The United States faces a growing mental health crisis, a problem made worse by the COVID-19 pandemic.
According to Mental Health America’s 2023 report, more than 52 million adults have reported having a diagnosable mental, behavioral or emotional disorder.
In Florida, almost 3 million adults fall in that category, with 1,679,000 saying they did not receive treatment.
Among Florida’s youth, 399,000 reported having a major depressive episode, or a severe major depressive episode.
There are nationwide and Central Florida hotlines, support groups and other resources available to help people, even if they do not have mental health coverage with insurance.
Here is a list of phone numbers, programs and groups available for the Central Florida area.
This is a free 24/7 treatment referral and information service for those facing mental or substance use disorders, and for their families. The helpline is in English and Spanish.
The agency also has an online treatment locator on its website.
This is a free 24/7 helpline for people who are suicidal or experiencing emotional distress. Trained crisis workers will talk to the caller, listen to their problems and provide any support they can.
NAMI’s helpline is free and open from 10 a.m. to 10 p.m. EST, Monday-Friday. Helpline volunteers answer questions and suggest programs for people living with a mental health condition, families and caregivers. They do not provide mental health counseling or advice, or referrals to mental health providers.
The Mental Health Association of Central Florida has been around since 1946, and runs several programs to help people and families when dealing with mental health conditions. That includes a mental health clinic for the uninsured in Orlando, a mental health referral service for Orange, Osceola, Seminole, Lake, Brevard and Volusia counties, telehealth services and peer groups.
Central Florida Cares is the group that works with the state to provide mental health care services in Brevard, Orange, Osceola and Seminole counties. Dialing 2-1-1 will connect you to a specialist who can help find the resources needed.
LSF Health Systems works with the state to provide mental health care services in 23 north-central Florida counties, including Flagler, Lake, Marion, Sumter and Volusia counties. Its 24/7 access to a care line can help you get connected to services in your area, regardless of whether you have health insurance. Among the services they have available are in-person counseling and telehealth services.
This is a nonprofit health care group with several locations throughout Brevard County that provides health care in several areas, including behavioral health, regardless of the ability to pay.
The Children’s Home Society offers mental health counseling at home, at school and online through telehealth, for uninsured, underinsured and Medicaid recipients. They have locations four locations across the Central Florida area. Even if they don’t have an office near you, you can call and see what help they can provide.
NAMI has local chapters across Florida that offer support groups, classes and other resources to help people cope with mental illness, whether it’s the patients or the families.
The declaration of a COVID-19 public health emergency three years ago changed the lives of millions of Americans by offering increased healthcare coverage, beefed-up food assistance and universal access to coronavirus vaccines and tests.
Much of that is now coming to an end, with President Joe Biden’s administration saying it plans to end the emergency declarations on May 11.
Here’s a look at what will stay and what will go once the emergency order is lifted:
COVID-19 TESTS, TREATMENTS AND VACCINES
The at-home nasal swabs, COVID-19 vaccines as well as their accompanying boosters, treatments and other products that scientists have developed over the last three years will still be authorized for emergency use by the Food and Drug Administration once the public health emergency is over.
But how much people pay for certain COVID-related products may change.
Free vaccines, however, won’t come to an end with the public health emergency.
“There’s no one right now who cannot get a free vaccine or booster,” said Cynthia Cox, vice president at Kaiser Family Foundation. “Right now all the vaccines that are being administered are still the ones purchased by the federal government.”
Many states expect they can make it through the spring and summer, but there are questions around what their vaccine supply will look like going into the fall — when respiratory illness typically start to spike, said Anne Zink, the president of the The Association of State and Territorial Health Officials.
“We’re all anxious to find out more about that,” Zink said.
MEDICAID
Medicaid enrollment ballooned during the pandemic, in part because the federal government prohibited states from removing people from the program during the public health emergency once they had enrolled.
The program offers health care coverage to roughly 90 million children and adults — or 1 out of every 4 Americans.
Late last year, Congress told states they could start removing ineligible people in April. Millions of people are expected to lose their coverage, either because they now make too much money to qualify for Medicare or they’ve moved. Many are expected to be eligible for low-cost insurance plans through the Affordable Care Act’s private marketplace or their employer.
STUDENT LOANS
Payments on federal student loans were halted in March 2020 under the Trump administration and have been on hold since. The Biden administration announced a plan to forgive up to $10,000 in federal student loan debts for individuals with incomes of less than $125,000 or households with incomes under $250,000.
