This story discusses suicide and mental health. If you or someone you know is struggling, support is available. In the U.S., you can call or text the Suicide & Crisis Lifeline at 988. It is free, confidential, and available 24/7.
Before Marisa Marraccini, Ph.D., the Donald & Justeen Tarbet Faculty Scholar in Education at the UNC School of Education, began leading national research on suicide prevention in schools, she was a school psychology intern in a rural Rhode Island high school supporting students returning to class after psychiatric hospitalization — without a roadmap.
At the time, schools had clear protocols for identifying students in crisis and getting them help. But once those students came back to school, she said the systems to support them weren’t ready for their return.
“We would spend a lot of time identifying risk, referring, or hospitalizing,” Marraccini said. “And then kids would come back, and we would have no idea how to support them.”
Even after connecting with hospitals, the guidance she received was limited — or nonexistent.
“I would ask, ‘What is helpful for this kid? What can I reinforce?,’” she said. “And it was just crickets. There was much less thought about school context.”
That gap — between crisis care and everyday school life — has provided the foundation of her decade-long research career. Marraccini has been a Carolina faculty member since 2017.
The recently released “School Re-Entry Guidelines: Recommendations for Hospitals, Schools, and Families in Supporting Youth Following Psychiatric Hospitalization for Suicide-Related Crises,” developed through the Marraccini-led School Reintegration Project in collaboration with national mental health experts, offers one of the first research-based roadmaps to help schools, families, and healthcare providers support students during a critical period of recovery.
The challenge of returning to school
When a student returns to school after a suicide-related crisis or psychiatric hospitalization, the transition is rarely simple, and it extends far beyond academics.
“On top of handling symptoms in school, there’s the academic piece, the social piece, and then just reacclimating to the routine,” Marraccini said. “For most kids, there’s something in school that’s hard — academics or social, or both.”
Students may face missed coursework, intense academic pressure, or difficult social dynamics — from peers asking questions to rumors circulating in hallways. In some cases, Marraccini said, students return to a school environment where their absence has already become a topic of conversation.
For other students, the pressure is quieter but still intense: high-achieving students grappling with missed opportunities and uncertain futures.
Marraccini emphasizes that these scenarios are not rare. In fact, she often begins presentations with educators by asking them to imagine their classrooms.
“If you have 30 students in your class, about five or six of them will have seriously considered suicide, and about two or three will report having attempted suicide in the past year,” she said.
Despite this prevalence, formal systems to support students upon their return to school were once scarce.
At the core of Marraccini’s “School Re-Entry Guidelines” is a clear, powerful message: Returning to school is not a single and concise moment or situation, but an ongoing process happening days and weeks following care — and is unique to each student. Schools play a vital role in creating stability and supporting students’ needs in recovery and in re-engaging their learning.
To create that stability, Marraccini says schools and districts should consider establishing clear, school-wide procedures for re-entry to improve consistency, reduce uncertainty, and better prepare staff — teachers, school support staff, and administrators — to respond when a situation arises. Strong communication among schools, families, and treatment providers ensures that everyone involved understands the student’s needs and can work together to support them. Whenever possible, that collaboration should begin before the student returns to school, with a clear point person identified to coordinate efforts and serve as a consistent source of support.
Equally important, the guidelines advocate for centering the student in the process. Re-entry plans are most effective when they are individualized — taking into account each student’s strengths, challenges, and preferences. Involving students in these conversations, when appropriate, can help restore a sense of agency and comfort as they transition back into school.
The guidelines also recommend a phased approach to re-entry, including the following:
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Pre-Return Planning
Before the student returns, schools should identify a point person or re-entry coordinator, gather relevant information, and convene a planning team. -
Initial Re-Entry Meeting
A structured meeting — often involving the student, family, and school staff — is recommended to establish expectations and supports. Topics may include academic load, schedule adjustments, coping strategies, and communication preferences. -
Structured Support during Reintegration
Students may benefit from a range of supports and modifications, such as flexible or reduced schedule, modified assignments, or other accommodations to ease transition — reducing stress while helping the student re-engage in learning and social environments. However, more is not always better, and these supports and modifications should be selected to target individual student needs. -
Ongoing Monitoring and Support
Re-entry is not a one-time event. Schools should regularly check in with the student, assess progress, and adjust supports as needed.
Ultimately, the guidelines underscore that thoughtful, coordinated re-entry support can make a meaningful difference. By combining communication, flexibility, and compassion, schools can help students not only return — but move forward with the stability and support they need to thrive.
Creating supportive schools
While schools cannot solve every aspect of a student’s mental health challenges, they can and do play a critical role in recovery.
“What schools can provide — safe, welcoming places — is really instrumental for these kids,” Marraccini said. “Kids who feel supported coming back after a hospitalization are going to fare better than those without these supports.”
She also emphasizes that supporting students does not always require complex interventions.
“It doesn’t have to be this huge thing that schools take on,” she said. “It can be something as simple as helping people understand how common this is, engaging in best practice teaching practices, and ensuring a supportive environment that facilitates learning and growth.”
For Marraccini, the ultimate goal is both immediate and long-term.
In the short term, she hopes schools will use the guidelines to strengthen or establish re-entry processes.
In the long term, she sees opportunities to expand supports for families, test new interventions, and build stronger connections across schools and healthcare systems.
A starting point, she said, is recognizing that educators are already doing important work to support students. These new guidelines provide them with straightforward ways to continue that work.
“[The return to school after a psychiatric hospitalization] can seem really scary and big, and it is,” Marraccini said. “But educators are already working with these kids. They’re already supporting them.”