How School Reopenings Amid the COVID-19 Pandemic Boosted Children's Mental Well-being

Evidence Linking School Reopenings to Improved Children’s Mental Health in the COVID-19 Pandemic

The reopening of classrooms across the United States during the COVID-19 pandemic has been associated with measurable changes in youth wellbeing. A large quasi-experimental study from researchers at Harvard T.H. Chan School of Public Health examined administrative health claims and school reopening timelines in California and found clear reductions in mental health diagnoses after students returned to in-person learning.

That analysis followed 185,735 children aged five to eighteen between March 2020 and June 2021 and compared mental health outcomes across districts that reopened earlier versus later. The study documented an increase in the overall proportion of children with a diagnosis from 2.8% to 3.5% during the pandemic interval, but importantly demonstrated that children in districts that resumed in-person learning experienced reduced probabilities of new diagnoses after reopening.

Key statistical findings and what they mean

By the ninth month following a district’s reopening, the probability of a child receiving a mental health diagnosis was reduced by 43% compared with the pre-reopening period. The declines were observed across several categories, including depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). Health care spending tied to these diagnoses also fell: non-drug medical spending declined by 11%, psychiatric medication spending by 8%, and ADHD-specific drug spending by 5%.

These figures point to both clinical and economic dimensions of the recovery in children’s mental health that coincided with the restoration of regular educational routines. The findings were published in Epidemiology on December 8, 2025, and supported by funding from the National Institutes of Health.

A real-world illustration: Aisha’s story

Consider the fictional case of Aisha, a tenth grader in suburban California. During school closures she experienced disrupted sleep, increased screen time, and a sense of isolation. Her parents observed academic decline and anxiety symptoms that prompted an evaluation.

After her school reopened, Aisha regained structure, access to counseling from the school wellness team, and daily peer contact. Within months teachers reported improved engagement and her clinician reduced medication reliance. Aisha’s case mirrors the cohort-level patterns found in the study and shows how educational environments can be therapeutic settings.

Large sample size and administrative claims provided objective outcome measures.
Variation in reopening timing across districts created a natural experiment.
Reductions in diagnosis and spending were evident within months after reopening.
Effect sizes were particularly notable among girls, suggesting gendered pathways.

Limitations remain: much of the sample was enrolled in commercial insurance and lived in higher-income areas, so the full equity picture requires further study. Still, these results strengthen the evidence base that school reopenings played a central role in restoring mental well-being for many students during the pandemic.

Insight: Robust administrative evidence shows that returning to in-person schooling during the COVID-19 pandemic was linked to rapid and meaningful improvements in children’s mental health and related spending.

Mechanisms: How In-Person Schooling Restores Mental Well-Being and Supports Child Psychology

Understanding why school reopenings were associated with better mental health requires exploring mechanisms in child psychology and social functioning. Schools are more than sites of academic learning; they provide predictable routines, social scaffolding, and access to support services that collectively sustain mental well-being.

During periods of closure, many children experienced disruptions in sleep schedules, diet, and daily structure. These routine losses amplify stress responses and can precipitate anxiety or depressive symptoms. Reinstating regular school days reintroduces predictable timing, peer interaction, and teacher oversight—all potent buffers against the destabilizing effects of a prolonged public health crisis.

Core pathways by which in-person school supports mental health

Several interlocking mechanisms explain the observed declines in diagnoses after reopening. Each mechanism carries implications for practice and policy.

Social interaction: Regular face-to-face peer contact restores belonging and reduces isolation.
Routine and structure: Fixed schedules regulate sleep, mealtimes, and homework rhythms.
Access to services: School-based counseling and special education services become accessible again.
Monitoring and early intervention: Teachers and school nurses can identify emerging issues sooner.
Reduced household stress: Schools relieve caregiving burdens and economic trade-offs for families.

For example, a middle school counselor who sees students five days a week can spot behavior changes, escalate supports, or connect families to community resources. This level of monitoring is hard to replicate via sporadic telehealth or during remote learning periods.

