Mental health struggles are driving more college students to consider dropping out, survey finds | CNN


Isabel, a 20-year-old undergraduate student, is no stranger to hard work. She graduated high school a year early and spent most of 2021 keeping up with three jobs. But when she started college that fall, she felt like she was “sinking.”

She knew that she wasn’t feeling like herself that first semester: Her bubbly personality had dimmed, and she was crying lots more than she was used to.

It all came to a head during a Spanish exam. Isabel, who identifies as both Latina and Black, overheard a video that other students were watching about racism in her communities. Negative emotions swelled, and she had to walk out without finishing the test. She rushed back to her room, angry and upset, and broke her student card when hitting it on the door to get in.

“And I just started having a full-blown panic attack,” she said. “My mind was racing everywhere.”

Isabel says she begged her parents to let her stay on campus, but they insisted that she make the three-hour drive home, and she soon took a medical withdrawal.

A new survey shows that a significant number of college students struggle with their mental health, and a growing share have considered dropping out themselves.

Two out of 5 undergraduate students – including nearly half of female students – say they frequently experience emotional stress while attending college, according to a survey published Thursday by Gallup and the Lumina Foundation, a private independent organization focused on creating accessible opportunities for post-secondary learning. The survey was conducted in fall 2022, with responses from 12,000 adults who had a high school degree but had not yet completed an associate’s or bachelor’s degree.

More than 40% of students currently enrolled in an undergraduate degree program had considered dropping out in the past six months, up from 34% in the first year of the Covid-19 pandemic, the survey found. Most cited emotional stress and personal mental health as the reason, far more often than others like financial considerations and difficulty of coursework.

Young adult years are a vulnerable time for mental health in general, and the significant changes that often come with attending college can be added stressors, experts say.

“About 75% of lifetime mental health problems will onset by the mid-20s, so that means that the college years are a very epidemiologically vulnerable time,” said Sarah K. Lipson, an assistant professor at Boston University and principal investigator with the Healthy Minds Network, a research organization focused on the mental health of adolescents and young adults.

“And then for many adolescents and young adults, the transition to college comes with newfound autonomy. They may be experiencing the first signs and symptoms of mental health problems while now in this new level of independence that also includes new independence over their decision-making as it relates to mental health.”

An estimated 1 in 5 adults in the United States lives with a mental illness, and young adults between the ages of 18 and 25 are disproportionately affected. The share of college students reporting anxiety and depression has been growing for years, and it has only gotten worse during the Covid-19 pandemic.

An analysis of federal data by the Kaiser Family Foundation shows that half of young adults ages 18 to 24 have reported anxiety and depression symptoms in 2023, compared with about a third of adults overall.

Mental health in college is critically important, experts say.

It’s “predictive of pretty much every long-term outcome that we care about, including their future economic earnings, workplace productivity, their future mental health and their future physical health, as well,” Lipson said.

And the need for support is urgent. About 1 in 7 college students said that they had suicidal ideation – even more than the year prior, according to a fall 2021 survey by the Healthy Minds Network.

Isabel knew that she was struggling, but it took a while to realize the extent of her mental health challenges.

“The number one thing I struggled with was feeling overwhelmed and like I had space to even remember to eat,” she said. “People were like, ‘You don’t know how to take care of yourself.’ But no – I had five papers due, and assignments, and I also had to work and go to [class] on top of that. And then I also had to find time to sleep. Most of the time, I was chugging an energy drink. And God forbid if you have a social life.”

For Isabel, as with many college students, thinking about or deciding to leave a degree program because of mental health challenges can often bring its own set of negative emotions, such as anxiety, fear and grief.

“For a lot of students, this isn’t what they saw their life looking like. This isn’t the timeline that they had for themselves,” said Julie Wolfson, director of outreach and research for the College ReEntry program at Fountain House, a nonprofit organization that works to support people with mental illness.

“They see their friends continuing on and becoming juniors and seniors, graduating and getting their first job. But they feel stuck and like they’re watching their life plan slipping away.”

It can create a sort of “shame spiral,” Lipson said.

But mental health professionals stress the importance of prioritizing personal needs over the status quo.

“There’s no shame in taking some time off,” said Marcus Hotaling, a psychologist at Union College and president of the Association of University and College Counseling Center Directors.

“Take a semester. Take a year. Get yourself better – whether it be through therapy or medication – and come back stronger, a better student, more focused and, more importantly, healthier.”

They also encourage higher education institutions to help ease this pressure by creating policies that simplify the process to return.

“When a student is trying to do the best thing for themselves, that should be celebrated and promoted. For a school to then put up a ton of barriers for them to come back, it makes students not want to seek help,” Wolfson said.

“I would hope that in the future, there could be policies and systems that are more welcoming to students who are trying to take care of themselves.”

Appropriately managing mental health is different for each person, and experts say a break from school isn’t the best solution for everyone.

Tracking progress through self-assessments of symptoms and gauges of functioning, like class attendance and keeping up with assignments, can help make that call, said Ryan Patel, chair of the American College Health Association’s mental health section and senior staff psychiatrist at The Ohio State University.

“If we’re making progress and you’re getting better, then it could make sense to think about continuing school,” he said. “But if you’re doing everything you can in your day-to-day life to improve your mental health and we’re not making progress, or things are getting worse despite best efforts, that’s where the differentiating point occurs, in my mind.”

Understanding the support system a student would have if they return home, including access to resources and treatment providers, is also a factor, he said.

For a while, experts say, it was a challenge to articulate the problem and build the case for broader attention to the mental health of college students. Now, the mental health of students is consistently cited as the most pressing issue among college presidents, according to a survey by the American Council on Education.

As the need for services increases, however, college counseling centers are struggling to meet demand – and the shortage of mental health professionals doesn’t stop at the edge of campus.

But colleges are uniquely positioned to surround students with a close network of support, experts say. Taking advantage of that structure needs buy-in to create a broader “community of care.”

“Colleges have an educational mission, and I would make the argument that spreads to education about health and safety,” Hotaling said.

College faculty should be trained in recognizing immediate concerns or threats to a student’s safety, he said. But they should also understand that students can face a range of mental health challenges and know the appropriate resource to direct them to.

Isabel recently graduated from Fountain House’s College ReEntry program and is back at school – this time at university that’s a little closer to home, one that a close friend from high school also attends. It helps her to know that she has a strong friend group to support her and an academic program that supports her professional goals – to become an art curator.

Things are still challenging this time around, but she says she feels like she now has the right tools to cope.

“This foundation I am building is constantly in need of maintenance. There’s like a crack every day,” she said. “Back when I was trying to figure everything out, I feel like I was looking for a screwdriver when I needed a hammer. Now, it’s not that I know I can handle it – but I know that I have the healthy coping mechanisms and strategies and people to help. That gave me confidence and stamina to do it again.”

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Teens Heal Differently Than Adults After Concussion

March 22, 2023 — Layla Blitzer, a 17-year-old high school junior in New York City, was playing field hockey for her school last October and was hit hard by the ball, right above her eye.

She sustained a serious concussion. She’s also had neck issues and headaches for the last 4 months. “They’re so severe I still need physical therapy for them,” she said.

At first, the staff at the opposing high school where she was playing didn’t realize she had a concussion. “Even the referee said, ‘You’re not throwing up, so you’re fine,’” Allison Blitzer, Layla’s mother, said. 

It was soon clear that Layla wasn’t “fine.” She consulted with a school-referred neurologist who diagnosed the concussion. 

Similar Symptoms, Different Severity

David Wang, MD, head team doctor at Quinnipiac University in Hamden, CT, said concussion symptoms — such as headaches, dizziness, visual disturbances, light and sound sensitivity, mood and cognitive problems, fatigue, and nausea — are similar between adolescents and adults. 

“But the symptom scores and severity are higher in adolescents, compared to younger kids and adults,” he said.

Moreover, the recovery time is longer. 

“The effects of an adult concussion, especially in men, may be around 7 days, but 3 to 4 weeks isn’t unusual in teenagers, and it can be even longer in female teens,” Wang, who is the director of Comprehensive Sports Medicine in Connecticut, said. 

The severity of symptoms, and how long they last, in teens “has to do with their stage of life because adolescents are going through puberty and in a rapid evolution phase, biologically, and are not neurologically mature,” he said. “The changes going on in their bodies may make them more vulnerable to the impact of a concussion, compared to younger children and adults.”

Similar to patterns found in adult women compared to men, girls tend to have more severe symptoms and a longer recovery, compared to boys — something Allison Blitzer was surprised to learn. Her older son has had sustained two concussions playing sports in high school, but after a couple of weeks, “he was fine and back at it.” Layla’s symptoms were more severe and long-lasting.

