More states are allowing children to take mental health days

With child mental health problems on the rise in the past few years, a growing number of states have adopted laws that let students take an excused absence if they feel anxious, depressed or need a day to “recharge.”

A dozen states already have measures in place that allow kids to take off for mental health and not just physical health reasons. A handful of others* are considering making similar changes to school absentee rules.

The move is a recognition of a disquieting trend: In December 2021, U.S. Surgeon General Vivek H. Murthy issued an advisory declaring a mental health crisis for American children, citing “an alarming number” of young people struggling with “feelings of helplessness, depression, and thoughts of suicide.” Between March and October 2020, the height of the pandemic, the percentage of children visiting the emergency room for mental health issues rose 24 percent for children ages 5 to 11 and 31 percent for children ages 12 to 17, according to the Children’s Hospital Association.

In 2020, according to Centers for Disease Control and Prevention, suicide was the second leading cause of death among teens, a 31 percent rise over 2019

Christine M. Nicholson, a clinical child psychologist in Kirkland, Wash., who sees many children with mental health struggles, said she supports this effort to allow mental health days. She said kids sometimes need to skip school, go for a hike, see a movie or even stay home and bake a cake or watch a movie.

“I think mental health has to be appreciated as much as physical health,” she said. “Kids are having a tough time, and they need a break.”

“The pandemic, with its isolation, didn’t help,” said California state Sen. Anthony Portantino, a Democrat who introduced a bill that was signed into law in 2021. The bill does not specify how many days a year a child can take. Portantino, whose brother Michael took his own life in 2010 at age 52, said he hopes other families can avoid the tragedy his family suffered: “The pandemic exacerbated the need, but if it can hasten the fix, then that is something positive.”

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Proponents of such measures say they are long overdue and can help de-stigmatize mental health in the eyes of parents and children. So far, Washington, California, Illinois, Maine, Virginia, Colorado, Oregon, Connecticut, Arizona, Nevada, Utah and Kentucky provide mental health days.

“If nothing else, it makes a huge statement that mental health matters as much as physical health,” said Mike Winder, a Republican Utah state representative who sponsored a bill that became law in 2021. Winder introduced the bill after conversations with his daughter who suffered her own mental health issues. “This policy is communicating from the highest levels that it’s okay to take care of your mental health,” he said of the bill, which does not limit the number of days a child can take.

But how does taking a “mental health day,” which Americans traditionally have construed as a “winkwink, nudge-nudge” excuse for playing hooky, improve mental health?

“When students are feeling physically unwell, there is a universal understanding that they should stay home and they should take time to feel better,” said Barb Solish, director of Youth and Young Adult Initiatives for the National Alliance on Mental Illness (NAMI), which supports the use of mental health days.

“School policies that recognize mental health as an acceptable reason for absence can help students take the time they need to care for themselves and restore their health,” Solish said. “Practically speaking, if you have a fever, you’re not paying attention in class, right? You’re not learning the lesson. If you’re feeling overwhelming anxiety, you’re not learning either.”

In states that have adopted them, the policies vary, although in all cases, parents must sign a note excusing their child. Some place limits on the number of days off a child can claim — for instance, in Connecticut, students can have two days per year and they may not be consecutive — while others, such as California, do not.

As with all absences, missed schoolwork is expected to be made up. But the policies do not dictate how the days off may be used — whether for staying in bed or attending therapy appointments or something else. Some suggest that could engender abuse. Portantino bristles at the idea.

“We don’t question that a parent would like Johnny to stay home because he has a cold. That’s the exact reason we have to have this bill. That’s a stigma we have to correct. We’re not making a distinction between physical and mental health. If your child is sick, your child is sick,” he said.

Most of the laws passed or introduced require that a parent provide the same kind of excuse note that a physical illness would require.

Some worry that providing mental health days isn’t the right approach to this crisis.

