Letter to The Hon. Alex M. Azar, Secretary, U.S. Department of Health and Human Services and The Hon. Betsy De Vos, Secretary of The U.S. Department of Education - Senators Warren and Cassidy Urge Hhs and Department of Education to Issue Guidance Addressing the Mental Health Needs of Students

Letter

Dear Secretaries Azar and DeVos:
We write to you as the coronavirus disease 2019 (COVID-19) pandemic continues and millions
of students across the country resume their education either in person, virtually, or through a
hybrid model. K-12 and college students have experienced some of the most severe effects of the
COVID-19 pandemic and the negative impact on their mental health is already becoming
apparent. As such, we urge you to issue guidance to both K-12 schools and colleges and
universities detailing how they should provide supports, services, and accommodations to
address the increased needs of their students who face new or ongoing mental health needs that
have arisen or been exacerbated by the ongoing pandemic. We also request that this guidance
take into consideration the unique challenges to mental health for minority students, students
with disabilities, students experiencing homelessness, and tribal nations to account for the unique
and disproportionate effect the pandemic has had on these communities.
The COVID-19 pandemic has upended the lives of people across the country, including
approximately 55 million students enrolled in K-12 schools and 20 million college students.1
Beginning in March, K-12 schools across the country began closing their doors for the remainder
of the school year to mitigate the spread of the virus.
2 Students, educators, and parents alike had
to rapidly shift and adapt to distance learning, transforming many parents or extended family

1 National Center for Education Studies, "Back to school statistics,"
https://nces.ed.gov/fastfacts/display.asp?id=372#College_enrollment.
2 CNN, "29 states announce school closures amid coronavirus," Shawn Nottingham, March 15, 2020,
https://www.cnn.com/world/live-news/coronavirus-outbreak-2-03-15-20-intlhnk/h_cb43d175eb1bc46d6f53eef202868c22.
members into their children's educators.3 Many children and youth, who may have relied on
lunches and other meals served by their schools, were cut off from once reliable food sources as
rates of food insecurity continue to grow nationwide.4 And, countless children and youth across
the country have lost parents, grandparents, friends, relatives, and even teachers to the deadly
pandemic.
Meanwhile, at the same time, colleges and universities across the country also began shutting
down their campuses and directed their students to leave campus in short order.5 Millions of
students were scattered across the country, leaving behind on-campus not only friends, faculty,
and mentors, but also established financial, academic, health, housing, and food support
systems.6 Many students who relied on their college counseling programs were separated from
their mental health providers as states were slow to expand access to tele-mental health services
across state lines - 60 percent of students surveyed between March and May 2020 indicated that
the pandemic has made it more difficult for them to access mental health care.
7
International
students were left stranded as many countries began closing their borders to prevent further
spread of the virus and students from difficult home situations were forced to return to settings
that may have been detrimental to their mental and overall health.
8
Collectively, these experiences may have caused trauma or significantly impacted millions of
students, and studies have already revealed the toll the pandemic is having on their mental
health. Among K-12 students, more than 25 percent of young people between the ages of 13-19
reported poorer emotional and cognitive health as a result of the pandemic.
9 Experts predict that
suicide rates and depression, which have been steadily increasing over the past decade and which
adolescents already disproportionately experience, will only continue to increase as a result of
the pandemic.
10 The effects of the pandemic are perhaps the greatest amongst youth who
struggled with mental illness before the pandemic. Experts have warned that the combination of
a public health crisis, social isolation, and financial hardship will likely exacerbate pre-existing

