As the school year winds down, education leaders are shedding light on increased mental-health demands among students, including thoughts of suicide.

Various organizations in Iowa also are calling attention to the issue during Mental Health Awareness Month.

Lisa Cushatt, executive director of the trauma healing group Iowa ACES 360, said concerns were building prior to the pandemic, but adds the crisis has added layers of mental health issues for children and adolescents.

She said what's happening now shatters the myth that kids are born resilient, especially when adults in their lives feel extra stress simultaneously.

"We want to believe kids are born resilient," said Cushatt. "But we have such a responsibility as adults to help cultivate that and model that and it's really hard to do when we're in crisis ourselves."

According to new Centers for Disease Control and Prevention data, 44% of U.S. high school students recently reported persistently feeling sad or hopeless in the past year. And nearly 20% had seriously considered attempting suicide.

Last month, the U.S. Preventive Services Task Force recommended screening for anxiety in youths between the ages of 8 and 18.

While school counselors are responding to more referrals, there are calls to enhance training for all staff to help these students. Those suggestions coincide with gaps in locating enough providers who can help a child away from campus.

Erin Drinnin, community impact officer for health of the United Way Central Iowa, said Iowa Children's Behavioral System is feeling the impact of the workforce shortage.

"How do we recruit enough mental-health professionals to go into school," said Drinnin, "to go into these professions to serve youth and adults?"

The Coalition to Advance Mental Health in Iowa for Kids recommends actions such as student loan forgiveness and maintaining telehealth flexibilities.

Julia Webb, program director for NAMI Iowa, said parents and educators can be proactive by intervening when warning signs pop up.

"If you're seeing a young person isolating themselves," said Webb "not taking joy in the things they've previously found happiness in, ending relationships with friends, not wanting to interact with friends."

For crisis situations, signs include expressing great shame and plans that point to ending their life.

The U.S. Supreme Court is expected to announce its decision on a case, which could upend abortion access across the country. The topic is a source of fiery debate, and one reason could be because of our anxiety about death.

At a webinar hosted by the Seattle-based Ernest Becker Foundation, panelists discussed the link between the anthropologist's work on terror-management theory and the issue of abortion.

Dr. Emily Courtney, social psychologist at the University of South Florida, said people manage their anxiety about death by constructing worldviews, such as religions, ideologies and political orientations. But it also makes people defensive when their worldview is challenged, making topics such as abortion more divisive.

"The fact that we deal with the death anxiety by putting more of our own kind of personal stake in the ideologies that we've adopted as human beings," Courtney explained. "When those things are threatened, we take a step back and things get a little bit more intense when we do confront those issues."

A leaked Supreme Court opinion on the Mississippi abortion case showed justices could be preparing to overturn the 1973 Roe v. Wade case, which legalized abortion.

Regardless of the ruling, the option will remain legal in Washington state.

Courtney pointed out death is a large part of terror-management theory, but there are other components to our fear of death, including existential threats to our identity and autonomy. Courtney noted threats can present themselves when someone is not able to make the choice to get an abortion.

"So by limiting those choices, you're presenting more of an existential threat to specific groups of people," Courtney emphasized. "Women, people who may be marginalized in society, people who may be in different socio-economic tiers who could simply not support children."

Dr. Lindsey Harvell-Bowman, associate professor at James Madison University and director of the Terror Management Lab, explored more hopeful messages of empathy and trying to neutralize the terror-management defense which can come up on issues such as abortion.

She recommended humanizing people on the other side of this issue from you, and using communication as a way to get there.

"We're all humans," Harvell-Bowman stated. "We all end the same way, and so really in order to enact change we have to engage in meaningful conversations with each other without completely ruining the other side."

On a given day in Massachusetts, more than 100 children and teenagers are brought to hospital emergency rooms because they're facing a mental-health crisis and sometimes have to stay there for days or weeks.

Nonprofit Youth Villages is partnering with the Massachusetts Health and Human Services Department for a program called Intercept, to provide immediate in-home mental-health treatment for kids and teens.

Matt Stone, executive director of Youth Villages, hopes to see similar programs in other communities.

"The vast majority of the children and adolescents that we are serving in this program," Stone explained. "They don't need a bed in a facility. What they need is intensive in-home support, to help the parents and caregivers be able to manage the crisis."

Stone noted Youth Villages has served more than 100 families, referred by 20 different hospitals. Family intervention specialists meet with families two to three times a week; help address issues with schools, courts and children's services; and build and help families execute treatment plans. They're also on call 24/7 in case of an emergency.

Joy Rosen, vice president for systems behavioral and mental health at Mass General Brigham, said during the pandemic, hospitals have seen increased numbers of children and teens in mental distress. She pointed out there are a number of factors, from remote learning and feeling isolated, to potential loss of a friend or family member.

"Anyone is accepted, regardless of their insurance, whether they're documented or undocumented," Rosen stressed. "It's really a breath of fresh air, and particularly at a time when clinicians did not feel they had many resources at their fingertips for these suffering kids and families."

Angela is a parent of a teenager who went through the Intercept program. She emphasized the difference it makes to be able to take care of your kid at home. She recounted when her daughter was experiencing an eating disorder and self-harm, she was stuck in the emergency room for two full weeks because inpatient facilities wouldn't take her, until she was discharged with Youth Villages.

"Awareness of this program really needs to be heightened up a bit to help get kids home. An emergency room is not a place for mental illness with kids," Angela asserted. "She saw way too many things as a teenager that she should not have seen in that emergency room."

Virginia is home to more than 780,000 military veterans, and one organization is offering mental and emotional support.

The National Alliance on Mental Illness' (NAMI) Homefront program is a free, six-class course for veterans, active-duty military members and their families.

Mary Beth Walsh, director of programs for NAMI-Virginia, said military families often have their own unique mental and emotional needs, which the program aims to address.

"It's an educational course that helps lead family members through ways that they can not only help their loved ones, but also ways that they can focus on themselves and gain support for their own needs," Walsh explained.

In addition to NAMI's program, the Department of Veterans' Affairs (VA) also offers care via its mental-health specialty clinics, primary-care clinics, nursing homes and residential-care facilities. Walsh pointed out NAMI also partners with VA facilities to offer peer-to-peer support programs, which emphasize connecting veterans with folks who have shared experiences.

Walsh noted the peer-to-peer support model is used across NAMI's other mental-health programs, but is particularly important for veterans. As she explained, military veterans have a unique culture, language and experiences.

"Being able to talk to somebody who has been there and can really say, 'I've been through what you're going through,' it's such a huge aspect of what can really help somebody feel not so isolated and alone," Walsh emphasized.

Dr. Rhonda Randall, executive vice president and chief medical officer for UnitedHealthcare employer and individual, said there are a few signs people should keep an eye out for if they think someone is struggling with their mental health.

"Things that you really worry about are like loss of interest in things, a loss of feeling happiness or pleasure, really feeling helpless or hopeless," Randall advised. "Generally, we get concerned when those kinds of feelings persist for more than two weeks."

According to the federal government, more than 1.7 million veterans received mental-health counseling through a VA program in the 2018 fiscal year. The department also has a veterans' crisis phone line for emergency situations.