Soft lighting, comfy seats, a closed-off room away from the hard desks and fluorescent lights of the classroom.

This is where a handful of David Douglas High School students come for therapy. They might talk to Clarke Miller.

“In some ways, it’s like I’m a friend … I guess a real supporter, both emotionally and physically, just someone who’s there for them that they can rely on and talk to.”

Or Michael Cortez.

“This is a space where they can come in, they can relax, they can be vulnerable and open up,” he said.

Or Kai Hostetler.

“If you walk through this door, I’d like you to be able to go, ‘oh,’ and feel a little bit less heavy by the time you walk out.”

These three in-school therapists are contracted through Trillium Family Services to be at David Douglas, providing both therapy and more informal help to students who need it.

Recent research and stories tell of deteriorating mental health for students. According to the most recent Oregon student health survey, 70% of 11th graders reported feeling nervous, anxious, or on edge several days in a 30-day period. Almost a quarter of students felt those things nearly every day. One national study found child and adolescent mental health outcomes are declining even as other indicators are improving. A 2023 Washington Post story warned that teen girls are in crisis, and in 2021, a group of national organizations including the American Academy of Pediatrics declared a national emergency in child and adolescent mental health.

David Douglas High School junior Ali is one of 27 students OPB has been following since first grade in the long-term reporting project, Class of 2025. She said she’s been affected by depression and anxiety in recent years.

“It was really hard because it didn’t allow me to do my best in school,” she said. “But I’m trying to overcome that and do better.”

Anna, another student in the Class of 2025, has also dealt with anxiety and heightened stress in high school.

“I’ve taken a lot of advanced classes, so there’s a lot of homework, a lot to worry about on tests,” she said.

Ali, Anna, and several of the other students in OPB’s Class of 2025 attend David Douglas High School, one the largest high schools in the state. Like other schools across Oregon and nationwide, David Douglas has placed an emphasis on supporting students’ mental health by providing a network of adults throughout campus whose job it is to help students succeed.

Schools across Oregon provide critical mental health resources at no or low cost to students and their families. But funding challenges and staff turnover due to burnout and other factors threaten the future of these services, even as students continue to struggle.

Hostetler, Miller and Cortez hear from David Douglas students on a range of topics — from anxiety and depression to parent and peer relationships. Sometimes that depression is rooted in childhood trauma, or anxiety is tied to a student’s post-pandemic struggle to pass classes or turn in assignments on time.

Miller wasn’t initially expecting students to talk about serious issues.

“I went into it thinking that there would probably be a lot of petty drama, ‘Beverly Hills 90210′ kind of stuff, and I don’t really get any of that,” Miller said.

Instead, he said students are intelligent, insightful, and interested in grown-up conversations.

“The issues that we work on, I think, would be very similar to if they were 40 years old, maybe even more so, because their minds are so malleable and they’re growing so much, and they want to grow so much and they’re so motivated to learn and be better.”

Physical health connected to mental health

High school for many students means traveling in groups — to the bathroom, to the cafeteria, and at David Douglas, sometimes to the student health center, an on-campus medical clinic.

This isn’t a typical doctor’s office.

“You can’t walk into a primary care center with five girls,” said Kristin Case, a nurse practitioner at the David Douglas student health center.

But at the student health center, a small gray building on the high school campus, you can.

They’ll stand outside, or at the front desk, Case says.

“There’s sometimes a group of kids that are just standing at the door,” she said. The door stays locked for safety reasons, but sometimes students need that extra push before coming in.

“We might just open the door and say, ‘can we help you?’”

When a group comes in, Case or someone working at the front desk might try and figure out who the spokesperson of the group is, or who needs to make an appointment.

“I think sometimes there’s safety in numbers,” Case said.

There’s also a written form in English or Spanish at the front desk so students can privately explain what they’re looking for.

The health center serves young people districtwide, from kindergarten all the way to 12th grade. It’s part of a system that operates eight other student health centers in other Multnomah County school districts, including Portland and Reynolds. The David Douglas health center has an onsite behavioral health provider and therapist, in addition to Case.

These facilities, sometimes called school-based health centers, have been around in Oregon since 1986. Some are operated through partnerships between counties and school districts, while others are supported by local health systems or the Oregon Health Authority.

At David Douglas, the center served a little over 1,000 clients last school year, almost half of them ages 15-18. Most often, students show up for routine well-check visits and sports physicals. The second biggest reason? Anxiety and depression.

“The numbers have significantly gone up from what I can see,” Case said, " … Has our detection gone up? Have kids felt safer coming here? Probably all of the above.”

Over her 13 years at David Douglas, Case said she’s seen an increase in students seeking behavioral and mental health help. The rise was so significant she obtained an extra certification in pediatric mental health. She attributes some of the rise to students being more open to seeking support, as well as assessments that staff will do at every well visit and sports physical to screen students for anxiety, depression, substance abuse, and suicide.