One of several possible reasons for the sex differences in concussion is that females generally have less neck strength, Wang said. Weaker neck muscles allow for more head acceleration following a blow, which results in greater forces to the brain. 

Working With a Teen’s Recovery Time

Layla attempted to go to school 3 days after the concussion, but “it didn’t go well,” she said. The bright classroom lights disturbed her eyes. And most of the instruction was digital, on a computer or a projector, and too much screen time causes eye strain and headaches following a concussion. 

“I couldn’t look up and I couldn’t do any of the work my class was doing,” Layla said. The noise stimulation in the lobbies, cafeteria, and elsewhere was overwhelming, too, so after 2 weeks, she stopped going to school.

Because Layla has several siblings, her home wasn’t consistently quiet either, so she isolated in her room.

“I fell behind in work,” Layla said, despite help from a concussion specialist who arranged with the school so Layla could have a reduction in workload, breaks, and extra time to complete assignments and exams.

Even after a few months, Layla was unable to keep up with her schoolwork. The school was “super supportive,” she said, but still didn’t understand how extensive her recovery time would be.

“It seemed like I was expected to be fully better much quicker. And although I’ve been improving, it’s almost 5 months since the injury and we’re in the middle of midterms, but I can’t take them because I’m still behind on my work,” Layla said.

In addition to headaches and memory issues, Layla experienced prolonged fatigue, which was worsened because of insomnia. The neurologist gave her medication for sleep, which helped the fatigue, but the headaches continued.

Finally, Layla consulted another specialist who was able to localize exactly where the headaches were coming from. He prescribed highly targeted physical therapy, which Layla attends twice a week.

“PT has been the most helpful for me and I’m finally beginning to catch up on my work, even though I’m still behind,” she says.

A recent analysis of eight studies (including almost 200 participants) looked at the effectiveness of physical therpay for post-concussion symptoms (such as headaches) in adolescents. 

The researchers found evidence that physical therapy is effective in treating adolescents and young adults following a concussion, and that it may lead to a quicker recovery compared to complete physical and cognitive rest, which are traditionally prescribed. 

Return to sports cannot be rushed, Wang said, not only because the person is still recovering and might not be “on top of their game” but because a second injury can be more harmful during recovery time.

“We call this “overlapping concussion syndrome,” he said. “The concussion is partially resolved, and the adolescent is functional enough to return to some playing, but then they get hit again. This complicates the situation and prolongs the recovery even more.”

‘Academic Quicksand’

Adolescence is a “challenging time,” Wang said. Teens are learning about themselves in the world, in school, and in their social group. An interruption in this process can disrupt the flow and make this process even more challenging.

“What we’ve seen with 2 years of teens who have missed school due to COVID is that they’re often not well adapted and not yet ready for the college environment,” Wang said. “These are critical maturation years. Similarly, when a teenager misses school or social activities due to a concussion, it increases the stress.”

Wang likens this to “academic quicksand,” and said, “it feels like the more the teenager struggles, the deeper they sink because the struggle itself can be so stressful.”

Layla can attest to this. 

“The stress of being behind, especially in a highly competitive academic environment, has definitely caused me a lot of anxiety,” she said. “I see everyone in my grade moving up and I’m still catching up on old math units, doing one old unit that the class had finished a long time ago, as well as the one everyone is working on now.”

Her mother said it’s hard for Layla to watch her friends go out on weekends and knowing that wherever they hang out is likely to be too loud and too bright for her while she’s still recovering. 

“This is an invisible injury and it’s hard to quantify or show someone else how much a person is suffering, so it’s very isolating,” she said.

Advocacy Efforts 

Layla is an intern at PINK Concussions, a nonprofit organization focused on concussions in women, where she advocates for other teenagers who have sustained concussions.

When she was playing field hockey, “we weren’t wearing goggles or helmets because the hockey league felt there wasn’t enough evidence to support wearing protective gear for girls,” Layla said.

Now she’s working with her school’s athletic director and with the director of other private schools to change her league’s rules so that protective gear will be required in field hockey games. 

“I think my concussion could have been prevented if I’d been better protected,” she said.

She’s also advocating for a more realistic back-to-school protocol. 

“Some teachers might worry that students with concussions might delay returning to school,” Katherine Snedaker, a licensed clinical social worker and founder of PINK Concussions, said. “But our research found that students want to be back in school so badly, they were minimizing their symptoms to get back to school/sport before they were ready. Students were not using their concussion as an excuse to stay out longer.” 

Layla said teachers “should be educated to expect that kids who have had a concussion may not be up to speed in work for some time. Some teachers may not be aware that recovery in girls and boys can be different. And they should know how to help a student successfully handle schoolwork again.”

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White House budget assumes student-debt forgiveness will move forward

Borrowers across the country are in financial limbo as they wait for the Supreme Court to decide whether the White House’s student-debt cancellation plan is legal. But the Biden administration’s own financial planning presumes the initiative will survive the courts.

As part of the Department of Education’s funding request to Congress for $2.7 billion for the Office of Federal Student Aid, officials took the costs and savings into account of President Joe Biden’s plan to cancel up to $20,000 in student debt for a wide swath of borrowers, Undersecretary of Education James Kvaal said on a conference call with reporters Thursday.

The “budget assumes that we will move forward,” with the plan, Kvaal said.

The fiscal-year 2024 funding request unveiled Thursday marks the latest salvo in a battle over the money Congress will give FSA. If the courts allow the Biden administration’s debt-relief plan to move forward, FSA would be charged with implementing it. That’s made FSA funding a flashpoint for congressional Republicans in recent months. But FSA is also responsible for almost every aspect of the financial-aid and student-loan system, something that could be put at risk if the office doesn’t get enough money from Congress.

Biden administration officials didn’t provide much detail on the call with reporters about how debt cancellation impacted the Department of Education’s request for funding for FSA. Implementing the debt-relief plan would likely be a cost, but wiping borrowers off the books could also save the agency money because there would be fewer accounts to deal with.

“My assumption is that if you take cancellation into account, the budget request would be smaller than it would be if you assume cancellation is not happening,” said Sarah Sattelmeyer, the project director for education, opportunity and mobility in the Higher Education Initiative at New America, a think tank.

That could create challenges if the court strikes down debt cancellation, she said. “The bottom line is, really we need to make sure there are sufficient resources for any situation that might happen with FSA,” she said. “That’s the most important because when there aren’t sufficient funds, students and borrowers bear the brunt of that.”

Like the IRS, FSA may not ‘seem sexy,’ but it’s important

Though FSA is not a household name, the office is in charge of all sorts of seemingly wonky tasks that touch almost every student and borrower. FSA oversees the Free Application for Federal Student Aid, which college students use to apply for loans and grants; it disperses student loans to borrowers; manages the companies collecting student-loan payments; monitors colleges for wrongdoing and more.

That’s why many researchers and student-loan borrower advocates were concerned when Congress level-funded FSA last year, despite a request from the Department of Education for an uptick of $800 million. Congressional Republicans touted the decision as providing “no new funding for the implementation of the Biden administration’s student-loan forgiveness plan.”

Dominique Baker, an associate professor of education policy at Southern Methodist University, compared FSA to the Internal Revenue Service. “It doesn’t always seem sexy,” to lawmakers to increase funding for these types of bodies, she said, but a lack of funds can have a real impact.

She cited delays in borrowers qualifying for relief under already existing programs as one impact of an underfunded FSA. Last year, the Department of Education said that student-loan servicers weren’t properly tracking the number of payments borrowers made toward qualifying for forgiveness under certain student-loan repayment plans.

“It is important to ensure that college is affordable,” Baker said. “It is sometimes easier to talk about funding pieces that make college more affordable than it is to talk about compliance and regulatory bodies that are ensuring that this one piece of paper that gets shuffled over to this other desk happens in a timely manner.” If it doesn’t, she added, “you will accidentally pay five months of extra loan payments past when your debt should have been canceled.”

Over the past few years, FSA has been asked to do even more than what’s typically required. Many of the Biden administration’s initiatives to improve the student-loan experience, including making it easier for borrowers to access Public Service Loan Forgiveness and proposing sweeping changes to the way borrowers repay their student loans, fall under FSA’s purview.

In addition, FSA is in the middle of overhauling its student-loan servicing contracts in an aim to provide a better experience for borrowers. Things like giving more direction to student-loan servicers about how they communicate with borrowers about their loans, and ensuring student-loan companies are more responsive to issues borrowers and regulators have raised in litigation, are part of that effort and will require resources, said Clare McCann, a higher-education fellow at Arnold Ventures.