3 Chicago Tribune, "Parents become teachers, homes become classrooms amid coronavirus closures," Hannah Reed,
May 20, 2020, https://www.chicagotribune.com/suburbs/post-tribune/ct-ptb-parents-as-teachers-st-0523-20200520-
h6imiejuhjgxjcfqdwusskagoe-story.html.
4 New York Times, "Why Hunger Can Grow Even When Poverty Doesn't," Jason DeParle, July 28, 2020,
https://www.nytimes.com/2020/07/28/us/politics/coronavirus-hunger-poverty.html?searchResultPosition=1.
5 New York Times, "Colleges and Universities Cancel Classes and Move Online Amid Coronavirus Fears," Sarah
Mervosh and Vanessa Swales, March 10, 2020, https://www.nytimes.com/2020/03/10/us/coronavirus-closings.html
6
Id.
7 The Healthy Minds Network and the American College Health Association, "The Impact of COVID-19 on College
Student Well-Being," https://healthymindsnetwork.org/wpcontent/uploads/2020/07/Healthy_Minds_NCHA_COVID_Survey_Report_FINAL.pdf.
8 New York Times, "My World Is Shattering: Foreign Students Stranded by Coronavirus," Catilin Dickerson, April
25, 2020, https://www.nytimes.com/2020/04/25/us/coronavirus-international-foreign-students-universities.html;
Substance Abuse and Mental Health Administration, "Intimate Partner Violence and Child Abuse Considerations
During COVID-19," https://www.samhsa.gov/sites/default/files/social-distancing-domestic-violence.pdf.
9 America's Promise Alliance, "The State of Young People during COVID-19," June 2020,
https://www.americaspromise.org/resource/state-young-people-during-covid-19
10 Centers for Disease Control and Prevention, "Death Rates Due to Suicide and Homicide Among Persons Aged
10--24: United States, 2000--2017," Sally C. Curtin and Melonie Heron, October 2019,
https://www.cdc.gov/nchs/products/databriefs/db352.htm.
challenges.
11 Furthermore, with many K-12 schools serving as the primary source of counseling
services for children and youth, millions of adolescents who have previously relied on them have
likely found themselves unsure of where to turn for the provision of mental health services.
12
In addition, there is preliminary evidence that a growing number of child abuse and neglect cases
are not being reported or investigated due to school closures. In New York alone, reports to the
Administration for Children's Services have declined by over 51 percent, largely due to the fact
that teachers are the primary reporters of child abuse.
13 Thousands of children and youth who
may be at risk of child abuse and neglect have been cut off from those most likely to get them the
help they need, raising questions on the effects this will have on their mental health.14
Emergency room physicians are reporting an increase in cases of children who are so severely
harmed that they require hospitalization, raising concerns that unsafe situations may not be
identified until they have escalated to serious physical injury or even death.
15 Children who
experience abuse and neglect at young ages are more likely to experience symptoms of traumatic
stress, such as depression, rates of suicidal thoughts, and poorer educational outcomes.
16
For college students, pre-pandemic rates of mental health conditions had been steadily
increasing, and suicide already ranks as the second leading cause of death in college-aged
populations.
17 The pandemic has only accelerated these trends. Rates of mental health conditions
such as depression and eating disorders have increased amongst college students since fall
2019.18 The Centers for Disease Control and Prevention recently reported that almost 75 percent
of people aged 18-24 reported at least one adverse mental or behavioral health symptom as a
result of the pandemic and 25 percent had seriously considered suicide in the past thirty days.
19
66 percent of college students reported that the pandemic has caused them undue financial stress,

