Talking about mental health isn't taboo in Andrea McCabe's fifth-grade class at Chatterton School in Merrick, New York. It's just another day at school.
On a recent day, Miss McCabe, as the children call her, lead the class in an exercise: "Everybody say, 'Stress,'" she instructed the students. The class echoed, "Stress."
"How many of you have ever felt stress?" McCabe asked. Every student raised his or her hand. "It's a normal thing, right? We all feel stress sometimes."
The students also learned about forgiveness. "Sometimes holding onto something that's bothering you is so much more stressful that just forgiving and moving on," McCabe told them.
Together, they breathed in and out.
"The best thing about belly breathing is you can do it without anybody knowing," McCabe instructed. "I can be walking down the street and do belly breathing, and de-stress while I'm walking."
Then, the students brainstormed ways to cope.
"Just start fresh with whatever you're stressed out on," a boy suggested.
"Count to ten," said another.
"Take a shower," a third recommended.
Mental health education required by law
This isn't the fifth-grade class you had in school. New York Bill A3887B, signed into law in 2016, requires mental health education to be a part of health education across all grade levels. One of its goals was to enhance understanding and promote human dignity, supporters wrote.
"When the law was passed, people were woken up," said Dominick Palma, superintendent of the Merrick Union Free School District.
In elementary school, most of it is focused on developing social-emotional skills and tying into children's understanding of how physical health and mental health go together, Palma told TODAY.
"As students get older, into the middle school and high school grades, that's where there's even more of a focus on what mental health is, what mental illness is, how you advocate for yourself, how you advocate for others," said Palma.
Mental health across the U.S.
A TODAY analysis found New York is among at least nine states that require a mental health curriculum by law. At least 20 states and the District of Columbia include mental health in their health or education standards.
Lawmakers in at least three states — Missouri, Nebraska and South Carolina — have proposed legislation to require mental health education. Texas and Georgia did not respond to TODAY's multiple requests for comment.
More than a dozen states appear not to require mental health education or incorporate it into their standards, according to TODAY's analysis.
Palma had a message for those states.
"I would ask them: What is a priority in your schools? Because if working on having kids understand what mental health is isn't your first priority, before all the academics, I just don't understand it," Palma said.
"This is not putting something else on the plate; this is the plate of education. You know, that has to be done first."
It's a foundation more important than ever as a growing number of kids struggle.
More than 6 million children in the U.S. have a diagnosis of anxiety or depression, according to the most recent data by the Centers for Disease Control and Prevention. Suicide is now the second-leading cause of death among 15- to 19-year-olds, the agency said.
'They're not alone'
Back in the classroom, students said mental health was just as important as all their other kinds of health — and they're not afraid to talk about it.
"Mental health is… not about your physical health,” Daniel, 10, said, "but your mind. And what you're thinking about."
The students said their top tips for defeating stress are to relax, exercise, go for a walk and use a stress ball.
"When you encounter it, you need to know what it is," Daniel added. "Like our lesson today. If you didn't know how to deal with stress, you would just be stressed out all the time."
Yael, 10, who said she experienced stress when she was the "new girl" in second grade, agreed: "You would have to know how to deal with it and what to do during that situation."
"I like to step away for a few minutes," 10-year-old Noah said. "Like if I'm doing my homework and I'm stressed out about something for my homework, I like to watch TV for a few minutes."
Their teacher said the lessons are making a difference. "Often, it's like the elephant in a room. It's something that they feel like, 'Oh, it's only me,'" McCabe noted. "Letting them know that they're not alone, and it is something that unfortunately exists, is so important."
When it comes to mental health, visibility can be crucial. Each student raised his or her hand when asked if they have stress in their lives.
"They were all comfortable with saying, 'Yeah, I'm stressed,' McCabe said. "It was like, 'Ah, man. I really hate to see that they're stressed.' But I'm also really glad to see that they can admit that, and it's OK. And they're not ashamed."
Removing the stigma of mental health is an education that will last a lifetime.