“All of that is incredibly important to making sure borrowers are going to have a smooth transition back into repayment, when that does happen,” she said.

It’s too early to say which of these priorities could be at risk because of Congress’ decision to level-fund FSA last year, Sattelmeyer said. “We don’t have a great idea yet of the tradeoffs FSA is going to make, but they’re going to have to make tradeoffs,” she said.

For fiscal-year 2024, the Biden administration has asked for a $620 million increase over the amount that Congress enacted for fiscal-year 2023. And if FSA doesn’t get that funding increase, researchers and advocates worry the office will continue to have to make tradeoffs that could hurt students and borrowers.

“D.C. is and remains a political town,” Sattelmeyer said of the possibility that the department’s funding increase for FSA could fall victim to the same forces that scuttled it last year. “I can’t predict the future, but I can say that it is really important to message,” through the budget, “that FSA needs additional resources,” she said. “It’s also important for practitioners and advocates and others in this space to be pushing for additional resources.”

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French museum of feminist struggles aims to shed light on neglected histories

In a first for France, the University of Angers has announced plans for a museum of feminist struggles, drawing on its ample archival resources and expertise to give the history of women’s fight for emancipation and equal rights a permanent home.

France is home to several thousand museums, ranging from the world’s most visited – the Louvre in Paris – to more obscure venues dedicated to themes as diverse as absinthe, vampires and cork screws.

Look for a women’s history museum, however, and you will find none.

In its index of museums dedicated to women, an A to Z of more than 150 virtual and physical venues from Albania to Zambia, the International Association of Women’s Museums counts just one French entry: Muséa, an online exhibition platform launched in 2004 by a group of historians at the University of Angers in western France.

Almost two decades later, their dream of a full-scale, physical museum is starting to take shape, soon to be housed in the university’s library and archival centre, which has established itself as a leading French hub for research on feminist movements.

“France had fallen behind other countries in not having a women’s history museum, whereas our history is full of things to talk about!” said Christine Bard, a historian at the University of Angers and one of the project’s key instigators.

Bard recently curated an exhibition at the Carnavalet museum of Paris history chronicling two centuries of women’s battles for emancipation, from their overlooked role in the country’s revolutionary upheavals to the mass mobilisations for the right to vote, divorce or have abortions. She says the exhibition’s runaway success is evidence of growing public interest in the topic.

“We’re carried by a very favourable context, with a new wave of feminism spurred on by the #MeToo movement,” Bard explained. A museum documenting women’s struggles for emancipation will have “a clear social utility”, she added, at a time when feminist conquests are ushering in profound societal changes and still need consolidating.

‘Museum of women’s conquests’

The #MeToo wave has helped “generate huge interest in discovering the women whose ground-breaking contributions to science, politics and the arts have been largely forgotten by history”, said Magalie Lafourcade, a magistrate and human rights expert who has teamed up with Bard and others to work on the future museum.

She highlighted the glaring discrepancy between younger generations’ growing awareness of gender-based inequalities and the lack of attention afforded to such topics both in schools and museums.

In May last year, as feminists around the world reacted in shock at the US Supreme Court’s decision to strike down abortion rights, Lafourcade penned an op-ed in French daily Le Monde calling for the establishment of a “museum of women’s conquests”, envisioned both as an educational facility and a sanctuary for women’s rights. Such a place would help “legitimise women’s place in all fields of the arts and knowledge”, she wrote.

Lafourcade’s plea landed at the right time for the University of Angers, which had just secured a €10 million budget to renovate its library. The combination of abundant archival resources and a refurbished venue made it a natural candidate to house the first museum dedicated to the history of women’s emancipation in France.

The contours of the future Musée des féminismes were unveiled at a conference in Angers on Wednesday, March 8, timed to coincide with International Women’s Day. The plan is to get the first exhibitions up and running as early as next year, ahead of a full opening to the public in 2027.

Focus on fine arts

The forthcoming museum has revived a dormant project for Bard, coming two decades after officials in Paris asked her to work on plans for a women’s history museum in the French capital, only to abandon the project altogether.

Historian Nicole Pellegrin, who worked with Bard on the Muséa online platform, points to a mix of cultural and political reasons for the lack of women’s museums in France.

“French museums have long privileged the fine arts, often disconnected from the civilisations that gave birth to them,” she said. “On top of that, you have the anti-feminist tradition of a masculine political establishment that claimed women were sufficiently represented without the need for them to wield any power.”

>> ‘Françaises, Français’: Could the French language be less sexist?

Unlike in the United States, where women’s museums are often sponsored by advocacy groups, such private initiatives are unusual in France, said Bard. She noted that elsewhere in the world, “state-backed women’s museums sometimes tend to instrumentalise their struggles to fit a heroic, nation-building narrative”.

Sheltered in an academic environment, the planned Musée des feminismes is opting for a third way, she added, “free from political pressure and firmly anchored in rigorous, scientific research”.

Cultural outreach

For the university of Angers, the forthcoming museum is not just a welcome spotlight. It is also a chance to fulfil an obligation often neglected by French museums, said Nathalie Clot, who heads the university’s library and archives.

“France’s state universities have three missions: to teach, carry out academic research and foster ‘cultural dissemination’ among the broader public,” she explained. “The latter mission has only recently been rediscovered. Our audience should not only be academia.”

While Clot is accustomed to welcoming researchers in Angers, she is also stunned by the number of demands from members of the public who wish to visit the university’s archives on feminist movements. She pointed to the Glasgow Women’s Library, the UK’s only accredited women’s history museum, as a model to emulate, praising its rich collections and array of public events.

“Here in Angers we are lucky to have a wealth of documentary and archival material, as well as students and expert staff, and a building to house the lot,” Clot added. “Now we need the money to turn it into a museum.”

Spearheading the hunt for sponsors, Lafourcade says she has encountered “enthusiastic responses” at the ministerial and parliamentary levels. She is now waiting for them to translate into concrete funds.

Meanwhile, the museum’s instigators are celebrating the success of their first crowdfunding campaign, which will enable them to purchase a painting by Léon Fauret depicting the French feminist and suffragist Maria Vérone as she campaigns for the “rights of man” to be renamed as “human rights”.

Féminismes, plural

While the Musée des féminismes is hoping to acquire more artworks by and about women over the coming years, its instigators stress it will not be an art institute. They noted recent progress in giving female artists greater visibility in French museums, though adding that a lot more needs to be done.

Far from exonerating other museums from addressing gender-based discriminations, the museum in Angers hopes to complement such efforts, acting as a catalyst and a source of expertise.

“We’re seeing more and more exhibitions focused on women, but what is still lacking is a focus on women’s struggles for rights and exposure,” said Pellegrin. “We need a museum that shows women not just as victims, but as fighters.”

Highlighting the struggles of LGBT groups as well as racial, religious and other minorities will be equally important, said Lafourcade, stressing the need for an interdisciplinary approach to battles for rights and emancipation. She pointed to the Mémorial de la Shoah in Paris, France’s main Holocaust museum, whose broad range of activities and focus on other histories have bolstered its reputation as a hub for research and education.

The desire to be inclusive, and to tread carefully at a time of growing divisions between feminist movements, is reflected in the museum’s use of the plural form féminismes.

“Feminist movements have very different histories, focuses and sensibilities, and some have enjoyed very little exposure,” said Bard. “Our job is to respect, display and contextualise this diversity.”

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GoFundMe fundraisers for college tuition are up by more than 50% over last year

College students are increasingly turning to crowdfunding to help cover their education expenses, according to new data from the fundraising platform GoFundMe.

GoFundMe fundraisers for tuition money are up more than 50% compared to last year, and both college and trade school fundraising are up 30%, a GoFundMe spokesperson said.

The rise in students seeking donations comes as the cost of higher education is in the national spotlight. The U.S. Supreme Court this week heard arguments in two cases involving President Joe Biden’s stalled student-loan cancellation plan, which could help an estimated 40 million borrowers erase up to $20,000 each in student-loan debt.

The average published price for tuition, fees, room and board at a four-year private college is $53,430 for the 2022-23 school year, up from $51,690 in 2021-22, according to the College Board’s Trends in College Pricing and Student Aid report.

Tuition and fees at four-year private colleges are 4.5 times higher than they were in 1992-93. For in-state students at public four-year universities, the average published tuition, fees, room and board for 2022-23 is $23,520, up from $22,700 in the previous year.

Changes in the published price, or sticker price, “tend to garner the most media attention,” the College Board said in its report. “However, it is important to note that the majority of undergraduate students do not pay the full sticker price.”