But that forgiveness plan — which more than 26 million people have applied for — is on pause, thrown into legal limbo while awaiting a ruling from the Supreme Court.
A Biden administration official told The Associated Press Tuesday that ending the health emergencies will not change the legal argument for student loan debt cancellation, saying the COVID-19 pandemic affected millions of student borrowers who might have fallen behind on their loans during the emergency.
Border officials will still be able to deny people the right to seek asylum, a rule that was introduced in March 2020 as COVID-19 began its spread.
Those restrictions remain in place at the U.S.-Mexico border, pending a Supreme Court review, regardless of the COVID-19 emergency’s expiration. Republican lawmakers sued after the Biden administration moved to end the restrictions, known as Title 42, last year. The Supreme Court kept the restrictions in place in December until it can weigh the arguments.
The end of the emergency may bolster the legal argument that the Title 42 restrictions should no longer be in place. The emergency restrictions fell under health regulations and have been criticized as a way to keep migrants from coming to the border, rather than to stop the spread of the virus.
TELEHEALTH
COVID-19’s arrival rapidly accelerated the use of telehealth, with many providers and hospital systems shifting their delivery of care to a smartphone or computer format.
The public health emergency declaration helped hasten that approach because it suspended some of the strict rules that had previously governed telehealth and allowed doctors to bill Medicare for care delivered virtually, encouraging hospital systems to invest more heavily in telehealth systems.
Congress has already agreed to extend many of those telehealth flexibilities for Medicare through the end of next year.
FOOD ASSISTANCE
Relaxed rules during the COVID-19 public health emergency made it easier for individuals and families to receive a boost in benefits under the federal Supplemental Nutrition Assistance Program, or SNAP. Some state and congressional action has started to wind down some of that. Emergency allotments — typically about $82 a month, according to the Food Research and Action Center — will come to an end as soon as March in more than two dozen states.
Food help for unemployed adults, under the age of 50 and without children, will also change after the public health emergency is lifted in May. During the emergency declaration, a rule that required those individuals to work or participate in job training for 20 hours per week to remain eligible for SNAP benefits was suspended. That rule will be in place again starting in June. SNAP aid for more low-income college students will also draw down in June.
STATE COVID EMERGENCIES
At least a half-dozen states — including California, Delaware, Illinois, New Mexico, Rhode Island and Texas — have some form of COVID emergency declaration or disaster order still in place. But those orders have limited practical effect.
New Mexico’s public health emergency, which has been extended through Friday, advised health care facilities to abide by federal coronavirus requirements. Delaware has continued to operate under a “public health emergency,” which has suspended staffing ratios in long-term care facilities.
California Gov. Gavin Newsom, a Democrat, has said his emergency order will end Feb. 28. Newsom has issued 596 specific orders, from stay-at-home mandates to tax-filing extensions, during the pandemic. Most have expired, but he plans to ask lawmakers make two into permanent laws — one letting nurses order and dispense COVID-19 medication and another allowing lab workers to solely process coronavirus tests.
The end to those payments comes at a time when many hospitals are under financial pressure, struggling with workforce shortages and dealing with the pain of inflation, said Stacey Hughes, the executive vice president at the American Hospitals Association.
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Associated Press writers JoNel Aleccia in Los Angeles, Colleen Long and Seung Min Kim in Washington and David Lieb, in Jefferson City, Missouri, contributed to this report.
A prohibition against puberty blocking hormones and gender-affirming surgeries for minors in Florida was tightened further after a board overseeing doctors eliminated an exception for research Friday at the request of Florida Gov. Ron DeSantis’ administration.
Some members of the public attending the meeting in Tallahassee shouted expletives, and law enforcement officers positioned themselves in the front of the room after the vote by the Florida Board of Osteopathic Medicine.
The decision came after one member of the public after another testified at the packed meeting of the osteopathic medicine board and the Florida Board of Medicine that gender-affirming treatment had been ”magical” and like “opening a prison door” for them or their children. One transgender adult man during his testimony gave himself an injection of hormones in front of the doctors’ boards. Others said treatment had stopped them from “fighting with themselves” and contemplating suicide.
“I’m a teenager. Without getting this medicine at this crucial age I would have been waiting for my life to start,” said L.J. Valenzuela, a trans man in high school who said he was getting hormone replacement treatment.
