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A school in Connecticut wants to expand their mental health services due to increased rates of mental illness, but were denied expansion.

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American teenagers are reporting severe levels of anxiety and depression. But when Connecticut moved to expand mental health services in schools, it ran into fierce opposition in one town.

Jasmine Berti, a resident of Killingly, Conn., demonstrated outside the town hall before a Board of Education meeting last month to discuss expanding the high school's mental health services. Credit... Christopher Capozziello for The New York Times

KILLINGLY, Conn. - One evening in March, a high school senior named Sydney Zicolella stood before the school board in this rural, blue-collar Connecticut town and described her psychiatric history, beginning in the sixth grade, when she was "by definition, clinically depressed."

Ms. Zicolella, 17, who wore her dark, curly hair pulled back, is the third of four children in a devout Christian family, and the editor of the newspaper at Killingly High School.

Many students there were struggling, she told the board. She had seen kids "walked, carried and cradled out of counseling, hysterical, not wanting to go to the hospital, but also not wanting to be sad anymore."

Convincing the board was a long shot, she knew that. Her own mother, Lisa, 49, who, by her own account, grew up in "the generation of toughing things out," didn't support the clinic.

It wasn't that Lisa entirely disapproved of therapy - when Sydney was in crisis, she scoured northeastern Connecticut in search of a therapist who would take her insurance - but she feared school-based therapists would end up advising teens on matters like gender identity or birth control, which she felt belonged firmly in the grip of parents.

"I do personally believe there's a lot of agendas out there," Lisa said. "And children are very malleable."

This debate has divided Killingly, and its families, since January, when Robert J. Angeli, the superintendent of schools, presented a plan to open a state-funded mental health clinic in the high school.

Legislation to expand Connecticut's network of school-based clinics had sailed through the legislature, passing the House by a vote of 143 to 4. When Mr. Angeli presented the plan before the town's Board of Education, though, it ran into a solid wall of resistance, mostly on the grounds that it infringed on the rights of parents.

Since then, Killingly's school board meetings have become a battleground for competing views on mental health, exposing divisions that are both partisan and generational. Teenagers have picketed on the well-manicured town common, where petunias grow around a memorial to the Civil War dead, with signs reading "14.7 PERCENT HAVE MADE A SUICIDE PLAN" and "TALK TO YOUR CHILDREN ABOUT MENTAL HEALTH."

Standoffs like the one in Killingly are being watched apprehensively by mental health advocates. During the pandemic, the mental health of children shot to the top of the agenda for both political parties. School-based services, which studies suggest can significantly decrease suicidal behavior and substance abuse, have emerged as a first-line policy response.

Over the last year, legislators in more than 30 states have considered an expansion of school-based services, according to Inseparable, a mental health policy group, and eight states, including Connecticut, have passed legislation to do so. Before the services reach students, though, they must be embraced by American communities.

In Connecticut, which already has more than 100 school-based health clinics, Killingly is an outlier. But lawmakers and conservative activists have targeted mental health curriculum in several states, often taking aim at social and emotional learning programs, known as SEL, which train students to manage emotions and practice conflict resolution. Lawmakers in Indiana and Oklahoma have put forward bills that would limit the use of SEL in the classroom.

On the January evening when the superintendent introduced staff from Generations Family Health Center, the nonprofit health care group that was to provide services in the school, the visitors peered out of Zoom screens with cheery smiles.

The plan was for licensed therapists from Generations to work in a space on the school's third floor. Students could be referred by teachers or family members, or could come in themselves, and therapy sessions would be scheduled during school hours. Therapists would bill insurance based on a sliding fee scale, using federal funds if necessary, so there would be no cost to the school and little, if any, to the families.

Then a chill entered the room as the board members began peppering them with questions. The visitors' smiles faded.

Would they advise students on birth control or abortion? (They wouldn't give medical advice, but might discuss if it comes up.) If children were referred and didn't want therapy, would they be forced to do it? (No.) Would students be seen by peers going into treatment, exposing them to ridicule and stigma? (Hopefully not.) Could they get therapy without their parents knowing about it?

Conceivably, yes, was the answer. By law, clinicians in Connecticut can provide six sessions of mental health treatment to minors without parental consent under a narrow set of circumstances - if the minor sought treatment, it was deemed clinically necessary and if requiring parental notification would deter the minor from receiving it.

This provision is used rarely; in the nearby town of Putnam, which has hosted a school-based mental health clinic for nine years, treating hundreds of students, no child has ever been treated without parental permission, said Michael Morrill, a Putnam school board member.

Another board member, Jason Muscara, said he had already heard enough to make his mind up.

