The pandemic in early 2020 forced snap changes in the way most people worked, learned and fundamentally lived. The change proved swift, jarring and unrelenting. The contoured surges and slumps in COVID-19 infections made a return to normalcy, if such a thing exists any longer, an inconsistent course with occasional reversals.

Learning environments adjusted to reach longer distances. Intimate therapy sessions moved from office couches to computer windows. Shifts came with cost. As discomforting feelings of isolation became more widespread, the delivery of mental health services became necessarily more remote. And the more time passes, the more it becomes clear some aspects of modern life may well have changed forever. 

Students at Ringling College of Art & Design, once abruptly told to leave behind their studios and high-tech tools on campus, have returned to campus. But even now, many classes continue to stream virtually. In the public schools, an effort to bring mental health professionals onto campus had to turn a significant part of its focus to reaching students and their families in their own homes. 

The pandemic has generated challenges in the field of mental health, including increases in feelings of depression and isolation. But it also spurred a move in a direction of helping people in their own homes instead of a foreign environment. In many cases, there are patients who don’t want to go back.

“This has really allowed us to connect with people in a different way,” said Dr. Kristie Skoglund, CEO for The Florida Center for Early Childhood. So the good news turns out to be that the benefits of telehealth and remote student service have turned up in expected and welcomed ways. The bad news, though, is that the demand for help is greater than ever. The pandemic brought with it stress, disconnection, and too often grief. Telehealth remains new if furtive ground, but the desire for face-to-face therapy remains strong. One thing is clear. The guidance counseling of yesteryear won’t ever change back to exactly what it was.

Anxiety has impacted Ella Cruikshank since the third grade. It’s one of the reasons she’s seen a therapist since grade school, which has helped her manage her mental health by engaging with other students. Through her school, she connected four years ago with Dr. Stacie Herrera, who helped her manage her emotions and negotiate mental health challenges.

“Mainly I have worked on my anxieties,” Ella says. “I was struggling just going to school.” But the therapy helped her to function fully throughout her life, while spending about an hour a week in counseling with Herrera. Then the pandemic in early 2020 introduced new stress into the life of people the world over, while bringing the threat of isolation, not only from the school environment she worked so hard to integrate with but away from her mental health support system. Fortunately, even before the pandemic, Herrera invested in telehealth capabilities, at first so her team of clinicians could more readily serve private and charter schools through the county. When COVID-19 and its social distancing protocols separated her from patients, video-conferencing helped restore that connection and a mental health lifeline.

Suddenly, Ella could attend therapy again, and the Cardinal Mooney Catholic High student no longer needed a parent to drive her to sessions each week. She could speak with Herrera, not in a medical office but from the comfort of her own bedroom.

“It’s easier for me to focus if that makes sense,” Ella says. “In person I get a little more anxious. Over the screen, it’s a little bit easier.” Ella’s case isn’t an isolated one. In fact, education organizations say there’s been a significant increase in demand for mental health support. 

Mandi Coker, a mental health professional for the Sarasota County Schools, said in many ways demand has always been there. In a sense, a series of tragedies has finally allowed, even forced, the schools to meet it. “We are recognizing the needs of students and offering a full continuum of support,” she said.

The school system started a process pre-pandemic of bringing more licensed mental health therapists into the schools. That began in the wake of the Marjory Stoneman Douglas High School shooting in 2018 and the passage of legislation in that wake, said Debra Giacolone, executive director of Student Services for the Sarasota County Schools. “Sometimes something really tragic happens and something comes out of it,” she said. “In this case, we allocated funding for the first time to support mental health in schools.”

The school district contracts with the Florida Center to place therapists in each elementary school on campus and with First Step to provide similar services to middle and high schools. But almost as soon as that program could go into full effect, another trauma would strike the world. COVID-19 forced a change in how those therapy professionals interacted with students.

Giacolone notes the term guidance counselor in itself has become outdated. Schools still staff up with certified school counselors to guide students through academia. But there’s now clearer differentiation between those helping students keep their college prep offerings on track and those aiding with the mental health of children in a challenging world. That brings its own staffing challenges, and she said the district has dealt with some professional departures in this challenging year. But the professional ranks never dipped to a level of “critical shortage.”

Still, philanthropy in the region has made sure to assist when necessary. Jennifer Vigne, president of the Education Foundation of Sarasota County, helped with funding for professional development and also has a pilot program specifically supplementing services for students in a foundation-managed mentoring program. But Vigne was quick to point at a number of other efforts in the 

region providing broader support. The National Alliance on Mental Illness of Sarasota and Manatee Counties offers specific help to families in the area, much of it geared for those directly impacted by COVID-19. Suncoast Behavioral Health has dispatched nurses and psychiatric professionals to assist.