Judy Schmidt told board members that she worried that her trans son, who was 6 when he told her he was a boy, will have been transitioning socially for four to five years before he reaches puberty and won’t be able to get the gender-affirming care he needs.
“You as doctors are supposed to do no harm,” Schmidt to the boards made up primarily by doctors. “If you make this blanket rule, you are doing harm.”
The Florida Board of Medicine and the Florida Board of Osteopathic Medicine approved rules last fall that prohibited gender-affirming surgery and puberty blocking hormones for minors, though minors receiving puberty blockers prior to the rules taking effect could continue to take them. The osteopathic medicine board made an exception for clinical research trials that examined the long-term impact of the treatments.
During Friday’s meeting, the Florida Department of Health asked the boards to tweak the rules to eliminate the osteopathic medicine board’s exception for research. The DeSantis administration’s health department got the ball rolling on curbing gender-affirming treatment for minors in Florida last year by petitioning the boards to pass the prohibition. In 2021, DeSantis, who is widely considered to be weighing a run for the Republican presidential nomination, signed a bill barring transgender girls and women from playing on public school teams intended for student athletes assigned female at birth.
John Wilson, general counsel for the Department of Health, told the boards that the exception would create confusion since one board allowed it, but the other didn’t.
“The department is concerned the exception undermines the purpose of this rule,” Wilson said.
State Rep. Anna Eskamani, a Democrat from Orlando, called the prohibition against gender-affirming care “politically motivated.”
“We should not be making policy based on who can make a fundraising letter off it,” Eskamani said.
Florida Board of Medicine member Hector Vila disputed that interpretation of the boards’ actions.
“This isn’t about trans- or homophobia,” said Vila, a doctor in Tampa. “This isn’t about politics.”
Total Doses Distributed = 958,658,535. Total Doses Administered = 670,306,507. Number of People Receiving 1 or More Doses = 269,208,743. Number of People Fully Vaccinated = 229,820,324.
She’d be a senior right now, preparing for graduation in a few months, probably leading her school’s modern dance troupe and taking art classes.
Instead, Kailani Taylor-Cribb hasn’t taken a single class in what used to be her high school since the height of the coronavirus pandemic. She vanished from Cambridge, Massachusetts’ public school roll in 2021 and has been, from an administrative standpoint, unaccounted for since then.
She is among hundreds of thousands of students around the country who disappeared from public schools during the pandemic and didn’t resume their studies elsewhere.
An analysis by The Associated Press, Stanford University’s Big Local News project and Stanford education professor Thomas Dee found an estimated 240,000 students in 21 states whose absences could not be accounted for. These students didn’t move out of state, and they didn’t sign up for private school or home-school, according to publicly available data.
In short, they’re missing.
“Missing” students received crisis-level attention in 2020 after the pandemic closed schools nationwide. In the years since, they have become largely a budgeting problem. School leaders and some state officials worried aloud about the fiscal challenges their districts faced if these students didn’t come back. Each student represents money from the city, state and federal governments.
Gone is the urgency to find the students who left — those eligible for free public education but who are not receiving any schooling at all. Early in the pandemic, school staff went door-to-door to reach and reengage kids. Most such efforts have ended.
“Everyone is talking about declining enrollment, but no one is talking about who’s leaving the system and why,” said Tom Sheppard, a New York City parent and representative on the city’s Panel for Educational Policy.
“No one,” he said, “is forthcoming.”
A PROBLEM NOT DISCUSSED
The missing kids identified by AP and Stanford represent far more than a number. The analysis highlights thousands of students who may have dropped out of school or missed out on the basics of reading and school routines in kindergarten and first grade.
That’s thousands of students who matter to someone. Thousands of students who need help re-entering school, work and everyday life.
“That’s the stuff that no one wants to talk about,” said Sonja Santelises, the chief executive officer of Baltimore’s public schools, speaking about her fellow superintendents.
“We want to say it’s outside stuff” that’s keeping kids from returning to school, she said, such as caring for younger siblings or the need to work. But she worries teens sometimes lack caring adults at school who can discuss their concerns about life.
“That’s really scary,” Santelises said.
Discussion of children’s recovery from the pandemic has focused largely on test scores and performance. But Dee says the data suggests a need to understand more about children who aren’t in school and how that will affect their development.
“This is leading evidence that tells us we need to be looking more carefully at the kids who are no longer in public schools,” he said.
