A few hours into the first day of school, a high school student entered the nurse’s office complaining of stomach pains.

The school nurse began asking him routine questions to determine the root of his troubles: Can you describe your symptoms? What have you eaten? Are you on any medication?

Cameron Traut, who has been the school nurse for 14 years, wasn’t surprised when the student eventually revealed that he had a history of mental health issues and was taking prescription pills to treat anxiety.

It’s a scene that school nurses are expecting many times over as school opens, reflecting both the growing number of mental health issues among school-age children, and how the traditional role of school nurses has evolved from cleaning up playground scrapes and taking temperatures to meet the needs of this growing population.

According to the Centers for Disease Control and Prevention, more than one in 20, or 2.6 million children ages six to 17 in the United States, had current anxiety or depression diagnosed by a health care provider in 2011-12.

School nurses say the increase is evident in the students from elementary to high school who enter their offices each day, requiring not only bandages and ice packs but also a quiet space to break from stress. Nurses now have to schedule meetings with parents about their child’s mental health histories and needs, then learn the side effects and potential complications associated with mood-altering medications.

To meet the new demands, school nurses are offered extra training in mental health as well as resources from the National Association of School Nurses. They are adding relaxation rooms to the typical beds in the nurse’s office, and they have had to develop detailed cooperation plans with school guidance counsellors and social workers, who are trained to handle such issues but, for better or worse, are not always the first stop for students seeking a nurturing response in a school building.

“In the past, we used to be kind of hard-nosed. ‘Nope, you don’t have a fever, you’ve got to go back to class,’” said Nina Fekaris, president of the National Association of School Nurses. But today, the nurse’s office is often the first place students turn for help with mental-health issues, she added. “It’s one of those areas where we’ve tried to create a space that’s super-nonjudgmental.”

Despite these efforts, local and national school nurse associations worry that they are outnumbered by the number of students in need of their help.

“I think we need to advocate for more school nurses in our buildings,” said Traut, who also serves as a director to the National Association of School Nurses.

“There’s definitely a trend that we are taking care of more students with actual diagnoses, generalised anxiety disorder, depression, panic attacks, panic disorders.”

At Amos Alonzo Stagg High School in Illinois, the nurse’s office has a room that is a quiet sanctuary for students having panic attacks or needing a break from stress.

“It’s just a safe place for them to come,” said Linda Vollinger, who has been amazed by the way mental-health issues have evolved from being closely guarded secrets to something she discusses with about three students each week.

“It’s a huge culture shift,” said Vollinger. “It’s great that we’re seeing that stigma ripped away.”

While many schools and districts have social workers and psychologists on staff, students tend to think of the nurse’s office as the first stop to get the attention they need. In turn, nurses, social workers and psychologists at schools today work closely together to make sure a student gets continued care.

The prevalence of mental-health issues has prompted structural changes in schools. Three years ago, district officials allowed Vollinger and other school staff to create an “intervention” classroom located between the nurse’s office and the guidance counsellor’s office.

The classroom is designed to help both students who have been out of class for disciplinary reasons and those who have had mental-health-related absences transition back to the daily routine in a more nurturing setting than being thrust back into busy hallways and full classrooms.

The room also is used for students who experience testing anxiety and need a quieter place for exams.

While such classrooms were unheard of even a decade ago, they are becoming more common across the state as schools recognise the adjustments needed to address students’ growing mental health needs.

Elementary school nurses are also encountering students with mental health needs.

“It’s becoming somewhat easier to talk about, so that’s good,” Kim said. “If I see a child with medications for diabetes, I do what we need to do to make sure that diabetic child is safe. If I notice a child coming in with psychotropic meds, I’m going to alert the teachers about what we can do in the same way.”

For now, Traut and other school nurses say they work with what they can to meet the needs of their student populations.

Through online resources and their own continuing education, they learn about how to talk to students struggling with mental health issues in a way that helps to position them for the best continued care.

And as students stop into her office, Traut tries to offer them the care they need, whether it’s a look at a cut, or a glass of water and a fidget toy to calm their anxiety.

“There’s a whole lot of rewards,” Traut said. “I love the challenge of working with teenagers and adolescents and helping them become independent, helping them build skills of independence and self-advocacy.” – Chicago Tribune/Tribune News Service