In 2018, Herrera was among many health professionals to offer their students to the traumatized student body in Parkland following the death of 17 students and faculty on campus. She also studied the mental health problems that contributed to a former student arriving on campus with a gun to kill his peers. Data suggested mental health service improvements for schools and initiating therapeutic support for at-risk students could help reduce the risk of another such tragedy, or at least help survivors recover.

Dr. Larry Thompson, president of Ringling College of Art & Design, said since the start of the 2021 academic year, the mental health division at the arts school has seen a greater level of demand than any other point in recorded history. “We have a robust counseling department, and 2021 was really bad with people having feelings of being depressed, lonely and isolated,” he said. “It was a really difficult year and we’ve had a much higher number of people seeking out our services. And we know this is still high even as we have had more opportunities for people to feel engaged and socializing.”

The arts college faced a number of challenges from the beginning of the pandemic, but at least the school specializes in creativity. Technical problems, even daunting ones, were solved with innovation. Students sent home to school when all classes went virtual feared they could never finish computer-based projects that relied on the mega-processing-speed computers on campus. “I call them Ferrari computers because they work as fast and cost as much as one,” Thompson said. The IT department emulated a technique from NASA allowing students from remote locations to access the Ringling servers from afar the same way engineers in Cape Canaveral can control the Mars Rover from a planet away.

But creativity requires human connection as well. Thompson describes the learning process in an arts field as much more collaborative than a typical academic letter. Imagine a sculpture student who can watch a teacher and learn the technique to hold a chisel from a professor. Perhaps this can be done through a Zoom window, though even that’s not preferred. But what comes next when the student must think of what to carve? In a studio of peers, one can look around at a dozen peers, each one making their own choices on scale, on shape, on subject. In a history exam, this may seem like looking over someone’s shoulders for answers on a test. At an art school, it’s a chance for inspiration lost to the flatness of a teleconference screen.

Today, some liberal arts classes remain offered remotely, but Thompson said studio work resumed. About 30 percent of every student’s curriculum is now done by the internet, even though 100 percent of students are back doing in-person instruction on campus. “Students, in all frankness, will tell you they learn as much from their fellow students as our faculty,” Thompson said. 

Across the street at New College of Florida, a smaller student body also conducts about a third of classes virtually, and the rest in-person with faculty. At the state’s honors college, it’s largely dictated by the students how much of their work happens through a computer screen and how much gets done in labs and classrooms.

“A lot of students prefer in-person and like to sit with an individual instructor, but the downside is masks,” said Dr. Anne Fischer, program director for counseling and wellness. Protocols remain in place that require face coverings during indoor activities, and that hasn’t changed at New College since the beginning of the pandemic. Those rules won’t always be in place. But nevertheless, there are advantages students have explored. “Some stuff is better online.”

It’s easier to set up a time to reach experts, on-campus or around the world, when people just need a Zoom connection. That’s also true with mental health services offered by the school. It’s easier to make appointments with counselors and students when everyone needs to just log on, not meet in an inconvenient location. “It’s something that adds to the availability we have with students,” Fischer said. “From what I understand, the same thing is happening in private practice. I imagine some things will remain online.”

Indeed for Herrera, she sees long-term prospects for private counseling through remote therapy. Even as the world slowly returns to one another’s company — with lockdowns lifted, schools in session and immunizations on the rise — Herrera has continued to expand the availability of telehealth. With Telement, a new practice dedicated entirely to providing mental health services remotely, she has been able to rely on clinicians with different specialties from around the country to help patients receive counseling more conveniently than ever before.

“We have the best student clinicians working with students to achieve the best progress,” Herrera says. It’s a delivery method Herrera has seen potential in for years. Telehealth, Herrera said, seemed a key part of any service delivery. Professionals from around the country could help counsel a large population of students struck by a tragedy. And Herrera found school-age students had fewer hang-ups about going through therapy communicating through a dialog window on their phone or laptop.

She also pointed to a delta variant surge this summer that hit Florida particularly hard just as the CDC advised the vaccinated could stop wearing masks and schools prepared to return to full in-school learning, a reminder that one can never tell when the need for remote counseling will instantly arrive anew. “We know telehealth reduces barriers,” she said. “It can reduce convenience barriers, and it reduces cost barriers for some families to access mental health. The great news is it’s no longer the same technical challenge.”