"I am not going to make it easier for kids to go around their parents," he said. "I don't think we should be helping a kid to walk into a mental health facility in a school and say, 'I'm thinking about an abortion, let's talk about that,' without the parents knowing, for up to six visits."

Killingly's school board, swept up in the culture wars of the Trump era, has repeatedly cast itself as a bulwark against liberalism and government intrusion. Several of its members were elected in 2020, amid popular outrage over a decision to retire the school's mascot, the Redmen, at the urging of a student group who said it was offensive. After the election, the new board voted 5 to 4 to reinstate the mascot.

The proposed mental health clinic has reopened those divisions, this time around psychotherapy and the values it might instill.

At one meeting, a school board member said that, years ago, a therapist had "meddled with my teenaged son's mind, because at that age they are most vulnerable and they want someone to talk to." A local man got up to say that "our modern-day psychology is rooted in occultism," noting that Sigmund Freud used drugs while writing his thesis and Carl Jung channeled spirit guides.

Their wariness has resonated with some people in this community.

Gerry Golob, 33, a house painter, said his view of psychiatry was shaped when his mother was committed to a state mental hospital, where "they just drug people up." Plenty of people in Killingly receive mental health treatment, he said - he called the town "a walking pharmaceutical clinic" - but he doesn't want his children exposed to it. If a clinic were placed in the school, he said, "I would remove my kids instantly."

"It almost seems like there's a fear that something about their belief system is under attack," Mr. Viens said in an interview, adding that he was offering his views as a citizen, rather than a board member. "They seem to think that they have to stop it here. It's almost like this line you don't cross."

The superintendent, Mr. Angeli, and other members of the school board declined to comment for this article.

On the night in March when the Board of Education voted down the mental health center, Ms. Zicolella was at work, at a Mexican restaurant in Dayville.

A mother from the school came up to the cash register, told her about the vote and burst into tears.

"It was crazy, it made such an outpouring of emotion," Ms. Zicolella said.

For Sydney and her close friends, mental health was a frank topic of discussion. Many of them had struggled after a series of deaths in the school community when they were seventh-graders, she said. In high school, she was diagnosed with depression and generalized anxiety disorder.

Jen Simpson, 28, said she listens to teenage customers who come in to her salon, BeautyHaus, and is startled by their sophisticated discussion of anxiety and trauma, a vocabulary she assumes they have picked up from social media.

Tips for Parents to Help Their Struggling Teens

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Teenagers here have always coped with what she called "home life problems," especially poverty and addiction, she said, but as recently as a decade ago, when she was in high school, mental health was a "taboo" subject.

"I get prom girls coming in for spray tans, and I'm just like, these are a whole different breed of person," she said - knowledgeable, but also, sometimes, fragile. "The amount of people I see with marks from self-harming, it breaks my heart."

A state working group listed public schools in Killingly among the 157 schools with the highest unmet needs in the state.

A 2021 survey of Killingly students conducted by the Southeastern Regional Action Council, a mental health policy group, found that 28.2 percent had thought about self-harm, and 14.7 percent reported making a plan for suicide. Though the response rate was low, at 42 percent, the results line up with findings from other communities, said Angela Rae Duhaime, the council's associate director.

At moments, some board members have cast doubt on those findings. "How do you know they were honest responses? They were dealing with kids," the board's chairwoman, Janice Joly, said at a board meeting in March, in remarks that were later televised. In the outcry that followed, Ms. Joly resigned from the board.

Killingly, with a population of around 18,000, is a blue-collar, predominantly white former mill town, where, for decades, substance abuse and suicide were topics addressed by priests or pastors, if they were addressed at all. That approach has failed older generations, said Alyssah Yater, 17, another senior who has advocated in favor of the clinic.

"People like to say that kids these days are so sensitive, but I think the older generations struggled with mental illness but they didn't get help," she said. "I think that's really dangerous. If you try to ignore it, or tell someone to shove it down, then one day, they're just going to snap."

At the school newspaper, Ms. Zicolella conducted a poll, and found that the clinic enjoyed nearly universal support. She was pleasantly surprised to see which students showed up at the protest on the issue, because they seemed to range across the political spectrum.

"In the beginning it was hard for us to talk about," Ms. Zicolella said. "But once students heard about this problem, this mental health stigma being passed around in our town, we were like, hold on, why are we treating this like it's taboo when it's not?"

Her voice shaking, she described patients she saw while visiting him on locked wards - young people bearing scars from self-harm, emaciated, or "slithering on the floor."

"I only came to tell my story in hopes that the Board of Education will listen," she said. "I'm here to ask the powers that be, pay attention. There is an urgent need for mental health in the school." One board member, a supporter of the clinic, wiped away tears.

