of stress and anxiety. School nurses can begin these conversations with their legislators about the benefits of partnering with organizations like Challenge Success that promote developmentally appropriate teaching practices to support policies that focus on play and age-appropriate learning, especially for younger students. They can also advocate that the policy definitions used to determine eligibility for educational and support services for conditions like autism remain broad and inclusive. While clinical diagnostic criteria are well established through the DSM-5-TR and ICD-11, the federal, state, and educational policy definitions that determine which students qualify for school-based services and accommodations vary and can be narrow. School nurses can advocate that these eligibility definitions remain inclusive so that students who meet diagnostic criteria continue to receive the support services they need. School nurses are well positioned to make schools more supportive and inclusive environments by advocating for policy changes at the federal and local levels.

State Level: Legislative Responses and Advocacy

State legislatures are shaping the school mental health landscape through both statute and funding. Missouri and 36 other states have passed laws restricting or banning cell phone and social media use during the school day (Ballotpedia, n.d.). Restrictions and bans at school may have some effect, but this is only part of the picture. School nurses are able to reach students and families to provide education on evidence-based recommendations for screen use. Illinois Public Act 104-0032 now requires universal mental health screening of public-school students (Illinois General Assembly, 2025). School nurses are key in identifying, facilitating, and delivering these screenings, then can help connect students who require extra support to appropriate resources and interventions. States have also begun setting school nurse staffing ratios and expanding Medicaid reimbursement for school-based services. School nurses can engage at this level by joining their state school nurse association, providing testimony at legislative hearings, and sharing aggregated, de-identified data from their own buildings with state lawmakers to inform screening mandates, staffing standards, and recess and screen-time policy.

Local Level (School/District): Recommendations for Practice

At the local level, primary prevention interventions for school nurses include advocating for policies such as longer recess and lunch breaks to make sure all students have enough time to relax and support their mental health. Without enough break time, students often feel more stress and anxiety (Rhea et al., 2025). Nurses can also lead efforts to create balanced daily routines and teach students and parents about healthy habits, like eating well and spending less time on screens, as suggested in the 2025 MAHA report (U.S. Department of Health and Human Services, 2025).

Emerging data are suggesting student engagement in screens and social media may have a “sweet spot,” with poor outcomes with too much as well as abstinence (Singh et al., 2026). The most recent recommendation from experts provides guidance on limit setting, monitoring, and encouraging digital literacy, and modeling appropriate technology use (AACAP, 2025; American Academy of Pediatrics, 2025). School nurses can translate and adapt recent research applicable to the specific population they serve, and educate students, families, teachers, and lawmakers on current evidence-based best practices.

School nurses play a critical role in supporting student mental health through both secondary and tertiary prevention strategies as well. School nurses can conduct mental health screenings using validated tools (e.g., the Pediatric Symptom Checklist, Patient Health Questionnaire for Adolescents [PHQ-A], the Generalized Anxiety Disorder 7-item scale [GAD-7], or Screening, Brief Intervention, and Referral to Treatment [SBIRT]) to identify early signs of psychological concerns and ensure timely intervention. Separately, school nurses can respond to concerns raised through teachers’ observations of behavioral patterns by coordinating referrals to mental health specialists, as demonstrated in programs implemented in Illinois. Additionally, school nurses can assist students with existing mental health diagnoses by managing individualized care plans that use school resources and accommodations. This comprehensive approach may reduce reliance on medication and enhance long-term outcomes.

Conclusion

The response to the child and adolescent mental health crisis is taking shape at every level of the system. Federal initiatives such as the MAHA report frame a national agenda; state legislatures are mandating screenings, limiting cell phones, and setting staffing ratios; and individual schools are deciding how to deliver screenings, care plans, recess, and family education. School nurses sit at the intersection of these decisions. Their building-level data, daily contact with students and families, and clinical training place them well to inform local practice and, through their professional associations, to bring that evidence into state and federal policy discussions. School nurses can act on this agenda now by joining their state school nurse association’s legislative committee, sharing aggregated, de-identified screening data with their district leadership, and piloting expanded recess and balanced daily routines in at least one building this school year.