Over months of reporting, the AP learned of students and families avoiding school for a range of reasons. Some are still afraid of COVID-19, are homeless or have left the country. Some students couldn’t study online and found jobs instead. Some slid into depression.
During the prolonged online learning, some students fell so far behind developmentally and academically that they no longer knew how to behave or learn at school. Many of these students, while largely absent from class, are still officially on school rosters. That makes it harder to truly count the number of missing students. The real tally of young people not receiving an education is likely far greater than the 240,000 figure calculated by the AP and Stanford.
In some cases, this wasn’t sudden. Many students were struggling well before the pandemic descended.
Kailani, for one, had begun to feel alienated at her school. In ninth grade, a few months before the pandemic hit, she was unhappy at home and had been moved to a different math class because of poor grades.
Kailani has ADHD and says the white teaching assistant assigned to help her focus in her new class targeted her because she was Black, blaming Kailani when classmates acted up. She also didn’t allow Kailani to use her headphones while working independently in class, something Kailani says was permitted in her special education plan to help her focus.
After that, Kailani stopped attending math. Instead, she cruised the hallways or read in the library.
Ultimately, the pandemic and at-home education relieved the anxiety Kailani felt from being in the school building. Kailani preferred online school because she could turn off her camera and engage as she chose. Her grades improved.
When the school reopened, she never returned.
A Cambridge schools spokesperson looked into Kailani’s complaints. “Several individuals demonstrated great concern and compassion towards her and the challenges she was facing outside of school,” Sujata Wycoff said. She said the district has a “reputation of being deeply dedicated to the education and well-being of our students.”
LOSING THE PHYSICAL CONNECTION
To assess just how many students have gone missing, AP and Big Local News canvassed every state in the nation to find the most recently available data on both public and non-public schools, as well as census estimates for the school-age population.
Overall, public school enrollment fell by 710,000 students between the 2019-20 and 2021-22 school years in the 21 states plus Washington, D.C., that provided the necessary data.
Those states saw private-school enrollment grow by over 100,000 students. Home-schooling grew even more, surging by more than 180,000.
But the data showed 240,000 students who were neither in private school nor registered for home-school. Their absences could not be explained by population loss, either — such as falling birth rates or families who moved out of state.
States where kindergarten is optional were more likely to have larger numbers of unaccounted-for students, suggesting the missing also include many young learners kept home instead of starting school.
California alone showed over 150,000 missing students in the data, and New York had nearly 60,000. Census estimates are imperfect. So AP and Stanford ran a similar analysis for pre-pandemic years in those two states. It found almost no missing students at all, confirming something out of the ordinary occurred during the pandemic.
The true number of missing students is likely much higher. The analysis doesn’t include data from 29 states, including Texas and Illinois, or the unknown numbers of ghost students who are technically enrolled but rarely make it to class.
For some students, it was impossible to overcome losing the physical connection with school and teachers during the pandemic’s school closures.
José Escobar, an immigrant from El Salvador, had only recently enrolled in the 10th grade in Boston Public Schools when the campus shut down in March 2020. His school-issued laptop didn’t work, and because of bureaucratic hurdles, the district didn’t issue a new one for several weeks. His father stopped paying their phone bills after losing his restaurant job. Without any working technology for months, he never logged into remote classes.
When instruction resumed online that fall, he decided to walk away and find work as a prep cook. “I can’t learn that way,” he said in Spanish. At 21, he’s still eligible for school in Boston, but says he’s too old for high school and needs to work to help his family.
Another Boston student became severely depressed during online learning and was hospitalized for months. Back home, he refuses to attend school or leave his room despite visits from at least one teacher. When his mother asked him about speaking to a reporter, he cursed her out.
These are all students who have formally left school and have likely been erased from enrollment databases. Many others who are enrolled are not receiving an education.
In Los Angeles last year, nearly half of students were chronically absent, meaning they missed more than 10% of the school year. For students with disabilities, the numbers are even higher: According to district data, 55% missed at least 18 school days. It’s not clear how many students were absent more than that. The city’s Unified School District did not respond to requests for this data.
WHEN SCHOOLS DON’T COME THROUGH
Los Angeles officials have spoken openly about attempts to find unschooled students and help remove obstacles that are preventing them from coming to school. Laundry services have been offered, as has help with housing. But for some students and their parents, the problem sits within a school system they say has routinely failed their children.
