An Assessment of Youth Mental Health in Nantucket, MA
Executive Summary
1.0 Introduction
According to the Center for Disease Control, 37% of public and private high schoolers
found their mental health consistently declining during the pandemic (CDC, 2021). One of the
primary factors contributing to the decline was the switch to remote learning, which isolated
many students from their friends and school communities (Rutkowska et al., 2022). While most
of the nation has returned to in–person learning, the impacts on youth mental health due to
COVID–19 continue to persist (Puteikis et al., 2022).
In light of the pandemic, growing concerns about youth mental health on Nantucket
have surfaced. The Town of Nantucket Health and Human Services Department (HHS) requires
baseline data to quantify these concerns and to secure funding for programs to support the
youth. (J. Mele, Personal Conversation).
The lack of data on Nantucket youth mental health poses a challenge in tracking the
program efficacy of efforts made by the HHS. In fact, a behavioral health needs assessment has
not been conducted on Nantucket since the COVID–19 pandemic. For HHS to deploy services
efficiently, baseline measurements of youth mental health must be established.
The goal of this project was to design a data–driven survey tool that the Nantucket
Health and Human Services Department can use to track the mental health of the youth
community on the island.
2.0 Background
The World Health Organization defines mental health as a “state of mental well–being
that enables people to cope with the stresses of life, realize their abilities, learn well and work
well, and contribute to their community.” (World Health Organization: WHO, 2022). In other
words, having “good” mental health enables people to fully engage and function in their
communities. A person struggling with poor mental health can experience feelings of loneliness,
helplessness, and depression, among many others. In extreme cases, poor mental health can
lead to substance abuse, self–harm, and suicide (CDC, 2023).
Mental health is difficult to understand and diagnose; not everyone struggling with their
mental health experiences the same symptoms, making finding help and support complex for
an adult. Children and adolescents, whose minds and social skills are still developing, need
extra support to ensure they grow into confident, happy, and productive young adults.
According to the Youth Risk Behavior Health Survey from the CDC in 2021, 1 in 5 students have
seriously considered attempting suicide, indicating that mental health for youth in America is
critical (Center for Disease Control, 2021).

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COVID–19’s Impact on Youth (Grades 8–12)
Throughout the COVID–19 pandemic, the mental health of the youth community in the
U.S. worsened. School closures due to the pandemic isolated many youths from the classroom
and their friends, leading to increased mental and social issues (CDC,2021). A Covid Experience
Survey (CES) conducted in the U.S. from October 16 to November 6, 2020, examined the
impact of virtual, hybrid, and in–person learning on adolescent (13–19 years old) mental health
and belonging (Hertz et al., 2022, p.59). 567 adolescents overall participated in the CES,
representing 460 from public schools, 36 from private schools, and 69 from another type of
school.
Almost one–half (44.7%) of students doing virtual learning reported high stress levels,
and 34.8% reported low levels of school connectedness (Hertz et al., 2022, p.59). The data
highlights the unfavorable impact that COVID–19 had on the youth community, specifically
middle and high–school–aged students. Social isolation from the schools brought many
challenges to students, particularly students of color (Black and Hispanic). These marginalized
groups experience many challenges, including racism and social and economic inequalities.
These challenges can contribute to a feeling of decreased social fit (ICMA, 2021).
Though the article does not reflect a disproportionate impact of COVID on LGBTQ+
youth, other studies indicate they experienced more loneliness than cisgender heterosexual
youth (CDC, 2017). Members of the LGBTQ+ community are statistically more at risk of feeling
lonely or socially isolated. Organizations such as the Trevor Project, founded in 1968, provide
support and services to youth in the LGBTQ+ community (Trevor Project, n.d.). The Trevor
Project conducted four polls: two included a poll with 600 LGBTQ+ youth ages 13–24, between
July 21 and July 29, 2020, and another poll of 600 cisgender/straight youth ages 13–24 from July
21 to July 24, 2020. The Trevor Project examined the poll results and found that 68% of LGBTQ+
youth reported feeling stressed compared to 56% of cis/straight gender youth amidst the
fallout of the pandemic. 54% of LGBTQ+ youth also reported feeling lonely compared to 38% of
cis/straight youth (Trevor Project, 2020). These statistics from the polls examined by the Trevor
Project show that the members of the LGBTQ+ community are more at risk for developing
mental health issues and experiencing feelings of loneliness and hopelessness due to being
socially isolated.
Previous Survey Efforts
National–Scale Survey Efforts
There are many notable initiatives to survey youth mental health nationally. Such
initiatives are conducted by Mental Health America (MHA), the CDC, and Pride Surveys. MHA
creates a report each year on mental health in the US; within that is data specifically related to
youth, such as depressive episodes and substance use disorders, as well as treatment and
insurance information (MHA, 2022). The CDC has the Youth Risk Behavior Surveillance System
(YRBSS) (CDC, 2023) and the Adolescent Behaviors and Experiences Survey (ABES) (CDC, 2022).

