Can peer mental health programs bridge access gaps for youth? Experts say it’s complicated. | SC Education Lab

The kids are not alright.

Even before the pandemic began, more than 1 in 3 high school students reported persistent feelings of sadness or hopelessness. In many communities, those numbers have skyrocketed. But in some places, educators and others are experimenting with new ways to address students’ mental health needs — or reinvent old strategies. In this reporting collaborative, the Education Labs at AL.com, The Dallas Morning News, The Fresno Bee, The Post & Courier, and the Seattle Times partnered with The Christian Science Monitor, The Hechinger Report, and Solutions Journalism Network to produce this series of solutions-oriented stories.

As schools and communities scramble to find more ways to support the well-being of youth amid a pandemic-fueled mental health crisis, some think part of the answer lies with students helping other students.

The basic idea behind these peer support programs is straightforward: They rely on students trained to offer a listening ear to those who reach out, provide direct mentorship and guidance, or spot struggling students and help connect them with an adult or professional resources.

Many people — especially students — want to see more licensed mental health experts in schools, but finding enough trained professionals takes time and money. And while peer support systems aren’t meant to replace trained adults equipped to handle severe issues, they can be a first line of early intervention and empowerment — though experts point out research on their effectiveness remains limited.

There’s no shortage of peer support programs to evaluate, and tools used to deploy them are evolving to become more professional and accessible in an increasingly digital world.

One example is Seattle’s Teen Link, a free phone line established in the 1990s that has since expanded to online chat and text messaging. Teens can talk with a trained teen volunteer about anything on their mind, and can call in or connect from anywhere in the country.

Stella Ruebel is a high school sophomore who has staffed the lines at Teen Link for more than a year because the program resonated with her values. “I have been struggling with different mental health things through my childhood … and knowing that people have helped me with my mental health, I want to help other people now,” she said.

Plenty of students are willing to take on these roles. Right now, the line has 58 teen volunteers — 18 of them new.

“One of the coolest and simultaneously heartbreaking things to see was that right around March-April 2020, interest in becoming a volunteer with Teen Link just skyrocketed,” said Zanny Shehata, Teen Link’s volunteer coordinator.

Teen Link stands out for its longevity, accessibility and broad focus; the line received more than 2,533 calls, texts and chat messages last year, and teens can talk with volunteers about pretty much anything — like how their day went or even a new episode of their favorite TV show.

One of the positives of peer-based support is that students who don’t have a trusted adult in their life may be more comfortable asking for help from a peer. According to the 2021 Washington state Healthy Youth Survey, about 13% of the state’s eighth graders said they don’t have an adult to turn to when they feel sad or hopeless. That number climbs to 15% for 10th and 12th graders.

“There’s something really special about being able to reach out and know that the person who picks up the phone is going to be someone your own age,” Shehata said. “Just generally having more peer-to-peer support options in the community breaks down a lot of the stigma … of reaching out for mental health support.”

There’s a wide range of peer-based support methods, including mentorship programs designed to keep kids going to school and achieving academically and peer leadership programs aimed at specific problems like substance misuse and suicide prevention.

Maggie Sibley, an associate professor of psychiatry and behavioral science at the University of Washington, has developed a program that provides targeted peer support for freshmen struggling with the transition to high school.

The pilot program trains 11th and 12th grade students to do basic interventions — helping with schoolwork planning and navigating new social dynamics — to reduce the risk of dropouts. Only one Seattle high school participated in the program last year, but Sibley is hoping to expand to a few more next year.

A research study Sibley published a couple of years ago showed students skipping class less often and feeling more confident or positive about their schoolwork and school community — the exact results she was hoping to see.

Sibley is hoping eventually to track how students are faring academically throughout high school, as well as socially and emotionally.

But overall, there isn’t much data about the effectiveness of peer mentoring or support programs.

Last year, researcher Mina Fazel analyzed studies from all over the world examining peer mental health programs in schools. The University of Oxford professor’s findings indicated that students trained to be mentors — not those receiving the mentorship — clearly benefited.

The analysis didn’t indicate there’s any risk of harm for students being mentored, said Fazel, who is a professor of adolescent psychiatry, but it shows there isn’t enough data to determine whether or not school-based peer programs meaningfully improve overall mental well-being.

“Right now we don’t know if it’s helpful, full stop,” she said.

Because the findings show peer support programs have benefits for mentors or peer leaders themselves, she suggests people offer those types of opportunities to students who may be struggling.

“Rather than to say ‘Oh, you need to be mentored,’ why don’t we give them the training … and help them look after and mentor a kid a couple years below them, maybe with similar problems to them,” she said.

Peer mentorship does come with challenges of its own. Teen Link volunteers receive training and get support from an adult volunteer on each call they take. But Shehata said not every call comes with a clear solution or fix, and training volunteers receive also focuses on helping them cope with that.

“We tell our volunteers from day one, ‘You are not expected to fix or solve anyone’s problems, we’re here to be a sounding board for people,” she said.

Assigning student roles in mentorship or other support programs could also come with drawbacks, like matching them with a person they don’t feel totally comfortable with.

That’s why, Fazel said, it’s vital for any school or community developing a peer program to closely evaluate its impact and adjust its design accordingly. It’s also critically important for schools and the staff within them to understand how to support what she calls “authentic social networks,” or the people kids naturally turn to when something’s on their mind.

“Young people would rather choose who they go to for help, but are there things we can do to make sure everybody at school feels a little bit more confident to listen to their friends?” she said.

Fortunately, interest in the mental health needs of young people is growing.

Federal entities like the Substance Abuse and Mental Health Services Administration are focusing more on building up peer support options and including youth voices in evolving systems of care. More grassroots organizations are offering virtual connections for those seeking help, making peer resource networks better-supervised and connecting them to established official resources. Many are also offering more professional training, said Mike Pullmann, a research associate professor at the University of Washington School of Medicine.

“We’re seeing much more digital remote options,” he said. “Definitely more scalable options.”

Virtual offerings like these could play a key role in increasing access, which is particularly helpful to youth who have limited resources. But Pullmann said that because many youth and children have been deprived of socialization opportunities with their friends throughout the pandemic, guided peer support may be even more essential now.

“There are so many youth out there whose social support networks have been disrupted,” Pullman said. “I think peer support can serve a huge role.”

Ruebel, the Teen Link volunteer, thinks more states should have resources like Teen Link.

She said volunteering with Teen Link has helped her support her friends.

“Instead of trying to relate the thing they’re saying directly back to myself, I’ve learned more to ask them questions about what’s happening to them,” she said.

Because when it comes down to it, peer support doesn’t have to be overly complicated or formal to make an impact.

Sometimes it’s as simple as saying hello, asking someone about their day, and really listening to what they say.