One Friday in early November, a bus carrying Appomattox County students was involved in a crash. By the following Monday, several elementary school students who had been on board told school staff they needed to talk to someone. They were shaken and scared. One of their classmates had been flown to a hospital by helicopter.
That same day, the students met with a licensed therapist on campus through a school-based partnership with a local mental health provider.
The Appomattox County school district recently expanded access to mental health care on its four school campuses where about 2,375 students are enrolled. With new funding from the Virginia Health Care Foundation, the district has broadened a long-standing partnership with the local community services board and local providers to bring mental health services into the elementary school and preschools, addressing growing needs in rural communities where access to care is limited.
Since 2007, the district has partnered with a local provider, FIVE18, to bring mental health services into Appomattox County High School. The new grant money, totaling $312,000 in the first year, supported the salaries and benefits of two licensed professional counselors from FIVE18 to serve the younger children. The school will receive a second year of grant funding to continue the services through 2026.
The funding came through a new Virginia grant program called Nurture Now, launched by the Virginia Health Care Foundation in 2024 to help communities integrate schools and mental health services. The two-year grants were awarded to local community services boards, local public agencies that provide mental health substance use disorder and disability services to residents across Virginia. The boards then worked with schools to bring services onto the campus.
Rockbridge Area Health, Tri-Area Community Health in Carroll County, ChildSavers in Colonial Heights and FIVE18 in Appomattox County all received funds to try out the new program.
In total, the Virginia Health Care Foundation distributed $1.2 million in 2024 to help these school divisions cover salaries for mental health professionals.
In the first year of the program, 1,200 students received mental health services at school. Foundation CEO Rachel Rees said Nurture Now has been successful in each locality, largely because of strong partnerships between community services boards, school systems and other local providers.
“They’ve all done extremely well because they’ve had a champion within the school who has propelled the program forward,” Rees said.
Virginia’s youth mental health struggles
The Virginia Health Care Foundation made expanding children’s mental health services a top priority after Virginia ranked 48th in the nation for youth mental health last year, according to Mental Health America.
The national nonprofit publishes annual state rankings that have fluctuated for Virginia. The state ranked 32nd for youth mental health in 2023 and 17th in 2022. In the organization’s 2025 rankings, Virginia again placed 32nd.
Workforce shortages remain a major barrier to improving access to care. In a 2022 study, the foundation found that 93 of Virginia’s 133 localities don’t have enough mental health professionals, based on federal guidelines. About 3.2 million Virginians, roughly 37% of the state’s population, live in those communities.
Although Virginia has about 40 graduate-level behavioral health programs that collectively graduate nearly 800 students each year, too few go on to become licensed in the state to meet demand.
School-based programs make a big difference in rural communities
Having mental health providers in the schools is especially important in rural communities, said Cortnie King, a student family support specialist for the Appomattox school district.
King is a licensed social worker, but the district changed her title when parents mistakenly associated her with the Department of Social Services. She works closely with school guidance counselors to connect students with therapists from FIVE18.
There aren’t a lot of health services in Appomattox, let alone mental health care providers, King said. The nearest area with robust health care options is Lynchburg, about 30 minutes away.
Many parents in the area lack reliable transportation, King said. Others work in Lynchburg and don’t want to drive back to Appomattox only to turn around and drive back to the city for an after-school appointment.
The school-based program removes those obstacles by allowing students to meet with mental health providers on campus during the school day. When a student asks to talk to someone or a teacher suspects a student needs additional support, the student is referred to the guidance counselor. From there, school employees work together to contact parents for permission to treat the child. Then a session with a provider from FIVE18 is set up. Sessions are scheduled to avoid core academic classes, often over lunch.
“Many of our kids don’t like to eat lunch in the lunchroom because of anxiety,” King said. “Our providers have given them a safe space to come in and eat lunch with them.”
Heightened awareness since the pandemic
FIVE18 has helped with suicide assessments and other threat evaluations in the county’s elementary and primary schools.
In recent weeks, one elementary school student said they had thought about driving their go-kart into a tree more than once, King said. Other students have told providers that they feel like a burden to their families or blame themselves for their parents’ divorce.
After the start of the COVID-19 pandemic, more children across the country began presenting with mental health concerns. The trend was so widespread that the American Academy of Pediatrics declared a national emergency in children’s mental health.
King said she thinks the pandemic led to greater awareness, but not necessarily more chronic mental illness. Now, there’s better identification and earlier intervention.
“Because of the pandemic, we have more attention and we are able to identify and support what is going on. We’re giving kids the skills to say that they need these things. …They’re really trying to navigate and find healthy ways to express themselves,” King said.
Rees, with the Virginia Health Care Foundation, hopes to continue offering Nurture Now grants in the future, though the foundation relies on donations to sustain the program.
The Nurture Now grants and other behavioral health initiatives were funded by organizations including the Collis Warner Foundation, Humana, Sentara Healthcare, the Anne Mullens Orrell Charitable Trust, Bank of America N.A. Trustees, Carilion Clinic, Dominion Energy and the Claude Moore Charitable Foundation.
[Disclosure: Dominion, Carilion and the Claude Moore Charitable Foundation are among our donors, but donors have no say in news decisions; see our policy.]