College tuition hasn’t risen as fast as other prices amid roaring inflation, but higher education remains unaffordable in the U.S., and has been for a long time, said Robert Kelchen, a higher education professor at the University of Tennessee, Knoxville. The uptick in tuition-related GoFundMe campaigns is another sign that concern about college affordability is now “front and center” in Americans’ consciousness, more than it was five or 10 years ago, Kelchen said.

While schools have kept tuition increases relatively low over the past few years, other costs associated with college have shot up, especially living expenses, he noted. “Housing, dining, things like that, whether you’re on campus or off, they’ve both gotten more expensive,” Kelchen said.

Students use a combination of their own money, grants (which don’t have to be repaid), and loans to cover their education bills. More than half (54%) of bachelor’s degree recipients graduated with debt in 2020-21, and the average debt was $29,100, according to the College Board.

Reducing the financial burden

Reducing the financial burden created by higher education would require one or both of two major changes, Kelchen said. “You either have to give students more money to go to college, or you have to try to make providing an education less expensive, so spend less money per student on education.” He added, “It’s the same issue we run into with healthcare. The cost of providing it has gone up, and people don’t want to pay it. It’s expensive.”

The parallel to healthcare costs is relevant in the context of GoFundMe: people often turn to the platform for help paying medical bills, often after a surprise diagnosis or accident. Similar to how GoFundMe campaigns serve as financial Band-Aids for systemic issues, canceling student-loan debt would be a “temporary fix” that would not solve the root causes of why students take out debt, Kelchen noted.

GoFundMe promotes itself as a solution for cash-strapped students, referring to itself as “the leader in online education fundraising” on its site. It says it hosts more than 100,000 education fundraisers per year, raising more than $70 million annually. GoFundMe offers tips on how to host a successful fundraiser for college costs, suggesting that students promote their fundraiser to alumni of their school and share their “hopes and aspirations” in their fundraiser story.

Students considering using crowdfunding for college costs should first make sure they understand how their school will treat the money when calculating their financial aid package, said Karen McCarthy, vice president for public policy and federal relations at the National Association of Student Financial Aid Administrators. Donations made to personal GoFundMe fundraisers are generally considered to be “personal gifts” which, for the most part, are not taxed as income in the United States, a  GoFundMe spokesperson said. GoFundMe charges a transaction fee of 2.9% + $0.30 per donation.

Students who’ve sought donations on GoFundMe recently include a Sacramento nursing student who said she needed to pay off a $4,600 balance before she could take her exit exam and graduate from her program; a sophomore art student in Santa Fe who said an “unexpected circumstance” left him with a $3,176 fee bill; and a student looking for $3,800 to finish her culinary degree at a Virginia community college.

Several of the tuition-related campaigns on GoFundMe appear to be for students in financial straits because of unanticipated setbacks. One silver lining of the pandemic is that colleges and universities have become more equipped to help students cope with such financial emergencies, McCarthy said. That’s because when federal pandemic relief money was flowing to college campuses, schools handed out emergency grants to students. In tracking how the money was spent, schools learned a lot about the types of surprise costs that can sometimes force students to drop out of college, McCarthy said.

Pandemic relief money is gone now, but some schools have set up their own emergency grant funds to help students bridge sudden financial gaps. “A lot of institutions really became aware of the emergency needs that their students have and how they might move forward in meeting those needs,” McCarthy said. “The development of some of those emergency-aid programs may help students meet those needs so they don’t have to resort to things like crowdfunding.”

See also: This 72-year-old hopes to retire one day — as soon as she raises enough money on GoFundMe

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Why Elly Schlein is freaking out Italy’s ‘soft’ socialists

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Right-wing hardliners could not dream of an easier target than Elly Schlein, the new leader of Italy’s center-left Democratic Party (PD).

A global citizen with a female partner and an upper-middle-class upbringing, the youngest and first female leader of Italy’s most-established progressive party has sparked the ire of the country’s conservatives.

“CommunistElly,” the right-wing newspaper Il Tempo dubbed her after the leadership contest was decided on Sunday. Schlein defeated the favorite Stefano Bonaccini with 53.8 percent to 46.2 percent of the vote.

Far-right Prime Minister Giorgia Meloni’s allies have been relishing the polarization around Schlein — the two political leaders, though both female, stand for very different values.

“She promised to prioritize the poor, public education and workers,” right-wing commentator Italo Bocchino said in attacking Schlein. “But unlike Meloni, she has never known the poor in her life,” he continued, pointing out how she attended a private school “for rich people” in Switzerland. Nor can Schlein know workers “as she’s never worked in her life,” he ranted.

Schlein’s surprise win has not only fired up her opponents, but also unsettled many in her own party. Fellow social democrats are spooked that Schlein could transform the PD from the broad progressive church it’s historically been into a much more radical sect.

There’s also concern about whether she’ll stand by the party’s support for sending lethal weapons to Ukraine given her self-described pacifist views.

Most skeptics are clinging on — for now — although a few have already jumped ship.

“The PD is over,” declared David Allegranti, a journalist for the Florence daily La Nazione. The expert on the Italian center-left argues that Schlein and many of her allies hail from leftist splinter groups and were not members of the PD until barely a few months ago — discrediting them in their critics’ eyes.

Ex-Cabinet minister Giuseppe Fioroni, among the founding members of the PD, told POLITICO: “Her project has nothing to do with my history and my political culture.” Having foreseen the outcome, Fioroni left the party one day before Schlein’s victory was announced. “My PD is no longer there, this is another party — it no longer belongs to the center left, but to the hard left,” he said.

As a youth leader in 2013, Schlein became the figurehead of Occupy PD, a protest movement set up by disaffected progressives angered over 101 center-left parliamentarians who voted against their own social democrat grandee Romano Prodi’s bid to become the president of Italy.

“With Elly Schlein, the PD has occupied itself,” quipped Allegranti.

Ex-Cabinet minister and PD founding member Giuseppe Fioroni left the party one day before Schlein’s victory, saying that the party “no longer belongs to the center left, but to the hard left” | Claudio Peri/EPA

The young radical

The daughter of a Swiss-based political scientist couple (one Italian and one American), Schlein was raised in Lugano, the Italian-speaking region of Switzerland, and spent her teens writing film reviews — her dream at the time was to become a film director — as well as playing the board game “Trivial Pursuit” and the cult 90s video game “The Secret of Monkey Island.”

Her first stint in politics came in 2008, when she cut her teeth working as a volunteer for Barack Obama’s two U.S. presidential election campaigns — heading to Chicago to do so.

“Here, I understood that you don’t need to ask for votes, but mobilize people with ideas,” she recalled to La Repubblica. A decade on, the lesson proved useful for her own leadership campaign.

In a first for the PD’s leadership contests, Schlein won the open ballot after losing by a wide margin in the caucus with party members the week before, demonstrating her capacity to win over voters.

The newly elected leader gained the upper hand over Bonaccini in big cities such as Milan, Turin and Naples, as well as performing well almost everywhere north of Rome — but lost in most southern regions, according to pollster YouTrend.

“There was a wave of support that brought along different kinds of voters, who were united by a strong desire for change,” said Lorenzo Pregliasco, the founder of YouTrend.

However, Pregliasco played down reports of a “youthquake,” and described the leadership campaign as “boring, dull and largely ignored by public opinion.”

End of the party, or a new beginning?

While there are no exact figures on voter turnout available, Italian media reports that around 1.2 million people cast their ballots — which would mark the lowest figures since PD party primaries were first held in 2007.

After becoming a member of the European Parliament with the Socialists & Democrats group in 2014 at the age of 28, Schlein took the unexpected decision to abandon the PD a year later, accusing then-prime minister and PD party leader Matteo Renzi of lurching to the right.

The decision turned out to be prophetic, as Renzi suffered a number of electoral defeats that snowballed into his resignation as prime minister in 2016, and as party leader in 2018.

Pippo Civati, a former parliamentarian and longtime ally of Schlein who is now out of politics, recalled of Schlein in 2015: “We left at the same time because he [Renzi] was making one mess after another.”

Speaking to POLITICO, Civati warned that the newly elected leader could end up having her hands tied by party bigwigs who backed the popular politician without necessarily having any genuine commitment to her radical ideas.

Pundits point out that the conflict in Ukraine could be the trickiest issue for Schlein, whose distant ancestors hail from a village close to modern-day Lviv. There are question marks over whether she will carry forward her predecessor Enrico Letta’s all-out support for the delivery of lethal weapons to Ukraine.