In the National Review, Daniel Buck, editor in chief of Chalkboard Review, a newsletter focusing on education, wrote that school mental health days “could alleviate immediate distress but facilitate habits that only worsen anxiety and depression in the long run.” He suggested that they would teach kids avoidance rather than how to deal with the real issues that plague them, such as too much social media. “By popularizing mental-health days, we are encouraging our students to allow the world to dictate their emotions in place of teaching self-regulation and emotional control,” he writes.

Instead, he suggests, “What if we built resilience back into our schools? What if we trained students in the stoicism of Marcus Aurelius and habits of virtue in Aristotle such that they can face the inevitable difficulties of life? And these would include habits of emotional awareness such as regular reflection, discussions with loved ones, or planned, appropriately timed days of rest.”

Solish said there is a fine line between taking a day off to feel better or missing school to avoid a test you haven’t studied for. That’s why it’s important for parents to get to the bottom of why a child might ask for time off. And, she added, if a child is asking for or taking an abundance of these days off, that can be a signal something is wrong, and indicates a need for professional help.

Solish said, “We’re not going to solve the youth mental health crisis with a few mental health days. But it’s a great starting point.”

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Dave Anderson, a clinical psychologist at the Child Mind Institute in New York who studies mental health services in high-need school districts around the country, agreed.

Days off will help, he said, but “there are too few [mental health] providers, too few online resources, too few school counselors trying to serve too many students and far too little information given to educators about how to support kids.” Of the more than 100,000 clinical psychologists working in the United States, only 4,000 are child and adolescent clinicians, according to a 2022 report by the American Psychological Association. “School psychologists are also in short supply, leaving kids without enough support at school,” the report said.

Jack Ramirez, 19, of Spring Township, Pa., said he believes mental health days could literally be a lifesaver for many young people.

He had urged Pennsylvania state Sen. Judith Schwank (D) to introduce a mental health days bill in 2020, when he was an intern in her office the summer before his senior year of high school. He was still reeling, he said, from the suicide of a classmate a few months earlier. Maybe if that student had felt he could stay home to take care of his mental health, Ramirez thought at the time, he would still be alive.

The measure, which would provide two excused mental health days per semester, is still in committee in the Pennsylvania state Senate.

“This is not a bill to skip school,” said Ramirez, now a sophomore at Rutgers University in New Jersey who has dealt with his own feelings of isolation and anxiety. “High school students are feeling isolated, they feel the pressure of grades. They are competing against each other. It’s getting really scary, and we don’t pay enough attention. … If we want to start saving lives and start talking about solutions, pressing pause on a lot of these things we face is so important.”

Make the most of a ‘mental health’ day

Should you encourage your children to take an occasional step back from their miniature rat race? And if you do, is there a way to make the most of it?

“There’s no perfect way to take a mental health day,” said Barb Solish, director of Youth and Young Adult Initiatives for the National Alliance on Mental Illness (NAMI). “But it does help to be intentional.”

Here are some of Solish’s tips for reaping the most benefit from a “mental health day”:

Listen to your child: Ask open-ended questions about their relationships and experiences and about why they think they need a day off. Then let them talk.

Make it meaningful: Try to avoid catching up on school work or getting lost in social media. “Those are stressors for kids,” Solish said.

Pursue calming activities: Take a walk, bake, draw, get lost in nature. “Whatever brings your kid back to center is a good thing to do,” said Solish, adding that you don’t want to overschedule the day, because that will be stressful in its own way. Should parents allow kids to indulge in video games, television or other screen time? “Nothing is really off limits,” Solish said. “You just want to make sure you’re being really thoughtful about what is going to help.”

Ease up on the feelings talk: “You don’t have to push kids to talk about their feelings all day,” Solish said. You can talk about how important it is to take care of your mental health.

Know when you need more help: If your child is showing increased irritability, sleeplessness, a depressed mood, low motivation or is regularly asking to stay home from school, you may need help from a mental health professional, said Dave Anderson, a clinical psychologist with the Child Mind Institute in New York. Contact a pediatrician, school counselor or your family doctor to find a recommendation.