With summer around the corner, the community was at a stalemate, with both sides waiting for the state to weigh in.

Advocates of the clinic have argued that Killingly's needs are "especially extreme," and that its board has persistently rejected additional services, imposing "its own extreme political views in a way that undermines the educational interest of the State."

The board has responded, through its legal team, that the school already offers an array of resources for student mental health, and that communities cannot be forced to accept a school-based mental health clinic if they do not want one.

The state's recommendation is expected in the coming weeks.

By then, Sydney Zicolella will have graduated, headed for a community college, and from there, she hopes, to a four-year degree and a career in journalism.

The March night she spoke at the school board, putting it all out there, had taught her a lot.

She could tell from the reaction of some of the school board members that nothing she had said that night had gotten through. Possibly, in the months since then, she had managed to open her mother's mind a little; but her father hadn't budged.

The experience, she said, has "definitely skewed my perspective on a lot of things having to do with adults and authority figures in my town." Certainly it colored the way she sees Killingly. She brightened a little when she considered the future, when, as she put it, "teens my age turn into adults, and go into places of power in politics."

"Things are going to look a lot different," she said.

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A Mental Health Clinic in School? No, Thanks, Says the School Board

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American teenagers are reporting severe levels of anxiety and depression. But when Connecticut moved to expand mental health services in schools, it ran into fierce opposition in one town. KILLINGLY, Conn.

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Mental health crises have increased due to the pandemic, but teachers are finding ways to help students cope.

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UNICEF Won't Stop Supporting Children's Mental Health

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Whilst the pandemic has, and continues to, take its toll on our mental health, the ability to reconnect through World Mental Health Day 2022 will provide us with an opportunity to re-kindle our efforts to protect and improve mental health.

Many aspects of mental health have been challenged; and already before the pandemic in 2019 an estimated one in eight people globally were living with a mental disorder. At the same time, the services, skills and funding available for mental health remain in short supply, and fall far below what is needed, especially in low and middle income countries.

The COVID-19 pandemic has created a global crisis for mental health, fueling short- and long-term stresses and undermining the mental health of millions. Estimates put the rise in both anxiety and depressive disorders at more than 25% during the first year of the pandemic. At the same time, mental health services have been severely disrupted and the treatment gap for mental health conditions has widened.

Growing social and economic inequalities, protracted conflicts, violence and public health emergencies affect whole populations, threatening progress towards improved well-being; a staggering 84 million people worldwide were forcibly displaced during 2021. We must deepen the value and commitment we give to mental health as individuals, communities and governments and match that value with more commitment, engagement and investment by all stakeholders, across all sectors. We must strengthen mental health care so that the full spectrum of mental health needs is met through a community-based network of accessible, affordable and quality services and supports.

Stigma and discrimination continue to be a barrier to social inclusion and access to the right care; importantly, we can all play our part in increasing awareness about which preventive mental health interventions work and World Mental Health Day is an opportunity to do that collectively. We envision a world in which mental health is valued, promoted and protected; where everyone has an equal opportunity to enjoy mental health and to exercise their human rights; and where everyone can access the mental health care they need.

WHO will work with partners to launch a campaign around the theme of Making Mental Health & Well-Being for All a Global Priority. This will be an opportunity forpeople with mental health conditions, advocates, governments, employers, employees and other stakeholders to come together to recognize progress in this field and to be vocal about what we need to do to ensure Mental Health & Well-Being becomes a Global Priority for all.

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World Mental Health Day 2022 - Make mental health & well-being for all a global priority

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Whilst the pandemic has, and continues to, take its toll on our mental health, the ability to reconnect through World Mental Health Day 2022 will provide us with an opportunity to re-kindle our efforts to protect and improve mental health.

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Jessica Dere talks about the different approaches to mental health

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Challenges and Rewards of a culturally-informed approach to mental health | Jessica Dere | TEDxUTSC

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Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care

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Current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness, which accounts for roughly one-third of adult disability globally. These circumstances call for radical change in the…

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This large ATLAS provides knowledge about mental health resources, programs, protocols, care, etc. and has been endorsed by World Psychiatric Association, World Health Organization, and IACAPAP.

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Suicide rates have been on a rise in Kazakhstan and are trying to make resources and education more available to adolescents.

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Partners in Health on Counseling the Community

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Partners in Health on Counseling the Community

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The Warriors of Sierra Leone partnered with PIH goals are to help treat and destigmatize mental health conditions.