A U-turn by Schlein on support for Ukraine would leave Meloni as the only national party leader in favor of sending arms to the besieged country, fueling concerns among Western allies who see Italy as a weak link.

“A change of line over Ukraine could be the trigger for many centrists to leave the PD,” Allegranti said.

But Civati played down rumors of an about-face, arguing that Schlein is unlikely to oppose the sending of arms to Ukraine.

“We support Ukraine’s right to defend itself, through every form of assistance,” said Schlein in a recent interview with broadcaster La7. “But as a pacifist, I don’t think that weapons alone will end the war.”

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Only 5.7% of US doctors are Black, and experts warn the shortage harms public health | CNN


When being truly honest with herself, Seun Adebagbo says, she can describe what drove her to go to medical school in a single word: self-preservation.

Adebagbo, who was born in Nigeria and grew up in Boston, said that as a child, she often saw tensions between certain aspects of Western medicine and beliefs within Nigerian culture. She yearned to have the expertise to bridge those worlds and help translate medical information while combating misinformation – for her loved ones and for herself.

“I wanted to go into medicine because I felt like, ‘Who better to mediate that tension than someone like me, who knows what it’s like to exist in both?’ ” said Adebagbo, 26, who graduated from Stanford University and is now a third-year medical school student in Massachusetts.

“The deeper I got into my medical education, the more I realized, if I’m in the system, I know how it works. I not only know the science, but I also know how the system works,” she said of how in many Black and brown communities, there can be limited access to care and resources within the medical system.

This has enabled Adebagbo to connect with patients of color in her rotations. She recognizes that their encounters with her are brief, she said, and so she tries to empower them to advocate for themselves in the health system.

“I know what to ask for on the patient side if I’m worried about something for myself. But then also, for my parents and my family,” Adebagbo said. “Because the way you have to move in the system as a Black person is very different, especially if you’re coming from a background where you don’t have family members that are doctors, you don’t know anyone in your periphery that went into medicine.”

Seun Adebagbo presenting her poster presentation as a first author at an international symposium and annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery.

Only about 5.7% of physicians in the United States identify as Black or African American, according to the the latest data from the Association of American Medical Colleges. This statistic does not reflect the communities they serve, as an estimated 12% of the US population is Black or African American.

And while the proportion of Black physicians in the US has risen over the past 120 years, some research shows, it’s still extremely low.

One reason why the percentage of US doctors who are Black remains far below that of the US population that is Black can be traced to how Black people have been “historically excluded from medicine” and the “institutional and systemic racism in our society,” said Michael Dill, the Association of American Medical Colleges’ director of workforce studies.

“And it occurs over the course of what I think of as the trajectory to becoming a physician,” Dill said. At young ages, exposure to the sciences, science education resources, mentors and role models all make it more likely that a child could become a doctor – but such exposures and resources sometimes are disproportionately not as accessible in the Black community.

“We can improve our admissions to medical school, make them more holistic, try to remove bias from that, but that’s still not going to solve the problem,” Dill said.

“We need to look at which schools produce the most medical students and figure out how we improve the representation of Black students in those schools,” he said. “That requires going back to pre-college – high school, middle school, elementary school, kindergarten, pre-K – we need to do better in all of those places in order to elevate the overall trajectory to becoming a physician and make it more likely that we will get more Black doctors in the long run.”

Many US medical schools have a history of not admitting non-Whites. The first Black American to hold a medical degree, Dr. James McCune Smith, had to enroll at the University of Glasgow Medical School in Scotland.

Smith received his MD in 1837, returned to New York City and went on to become the first Black person to own and operate a pharmacy in the United States, and to be published in US medical journals.

A few decades later, in 1900, 1.3% of physicians were Black, compared with 11.6% of the US population, according to a study published in the Journal of General Internal Medicine in 2021.

Around that time, seven medical schools were established specifically for Black students between 1868 and 1904, according to Duke University’s Medical Center Library & Archives. But by 1923, only two of those schools remained: Howard University Medical School in Washington and Meharry Medical School in Nashville.

In 1940, only 2.8% of physicians were Black, but 9.7% of the US population was Black; by 2018, 5.4% of physicians were Black, but 12.8% of the population was Black.

“The more surprising thing to me was for Black men,” said Dr. Dan Ly, an author of the study in the Journal of General Internal Medicine and assistant professor of medicine at the University of California, Los Angeles.

Data on only Black men who were physicians over the years showed that they represented 1.3% of the physician workforce in 1900, “because all physicians were pretty much men in the past,” Ly said. Black men represented 2.7% of the physician workforce in 1940 and 2.6% in 2018.

“That’s 80 years of no improvement,” Ly said. “So the increase in the percent of physicians who were Black over the past 80 years has been the entrance of Black women in the physician workforce.”

Over more than four decades between 1978 and 2019, the proportion of medical school enrollees who identify as Black, Hispanic or members of other underrepresented groups has stayed “well below” the proportions that each group represented in the general US population, according to a 2021 report in The New England Journal of Medicine.

Diversity in some medical schools also was affected in states with bans on affirmative action programs, according to a study published last year in the Annals of Internal Medicine. That study included data on 21 public medical schools across eight states with affirmative action bans from 1985 to 2019: Arizona, California, Florida, Michigan, Nebraska, Oklahoma, Texas and Washington.

The study found that the percentage of enrolled students from underrepresented racial and ethnic groups was on average about 15% in the year before the bans were implemented but fell more than a third by five years after the bans.

Now, the United States is reckoning with medicine’s history of racism.

In 2008, the American Medical Association, the nation’s largest organization of physicians, issued an apology for its history of discriminatory policies toward Black doctors, including those that effectively restricted the association’s membership to Whites. In 2021, the US Centers for Disease Control and Prevention declared racism a “serious public health threat.”

One encouraging datapoint says that the number of Black or African American first-year medical school students increased 21% between the academic years of 2020 and 2021, according to the Association of American Medical Colleges, which Dill said shows promise for the future.

“Does the fact that it’s higher in medical school mean that eventually we will have a higher percentage of physicians who are Black? The answer is yes,” he said.

“We will see the change occur slowly over time,” he said. “So, that means the percentage of the youngest physicians that are Black will grow appreciably, but the percentage of all physicians who are Black will rise much more slowly, since new physicians are only a small percentage of the entire workforce.”

But some medical school students could leave their career track along the way. A paper published last year in JAMA Internal Medicine found that among a cohort of more than 33,000 students, those who identified as an underrepresented race or ethnicity in medicine – such as Black or Hispanic – were more likely to withdraw from or be forced out of school.

Among White students, 2.3% left medical school in the academic years of 2014-15 and 2015-16, compared with 5.2% of Hispanic students, 5.7% of Black students and 11% of American Indian, Alaska Native, Native Hawaiian and Pacific Islander students, the study found.

The researchers wrote in the study that “the findings highlight a need to retain students from marginalized groups in medical school.”

During her surgical rotation in medical school, Adebagbo said, she saw no Black surgeons at the hospital. While having more physicians and faculty of color in mentorship roles can help retain young Black medical school students like herself, she calls on non-Black doctors and faculty to create a positive, clinical learning environment, giving the same support and feedback to Black students as they may provide to non-Black students – which she argues will make a difference.

“Despite the discomfort that may arise on the giver of feedback’s side, it’s necessary for the growth and development of students. You’re hurting that student from becoming a better student on that rotation, not giving them that situational awareness that they need,” she said. “That’s what ends up happening with students of color. No one tells them, and it seems as if it’s a pattern, then by the end of the rotation, it becomes, ‘Well, you’ve made so many mistakes, so we should just dismiss you [for resident trainees] or we can’t give you honors or high pass [for medical students].’ “

Seun Adebagbo, right, with the site director (second from left) and two peers on her last day of her surgery rotation.

Adebagbo says she had one site director, a White male physician, during her surgery rotation who genuinely cared, listened and wanted to see her grow as a person and physician.

“He has been the first site director who has legit listened to me, my experiences navigating third year as a Black woman and tried to understand and put it in perspective – a privilege I’m not afforded often,” Adebagbo said. “He made making mistakes, growing and learning from them a safe and non-traumatizing experience. Not everyone may understand the depths of what I’m saying, but those who do will understand why I was so grateful for that experience.”

But not all attending physicians are like her “mentor,” as she calls him.

For Dr. David Howard, one question haunted his thoughts in medical school.

During those strenuous days at Johns Hopkins University, when all-night study sessions and grueling examinations were the norm, his mind whispered: Where do I fit?

Howard, now a 43-year-old ob/gyn in New Jersey, reflects with pride – and candor – on the day in 2009 when he completed his doctoral degrees, becoming both an MD and a PhD.

