As the school year winds down, mental-health providers say they recognize many students still feel the weight of the pandemic, and in North Dakota, it has prompted a more dedicated response to help kids dealing with higher levels of stress and anxiety.

The Centers for Disease Control and Prevention (CDC) recently issued findings which showed more than a third of high school students reported having poor mental health during the crisis. Another 44% said they persistently felt sad or hopeless in the past year.

Christy Wilkie, a therapist with Dakota Family Services, said they have seen a big increase in referrals.

"When they do come into the office, we're seeing more anxiety, more depression," Wilkie reported. "And I would say it's more intense anxiety."

She said some of it might be greater awareness from parents after spending more time together during the crisis. Any family financial stress or disruptions in connections with peers are other factors. Wilkie pointed out they are doing more outreach with local schools to help identify concerning situations and to navigate the referral process.

Wilkie emphasized they are also trying to help fill gaps in areas where services are scarce, including having one of their staff routinely visiting a rural high school in Barnes County to provide therapy. She added telehealth has helped during a time of greater need.

"The schools will provide spaces for kids to do therapy in school," Wilkie noted. "It's one less barrier to getting help for kids when the parent doesn't have to take time off and drive them to the clinic and then wait for that hour and then drive them back."

Despite the extra efforts, Wilkie stressed waiting lists are long, and recruiting is ramping up in hopes of adding providers. The CDC report revealed more than half of high school students reported experiencing emotional abuse by a parent or other adult in their home during the pandemic.

Losing a loved one can be traumatic, but when it happens to children, it can leave them at risk of anxiety, depression and even post-traumatic stress that can derail their educational progress. Experts in grief say it's always a good measure to seek help.

New Hope for Kids in Maitland runs a program designed to bring hope and healing to children and families suffering from grief, for as long as they need.

"Kids are with us typically, very seldom are they here less than a year's period of time," said David Joswick, executive director of the volunteer-based organization that provides group grief support, free of charge. "More typical is two to three years."

The American Psychiatric Association recently added Prolonged Grief Disorder to its list of mental disorders, describing it as intense emotional pain that persists more than a year after a loss. Those at particular risk include people who lose loved ones to violence, parents who lose children and anyone without a support system to help them cope.

Joswick said the cost to run New Hope for Kids is about $600,000 a year, all through charitable donations. He said the program serves, on average, 400 to 425 children and more than 350 adults. As kids work in groups to overcome their grief, he said, the adults meet concurrently, so they can cope as a family.

"They've seen changes in the demeanor of kids in the family," he said, "and it's created questions on their behalf of, 'How do I interact with the kids during this period of time?' And so, we provide guidance to the adults in the family."

Prolonged grief disorder, also known as complicated grief, has sparked debate in the medical community. But clinicians now can bill insurance companies for treating anyone with the condition. Some say the APA designation also opens the door for more research and awareness. Joswick said his group made a decision years ago to stay non-clinical, avoiding insurance reimbursement forms.

Many parents in Oregon and around the country will soon be bidding their children farewell as they head off to college for the first time, and a growing question on some parents' minds is about the mental health supports schools provide.

According to a recent survey, three of five college students have been diagnosed with a mental health condition. Schools like the University of Oregon have beefed up their services in recent years to meet the growing demand.

Mariko Lin, assistant director of counseling services at the university, said when they first come to college, students can be scared about making appointments with health services.

"But I want to make sure that parents and family members know that we really want to help their students," Lin stressed. "And are looking forward to them reaching out to us to make those appointments and to get the care that we want to give them."

Lin pointed out the University of Oregon is contracting with an outside company this year to meet any overflow in demand. Along with individual therapy, Lin noted her school also provides group therapies related to specific topics such as sexual assault survivors, as well as for marginalized community members.

Nance Roy, chief clinical officer of the Jed Foundation, which aims to prevent suicide among young people, encouraged parents to ask schools about their mental health supports when their children are deciding on a school, such as on college tours. Roy also urged parents to explore what the university is like beyond the walls of its counseling department.

"It's helpful to ask some questions about what is the culture like on their campus?" Roy emphasized. "Is it a campus where there's no wrong door for a student to walk through for support? Is everyone open and accepting, offering a warm hand? Are faculty and staff engaged in student well-being?"

Roy advised parents who know their children already have therapy needs may want to find local options off campus as well. And while stigmas around mental health are slowly coming down, she added it is important for parents to talk about this issue. For prospective students, Roy acknowledged going away to college can be scary, and it is OK to reach out to someone if they need help.

"Talk to a friend, talk to us," Roy recommended. "Don't feel like you're alone in that because it's very normal during periods of transition to feel a little bit of anxiety, and that's all right."

Support for this reporting was provided by Lumina Foundation.

Mental-health advocates say the new 988 Suicide and Crisis Lifeline could save the lives of many Utahns and others facing mental-health crises.

The new three-digit number is a "shorthand" version of the previous 10-digit National Suicide Prevention Lifeline that has been in use since 2005. The new number links callers to a local mental-health help center based on their area code.

Rachel Lucynski, director of community crisis intervention at the University of Utah's Huntsman Mental Health Institute, said saving the time it takes to look up an unfamiliar number could make the difference for someone in a crisis.

"We're confident that if folks can remember '911,' that they can definitely remember '988' in an easier way," she said, "and that remembering that, accessing the service, could be the difference in keeping someone alive in a suicidal crisis."

The 988 system was first proposed in 2014 by a Utah legislator who had experienced a suicide in his family. Subsequent efforts to pass the measure failed, but Congress finally approved the plan in 2020.

Lucynski said the Utah crisis team currently handles an average of 8,600 calls a month. While most of them are people looking for information, she said, a significant number are individuals dealing with a personal crisis.

"We know that the Utah crisis line really is effective for folks in accessing 24/7 life-saving services," she said, "being connected immediately to a crisis worker who can help de-escalate a situation and help keep folks safe during emotional and potentially suicidal crises."

The state Department of Health reported that from 2018 to 2020, Utah had the sixth-highest age-adjusted suicide rate in the United States, with an average of 657 incidences per year.

If someone you know is facing a crisis, Lucynski said, you can call 988 to get them help.

"It doesn't have to be just you that you're calling in for," she said. "If you're worried about a friend or family member or coworker, someone who is acting differently or maybe expressing thoughts of suicide, you can call 988 and ask those questions."