Gendered responses and social environments

The California study found that girls experienced larger mental health gains after reopening. From a child psychology perspective, girls often rely heavily on social networks for emotional regulation during adolescence. Restored peer contexts, collaborative activities, and in-person group support likely reactivated coping pathways that were attenuated during closures.

Meanwhile, boys may show different symptom presentations, sometimes externalizing stress in ways less likely to be captured in traditional diagnostic patterns. That difference underscores the need for diverse in-school supports that address a spectrum of behaviors and emotional needs.

Peer relationships rebuild social skills and reduce loneliness.
Extracurriculars provide identity, purpose, and physical outlets for stress.
School meals and physical education support overall health and routine.

Reopenings also reduced reliance on emergency-driven responses by enabling proactive, school-led interventions. When schools function as hubs, they can coordinate with community mental health providers and primary care to create continuity for students who need long-term support.

Insight: The combination of social interaction, structured routines, and accessible school-based services explains much of the mental health recovery seen after school reopenings during the pandemic.

Unequal Effects: What Reopening Data Reveal About Equity, Access, and the Pandemic Impact

Not all students experienced the same pandemic trajectory, and the mental health benefits of reopening varied across communities. The California study highlighted that its sample largely reflected children in commercially insured, higher-income areas, so the observed gains may differ in magnitude for marginalized populations.

Children in low-resource settings often faced steeper pandemic impacts: crowded housing, parental job loss, limited broadband for remote learning, and reduced access to school-based supports. These contextual differences influenced both the severity of initial harms and the speed of recovery once in-person operations resumed.

Factors that drive unequal recovery after school reopenings

To design equitable policies, educators must parse the structural drivers of disparate outcomes. Key factors include differential access to mental health care, variability in school resources, and broader socioeconomic stressors that persist even after reopening.

Health care access: Students without reliable insurance or community providers may have unresolved needs.
School funding: Under-resourced districts may lack counselors, nurses, or programs to scale recovery efforts.
Language and cultural barriers: Families may face obstacles connecting to services or interpreting guidance.
Conflict and displacement: Students in areas affected by instability (e.g., conflict zones) face compounded challenges.

Global perspectives from 2025 show similar patterns. Efforts like humanitarian education programs emphasize that returning to school after crises can restore hope and routine, but the process requires targeted supports. For practitioners seeking context-specific resources, work on emergency-education initiatives provides useful models for reintegration.

Local examples also matter: in certain regions, child-care shortages and workforce instability shaped how families managed school reopenings. Policy briefs documenting these crises offer concrete evidence for bolstering early learning systems and family supports during recovery phases.

Partnerships with community agencies amplify school capacities.
Mobile mental health teams can reach students in underserved neighborhoods.
Flexible funding streams enable rapid deployment of school-based services.

Equity requires intentional design: reopening plans that assume equal baseline access will widen disparities. Thoughtful implementation includes targeted outreach, culturally responsive care, and investment in the districts most strained by the pandemic.

Insight: The pandemic impact was uneven, and maximizing the mental health benefits of school reopenings requires policies that explicitly focus on equity and access.

Practical Strategies for Schools and Parents to Sustain Mental Well-Being After Reopening

Translating evidence into practice means equipping schools and families with concrete strategies that support student mental health. The dataset showing declines in diagnoses and spending post-reopening points to interventions that can be scaled and adapted.

Below are actionable recommendations drawn from research, practice, and frontline examples in educational settings. Each recommendation includes an explanation, steps for implementation, and an illustrative anecdote.

Strategy 1: Strengthen school-based mental health services

Reopenings are opportunities to expand counseling, screening, and referral pathways. Schools should increase the number of trained counselors, adopt universal social-emotional screenings, and create clear referral protocols for community providers.

Implement weekly check-ins for students identified as at-risk.
Train teachers in trauma-informed pedagogies and classroom management.
Establish partnerships with local mental health agencies for stepped care.