At the time, “I felt like I didn’t fit,” Howard said. “I’m sure I’m not the only person who has thought those thoughts.”

Howard was one of very few men in the obstetrics and gynecology specialty, where most providers were women – and he is Black. He saw very few peers who looked like him and extremely few faculty in leadership positions who looked like him.

“When you’re going through a really difficult training program, it makes a big difference if there are people like you in the leadership positions,” he said, adding that this contributes to the disproportionate number of Black medical school students and residents who decide to leave the profession or are “not treated equally” when they may make a mistake.

Early on in his career, Howard shifted his thinking from “Where do I fit?” to “How do I fit?”

He even authored a paper in 2017, published in the American Journal of Obstetrics and Gynecology, about this self-reflection.

“Only slightly different semantically, the second question shifts focus away from the ‘where’ that implies an existing location. Instead, ‘how’ requires me to illustrate my relationship with existing labels and systems, rather than within them, allowing a multitude of answers to my question of ‘how do I fit?’ ” Howard wrote.

“Despite the challenges and realities of the medical field today, I fit wherever and however I can, actively shaping my space and resisting the assumptions that first prompted me to ask where I fit,” he said. “To finally answer my question: I don’t fit, but I am here anyway.”

The United States has made “some progress” with diversity in both clinical medicine and research – but diversity in medicine is still not at the point where it needs to be, said Dr. Dan Barouch, a professor at Harvard Medical School and director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, who has been an advocate for diversity and inclusion.

That point, essentially, would be where diversity in the physician workforce reflects the diversity in their patient population.

“It’s particularly important to have a diverse physician workforce to aptly serve the patients,” Barouch said. “We want to increase diversity in academia as well, but it’s particularly important for doctors, because having a diverse workforce is critical for the best patient encounters, and to build trust.”

Service to patients and patient trust are both among the cornerstones critical to the status of public health, according to researchers.

One example of broken trust between physicians and Black patients happened in the 1930s, when the US Public Health Service and the Tuskegee Institute launched an unethical study in which researchers let syphilis progress in Black men without treating them for the disease. The study ended in 1972.

Among Black men, “there were declines in health utilization, increases in medical mistrust and subsequent increases in mortality for about the 10- to 15-year period following the disclosure event,” when the true nature of the study was exposed in 1972, said Dr. Marcella Alsan, an infectious disease physician and professor of public policy at Harvard Kennedy School.

Yet research suggests that when Black physicians are treating Black patients, that trust can be rebuilt.

For instance, the impact is so significant that having Black physicians care for Black patients could shrink the difference in cardiovascular deaths among White versus Black patients by 19%, according to a paper written by Alsan while she was attending Stanford University, along with colleagues Dr. Owen Garrick and Grant Graziani. It was published in 2019 in the American Economic Review.

That research was conducted in the fall and winter of 2017 and 2018 in Oakland, California, where 637 Black men were randomly assigned to visit either a Black or a non-Black male doctor. The visits included discussions and evaluations of blood pressure, body mass index, cholesterol levels and diabetes, as well as flu vaccinations.

The researchers found that, when the patients and doctors had the opportunity to meet in person, the patients assigned to a Black doctor were more likely to demand preventive health care services, especially services that were invasive, such as flu shots or diabetes screenings that involve drawing blood.

“We saw a dramatic increase in their likelihood of getting preventive care when they engage with Black physicians,” said Garrick, who now serves as chief medical officer of CVS Health’s clinical trial services, working to raise awareness of how more diverse groups of patients are needed to participate in clinical research.

Initially, “it didn’t look like there was a strong preference for Black doctors versus non-Black doctors. It was only when people actually had a chance to communicate with their physicians, talk about ‘Why should I be getting these preventative care services?’ ” Alsan said.

The researchers analyzed their findings to estimate that if Black men were more likely to undergo preventive health measures when they see a Black doctor, having more Black doctors could significantly improve the health and life expectancy of Black Americans.

The nation’s shortage of Black physicians is concerning, experts warn, as it contributes to some of the disproportionate effects that infectious diseases, chronic diseases and other medical ailments have on communities of color. This in itself poses public health risks.

For example, in the United States, Black newborns die at three times the rate of White newborns, but a study published in 2020 in the Proceedings of the National Academy of Sciences found that Black infants are more likely to survive if they are being treated by a Black physician.

Black men and Black women are also about six to 14.5 times as likely to die of HIV than White men and White women, partly due to having less access to effective antiretroviral therapies. But Black people with HIV got such therapies significantly later when they saw White providers, compared with Black patients who saw Black providers and White patients who saw White providers in a study published in 2004 in the Journal of General Internal Medicine.

And when Black patients receive care from Black doctors, those visits tend to be longer and have higher ratings of patients feeling satisfied, according to a separate study of more than 200 adults seeing 31 physicians, published in 2003 in the journal Annals of Internal Medicine.

“There’s plenty of evidence, and other research has shown that the more the workforce in a health care setting really reflects the community it serves, the more open the patient population is to recommendations and instructions from their doctor,” said Dr. Mahshid Abir, an emergency physician and a senior physician policy researcher at the RAND Corp., a nonpartisan research institution.

But it can be rare to find health systems in which the diversity of the workforce reflects the diversity of the patients.

During her 15-year career as an emergency physician, Abir said, she has worked in many emergency departments across the United States – in the Northeast, South and Midwest – and in each place, the diversity of the health care workforce did not mirror the patient populations.

This lack of diversity in medicine is “not talked about enough,” Abir said.

“The research that’s been conducted has shown that it makes a difference in how well patients do, how healthy they are, how long they live,” she said. “Especially at this juncture in history in the United States, where social justice is in the forefront, this is one of the most actionable places where we can make a difference.”

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French teachers open up about integrating Ukrainian students into the school system

Since Russia began its invasion of Ukraine on February 24 last year, thousands of Ukrainian refugees have enrolled in the French school system. As they adapt to their new daily routine, their teachers look back at how the integration process went.

On her first day of school, Yulia cried rivers. It was the March 28, 2022, a little over a month since her home country Ukraine was invaded by Russia. Squeezing her mother’s hand tightly, it took Yulia’s teacher Marie-Laure* several attempts to peel her away and bring her through the doors of her new primary school thousands of kilometres from home, in an eastern Parisian suburb.

Slightly reassured that her mother would come see her at lunchtime, the 9-year-old hesitantly took a seat and put down her school bag. Marie-Laure introduced her to her classmates and Yulia seemed to relax, but only for a short while. The reality that this was her new life, that these were her new peers and that she wouldn’t be spending 24/7 with her mum quickly began to sink in. Yulia welled up, again.

“She would scream, cry and beg me to call her mum,” says Marie-Laure, who has been working as a specialised teacher in Seine-Saint-Denis for five years. Although it was a difficult time, she understood Yulia’s anxiety. “You suddenly find yourself in a setting where nobody speaks your language or understands you. That’s bound to bring on a lot of fear and frustration. Add to that being uprooted from your country, which is at war… Well, it mustn’t be easy.”

*Name has been changed to maintain confidentiality

Back to school

Since the war in Ukraine began on February 24, 2022, France has enrolled 17,677 Ukrainian students like Yulia in its primary, secondary and high schools. Most of them have joined classrooms in the Ile-de-France region, which is home to three local education authorities: Paris, Versailles and Créteil.

Ukrainian refugee pupils have been placed in schools with special UPE2A units, programmes designed to accommodate foreign children who don’t speak French. Led by teachers like Marie-Laure, these classes help newcomers ease into the French school system gradually, giving them time to familiarise themselves with the language and their classmates.

Over the course of a year, UPE2A students take 21 hours of traditional classes like French, maths, history, English and geography. After the first month, they are allowed to join their francophone peers in sessions that don’t require a school bag (“classes sans cartable”), like P.E., music, or arts and crafts. If by the end of the first year they have reached a high enough level to enter the French school system, they are integrated into a francophone classroom. If not, they can continue the UPE2A programme for one more year. In other words, non-French speakers have two years to catch up.

>> Paris schools prepare to take in refugee children from Ukraine

“It’s essential that the student is integrated into the French school system after those two years,” says Nicolas Monteil, a UPE2A teacher at the Blanc-Mesnil secondary school, northeast of Paris. “Especially when secondary school ends, because that’s when students make their [high school] course choices,” he says.

In France, students can choose to attend three types of high schools: lycée général (academic training), lycée technique (arts, applied sciences or technical training) or lycée professionnel (vocational training).

