Over the past three years, Amy Edelstein, founder and executive director of Inner Strength Foundation, says that she’s seen more and more of Philadelphia’s students struggling with trauma, depression and anxiety.

Nationwide, more than 40 percent of teenagers say they experience “persistent feelings of sadness or hopelessness,” according to a 2021 study by the CDC. A survey by the American Psychological Association found that over half of parents and caregivers expressed concern over their child’s well-being. Last year, the Surgeon General issued an advisory saying children are “facing an unprecedented mental health crisis.” In 2020, death by suicide became the second leading cause of death in children ages 10-14.

Edelstein sees Philly youth juggling all of the above factors, plus Covid, plus ​​23.1 percent poverty rate, the opioid epidemic, rising homicide rates, and, this year, a 2 percent increase in deadly shootings over 2021.

“Many students in our classes know somebody who has been shot. They have lost family members or friends or classmates,” says Edelstein, who has worked teaching mindfulness and other mental health coping strategies to 20,000 high school students across 20 different public schools in the city. “I’ve seen a huge shift in [students’] mental health over the last three years.”

With all these potential mental health stressors, Philly students may just find themselves needing a break — from school, from the social and academic pressures that come with going to classes, from the parts of their lives that are scary or stressful. Wouldn’t it be great if they could just take a day off?

In 12 states, that’s what school kids can do.

A day off to grieve … or sleep

Today, students in Oregon, Utah, Maine, Colorado … can take a day off to do anything from grieve the loss of a pet, celebrate a personal milestone, attend a much-needed therapy appointment, or catch up on adolescent sleep. The rules vary state to state — and some individual municipalities, such as New York City have similar policies — but it’s part of a movement that “acknowledges that mental health is physical health,” says Alexa James, MS, LCSW, chief executive officer of the National Alliance on Mental Illness, Chicago (NAMI Chicago).

In January, Illinois became the 11th state to pass such a law, allowing students ages 7 through 17 to take up to five mental health days per school year without a doctor’s note. If an Illinois student takes more than two consecutive such days, school counselors work with parents and caregivers to decide if the child needs to be referred to professional mental health services.

For students in Chicago, the policy allows them to take time to cope with some of the same issues Philly students are facing.

A March 2020 to March 2021 report from Lurie Children’s Hospital in Chicago found that 44 percent of local children ages 2 to 11 experienced an increase in mental or behavioral health concerns — and 48 percent of parents with children ages 0 to 17 had talked about mental health concerns with their child’s primary care physician.

“There’s a tremendous amount of stressors facing young people,” James says. “We’re in a whole new ballgame here with young people because Covid has made such a significant impact.”

Like Philly, Chicago has seen an increase in violence. Last year, there were 3,561 shootings and 797 homicides there — more than any other city in the U.S., per reporting from NBC Chicago.

Chicago Public Schools (CPS) hasn’t collected data on how many students have taken mental health days or why; they’re still developing a procedure for analyzing the policy. But a 2022 nationwide survey on mental health days in schools by Very Well Mind and Parents found that 56 percent of parents have allowed their children to take a day off from school for their mental health day, and an additional 32 percent would consider doing so.

Last year, the Surgeon General issued an advisory saying children are “facing an unprecedented mental health crisis.” In 2020, death by suicide became the second leading cause of death in children ages 10-14.

The survey also found that respondents from lower income households were three times less likely to report that their child’s school offered mental health days. That gap is part of what makes universal, statewide policies so important.

Allowing students to take days off that, in olden times, were sometimes called “personal days,” “allows our students at CPS to see the investment in their emotional well-being and self-care, while also helping to destigmatize mental health,” according to a Chicago school district spokesperson.

James believes that today’s high schoolers may be more likely to utilize policies like this than previous generations. The young people she’s worked with tend to be more open to talking about their mental health and have a better sense of when they may benefit from taking a day off.

“I’m very encouraged at how I’ve seen young people talk about their emotional health and how in tune they are with it,” James says.

Up next: Pennsylvania?

State legislators in Pennsylvania are currently considering whether or not to amend the state’s Public School Code to allow students to be excused for mental health days. The proposed bill, Senate Bill 506, would allow students to take two mental health days per semester, so long as they have a note of approval from their parents. State Senator Judy Schwank, the Bill’s primary sponsor, envisions students using the days to rest or to seek help from mental health professionals, if need be.

