For more than a year, young people have been waving danger flags: They miss class. Their schoolwork is weak or nonexistent. They’re exhausted, unfocused. As schools step up their support, one simple, concrete step is becoming popular: allowing excused absences for mental health days.

State legislatures and school districts are responding to a tidal wave of student trauma. Rates of anxiety, depression, and suicidality among young people were already on an alarming rise before the pandemic, but soared as schools and communities shut down to fight the virus. In a June 2020 Harris poll of 1,500 teenagers, 78 percent said schools should prioritize mental health days so students can take proper care of themselves. In a June roundtable with Education Secretary Miguel Cardona, high school students urged him to make mental health in schools a top priority.

“This year was really hard,” said Sara Falluji, 15, a rising junior at Paul Laurence Dunbar High School in Lexington, Ky., who has written about mental health struggles among her peers and waged her own battle this year with stress-related exhaustion. “If we don’t normalize having excused mental health days, then students’ stress and anxiety could get worse. It could turn into physical health issues and longer absences if we push students too far.”

State legislatures, typically responsible for defining the acceptable reasons for school absence, are increasingly adding mental illness or mental health to their lists. Minnesota has allowed it since 2009; Utah and Oregon passed similar laws in 2018 and 2019. But the pandemic has sparked a new flurry of legislative activity on the issue.

In 2020 and 2021, seven states—Arizona, Colorado, Connecticut, Maine, Nevada, Utah and Virginia—enacted new laws allowing excused absences for mental health reasons, or expanded on previous laws allowing it. This year, legislatures in another five states—California, Florida, Illinois, Maryland and Massachusetts—debated such bills.

“It’s really a flaw in the education code,” said California state Sen. Anthony Portantino, a Democrat who has sponsored a series of K-12 mental health bills since he lost a brother to suicide 10 years ago. “If you break your ankle or have the flu, your parent sends a note. But if you’re home with depression or anxiety, it’s not treated the same way. The district doesn’t have to recognize it.”

One of Portantino’s bills, which passed in the state Senate and is under consideration in the Assembly, would permit excused absences for mental health reasons, and require half a school’s staff to be trained to recognize early warning signs of mental illness. Another would create mandatory mental health courses for students in elementary, middle, and high school.

The Utah legislature passed a law in 2018 that lets students take excused absences for mental illness. But lawmakers expanded on that this year. A new law specifies that taking care of one’s mental health—not just having a mental illness—is an acceptable reason for missing school.

“Not all of us have a diagnosed mental illness, like anxiety or schizophrenia, but all of us have mental health, just like physical health,” said Mike Winder, the Republican representative who sponsored the new bill. “Even the healthiest among us sometimes have days where our mental health is just not well. Rather than push kids beyond the breaking point, this allows them to better manage their mental health.”

School districts, too, are getting on board. In May, the school board in Montgomery County, Md., a Washington D.C. suburb, approved a resolution calling on the superintendent to change the district’s definition of an acceptable absence from “student illness” to “student illness and well-being.” Board Vice President Karla Silvestre said the board chose its words carefully.

“We didn’t want to call it a mental health day, because we know there is still stigma around that,” she said. “Maybe parents or students wouldn’t want to self-identify as needing a mental health day. So we used the word ‘well-being.’”

Schools try to topple stigma and build early-warning systems

Many of those who have fought for the new crop of mental wellness laws want to erase the stigma that keeps so many people silent on the issue.Schools must embrace a range of strategies—not just mental health days—if they are going to help students recover their emotional balance after COVID-19, and deal effectively with life’s challenges in the years ahead.

One of those strategies is building a culture of follow-up. In Ohio’s Hilliard City school district, which serves 17,000 students in Columbus, counselors reach out to students or their families after daily absence reports show that a student took two consecutive mental health days, said Mike Abraham, the district’s director of student well-being. That follow-up wouldn’t be possible if mental health days didn’t have their own unique absence code.

The district created the code in the fall of 2019, shocked into action by a wave of depression, anxiety, and suicides among students and staff members, Abraham said. And it added a range of programs to support students’ emotional struggles.

The district’s four-year-old “hope squad” trains 35 students in each middle and high school to recognize early signs of mental health problems in their peers—including those that appear in social media posts—and team up with adult advisers to connect those students to counselors or social workers.

Students can connect with mental health specialists through a district “safe school help line,” too. The district is also working to train teachers in trauma-informed care, and plans to use federal stimulus money to hire 10 social workers. The idea is to build layers of support strategies, Abraham said.

Sometimes emotional struggles are hiding in plain sight

Following up on mental health days has enabled the district to “find students we wouldn’t otherwise know are struggling,” Abraham said. And Hilliard refers more students to a local children’s hospital for mental health care than other similar-sized districts in the county, Abraham said.

“I consider that a good thing,” he said. “It means kids are getting the help they need.”

Mental health experts urge districts to take these kinds of multipronged approaches.

“Mental health days aren’t the ultimate solution; they’re a piece of a larger puzzle,” said Jill Cook, the executive director of the American School Counselor Association. Noting that federal stimulus funds can be used to hire mental health professionals, Cook encouraged districts to get as close as they can to the ratios recommended for school counselors (one per 250 students) and psychologists (1 per 500 students). Most fall far below those levels.

Cook also recommends that schools build strong partnerships with community mental health providers, and train all staff members—not just teachers and administrators—to recognize signs of struggle in their students.

Mary Giliberti, the vice president for policy at Mental Health America, encourages schools to envision their mental health programming as a spectrum that includes prevention, recognition, and services. Granting excused absences for mental health days can help prevent a serious problem, or facilitate getting treatment, she said.

She urged schools to provide counseling on campus, too, wherever possible, whether they use their own staff or staff members from a community organization. Students of color are more likely to face transportation challenges if they have to seek treatment off-campus, Giliberti said, so school-based options carry an outsized benefit for those students.

Nevada’s law requires a note from a medical or behavioral health professional. Most of these laws, however, permit parents to report such absences. But experts and policymakers don’t seem too concerned that the policies will be abused.

Popular culture loves to depict mental health days with air quotes and a wink, an excuse for perfectly healthy people to play hooky from work. But taking “decompression days” occasionally can be one effective way to manage emotions and stress, Cook said. Even still, it’s not a bad idea for schools to make sure those days aren’t used by the “school avoidant,” she said.

In Hilliard City, overuse of mental health days is not something Abraham worries about.

“Maybe a few kids might take advantage of it,” he said. “But if we catch just one kiddo struggling with mental health and we’re able to get that student some help, it’s well worth it.”