A suburban district leveraged grant funds to add two counselors and a part-time school psychologist, lowering caseloads and improving follow-up with families.

Strategy 2: Rebuild routines and hybrid supports

Routines are protective; even small measures—consistent start times, designated wellness periods, and structured recess—make a difference. Hybrid models that combine in-person and targeted remote supports can preserve access for students who cannot attend daily.

Create daily advisory periods focused on social-emotional learning.
Offer telehealth options for medication management and therapy follow-up.
Provide resources for healthy sleep and screen-time habits to families.

Parents reported improved sleep and reduced anxiety in children after the school standardized a 20-minute daily advisory focused on coping skills.

Resources and partnerships to consider

Practical supports often come from local collaborations. Resources on early learning, literacy, and accountability measures provide guidance for schools navigating recovery. Schools that connect with community child-care programs and literacy initiatives accelerate holistic recovery for students and families.

Use program guides for early learning to strengthen transitions for younger children: early learning resources.
Integrate evidence-based literacy supports that reduce academic stress: boosting children’s literacy.
Address systemic barriers with accountability and review: policy accountability analyses.

For parents, small daily practices—open conversations about feelings, consistent sleep schedules, and family routines—reinforce what schools are rebuilding. For schools, prioritizing emotional support alongside academic catch-up is essential to avoid trade-offs that hurt children’s mental health.

Insight: Coordinated, practical strategies that combine school-based services, family engagement, and community partnerships sustain the mental health gains associated with reopening.

Policy Lessons for Public Health and Educational Environments in Future Emergencies

Evidence from the pandemic-era reopenings carries forward a set of policy lessons for balancing infection control with the imperative to protect youth mental health. Decision-makers must integrate public health planning with educational continuity to preserve the networks that underpin child development.

The Harvard-led research underscores a key principle: schools are essential infrastructure for both learning and mental health. In future emergencies, policies should prioritize safe, equitable strategies for keeping schools operational whenever possible while safeguarding public health.

Core policy recommendations

Policymakers can translate lessons into concrete actions across planning, funding, and accountability domains.

Prioritize safe reopening: invest in ventilation, testing, and vaccination access so schools can remain open safely.
Fund school mental health: allocate sustained resources for counselors, psychologists, and social workers.
Ensure equity: target supports to under-resourced districts and marginalized groups.
Embed flexibility: create protocols for hybrid learning that maintain continuity of support services.
Monitor outcomes: use administrative data to track mental health trends and resource needs.

Budgetary lessons are also important: the study found reduced health care spending associated with reopened schools, suggesting that investments in safe operations and student supports can yield downstream savings. Decision-makers should consider these cost-offsets when weighing the full societal costs of prolonged closures.

International and humanitarian implications

The imperative to reopen safely extends beyond high-income contexts. In conflict-affected regions, restoring schooling can rebuild civic trust and psychosocial recovery. Programs that supply basic learning materials and psychosocial first aid have been central to recovery efforts in multiple humanitarian settings.

Education in emergencies must integrate psychosocial and academic recovery.
Humanitarian education programs emphasize continuity and community trust.
Documentation of best practices, including case studies from global initiatives, informs domestic policy design.

For policymakers and educators seeking examples of targeted responses, case studies of school-based relief and child-focused initiatives provide blueprints for integrating educational continuity with mental health supports. Reports on child-care system strain and regional crises offer cautionary lessons about the cascading effects of closures and insufficient supports.

Insight: A public health approach that centers schools as critical support systems—resourced, equitable, and adaptable—will better protect children’s mental well-being in future emergencies.

For further reading on educational responses in fragile contexts and practical outreach efforts, see initiatives that combined schooling with psychosocial supports and resource distribution, such as programs providing school supplies in crisis settings and reviews addressing educational continuity amid conflict: school backpack initiatives and education amid conflict guidance. For regional system stresses in the United States, analyses of child-care crises highlight how interconnected services influence school operations: child-care crisis reporting.