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Both tools track the habits and health of high school students, with ABES focusing on the
COVID–19 impact specifically. The Pride Student Survey gathers data on bullying, substance
abuse, and many more factors in grades 6–12 (Pride Surveys, 2023). The data these
organizations report strengthens people’s understanding of the mental health of American
youth. The results of these initiatives can be shared across the country and used to impact
youth populations nationally.
State–Wide Survey Efforts
Efforts to assess youth mental health also exist statewide. The Massachusetts Youth
Health Survey (MYHS) investigates the health of children and young adults in grades 6–12
(Commonwealth of Massachusetts, 2021). Topics covered include chronic disabilities, drug use,
obesity, and violence. The MYHS also identifies factors associated with lower youth health risk,
such as having a solid support network. The Massachusetts Department of Public Health
(MDPH) is responsible for this initiative, which provides data–driven insight into the mental
health of youth in Massachusetts specifically. This initiative allows for the isolation of data
pertaining only to this state, increasing relevance, and narrowing the context of the results.
State–level data can drive state–level efforts to improve youth mental health.
3.0 Methods
The goal of this project was to design a data–driven survey tool that the Nantucket
Health and Human Services Department can use to track the mental health of the youth
community on the island. The team achieved this goal through the following objectives:
1. Identify factors (e.g. social or cultural) that contribute to the students’ sense of
belonging.
2. Identify the barriers that impede the students’ willingness to use current mental health
resources available in their schools and communities.
3. Document the impact that the COVID–19 pandemic had on the students’ mental health
and academic performance.
4. Assess how the students’ involvement, or lack of involvement, in their schools and
homes (e.g. family and friends) impacted their mental health.

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Methods Used for All Objectives
In–depth Interviews
Multiple in–depth interviews were conducted individually with subject matter
professionals. The interviews were meant to provide insight into the types of problems that the
professionals find are prevalent in the youth community.
Online Survey for WPI Students
Before releasing the HHS survey to Nantucket youth, the team advertised a similar
version to WPI students. This survey’s goal was to receive feedback on the survey design and
collect additional data relevant to this research. The design of this survey was consistent with
that of the Nantucket HHS survey. The main difference between the 2 surveys was the change in
questions relating to a student’s age. This version of the survey also included a question at the
end requesting feedback and suggestions for survey improvement.
Online Survey for Nantucket HHS
The team developed an online survey (Appendix A) with Qualtrics. The goal of the
survey was to assess the mental health of middle and high school students, providing the team
with baseline information on the youth population. The survey was designed to be modular so
students could opt out of any sections they felt uncomfortable answering. Once the team
finished creating the survey, it was sent to the Health and Human Services Department, which
administered links to the survey to the principals of the schools. The principals then distributed
the links to the teachers and scheduled a time during the school day for the students to take
the survey.
4.0 Results and Findings
Once the HHS’ consent form distribution plan was approved by the Town of Nantucket,
the link to the student survey and parental consent form was distributed to school
administrators and through town–affiliated social media outlets. The survey was administered to
students at Cyrus Peirce Middle School only in the absence of an opt–out form signed on their
behalf. Time was allocated for these students to complete the survey during the school day on
Friday, December 1st. Neither the Nantucket High School nor the Nantucket New School
allocated in–class time for students to complete the survey.
Scoring System
To aid in data analysis, The team developed a scoring system for questions relating to
mental health, belonging, and COVID–19. This method yielded three different scores that were
used to quantify a student’s overall mental health, sense of belonging, and the experiences with
learning during the pandemic. Below is an outline explaining each of the three scores,

