'As Scary As A Virus In Some Ways': Mental Health Concerns Grow As Remote Schooling Continues

Dec 21, 2020

Across the country, there are middle and high school teachers begging their students to turn on their Zoom cameras.

You can read their angst-ridden posts on Twitter and Facebook. I can hear their pleas coming from the laptop in my 14-year-old son’s bedroom (he rarely turns on his camera, by the way). 

The frustration and desperation in teachers’ voices reflect a fundamental fact: it’s hard to connect with teenagers in remote school.

“I've had some students who will not even turn on their cameras,” said Daniel Thiombiano, a ninth grade earth sciences teacher at Holyoke High School, where most students are still attending classes remotely. “You can imagine teaching someone you perhaps have never seen. You do not even know if there's someone on the other end.”    

Daniel Thiombiano teaches ninth grade earth sciences at Holyoke High School. Remote learning has made it hard for many of his students to stay motivated, he said.
Credit Ben James / NEPM

Thiombiano said five of his students have had family members die of COVID-19 in the last month. Some parents are dealing with food insecurity and unemployment. The strain on students is palpable.

“One key symptom of such stress, and an onset of depression really, is a total lack of self-motivation,” Thiombiano said.  

Public health officials have been warning for months about the potential risks to kids’ social and emotional well-being during remote schooling. Now, doctors in the Springfield, Massachusetts — and across the country — are increasingly concerned, as youth mental health cases rise in clinics and emergency rooms. 

This comes as no surprise to Thiombiano. During one of our interviews, he received a call from the parent of a student in the midst of a panic attack.

Thiombiano described some students as bombarded with so many issues they simply cannot perform academically. Then he introduced me to ninth grader Lilly Nieves. She is not one of those students.

“Me personally,” Nieves said. “I suffer from depression. And my depression sometimes gets the best of me, and I'm not in the best mood sometimes. But I have to try putting that behind me and push myself to do this. Because this is high school. It's different.”  

Nieves does the work, even when it’s hard or confusing. She said some aspects of remote school actually make it easier for her to push herself. And she does turn on her camera. 

“I have insecurities myself,” Nieves said. “I really do. But I have to put myself out there.”  

But an unusually high number of students aren’t managing to rally.

“The student that just stops is our biggest concern,” said Stephen Mahoney, former principal at Holyoke High, and now a district administrator.

Mahoney said he’s concerned about a rise in students who are “moving out of formal education.” 

“A lot of our students went out and got jobs,” Mahoney said. “We have more students trying to balance work, family and school than ever before.”  

The pressure keeps building 

Economic stress, the tedium of remote school and disconnection from friends are all of tremendous concern to Dr. John O’Reilly, chief of general pediatrics at Baystate Health.

Dr. John O'Reilly, chief of general pediatrics at Baystate Health, said mental health issues are on the rise for kids of all ages, due to school disruption and social isolation.
Credit Screen Shot / Ben James / NEPM

“We're starting to see more mental health issues that are coming out of this sense of social isolation.” O’Reilly said.  

According to O’Reilly, physicians at his Springfield pediatric clinic are seeing a sharp increase in somatic symptoms — things like stomach aches and headaches with no clear cause — among younger kids, who are also showing signs of developmental regression like sleep disruption and bedwetting. O’Reilly said the number of preschool- and elementary-age children needing outpatient behavioral health support has risen by almost 40%.

Teenage mental and behavioral health issues are up by similar amounts, O’Reilly said. That includes issues like anxiety, depression, sleep problems, substance abuse and self-harm. 

“For an adolescent, their social peer group is critical to their social-emotional development,” O’Reilly says. “A lot of adolescents will have a fight with their parents and then go to their friend's house and complain about their parents or complain about their siblings.”    

That complaining is a good thing. But without school and other places to meet friends, O’Reilly said, “those conversations that were happening in person are not happening.”   

For some teenagers, the pressure just keeps building. 

Ellie Du Toit is the coordinator for mobile crisis intervention, which serves youth for the Behavioral Health Network. She said crisis doctors are seeing suicide attempts from kids who are isolated and struggling with online learning. She describes “skyrocketing” incidents of students with severe mental health concerns.

“When I see numerous children coming in having made an attempt on their life because of how isolated and lonely they're feeling,” Du Toit said, “that to me feels really scary, as scary as a virus in some ways.”

Du Toit said many of the kids they’re currently seeing would probably never have required crisis treatment before the pandemic. 

Ellie Du Toit is coordinator for mobile crisis intervention, which serves youth for the Behavioral Health Network in Springfield, Massachusetts.
Credit Screen shot / Ben James / NEPM

“Both the child and the family will say, ‘Up until the pandemic, I was happy, I had friends, I was outgoing. I had after-school activities. I had a social life,’” Du Toit said. “Now some of them are struggling with their remote learning falling behind. And then the pressure of that just kind of compounds the depression that they're experiencing.”

It’s important to note that Springfield-area hospitalizations for teen mental and behavioral health have not risen significantly in the last year. The numbers are actually down for October 2020 as compared to October 2019. But Du Toit said this data doesn’t capture the full picture of the increase in suicidality that doctors are seeing among teenagers.

One reason, she said, is that a shortage of youth hospital beds in western Massachusetts means cases need to be much more acute for kids — even suicidal kids — to be hospitalized. 