“Parents are bereft,” said Allison Hertog, who represents around three dozen families whose children missed significant learning when California’s physical classrooms closed for more than a year during the early pandemic.
Ezekiel West, 10, is in fourth grade but reads at a first grade level. Before the pandemic shutdowns, he was shuffled from school to school when educators couldn’t address his impulsive behavior.
During online learning, his mother couldn’t get home internet and struggled with the WiFi hotspots provided by the school. She worked as a home health aide and couldn’t monitor Ezekiel online.
When he returned to school in fall 2021 as a third grader, he was frustrated that his classmates had made more progress as the years passed.
“I did not feel prepared,” he said in a recent phone interview. “I couldn’t really learn as fast as the other kids, and that kind of made me upset.”
An administrative judge ruled Los Angeles’ schools had violated Ezekiel’s rights and ordered the district to give him a spot at a new school, with a special plan to ease him back into learning and trusting teachers. The school didn’t follow the plan, so his mother stopped sending him in October.
“I can’t trust them,” Miesha Clarke said. Los Angeles school officials did not respond to requests for comment on Ezekiel’s case.
Last month, Ezekiel signed up for a public online school for California students. To enroll him, his mother agreed to give up his special education plan. His attorney, Hertog, worries the program won’t work for someone with Ezekiel’s needs and is looking for yet another option with more flexibility.
At least three of the students Hertog has represented, including Ezekiel, have disappeared from school for long periods since in-person instruction resumed. Their situations were avoidable, she said: “It’s pretty disgraceful that the school systems allowed this to go on for so long.”
When Kailani stopped logging into her virtual classes during the spring of her sophomore year, she received several emails from the school telling her she’d been truant. Between two to four weeks after she disappeared from Zoom school, her homeroom advisor and Spanish teacher each wrote to her, asking where she was. And the school’s dean of students called her great-grandmother, her legal guardian, to inform her about Kailani’s disappearance from school.
They didn’t communicate further, according to Kailani. She went to work at Chipotle, ringing up orders in Boston’s financial district.
In December, Kailani moved to North Carolina to make a new start. She teaches dance to elementary school kids now. Last month, she passed her high school equivalency exams. She wants to take choreography classes.
But she knows, looking back, that things could have been different. While she has no regrets about leaving high school, she says she might have changed her mind if someone at school had shown more interest and attention to her needs and support for her as a Black student.
“All they had to do was take action,” Kailani said. “There were so many times they could have done something. And they did nothing.”
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This article is based on data collected by The Associated Press and Stanford University’s Big Local News project. Data was compiled by Sharon Lurye of the AP, Thomas Dee of Stanford’s Graduate School of Education, and Justin Mayo of Big Local News.
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The Associated Press education team receives support from the Carnegie Corporation of New York. The AP is solely responsible for all content.
New York City, which once had the nation’s strictest workplace vaccination rules for COVID-19, is ending one of its last such mandates, saying it will no longer require the shots for municipal employees including police officers, firefighters and teachers.
The vaccine mandate, which led to the firing of hundreds of city workers who declined to get the shots, will end Friday, Mayor Eric Adams announced Monday.
Adams, a Democrat, said that with more than 96% of city employees and more than 80% of city residents having received their initial vaccine series, “this is the right moment for this decision.”
City Health Commissioner Dr. Ashwin Vasan said, “It’s clear these mandates saved lives and were absolutely necessary to meet the moment. We’re grateful that we can now, as we leave the emergency phase of the pandemic, modify more of the rules that have gotten us to this point.”
The vaccination mandate for city employees was one of the last COVID-19 measures still in place in New York City. The city ended its vaccine requirement for employees of private businesses in November 2022, and masks are now optional in most public spaces including subways and buses.
New York City’s private-sector mandate forced All-Star point guard and vaccine skeptic Kyrie Irving to miss most of the Brooklyn Nets home games last season.
Irving will no longer be affected by any changes in New York City’s coronavirus policies. The Nets and the Dallas Mavericks reached a deal over the weekend that will send Irving to Dallas, according to a person familiar with the terms of the deal who spoke to The Associated Press on condition of anonymity because it had not been finalized.
New York City’s municipal work force of about 337,000 was one of the largest groups of government employees in the United States to be affected by a COVID-19 vaccine mandate.
The vaccine requirement for the 1.3 million-strong U.S. military was lifted in December under an $858 billion defense spending bill passed by Congress and signed into law by President Joe Biden.