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highlighting the survey questions that were used for the calculation of each score and the
respective scale that each score is on.
Table 4.1 displays the averages and standard deviations for the three scores among the
entire population of students who took the survey.
Table 4.1 Breakdown of Scores
Score Sample Size Mean Standard Deviation
Mental Health Score 202 3.86 0.91
Belonging Score 202 3.56 1.12
COVID Score 198 0.89 0.92
Note: A higher score represents a healthier mental health state using the scoring system described earlier.
Nantucket Youth Results and Findings
The team received a total of 204 responses from the survey that was distributed to the
Nantucket Public Schools, and the Nantucket New School.
Gender seemed to play a larger role in mental health scores. Male and female
identifying students differed by around a half point for their average Mental Health and
Belonging scores, with men seeming to have better mental health and a better sense of
belonging than women. The data also seems to point to women struggling more during virtual
learning than men according to Figure 4.1.
Figure 4.1 Comparison of Mental Health (MH), Belonging (B),
and COVID Scores Across Gender Identities

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Barriers to Mental Health Resources
The majority of students (66.2%) answered “No” to Question 37: “Would you ever use
mental health services offered at your school?”. A thematic analysis of these students’
responses to Question 38: “Why would you use or not use these services?” is shown below in
Figure 4.2:
Figure 4.2 Common Themes of Student Hesitance
The primary reason students said they would not use mental health services was that
they did not feel a need to use them. Many students reported that they were not struggling
with any issues that mental health services could fix. Others responded that they had resources
at their disposal that they would prefer to utilize over school–offered mental health services.
The secondary reason students answered “No” to Question 37 was that they felt
uncomfortable using mental health services offered at their school. Students reported that they
did not trust their school with sensitive information concerning their mental state. Others
feared potential consequences that could arise from using these services.
Academics
Students were asked to self–report their overall grades in Question 23: “How would you
describe your grades in school this year?”. Figure 4.3 shows the distribution of students for each
response and the average Mental Health, Belonging, and COVID score that correlated with a
student’s respective grades.

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Figure 4.3 Comparison of Mental Health (MH), Belonging (B),
and COVID Scores Relative to Students’ Grades
The graph shows a steady decline in both Mental Health Score and Belonging Score as a
student’s grades get lower. The graph also shows that students with lower grade averages
tended to struggle more during the pandemic, as evidenced by the increased COVID Score. Due
to the limitations of the survey, it is unclear which factor affects which. It could be the case that
having poor mental health causes a student to struggle with grades, or the opposite may be
true; students receiving lower grades may cause their mental health to decline. More
concentrated research must be conducted to further determine this relationship.
Interviews
The team interviewed Pauline Proch, an executive director of Our House and a board
member of the Nantucket School Committee. Through this interview, the team learned more
about the struggles that Nantucket youth are experiencing in the classroom. Her previous
position as a schoolteacher provided a valuable perspective that the team considered while
crafting the survey. Overall, Mrs. Proch emphasized the lack of student engagement and
motivation to learn and ask critical questions that could benefit their future career and
academic endeavors.
The team also interviewed Jason Bridges, a previous member of the select board of
Nantucket, and the executive director of Fairwinds—Nantucket’s Counseling Center. In speaking
with Mr. Bridges, the team learned more about the challenges that youth are facing outside the
classroom regarding extracurriculars and outside support resources. The team learned more
about the challenges that youth are facing outside the classroom regarding extracurriculars and
outside support resources.