A bumpy start

“UPE2A teachers only meet their new students once all the procedures have been completed,” says Fatima Messaoudi, a school mediator who works at the academic centre (CASNAV) in Paris where newly arrived “allophone” students take their entrance exams.

Ukrainian families, like any other refugee family in France, have many hoops to jump through before they can enrol their children in the school system. “They are obliged to meet with a social worker, find housing, translate documents, find a job and then sign their children up for their placement tests,” says Messaoudi. “It can be a lengthy process.”

Luckily for Yulia and her family, things moved quite rapidly, and she was enrolled in Marie-Laure’s class only one month after setting foot in Paris. The 9-year-old’s father had already been living in France for 10 years so could help with translations and navigating the country’s labyrinthine bureaucracy. Still, integrating into a new primary school was difficult for Yulia.

“I spent hours making sure both Yulia and her family felt at ease, but the panic attacks and crying fits didn’t stop,” says Marie-Laure. With the consent of her parents, Marie-Laure eventually escalated the child’s distress to the school director, who agreed that psychological support was the best course of action for little Yulia.

In April 2022, “the director contacted a special number set up by the French government for Ukrainians, but it was too early,” says Marie-Laure. “The phone number didn’t work, it was an empty shell.”

A few kilometres west in a suburb northeast of Paris, Nicolas Monteil tells of his experience welcoming three Ukrainian boys into his classroom. He has been working as a UPE2A specialised French teacher in Blanc-Mesnil for six years.

“Ivan, Volodymyr and Arthur all arrived at different times,” he says. The two older boys Volodymyr, 12, and Arthur, 13, joined his class in February and September 2022. Ivan, the youngest who is 11, only started two weeks ago despite having arrived in France last year.

Monteil acknowledges that it takes time to get settled, but says the administrative system is also to blame. “Some students arrive in France and wait six months to be enrolled in a school,” he says. “That’s because there aren’t enough UPE2A units for the amount of requests that come in, especially in Seine-Saint-Denis. It’s one of the poorest departments in France, with a high population of non-French speakers, so we’re under a lot of pressure.”

As a result, Monteil never has a full classroom at the start of the school year in September, and his students all have different levels in French. While Volodymyr is getting along well, he has difficulties with pronunciation. Arthur, on the other hand, is “very comfortable” in the classroom and “stops making an effort when he thinks he has understood something”, his teacher says. And as for Ivan the newcomer, he has trouble writing.

The boys’ fathers, unlike Yulia’s, all stayed behind to fight the war in Ukraine. With no one to help translate, Monteil had to improvise strategies to introduce his students and their families to the school. “There’s always another student or a family friend that can help out,” he says, “But you can also count on the pupils themselves. They’re very intelligent, they’ll find ways to understand, and be understood.”

The French government doesn’t provide schools with allocated translators, so teachers are often left to their own devices when welcoming non-francophone students in their classrooms.

Challenges, victories and differential treatment

“After about two weeks, Yulia began to feel at ease,” Marie-Laure says, letting out a sigh of relief. Along with the homeroom teacher who would eventually become Yulia’s main point of reference, Marie-Laure worked hard to ensure she was surrounded by as many familiar faces as possible. “We worked as a team and made sure she was getting the attention she needed”.

Just two months after her arrival, Yulia took part in a theatrical production the students put on for their families at the end of the school year in June. “She was playing the clown, expressing herself fully, laughing… It was beautiful to see,” says Marie-Laure, beaming with pride. Being trilingual in Russian, Ukrainian and Romanian before arriving in Paris helped little Yulia pick up the French language quite quickly.

It’s been less than a year since she started school and Yulia is almost fully integrated. Now Marie-Laure only teaches her for one and a half hours a day, a massive improvement from last year. “She’s excelled so quickly, her level is even higher than some of her peers who have been with me for a long time,” says her teacher. “Being trilingual helps, I guess!”

Volodymr, Ivan and Arthur have all made improvements since they arrived too, Nicolas Monteil smiles. “There are Moldovan students who speak Russian and one Russian student. The boys also speak Russian, which allows them all to communicate,” he says, “I was slightly concerned about the Russian student coming in, but they all became friends right away. That’s what’s great about kids. The context of war doesn’t stop them from building relationships.”

Monteil has organised an end-of-year project focussed on cinema, where he asks his students to make short films that mimic a specific style in film history. “As soon as we started working with the cameras, recording interviews, Volodymyr lit up,” he says, citing this moment as a victory. “It’s always a joy to see a student open up. It’s these small things that make all the difference as a teacher.”

Although Monteil and Marie-Laure have had different experiences in welcoming their Ukrainian students, they both share a frustration at the differential treatment these students received after fleeing their home countries. When the war broke out, the French government published an online pamphlet for teachers, created a special school reception plan for Ukrainian refugees and opened up an academic hotline (that is now fully functioning).

“I never had any support for the reception of my other students,” says Marie-Laure. “It’s great for Ukrainians. I’m really glad that all of that help was available, but some kids have parents who were almost killed, who come from countries like Afghanistan or Bangladesh where there are serious conflicts. There’s a sense of injustice, and that reaches beyond the school system,” she says.

“It was the first time we were prepared to receive new pupils,” says Monteil. “We received documents explaining Ukrainian culture, characteristics of the language, all kinds of things. That doesn’t necessarily happen with other nationalities.”

“It’s abhorrent,” says Marie-Laure. But for her, the priority will always be her students. Seeing Yulia excited to attend school without any tears in her eyes is a victory in itself.

In France, all children between 3 and 16 are guaranteed an education by law, regardless of their status or nationality.

According to UNICEF, there were an estimated 650,000 Ukrainian children living as refugees in 12 host countries still not enrolled in the local school system.

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Almost half of children who go to ER with mental health crisis don’t get the follow-up care they need, study finds | CNN

Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.


Every night that Dr. Jennifer Hoffmann works as an attending physician in the pediatric ER, she says, at least one child comes in with a mental or behavioral health emergency. Over the span of her career, she’s seen the number of young people needing help grow enormously.

“The most common problems that I see are children with suicidal thoughts or children with severe behavior problems, where they may be a risk of harm to themselves or others,” said Hoffmann, who works at Ann & Robert H. Lurie Children’s Hospital of Chicago. “We’re also seeing younger children, especially since the pandemic started. Children as young as 8, 9 or 10 years old are coming to the emergency department with mental health concerns.

“It’s just mind-blowing.”

The surge of children turning up in emergency departments with mental health issues was a challenge even before 2020, but rates soared during the Covid-19 pandemic, studies show.

ER staffers may be able to stabilize a child in a mental health care crisis, but research has shown that timely follow-up with a provider is key to their success long-term. Unfortunately, there just doesn’t seem to be enough of it, according to a new study co-authored by Hoffmann. Without the proper follow-up, these children too often wound up back in the ER.

For their study, published Monday in the journal Pediatrics, Hoffmann and her co-authors looked at records for more than 28,000 children ages 6 to 17 who were enrolled in Medicaid and had at least one trip to the emergency department between January 2018 and June 2019. They found that less than a third of the children had the benefit of an outpatient mental health visit within seven days of being discharged from the ER. A little more than 55% had a follow-up within 30 days.

Research has shown that follow-up with a mental health care provider lowers a person’s suicide risk, raises the chances that they will take their prescription medicine and decreases the chances that they will make repeated trips to the ER.

The new study found that without a follow-up, more than a quarter of the children had to go back to the ER for additional mental health care within six months of their initial visit.

“The emergency department is a safety net. It’s always open, but there’s limited extent to the types of mental health services we can provide in that setting,” Hoffmann said. “This really speaks to inadequate access to services that these kids need.”

This dynamic can be “devastating” for parents and emergency department staff alike, she said.

“We know what a child needs, but we’re just not able to schedule follow-up due to shortages among the mental health profession. They’re widespread across the US,” she said.

A lack of professional help is a problem for many children. Before the Covid-19 pandemic, the US Centers for Disease Control and Prevention found that 1 in 5 children had a mental health disorder, but only about 20% got care from a mental health provider.

Children’s mental health has become such a concern in the US that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association declared a national emergency in 2021.

Hoffmann’s study found that Black children fared worse than their peers. They were 10% less likely to have timely follow-up than White children – “which is very concerning, given that there are many disparities in access to care in our mental health system,” Hoffmann said.

The study can’t pinpoint why there is this racial disparity, but Hoffmann thinks there may be a few factors at play.

Black children are more likely to live in neighborhoods that have shortages of mental health professionals. There is also limited diversity among the mental health work force. Studies show that nearly 84% of psychologists are White, as are nearly 65% of counselors and more than 60% of social workers. And Black children more often rely on school-based mental health services, studies show.

