Megan Gilmour, Churchill Policy and Deakin University Honorary Fellow, Australia, calls for legislation, technology, and policy to address complex school absence during medical or mental health challenges
Health and education are vital to sustainable development. Yet in schools across developed countries, up to 30% of students (1.2 million in Australia), risk missing school, for months to years, due to complex medical or mental health challenges.
Complex health conditions can range from physical illnesses like arthritis, cancer, or rare diseases, to mental conditions (including anxiety), and may cross-over with disability and the recent surge of students confronting so-called “school refusal”.
Declines in school attendance are not new but spiralled after COVID-19, exposing harmful impacts of education isolation, while highlighting government expectations for continued school connection and ongoing access to teachers, learning and peers during a health crisis.
While the pandemic proved that schools can rapidly adopt remote solutions, including telepresence, as a safe and effective intervention to tackle school absence before it becomes chronic, these were largely dropped when in-person classes resumed.
This decision once again stranded students facing complex school absence during medical or mental health challenges, ignoring 21st century solutions (like now-ubiquitous videoconferencing tools), and entrenching inequities.
Policy Impacts
In Australia, we already have necessary legislation and technology to address chronic school absence. Now we just need policy to address a blind spot where schools often fail to connect a student’s health condition with specialised education support.
Just as wheelchair ramps provide accessibility, without discrimination the Australian Disability Standards for Education regulates for access to classrooms, curriculum, and support on the same basis as peers, including via “assistive technology/devices”.
The problem is that education systems historically count attendance as physical presence, discounting students’ ability or desire to “be there” when they physically can’t. During physical absence, regular school support usually ceases.
Outdated policies label absences as either “approved” or “unexplained”, based on evidence of diagnosis. But a cold isn’t cancer, nor is trauma truancy, and schools must be able to distinguish between short-term and chronic absences caused by serious health conditions, so specialised support can be given.
Data from nonprofit MissingSchool’s service reveals that close to two-in- three students in Australia with chronic conditions and school absence lack an individual education plan, while at least 40% have already missed between four and 12 months of school.
Economic and Social Impacts
There is “no safe threshold for absence” from school. A child who misses more than 10 school days per semester (less than 90% attendance), faces penalties in academic and mental health outcomes. Of children helped by MissingSchool:
- 71% endured disruptions to friendships;
- half fell behind academically and experienced increased anxiety;
- 47% experienced decreased social support as a result of lower school attendance; and
- 42% had reintegration difficulties and ‘school refusal’, entrenching already-extensive absences.
Peer reviewed research finds these students at greater risk of academic failure or lower performance, incomplete schooling, and lower career attainment. They also face social isolation, bullying and increased risk of maltreatment, and poor mental health.
MissingSchool data also identifies notable mental health effects on siblings, peers, and families— particularly mothers, who carry the load as caregivers and reluctant home educators, compromising their ability to participate in paid work.
Additionally, teachers face increased workloads as they navigate the administrative issues of chronic school absence, deal with vicarious trauma, and struggle to support absent students who are falling behind.
In Australia, hundreds of thousands of children are currently missing school due to personal health crises, with lifetime productivity losses nudging $1 million per student, and national costs into the billions. This undoes sizable healthcare investments.
Policy Opportunity
MissingSchool data from over 1,400 teacher and parent surveys shows that maintaining school connections reduces student anxiety, reactivates support, and smooths transitions between home, hospital, and school.
At a time when UNESCO reports 251 million children worldwide are out of school, with one new child needing to attend every two seconds until 2030 to achieve the UN Sustainable Development Goal of “quality education”, technology is a solution.
Telepresence connects students to their classes in real time, supporting learning and belonging while easing teacher workload as “teach once” technology. Since 2017, MissingSchool has reconnected over 7,050 classmates and trained 700+ teachers.
Policy must explicitly address students with health conditions, mandating business-as-usual access to assistive telepresence to bridge absences, setting support and training standards, and introducing attendance data granularity and early intervention triggers.
Economic and Social Outcomes
Keeping students with complex health challenges and absence connected to school unlocks broader benefits. For example, for each additional year of schooling completed, a person’s future income rises by approximately 9-10%.
Beyond individual earnings, the impact includes higher tax revenue, reduced welfare costs, better healthcare outcomes, greater social stability, and less strain on public systems. These are amplified by returns on past healthcare investments.
The solution to absence isn’t just attendance—it’s presence. In today’s world, presence can be virtual when physical attendance isn’t possible, paving the way for inclusive, future- proof school systems.
Why it matters
We have an opportunity to address the economic, health, and social challenges faced by students with complex health and attendance issues. We can do this by counting this hidden cohort and mainstreaming “learn from anywhere” as the new standard.
Investing in large-scale, well-designed implementation of “teach once” telepresence, supported by randomised controlled trials, will equip schools to meet 21st-century challenges with innovative solutions for significant economic and social returns.
This issue demands global attention in line with UN Secretary-General António Guterres’ call to make education fit for purpose by harnessing digital tools to expand access, improve learning, and build future capacities.
All children must be seen and heard. Adaptable education models can tackle 21st-century disruptions head on, ensuring that learning and wellbeing continue for all, even in crises.