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5.0 Conclusions and Recommendations
Conclusions
HHS Survey
Trends within the data may suggest that there is an overall lack of willingness among a
majority of students to use mental health resources offered in schools. To better understand
this trend, the team performed a thematic analysis of student responses. The two most
contributory factors to student hesitance were the perceived lack of need and a lack of comfort
with using services. These themes were consistent across more than half of the 133 students
who said they would not use mental health services at their school. Other barriers that were
identified included the following; questioning the helpfulness of the resource, being unaware
that such resources were available, and the stigma related to needing or using such resources.
The data also may suggest that students who do not identify with the LGBTQ+
community experience better mental health overall than students who do. However, because
only 8.5% of students identified as part of the LGBTQ+ community, further research is needed to
confirm this correlation.
The team concluded that students who reported receiving lower grades experienced
worse mental health than those with higher grades. Additional research is needed to conclude
the nature of this correlation, and to identify which factor influences which.
Interviews
As a result of the interviews conducted with Pauline Proch and Jason Bridges, the team
drew the following conclusions that impacted survey design.
• Isolation and loneliness are prevalent concerns among the youth community on
Nantucket (Pauline Proch Interview, November 2023).
• The geographical isolation of Nantucket is a contributing factor to such feelings of
loneliness and isolation (Jason Bridges Interview, November 2023).
• Loneliness and isolation are two of the many implications that the COVID–19 pandemic
had on Nantucket youth (Pauline Proch Interview, November 2023).
Recommendations
Focus Groups & Interviews
The team recommends that future investigators contact subject matter experts, school
faculty, and parents of students in Nantucket and a peer community as soon as possible to
schedule focus groups and interviews.
Interviews with experts in the field of youth mental health could provide reputable,
insightful, and well–structured qualitative data relevant to this research. Focus groups with
faculty and parents could provide firsthand perspective of the behavioral trends observed in

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Nantucket schools and homes respectively. This insight could then be used to develop and
revise the questions for an online survey (Deaton et al., 2022). Relevant guidelines and scripts
can be found in Appendices C, D, and E.
Implementing this qualitative methodology with members of a peer community, such as
Martha’s Vineyard, would allow for the comparison of data gathered from Nantucket with that
of a population with similar characteristics. Such a comparison could be used to identify
common trends between the two populations and further shape recommendations made to the
HHS.
The team’s success in conducting focus groups and interviews was limited by the
communication and availability of contacted individuals. Reaching out to schedule times for
focus groups and interviews in the earliest possible stages of project work could reduce the time
spent waiting for communication while on the island.
Online Survey Tool
The team recommends the following, in no particular order:
1. Implement survey questions related to the home environment of students.
2. Implement survey questions related to academic subject affinity and career interests.
3. Clarify questions which ask a participant to describe their interpretation of a word or
phrase.
4. Specify to survey participants that personally identifiable information should not be
included in their responses.
5. Determine survey approval processes, distribution methods, consent responsibilities,
and any ethical or legal implications as soon as possible.
6. Implement all survey methodologies in a peer community to Nantucket.
7. Explore multiple networks of distribution for surveys.
Further Investigation
The team recommends that additional research be conducted to assess the following:
– The mental state of female students—as well as minorities of gender, orientation, or
ethnicity—relative to that of their peers.
– The relationships between students’ behavioral health and their grades, substance use,
and any other measurable factors.
The survey responses of minorities fall short of significance to the Nantucket youth
population. The team suggests a more thorough investigation into the behavioral health of
students whose identity is underrepresented by a quantitative needs assessment of this scale.
Monitoring these demographics could reveal actionable insights which inspire a higher degree
of confidence than those found by the team. Majority demographics should not be ignored,
however, as even these students’ survey responses cannot stand on their own. More data is
required to support the trends found in this study.