Edelstein has worked with a number of Philly students who could have benefited from taking a day off of school to rest or to seek help from a counselor or other mental health professional. She recalls working at schools in the aftermath of a student suicide, when fellow pupils needed more time and space to grieve.

It can take students time to process their emotions, whether it be sadness over a break up, anxiety over a test or grief after a loss due to the ways their brains are developing. Some may think they’re fine, but end up struggling with their emotions days, weeks or years after the event.

“Mental health is not separate from academic health. It’s not separate from financial health. It’s not separate from physical health or illness — all of those things are related,” Edelstein says. “Forcing them to work through serious mental health issues and do geometry is not going to help them.”

Edelstein remembers one student who lost a sibling to gun violence began having panic attacks years after the fact. She was unable to focus in class, so she’d go sit in the school counselor’s office. A policy like Illinois’, where students are referred to mental health professionals after using two mental health days could have helped her find the resources she needed to protect her mental health.

“Mental health is not separate from academic health. It’s not separate from financial health. It’s not separate from physical health or illness — all of those things are related,” she says.

Students who are struggling with mental health issues may also have difficulty focusing in class, which can hurt them academically in the long-run.

“Forcing them to work through serious mental health issues and do geometry is not going to help them,” Edelstein says.

Policies excusing mental health-related absences have limitations. Some adults think students may abuse them, but experts think that’s unlikely. Most states have set limits on how many mental health days can be taken within a school year. If a student exceeds that number, teachers, parents and other caregivers can step in to see if a particular student is facing more serious mental health concerns or if they’re misusing their days.

“If schools see a pattern in which the student exceeds the allotted number of mental health days, that really signals to the school that perhaps a student requires more mental health support,” Dr. Christine M. Crawford, associate medical director for the National Alliance on Mental Illness, told Today.

A more serious concern is leaving a student in crisis alone, or in an unsafe home environment. To some children experiencing absent caregivers or food insecurity, school can be a safe place. Last year, an estimated 28.6 percent of children in Philly faced food insecurity.

What’s more, a day off here or there won’t cut it for kids who are experiencing long-term mental health conditions like depression.

“Mental health days are tricky because we need to be sure that [students are] in an environment where taking time out of school is going to be healthy and supportive,” Edelstein says. She is all for more in-school social workers and counselors in schools.

Illinois’ innovative model is one to emulate

Part of what makes Illinois’ policy innovative is that it automatically provides additional support services for students who may have more complex mental healthcare needs. In Chicago, if a student request for a mental health day suggests they’re in a crisis, the district may make a referral to a school counselor, social worker, psychologist, nurse or other mental health professional for immediate assistance.

It’s also important to educate students about what resources they have both inside and outside of school. NAMI Chicago operates a helpline students and their families can call to be connected with mental health resources.

Through Inner Strength, Edelstein has developed a 12-week program that brings instructors into classrooms once a week for a full class period to teach seven evidence-based, trauma-informed tools for managing emotions like anger, fear and anxiety.

“Nobody really helps [students] deal with difficult emotions,” she says. “When students feel like they know what to do with the moment, it’s very empowering.”

Edelstein believes Philly kids shouldn’t have to deal with more trauma and stress than other students. She would like to see the City do more to reduce some of the root causes of student trauma. Like gun violence.

“I always like to preface what we do with a PSA to our elected officials to get the cheap guns off the street. It is much better to get the guns off the street than to try to remediate students who have been traumatized,” Edelstein says.

Still, she and other educators don’t discount the impact of a seemingly simple tool like a mental health day. Edelstein points to her own experiences working with students as proof of how a little help can go a long way. One student of hers had recently lost several relatives. He began classes withdrawn, hoodie pulled over his head. By the end of the program, he told her he felt like himself again.

“He said, I didn’t want to be here. I didn’t want to be anywhere. My grandma had just died. I’ve had a lot of deaths in my family. I need to do a lot at home. I need to take care of a lot of people … But the more I was in this class, I started to feel like myself again. I started to have fun again. And I started to be happy again,” she remembers.

Note: If you are having thoughts of suicide, please call the free National Suicide Prevention Lifeline at 988 any time of day, any day of the week.

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