Case said what might start out as a physical health visit often turns into a mental or behavioral health visit, but sometimes it takes time to build a relationship and build trust with a student.

“I might see a kid and they’re coming in for headaches, but really it’s sleep,” Case explained, noting the possible connections between physical symptoms like headaches and sleep problems, and behavioral or mental health.

Removing the barriers to getting help — starting in the counselor’s office

Not every student will have a reason to go to the health center. But they will at some point see a school counselor. That’s often the first person who hears a student mention a problem with mental health.

At David Douglas, eight counselors work with the whole student body. They meet with students a couple of times a year to discuss schedules and planning for the future. But sometimes, other things come up.

“School counselors are trained in mental health,” counselor Sarah Hunt said.

But time constraints make it difficult to have in-depth conversations with students.

“We certainly will sit and talk with a student that is going through, you know, ordinary teenage crises,” Hunt explained. “We have, ‘my best friend is moving’ or ‘we’re fighting,’ or ‘my boyfriend, my girlfriend,’ certainly all of those things are still things for teenagers and we still talk with them about that.”

But for things that are more serious, a student might get referred to one of the school’s two social workers. One of them is Caty Buckley.

“Last year I had a lot more kids who were feeling suicidal,” Buckley said. “Thankfully this year, I’m not hearing that quite as much, but right now … especially after the pandemic, we had a lot of kids with eating disorders.”

“And I think we continue to see drugs and alcohol increase with our students … I think that I’m also hearing a lot more trauma stories and I’m not sure if that’s because that’s being normalized in social media, but I think students are feeling more comfortable talking about what’s happened to them.”

But for all of these services that are offered, they’re only reaching a small number of students. Buckley has a caseload of about 40 students, less than 2% of the students that attend David Douglas.

While she’s happy she can help those students, Buckley is overwhelmed thinking about the many others who are not speaking to a counselor or other adult about what’s going on in their lives.

“Sometimes it can be like a little bit of a tsunami,” she said.

The limitations of in-school services

Even when fully staffed, working as a mental health provider can take a toll.

And sometimes, there’s not much a therapist can provide for students when there are bigger issues families are facing — like paying the bills.

“You can’t cope your way out of poverty,” Hostetler said.

“I feel like sometimes people do look to us to fix the problem, and the problem is the rest of the environment … That’s kind of where I hit a brick wall and I’ve noticed that a lot of other clinicians, that’s where they start to hit their burnout point too.”

Therapists say they can also have difficulty getting students to come to appointments, or engaging parents or family members in a student’s mental health journey.

“A lot of the things that our kids struggle with is their relationship with their parents. And it can be really tough for me sometimes to sit there and just to realize that like, they just don’t have a lot of options if their parents aren’t gonna be involved or supportive about these things and are not willing to make any changes,” Hostetler said.

Hostetler and Cortez, the Trillium therapists, are new to David Douglas this year, filling positions that were vacant at the beginning of the school year.

Waitlists of students seeking help filled up faster than usual. Counselors stepped in, playing a triage role helping students who might not need the level of support Buckley, school therapists, or a behavioral health professional can provide.

Not every school has all of the resources David Douglas has, and it is costly for Multnomah County to provide services to students. Despite a strong desire to support student health, sometimes staff turnover has prevented the student health center from fully being able to serve students.

But when it comes to mental health services, not a lot of Oregon students seek out formal help. According to the statewide student survey, only 4.1% of students go to a school-based health center when they have a physical or mental health problem or feel anxious during the school day.

Only 5.3% of students seek out a mental health therapist at school, while 18.7% go to their counselor. 33.2% talk to a parent, step parent, or guardian.

The vast majority of 11th graders surveyed, 62.2%, go to their friends.

Sometimes it just takes a group of your peers

Teenagers talking to their friends about the problems they’re having isn’t a bad thing. Improving mental health is not just about going to therapy. Spending time with friends, exercising, or getting enough sleep are all ways that have been proven to help teens and their mental health.

Class of 2025 student Ali said there haven’t been any adults at school who directly helped her when she’s struggled, other than a math teacher who helped her pass a class. She says her friends have played a big role.

“They make me want to come to school and they help me learn and when I need help, I know I can ask them and they’ll help me,” she said.

Also a big help? Her dog and her sister.

“I like to go out and spend time with everyone that I love and that helps me a lot,” she said.

In Oregon, grant funds have been doled out to school districts to help support youth-led projects that relate to mental health. From 2021 to 2023, youth-led projects included hosting movie nights and organizing mental health awareness weeks at schools. Additionally, there are regular groups where students can hang out with their peers, doing the things they enjoy, like Lane County Behavioral Health’s Dungeons & Dragons groups.

Sometimes dealing with anxiety or other mental health challenges might just come down to the individual finding their own coping strategies.

When Class of 2025 student Anna is stressed, she likes to break down the different things she’s stressed about into smaller, more manageable pieces.

“It doesn’t feel as worrying as this one big thing instead of a few small things,” she said.