By Ketan Tamirisa, SBHA YAC Member
By Ketan Tamirisa, Youth Advisory Council member.
The following reflects Ketan’s lived experiences, thoughts, and opinions.
When people talk about school-based health centers (SBHCs), they often focus on what services are offered: checkups, vaccines, mental health support, referrals, health education, or help when something feels wrong. Those services matter. But for students, asking “Do I feel safe enough to use this resource?” is just as important as “What can this health center do for me?” That question matters more than many adults realize.
According to the CDC’s[1] 2023 Youth Risk Behavior Survey, 39.7% of high school students reported persistent feelings of sadness or hopelessness, and 20.4% seriously considered attempting suicide. At the same time, school-based health centers have expanded nationally, from 2,584 SBHCs in 2016[2] to over 3,900 SBHCs in 2021[3]. Those numbers show two things at once: students need support, and schools are becoming one of the most important places to provide it. But access only matters if students actually feel comfortable using it. That comfort is shaped before a student ever sits with a nurse, counselor, or provider. It begins in the hallway, at the front desk, in the waiting room, and in the few quiet moments when a student decides whether to tell the truth or say, “I’m fine.” The waiting room may seem like a small part of health care, but for many students, it is where trust is either built or broken.
I saw this firsthand while serving at a school-based health center in an elementary school in St. Louis. I expected to notice the medical side of the center first, but what stayed with me most were the small details designed around students’ feelings. The walls were not plain or cold. They had bright paintings of giraffes, animals, and other welcoming images that made the room feel less intimidating. There were visuals on the walls where students could point to emotions like happy, sad, angry, or scared. For younger students, that mattered. Not every child knows how to explain what they are feeling, especially when they are nervous, embarrassed, or still learning the words. I also watched the nurse give students slips of paper where they could describe how they felt. If a student did not know how to write it out, there were ways to help them communicate. Sometimes that meant pointing to a feeling. Sometimes it meant using simpler words. Sometimes it meant slowing down and letting the student try again. The nurse constantly validated them. She did not make students feel silly for being confused or scared. She made it clear that their feelings were real and that they were allowed to ask for help. That experience changed how I thought about school health.
A health center can have the right services, the right equipment, and the right staff, but if a student feels judged or exposed, they may never use those resources fully. They may avoid going altogether. They may walk in, but leave out the most important detail. They may say their stomach hurts when the real problem is anxiety. They may say they are tired when they are actually overwhelmed. They may need help, but choose silence because silence feels safer than being honest. This is especially true for mental health. Many students already worry that asking for help makes them look weak, dramatic, or different. If the environment feels cold, rushed, or public, that fear grows. A student may be sitting only a few feet away from classmates and still feel completely alone. A poster may say support is available, but the feeling in the room may say, “Be careful what you say here.”
That gap matters.
Trust is not built only through official policies or big speeches, but rather through seemingly small details. Is the front desk welcoming? Is privacy clearly explained? Are students spoken to with respect? Are there tools for students who cannot explain their emotions easily? Does the room feel like a place where someone will listen, or just another office where they might get in trouble? For school administrators and health staff, student experience cannot be treated as an extra. It is part of care. A student-friendly health center is not only about providing medical resources. It is about creating an environment where students can take the first step without feeling embarrassed, exposed, or afraid. That may mean asking students for feedback, making the waiting area more welcoming, using emotion charts, explaining confidentiality clearly, and training staff to recognize that a nervous student may not know how to ask for help directly.
For students, it means our voices matter. We are not just the people using these services. We are the people who know what it feels like to walk into that room. We know what makes us comfortable and what makes us shut down. We know when a space feels safe and when it does not. The reason this matters is simple: school-based health care only works when students actually use it. And students only use it fully when they believe they can be honest. A waiting room may look like a small space, but it can decide whether a student opens up or stays silent.
So the next time you walk past your school health center, ask yourself: Would I feel comfortable being honest here? Would my friends? Would a student who is scared, stressed, or embarrassed feel safe enough to ask for help? If the answer is no, then the conversation should not end there. It should begin there. Because the waiting room is not just where students wait. It is where trust starts.
[1]https://www.cdc.gov/mmwr/volumes/73/su/su7304a9.htm
[2]https://www.dshs.texas.gov/sites/default/files/schoolhealth/pdf/2016-17-Census-Report-Final%20(1).pdf
[3]https://sbh4all.org/wp-content/uploads/2023/10/FINDINGS-FROM-THE-2022-NATIONAL-CENSUS-OF-SCHOOL-BASED-HEALTH-CENTERS-09.20.23.pdf