Although the number of school counselors has been increasing over the years, few schools meet the National Association of School Psychologists’ recommended ratio of one school psychologist to 500 students. The national ratio for the 2021-22 school year was 1,127 to 1, the association found.

The new study found that the children who did not have mental health help before their ER visits had the most difficulty finding timely care afterward.

Dr. Toni Gross, chief of the Emergency Department at Children’s Hospital New Orleans, said she wasn’t entirely surprised by the study findings. Her hospital’s beds for with mental health concerns are “always busy,” she said.

“I’m well aware of the fact that we need more providers for these services. We deal with it every day,” said Gross, who was not involved in the new research.

The lack of providers who can do follow-up is a real source of concern. It’s not ideal to hand a phone number to a parent and hope they can arrange care, she said. It often takes weeks or even months to get a first appointment with a child and adolescent psychiatrist.

“It leaves a lot of us feeling like we wish we could do more,” Gross said. “When you always leave asking yourself at the end of the day, ‘did I really do what I set out to do, and that is to help people,’ it’s one of our biggest frustrations, and it may be one of the biggest reasons people in my group of physicians feel burnout.”

Like many children’s hospitals, hers has an active partnership with local school health programs that can provide some mental health care.

Hoffmann said that the amount of support varies by emergency department. Lurie has 24/7 coverage by mental health workers who can do an evaluation and provide recommendations for appropriate care, but not all areas do. For example, many rural emergency rooms don’t have pediatric mental health providers and may have few resources in the community, if any.

Several US counties have no practicing child and adolescent psychiatrists. Primary care physicians can help, but some patients would benefit from more specialized care, Hoffmann said.

President Joe Biden’s administration announced in August that plans to make it easier for millions of children to get access to mental health services by allowing schools to use Medicaid dollars to hire additional school counselors and social workers. He even mentioned the issue in his State of the Union address Tuesday.

But even more will need to be done. Hoffmann hopes her study will prompt policy-makers to invest more so children can access care no matter where they live. Investing in telehealth could also bridge the gap, she said, as would increasing Medicaid reimbursement rates for mental health services and more funding to pay for people to train to work with children as a mental health professional.

In a commentary published alongside the new study, the authors say their research shows that the US “is not meeting the behavioral health needs of our young people.”

“EDs are the last stop when all else has failed, and they, too, lack the resources to support, or even discharge, these patients,” the commentary says.

It points out that research has found this lack of access as far back as 2005.

“This new analysis adds to the overwhelming evidence that there is an urgent need for a dramatic change in our pediatric mental health care system,” the commentary says. “We believe it is time for a ‘child mental health moonshot,’ and call on the field and its funders to come together to launch the next wave of bold mental health research, for the benefit of these children and their families who so desperately need our support.”

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Nicola Sturgeon’s quitting. Who could replace her as Scotland’s leader?

Nicola Sturgeon’s sudden exit as Scottish first minister and leader of the pro-independence SNP stunned her allies — and leaves a wide open field of hopefuls vying to succeed her.

Sturgeon said Wednesday that she had asked the party’s top brass to “begin the process of electing a new party leader” in the coming days. The SNP is, she insisted, “awash with talented individuals” who could fill her shoes — though she declined to name any.

The departing first minister has dominated the top of the SNP and Scottish politics for almost two decades, first as deputy leader to her mentor-turned-nemesis Alex Salmond, and then as leader since 2014.

She’s largely eclipsed the rest of the SNP’s top team, and leaves no obvious successor. Indeed, recent polling for the Sunday Times found “don’t know” was the resounding favorite for next leader, on 69 percent.

Here’s a guide to the contenders and pretenders as Sturgeon prepares to depart.

Kate Forbes

The Scottish finance secretary will be in pole position — if she wants it.

Currently on maternity leave until April, Kate Forbes’ interest in the top job has been the subject of much debate since her sudden elevation to Sturgeon’s Cabinet back in 2020.

That followed the resignation of scandal-hit predecessor Derek Mackay, and saw Forbes, 32, forced to deliver the Scottish government’s budget announcement at hours’ notice. But the move cemented her status as a rising star from the SNP’s post-Sturgeon-and-Salmond generation.

In the years since, Forbes’ handling of the tricky economy brief has earned her admirers.

“Kate Forbes is the person that is most capable, she has a great grasp of her subject matter and she knows the Scottish economy. She’d come with a different set of ideas to Nicola Sturgeon,” one former senior SNP adviser said, pointing to her as a more “centrist” politician than the departing Scottish FM.

Despite this, she has denied any interest in the top role. In late 2020, Forbes gave a categorical “no” when asked by POLITICO in 2020 if she would ever want to be first minister.

A series of glowing media profiles — including one in the Sunday Times that cited a “source close to” her saying she had not ruled out standing — could encourage her to reconsider. Polling in the same newspaper also flagged Forbes’ position as the front-runner (albeit behind top contender “don’t know”) in a largely anonymous field.

And yet Forbes’ differing views to Sturgeon on a key culture wars issue — the Scottish government’s bid to ease gender recognition laws — could pose difficulties in a leadership contest.

Though Forbes — a devout Christian — never publicly voted or spoke against the Scottish government’s gender reforms, she was among a handful of SNP lawmakers to sign a letter expressing their concerns about the legislation back in 2019 and has avoided offering full-throated backing to the plans.

Angus Robertson

As one of Sturgeon’s closest allies and a nationalist veteran present during the SNP’s rise to power, Angus Robertson has long been thought of as a potential future leader.

Once the party’s chief in Westminster, Sturgeon immediately gave Robertson the constitutional affairs brief when he returned to elected office in the 2021 election to Scotland’s devolved parliament at Holyrood.

As part of that brief, the 53-year-old has become a familiar presence in Brussels and some European capitals, leading the SNP’s efforts to win favor and friends in the EU.

Some in the SNP worry he isn’t exciting enough — though he’s seen as a safe option.

One SNP MP described him as “like an SNP leader from central casting,” while another MP from the same party said they’re “not sure he’s as popular as he thinks he is.”

While Robertson is widely expected to run in the leadership election, some doubt remains.

“I’m a happy father of two extremely young children and that is what is taking up a lot of my time, effort and focus,” Robertson told POLITICO in an interview in late 2022. A close friend, speaking before Sturgeon quit, said at the time that Robertson wasn’t interested in the job.

John Swinney

If the SNP is looking for a safe pair of hands to ease the transition to its next generation, Sturgeon’s trusted number two could become an attractive option.

John Swinney, as deputy first minister, has effectively acted as Sturgeon’s fixer during her nine years in government.

Initially finance minister, Swinney has also held the difficult briefs of education and pandemic recovery during his time in Sturgeon’s government. He returned to the finance job to fill in for Forbes during her current maternity leave.

Swinney has already served as SNP leader, heading up the party for four years during a difficult period in the early 2000s.

Senior party figures worried about life after Sturgeon might be tempted to persuade him to return.

Neil Gray

Described as a decent “outside bet,” by one SNP MP, Neil Gray could become a serious contender if no front-runner emerges.

Another member of the SNP’s next generation, Gray swapped his seat in Westminster for a Holyrood one in 2021 — sparking whispers about his ambition for higher office.

Gray is seen as an assured media performer and has impressed colleagues both in Westminster and Holyrood. He currently serves as the minister for culture and Europe, after steering the Scottish government’s Ukrainian refugees program.

Other outside bets

The current environment minister and former special adviser to Sturgeon Màiri McAllan is seen as a potential future SNP leader, though — with less than two years of experience as an MSP — the current vacancy may come too early.

Sturgeon loyalist Humza Yousaf was once seen as a likely contender, but a tricky few years of running Scotland’s beleaguered NHS as health minister have dented his credentials.

Rebel MP Joanna Cherry, one of Sturgeon’s harshest SNP critics, could launch an unlikely pitch as a candidate offering to ditch the party’s contentious gender reforms. Cherry lacks support from outside the party’s fringes, however.

Not running

34-year-old Stephen Flynn‘s rapid rise to become SNP leader at the Westminster parliament was as swift as it was unwelcome for Sturgeon’s top team, who did not want their ally, the former Westminster leader Ian Blackford, to be deposed. However, as an MP and not an MSP (member of the Scottish parliament) Flynn could currently only replace Sturgeon as SNP leader — and not as Scotland’s first minister. He ruled himself out of the top job Wednesday, telling the BBC he had “no intention” of running and that “the next leader of our party, of Scotland’s government, will be a member of the SNP Holyrood group.”

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