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At Partners In Health (PIH)-supported Koidu Government Hospital (KGH) in Kono, Sierra Leone, PIH’s mental health care team gathers in their office, the walls covered with evidence of their work: posters detail their schedules and contact information; fliers bear educational messages about the hospital’s mental health care services; and shelves reveal tomes of records for each patient they’ve treated.

Their efforts began just over one year ago, but have already made a world of difference.

In partnership with the government of Sierra Leone, PIH formally established mental health care programs through KGH and nearby PIH-supported Wellbody Clinic in February 2019. The mental health team—comprised of eight community health workers (CHWs) trained in mental health care, three psychosocial counselors, a program manager, and a psychiatrist—works to destigmatize mental health conditions within communities around Kono and provide essential therapy and medication to people living with conditions like depression, psychosis, and bipolar disorder.

Posters destigmatizing epilepsy--which falls under the purview of mental health in Sierra Leone--and encouraging  people to pursue care like group therapy hang in the mental health office at KGH.

Such services had never been as robustly available in Kono, an eastern district located hours away from Sierra Leone’s only dedicated mental health facility in the capital of Freetown. Beyond the biological roots of mental health conditions, which disregard history and geography, Kono’s population of 500,000 contend with ongoing trauma from Sierra Leone’s decade-long civil war, historic Ebola outbreak, and day-to-day reality of extreme poverty.

As the mental health team supports individuals and their families during regular home visits and connects patients with the district’s first and only psychiatrist, more people than ever before are accessing the care they need to live independent, healthy, productive lives. By December of last year, more than 750 patients were receiving mental health care at KGH—up from 115 patients in December 2018.

Patient records stored in the mental health office show that 2019 was the year with the highest volume of mental health patients receiving care at KGH to date.

Alongside the longtime need for mental health services in Kono, personal experience drives the work of each PIH mental health care provider in Sierra Leone. Below, meet some of the team members, and learn about the inspiration behind their efforts to make mental health care a human right.

*John Kamara, mental health CHW at Wellbody Clinic: I was an Ebola patient. I managed to survive with help from people really caring for me, spending their time with me, talking to me, building my confidence. That kind of love, and the hope and courage they built in me—it’s the same thing I want to extend to my patients. I was run down like them. I want to give back to them the mental support that was given to me.

Kumba Judith Conteh, psychosocial counselor at KGH: I was once a refugee. When the [civil] war broke out, my family and I went to Guinea. Being a refugee, you also have mental illness, because you leave your home forcefully and go to another man’s country. But people were caring for me; there were NGOs that were going around to talk to us about how to adjust to our situation as refugees. When I came home to Sierra Leone, I found myself in the mental health program. I’m really happy about it. I’m passionate about giving care to other people, helping somebody who is in need.

David T. Mafinda, psychosocial counselor at KGH: During the war, as a refugee in Guinea, the Center for Victims of Torture’s program trained and employed me as a psychosocial counselor. When I came back to Sierra Leone, my colleagues from Guinea and I started a local version of that program. We called it the Community Association for Psychosocial Services. During Ebola, I volunteered as a counselor at Koidu Government Hospital. And this year, PIH came and took me on board as a full-time, paid staff member. This is my field—I love giving help to my people.

Mary Kargbo, psychosocial counselor at KGH: I was one of the refugees in Guinea. Because I didn’t have any relatives there, and because of what I saw during the war, I wanted to kill myself. But I worked with some angels who taught me how to take care of myself and others, and when I returned to Sierra Leone, I was trained by the Center for Victims of Torture as a psychosocial counselor. I was a volunteer at Koidu Government Hospital, and then PIH hired me. I see myself in my colleagues and patients. I empathize with them and know the pain they are going through or have gone through, and that compassion drives me to take care of them. I know the benefits that mental health support gave to me, so I love this work and our program.

Lansana Kamara, mental health CHW at KGH: I feel relieved to work on [mental health care with] my fellow human being, who to me has lost his senses and cannot concentrate. I enjoy working with such an individual to regain his consciousness. I feel passionate that if I achieve that, I will be rewarded in the kingdom of God.

Cathy Conteh, community health officer at KGH: If we think about the horrors that have happened here—from the war in 1991 to the Ebola outbreak—and looking at our people, they have really been suffering. Now, with support from PIH, people have the knowledge that mental illness is a condition, just like malaria. It can be treated. Seeing people on treatment, who now fit into their community, they are really grateful.

*Comments were edited and condensed for clarity.

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Meet the Mental Health Warriors of Sierra Leone

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PIH formally established mental health care programs in Kono, Sierra Leone, last year. Alongside the longtime need for mental health services here, personal experience drives the work of each PIH mental health care provider. Meet some of the team, and learn about the inspiration behind their efforts to make mental health care a human right.