11 Jama Pediatrics, "Coronavirus Disease 2019 (COVID-19) and Mental Health for Children and Adolescents," Ezra
Goldstein, April 14, 2020, https://rb.gy/dkze0y.
12 District Leadership Forum, "Are Districts the Nation's Adolescent Mental Health Care Providers?," February
2020, https://attachment.eab.com/wp-content/uploads/2020/02/PDF-DLF-Adolescent-Mental-Health.pdf.
13 New York Times, "Child Abuse Cases Drop 51 Percent. The Authorities Are Very Worried," Nikita Stewart, June
9, 2020, https://www.nytimes.com/2020/06/09/nyregion/coronavirus-nyc-child-abuse.html.
14 Id.
15 Washington Post, "With kids stuck at home, ER doctors see more severe cases of child abuse," Samantha Schmidt
and Hannah Natanson, April 30, 2020, https://www.washingtonpost.com/education/2020/04/30/child-abuse-reportscoronavirus/.
16 Substance Abuse and Mental Health Services Administration, "Recognizing and Treating Traumatic Stress,"
https://www.samhsa.gov/child-trauma/recognizing-and-treating-child-traumatic-stress
17 Psychiatric Services Volume 70 Issue 1, "Increased Rates of Mental Health Service Utilization by U.S. College
Students: 10 Year Population-Level Trends," Sarah Ketchen Lipson, November 6, 2018,
https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800332;
https://webappa.cdc.gov/sasweb/ncipc/leadcause.html.
18 The Healthy Minds Network and the American College Health Association, "The Impact of COVID-19 on
College Student Well-Being," https://healthymindsnetwork.org/wpcontent/uploads/2020/07/Healthy_Minds_NCHA_COVID_Survey_Report_FINAL.pdf; Psychiatry Research:
Volume 290, "Letter to the editor: Eating disorders in the age of COVID-19," Monic Shah, August 2020,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259905/.
19 Centers for Disease Control and Prevention, "Mental Health, Substance Use, and Suicidal Ideation During the
COVID-19 Pandemic -- United States, June 24--30, 2020," Mark E. Czeisler et al., August 14, 2020,
cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.
a known predictor of student mental health and well-being.20 Some experts have warned we
should begin treating students for post-traumatic stress disorder (PTSD) given the extreme
distress many have experienced.21 Isolation as a result of distance learning will only serve to
exacerbate existing mental health illnesses, much as they have done so for the broader population
during the pandemic.
22 Additionally, many of these students who attend school outside of their
home state may still not have access to mental health services as many states still have not
relaxed telehealth regulations across state lines and others have already begun to roll back the
temporary changes.
23
Young adults between the ages of 18 and 24 are among the most at-risk population for mental
health illnesses, and studies show that identifying and treating early signs of mental health
illnesses can vastly improve outcomes.24 Prevention and early intervention are especially crucial
during the college years given that 75% of lifetime mental illnesses first onset by age 24,
meaning that many students experience their first signs and symptoms during their college
years.25 Furthermore, mental health is an important predictor of student success in higher
education. Students with depression are twice as likely to drop out of college, and 64 percent of
students who did drop out reported doing so for reasons related to mental health.
26 Investing in
our college students' mental health now will help to provide them with the coping skills to
overcome these challenges and thrive in their lives.
Due to the immense toll the pandemic has taken on the mental health of students, K-12 schools
and colleges and universities must be equipped and prepared to help students and address the
diverse range of mental health challenges they face as a result of the pandemic. These students
may be particularly vulnerable during these difficult times, and both K-12 schools and colleges
and universities should be proactive in ensuring students are able to access the resources they
need. This includes removing barriers to continuity of care for students already engaged in
treatment, leveraging technology to reach students remotely, improving access to mental health

20 The Healthy Minds Network and the American College Health Association, "The Impact of COVID-19 on
College Student Well-Being," https://healthymindsnetwork.org/wpcontent/uploads/2020/07/Healthy_Minds_NCHA_COVID_Survey_Report_FINAL.pdf.
21 Inside Higher Ed, "Pandemic Hurts Student Mental Health," Elizabeth Redden, July 13, 2020,
https://www.insidehighered.com/news/2020/07/13/survey-finds-higher-prevalence-depression-among-students-anddifficultiesaccessing#:~:text=Sixty%20percent%20of%20college%20students,19%20on%20student%20well%2Dbeing.
22 Kaiser Family Foundation, "The Implications of COVID-19 for Mental Health and Substance Use," Nirmita
Panchal, April 21, 2020, https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-formental-health-and-substance-use/.
23 Id.
24 National Alliance on Mental Illness, "Mental Health by the Numbers," https://www.nami.org/mhstats; Kaiser
Family Foundation, "The Implications of COVID-19 for Mental Health and Substance Use," Nirmita Panchal, April
21, 2020, https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-andsubstance-use/.
25 Current Opinion in Psychiatry, "Age of onset of mental disorders: a review of recent literature," Ronald C.
Kessler, et al., July 2007, 10.1097/YCO.0b013e32816ebc8c.
26 American Council on Education, "Investing in Student Mental Health,"
https://www.acenet.edu/Documents/Investing-in-Student-Mental-Health.pdf; National Alliance on Mental Illness,
College Students Speak: A Survey Report on Mental Health," https://www.nami.org/getattachment/AboutNAMI/Publications-Reports/Survey-Reports/College-Students-Speak_A-Survey-Report-on-Mental-Health-NAMI2012.pdf.
services for students with untreated symptoms, and investing in culturally-tailored intervention
and prevention programs to reduce mental health racial disparities among college students. It is
imperative we invest in our students' mental health, particularly now that many of their lives
have been upended by the pandemic and are now cut off from their on-campus support systems
and primary mental health providers.
As such, we request that you issue guidance so that K-12 schools and colleges and universities
may be better equipped to help their students -- and particularly minority students, students with
disabilities, students experiencing homelessness, and students from tribal nations -- cope with the
unique mental health challenges posed by the COVID-19 pandemic. This includes guidance on
how both K-12 schools and colleges and universities can best use federal funds to support the
mental health needs of students.
We appreciate your attention to this matter.
Sincerely

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