Each day, psychotherapist Kerry Hospelhorn rises at 6 a.m., sips her morning coffee and checks text messages to see which of her 20 clients need prompt mental health support. It may be one, or as many as 10.
All are students at Baltimore County schools; there’s always a list of teens who need to talk. Their fears run the gamut, from school to social to family matters. And Hospelhorn, who is employed by Talkspace, a national digital mental health platform, is there to listen.
“There are kids who say they want get to know themselves better, and others with severe social anxiety and symptoms of depression. It’s a really big range,” she said. “They’ll say, ‘I’ve got to speak in front of the class and I’m freaking out,’ or ‘I don’t know how to talk to my parents about dropping a class.’ Some are applying to college and are scared their grades aren’t good enough.”
Talkspace, which began in 2012, partnered with Baltimore County Public Schools last spring in a two-year, $1.8 million contract that allows its more than 32,000 high schoolers free virtual mental health support through a network of licensed Maryland therapists in the Talkspace program. Each student is matched with a therapist, and given a link to self-help tools, along with the promise of total confidentiality — though, at sign-up, an emergency contact is required.
Other area school systems have also recently added virtual therapy programs and apps. This year, Baltimore City partnered with Hazel Health, a California firm, to provide free telehealth services, with one-on-one consults, to students of all ages — but only from the client’s home and with parental consent.
Through Prosper, another digital health app, students in Anne Arundel County may now access their teachers, self-care tools and links to mental health resources. Frederick County has implemented a self-help therapy app called Basecamp for both middle and high school students. The program is billed as confidential, though parents of clients under 18 “may request access to their child’s data at any time.”
School systems in Carroll, Harford and Howard counties still favor in-school counseling and crisis hotlines available to all Maryland students.
Clearly, kids are hurting. On Sept. 6, at Joppatowne High in Harford County, a 16-year-old student shot and killed a 15-year-old with a handgun. On Aug. 14, at Franklin High in Baltimore County, a 16-year-old student-athlete collapsed and died during football practice.
A 2022 Youth Risk Behavior Survey of Maryland high school students, commissioned by the state health department, revealed sobering statistics. During the previous 12 months, the survey found, 3.9% of students reported having been threatened, or injured, by someone with a weapon (gun, knife or club) on school grounds. During the same period, 17.9% of students had “seriously considered” attempting suicide, 14.3% had made plans to do so, and 4.9% had actually tried to kill themselves.
Baltimore County’s suicide numbers were higher: 20% of students said they’d considered it, 17.1% made plans and 5.5% did attempt to end their lives.
“That data is pretty wicked; it’s scary,” said Andra Broadwater, health and safety committee chair for the Baltimore County PTA Council. Moreover, she said, many brick-and-mortar mental health providers are overbooked at present, and “finding [support] for adolescents is especially challenging. Not everyone is qualified to treat children.”
Hospelhorn, 51, a Harford County resident and a therapist for 27 years, the past six of them with Talkspace, said she doesn’t see suicide ideation with many adolescents. “If someone says, ‘I hate my life,’ I’ll say, ‘Tell me more about that.’ I’ll have them take a moment to take a breath. Then we’ll go on.”
If needed, she’ll bring other therapists on board.
“Most kids don’t actually want to die,” Hospelhorn said. “They are just overwhelmed and want to feel better.”
Last spring, on the Talkspace app, Baltimore County students participated in more than 2,800 therapy messaging sessions with clinicians and swapped 17,000 chat messages with them, said Patricia Mustipher, director of student support services for the county schools. More than two-thirds (69%) of survey respondents reported having found the sessions helpful. Data for the first quarter of the current school year will be available in November.
Talkspace clinicians cannot prescribe medication for students.
“If a therapist believes a teen has a higher acuity concern, like a need for psychiatric evaluation or possible medication, they would recommend additional [outside] services,” said Jeannine Feyen, director of communications for Talkspace.
Teens today feel that the ground is always shifting beneath their feet, psychologists contend.
“We are in the middle of an adolescent mental health crisis; kids feel a lot of uncertainty that previous generations didn’t,” said Alison Papadakis, director of clinical psychological studies and a teaching professor at the Johns Hopkins University. For teens, social media, cyber-bullying and the rise of AI all create stress in the present and fears for the future, she said — and many adolescents lack the coping tools they might have acquired earlier, but for school closings during COVID-19.
“During the pandemic, our kids were isolated from their peers and their mental health went down, down, down — and we’re still climbing out of that,” Broadwater said.
“Kids missed personal skill-building during COVID,” Papadakis said. “They bear lingering scars from that time, but may not realize it themselves.”
The pandemic curbed office sessions and triggered the boom in virtual therapy, particularly for teens who were holed up at home. Now, with that foothold, do nontraditional methods like Talkspace spell the future for high schoolers?
“There are unprecedented levels of suicidal thinking amongst our youth, and great concerns about violence in their schools,” said Nikole Benders-Hadi, chief medical officer of Talkspace. “Our goal is to connect with students before they get to crisis [mode] and help them build their skills.”
Such platforms “are certainly filling a gap,” said Broadwater, who knows students who have reached out via Talkspace. “We don’t have school psychologists in every building and, for [guidance] counselors, mental health is only one thing that they focus on — so having an app where a kid can access support can only be a plus.
“As a parent, if my child is in crisis, I don’t care how it’s delivered, I just want the help.”
Traditional clinicians suggest the need to tread lightly.
“[Telehealth] is still evolving, but we’re heading in that direction — though we need to be cautious,” said Papadakis, an expert in adolescent psychopathology. Research suggests that virtual platforms help assuage common problems, like depression and anxiety. But more severe issues, such as bipolar disorder and budding schizophrenia, are another matter, she said. One risk is that if telehealth fails to help teens, “they may overgeneralize and think that [all forms of] therapy do not work, in general, or for them, in particular.”
Those with attention-deficit/hyperactivity disorder (ADHD) also bear watching during videoconference therapy, Papadakis said:
“Kids who have trouble focusing may not be as engaged in [telehealth] treatment because they are multitasking and aren’t paying as much attention — which [ironically] is why they sought therapy in the first place.”
On the plus side, health apps can grant therapists a peek into a client’s everyday life, perhaps siblings screaming or parents bickering in the background.
“It allows us to parachute into the world of the patient, something you wouldn’t get in an office visit,” she said. “The format can filter in the context we need to understand what’s happening in the home.”
At the same time, peering into a tablet or cellphone can cause therapists to miss nonverbal signals (a shiver, a sigh) that are harder to read than in person. Privacy is another concern.
“There’s a worry [during virtual sessions] about who’s walking past the client’s room, or who’s got an ear to the door,” Papadakis said. “Sometimes, therapists have students flip their phone around 360 degrees to make sure it’s safe to talk.”
Generally, health professionals agree that it’s easier for teens to confide in a therapist they’ve never met, on a virtual platform, than it would be for their parents to do so.
“Personally, it would feel odd to me to have an intimate conversation with someone I’ve never met, but that’s less an issue for this generation than for ours,” Papadakis said. “I do worry that the strategy of teens reaching out in moments of ‘crisis,’ for help via texting, may not lend itself to their learning the tools of the trade, or coping strategies of their own. It may help in that moment, but they’ve also learned [to use a crutch] rather than try to manage hard situations themselves.”