“A child we would have hospitalized in the past, we've sent home,” Du Toit said. “It really feels like things are worse now than they've ever been.”

Nationally, the CDC reports that mental health-related emergency room visits for teenagers — as a proportion of all teenage emergency room visits — is up by 31%. 

Du Toit said crisis physicians in the Springfield area are seeing Black and Latino kids with severe mental issues at higher rates.

Economic factors like food insecurity and unemployment affect communities of color disproportionately, and a higher proportion of people of color are essential workers, which means they often can’t help their children during remote classes. These factors take a toll on kids’ ability to cope with stress.

Du Toit said crisis doctors are also seeing increasing numbers of lesbian, gay and transgender kids.

“We're seeing lots of children who are LGBTQ, that are feeling really isolated,” Du Toit said. “Particularly if they're coming from homes where their families aren't necessarily accepting of their identity, [and] where they've always accessed that support through school — through their peers, through teachers.”    

Having cameras on sends a message 

With well over 100 western Massachusetts schools operating remotely — and with the stakes for student mental health so high — it matters how remote school is conducted. Some schools have been more successful than others at keeping students engaged with online learning. And some teachers are shifting their lessons, trying to make stronger connections with their students.  

“There's a lot of things that I would have considered silly, that I've been doing this year, because I feel like kids are just in such a challenging place emotionally,” said Sarah Banning, a tenth grade English teacher at The Springfield Renaissance School, which will remain fully remote at least through April 8. 

Shane Dillon attends his school in Springfield, Massachusetts, from home.
Credit Christine Dillon

In one assignment, Banning had her students write instructions on how to make a peanut butter sandwich, and then, over Zoom, she followed their directions to the word.

“Some kids would be like, ‘Put the peanut butter on the bread,’” Banning said. “And so I would take the peanut butter and just place it on the bread. And I'd be like, ‘Did I do it right?’”

Her students cracked up as she literally scooped the peanut butter out of the jar with her hand.

“My grounding principle has been joy,” Banning said.

Sarah Banning is a tenth grade English teacher at The Springfield Renaissance School.
Credit Screen shot / Ben James / NEPM

Renaissance is a magnet school that said it has managed to get an unusually high number of students — 90-95% — on camera almost every day. There are a lot of factors involved in that success, including team teaching, a well-regarded advising program called “crew,” and consistent behavioral expectations. 

“If a student goes from one class to the next,” said Katrina Danby, a founding teacher at the school, “they're not going to get a different response from a different teacher. It is the same expectation from class to class.”  

It’s a school rule that cameras must be turned on, but students can show just the tops of their heads if they don’t want to show their faces. Banning said when students have their cameras on, it sends a message.

“You are present, you are here. We can see you, or we can see most of you. We know who you are,” Banning said. “Kids hate structure, but they also love and crave structure.”

The principal at Renaissance, Arria Coburn, said educators also need to take into account kids’ legitimate concerns about going on camera. 

“You can’t just have teachers meeting to talk about, ‘What does it mean to have cameras on?’” Coburn said. “You need to include your student body to say, ‘Okay, so what are some of the reasons why cameras are off?’”  

Arria Coburn is principal at The Springfield Renaissance School, where the school's cameras-on policy has paid off with increased student engagement.
Credit Screen shot / Ben James / NEPM

One reason students can be hesitant to turn on their cameras is because they share their workspace with siblings. That’s the case for tenth graders Madison Nicholson-Franklin and Isa DeJesus, two of Banning’s students. DeJesus said helping her little brother with remote preschool is challenging.

“Because he's only three. And like, helping my parents, just keeping up with the house and school — it kind of gets intertwined at times,” DeJesus said.

DeJesus and Nicholson-Franklin are both dedicated students. They’re psyched about Banning’s open writing assignment on Maya Angelou’s poem “Still I Rise.” But this learning from home situation is tough.

“It's hard for me to focus,” Nicholson-Franklin said. “It's hard for me to get my work done. And another thing that's hard is having motivation.”  

Warning signs

Focus and motivation — many kids in remote school are struggling with these right now. Still, Du Toit said caregivers should be on the lookout for unusual behaviors from their kids.

“If you're noticing that your child is suddenly eating less, sleeping all day or up all night, having [a] reverse sleep schedule — if they just seem shut down,” she said.

These are all warning signs, and the first step, Du Toit said, is to reach out to the child’s pediatrician. After that, both Du Toit and O’Reilly emphasize the importance of strengthening family connections during these isolated months.

“I think the biggest thing is opening up the communication between parents and children to talk about how difficult this is, and that it's okay that it's hard,” Du Toit said.

Looking to the future, O’Reilly said — based on the science of COVID transmission — he believes elementary schools throughout the region should open this spring. Middle and high schools, he said, may have to wait a bit longer.

And while it’ll be awhile before most kids can get vaccinated, O’Reilly had this message for parents: “Get the vaccine as soon as you can. Get the vaccine done so your kid can start school in September, because your kid needs to be in school.”    

Ninth grader Lilly Nieves agrees. She wants to be in school, but it’s not only so she can get back to in-person classes. 

“I want to interact with people that I don't know,” Nieves said, “and I could possibly become friends with them.”