School Nurses: The First Line of Treatment for Mental Health

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Why you should care

Because it’s more than stomach aches and Band-Aids.

This story is part of a series between OZY and Well Being Trust called Mental States of the Nation, where we explore ways that different states across the U.S. are enforcing and facilitating mental health parity.

Linda Vollinger has been a school nurse for 10 years at Amos Alonzo Stagg High School in Palos Hills, Illinois. But if you think her job involves just handing out ice packs and Band-Aids, think again. President of her local chapter of the National Association of School Nurses (NASN) and a former ER trauma nurse, Vollinger says her fellow school nurses do a lot more. Beyond scrapes and stomach aches, many school nurses are now the first stop for treating kids’ mental health.

According to a 2018 study in the Journal of Developmental and Behavioral Pediatrics, the number of American children diagnosed with anxiety and/or depression has risen from 2.6 million in 2012 to nearly 15 million in 2018. Luckily, there’s growing evidence showing how school nurses can step in to help early on.

Just up the highway from Amos Alonzo Stagg is Libertyville High School — another school dealing with the same mental health problem. School nurses here are seeing more and more students come to their office not just for small medical treatments, but also for quiet spaces to relieve stress. To meet these new demands, school nurses are being offered extra training in mental health as well as resources from the NASN. Some nurses are even being encouraged to develop detailed cooperation plans with school guidance counselors and social workers who have more formal training when it comes to dealing with mental health issues.

“The school nurse is now more of a health detective,” Vollinger says, teasing out what might really be going on beneath a child’s ailments. “We have to look past benign complaints of stomach aches to see what the root of those problems really is. It could be issues at home, or depression, or stress at school.”

I think the school nurse will be a key person to help these students excel.

Linda Vollinger, school nurse

Vollinger believes that part of the reason they see so many more kids coming forward with their mental health issues is that there’s been a shift in the mindset of mental health. She feels society is becoming much more accepting of these health conditions. “People are seeing that it’s not something made up or something you can push under the rug.”

Robin Henderson, PsyD and clinical liaison for Well Being Trust, agrees that mental health is becoming less stigmatized, but feels there’s still a long way to go. “If you had a kid in your school system who had cancer, you’d rally and do fundraisers,” she says. “If a kid attempts suicide and ends up in a psych unit, we don’t talk about it.” She is emphatic that adults have to change their frame of mind and understanding when it comes to mental health.


Fortunately, both Amos Alonzo Stagg and Libertyville are cutting edge in this regard. Along with a team-based approach to treating the mental health issues, Vollinger’s school also created a space they call “the intervention room.” This space allows students — who would normally be expelled or suspended for their behavior — to remain in their classes, but also experience a consequence for their behavior.

The intervention room has evolved over the years beyond just discipline. Staffed by a teacher and a teacher’s aide, it’s now the place for students who have returned to school from a long absence to decrease their stresses and anxiety over coming back. Additionally, if the nurse’s office or school counselor’s office isn’t available to help a student who needs a safe space to go, the intervention room can serve as a place for that too.

The nurses at Libertyville are making a point to consult online resources and share information with one another, doing their best to learn how to talk to students struggling with mental health issues in a way that helps to position them for the best continued care. And given that the onset of mental health issues takes place for many people well before the age of 18, school nurses could play a vital role in helping people address, and overcome, challenges early on. Benjamin F. Miller, chief strategy officer for Well Being Trust, believes that if “there is an opportunity for early intervention, we are more likely to see people improve their outcomes and even recover from their problems.” This can be seen at Willow Bend Elementary in Rolling Meadows, Illinois where school nurses are making a point to talk more openly about mental health issues with the young students. Nurses will even consult with teachers, taking a more team-based approach to ensure all students feel safe at every point in school.

But challenges persist. Illinois, for instance, does not mandate nurses in every district, so there are currently only 700 school nurses in the Illinois Association of School Nurses and almost 4,000 public schools across the state. School nursing positions can also be lower paying than traditional nursing jobs. However, Vollinger is encouraged by the number of younger women she sees going into school nursing as a profession. According to registered Census data, there were roughly 1.9 million registered nurses in the U.S. in 2009. And in just eight years, that number has grown to 2.4 million.

“As time goes on and we see more and more individuals with mental health diagnoses,” she says, “I think the school nurse will be a key person to help these students excel.”

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