An insidious problem is lurking in Kentucky's schools: Students across the state are reporting high amounts of psychological stress, anxiety, and depression. The problem has become so bad that suicide is now the second leading cause of death for the state's youth.

While nationally, mental health awareness has increased, for Kentucky's teenagers, the issue isn't getting nearly enough attention. During her sophomore year, Kentucky high schooler Allison Tu realized mental health was being treated like an afterthought in her school. "One student told me that all of their suicide prevention education, which is mandated, technically, by Kentucky law but left up to districts to administer, is just a bookmark," Tu explained to The Week. "A literal, physical bookmark that has a suicide prevention hotline number on it, and that was it."

This felt to Tu like the equivalent of a shoulder shrug. Stress and anxiety don't come with a power-off button for teenagers; it seeps in through peer pressure, and lingers on social media. It's exacerbated by an overwhelming sense that one needs to have their entire life mapped out at 16. Tu wanted more focus on helping her peers battle mental health problems, and she figured that if the adults in the room weren't going to make it a priority, the students would have to take things into their own hands. So in 2016, she founded StAMINA (Student Alliance for Mental Health Innovation and Action), which she calls "a network of really passionate students who are dedicated to improving mental health through a bottom-up approach."

StAMINA's goal is to let teenagers talk about mental health in a way that makes sense to them. "I noticed there was such a significant lack of student voice when it came to mental health," says Tu, who is now a senior. In the two years since the group's founding, its leadership team has grown to include a dozen students across the state. They connect weekly via video calls and discuss ways to raise the conversation. And the group isn't messing around: It has partnered with a handful of organizations, including Kentucky Education Television, the Kentucky Partnership for Families and Children, and the Kentucky Attorney General's office to raise awareness locally. It also recently hosted a Youth Mental Health Ideathon where community stakeholders gathered to brainstorm ideas for new policies and programs addressing challenges in youth mental health services.

One of those challenges, Tu says, has been helping teens overcome the huge stigma that attaches itself to conversations about mental illness. "In Kentucky, there is still so much stigma, and the state of mental health is really pretty poor, and really urgent, too," Tu explained. "Every single time we have a focus group, every single time I even say the words 'mental health,' the number one issue is always stigma."

There are a lot of reasons why stigma exists so strongly in Kentucky, but psychologists say a lack of access to mental health care in rural communities, plus a general "suck it up" attitude toward feelings of stress and anxiety are some of the biggest contributing factors. But the stigma keeps teenagers from talking to anyone about how they're feeling — even their parents.

"In some of the smaller communities, it seems like if you were identified as having some mental health issues, that it could impact the way that you're perceived in the community," says Stephen O'Connor, a licensed psychologist and assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Louisville. StAMINA partnered with O'Connor recently on a research study to identify sources of stigma and found that peer and family attitudes, religion, and a misrepresentation of mental health in the media all play a role. But the study also found, optimistically, that young people were actively interested in improved education about symptoms, resources, and coping mechanisms. O'Connor says it's not just students who need support; parents and teachers need help, too.

"It seems like in today's world, given all of the stress that youth experience from all these different sources of information and expectation and everything, it needs to be kind of a universal approach," O'Connor says. "It's not just for people who might need to have some mental health care. I think there's a lot of social and emotional type of coaching and skill-building that could be done that could really help people prevent maybe using drugs and alcohol as ways to cope, or making other less effective decisions in adolescence."

The study also found that health-care providers and educators were not engaging in effective dialogue with youth about mental health, and that school counseling departments are often understaffed and leave little room for parents to have access to counselors trained in mental health support. The group wants to see more mental health-care professionals in schools.

"Mental health is just as important as physical health, and we have a nurse in schools, so why don't we have a mental health professional?" asks StAMINA's Will Powers.

Beyond the study, which StAMINA plans to publish in an academic journal, the group has also earned $100,000 in grants from GE Appliances, and met with state Attorney General Andy Beshear in March of this year. And when Kentucky legislators come back into session, the students plan to continue lobbying for House Bill 604, which would require a school to have one mental health professional for every 1,500 students. This would lessen the burden on school counselors, who average a caseload that's more than 200 students above the national recommendation.

When the group isn't working with psychologists or lobbying politicians, they're hosting summits where students can talk about their own experience with mental health. "It was so eye-opening to see so many people open up to you, that you just met maybe five minutes ago, just because they were given the opportunity to be in a safe environment and speak to other people that didn't have a stigma attached to them," says Powers, who leads the summits. "Especially in rural communities, we don't see a conversation. But now we're starting to see one."

The summits also let students come up with plans for progress. The goal is to create a guide for students who want to take action in their own schools. "If we had really good, really effective mental health education, then there's no misconceptions," says Tu.

StAMINA's work certainly bucks the stereotype of disengaged teens. There's still a long way to go to improve health care for Kentucky's students, but as Tu says, "The movement to improve youth mental health has to come from youth."