An Inflection Point for School-Based Mental Health: Key Steps States Can Take to Serve All Students
by Amy Kennedy, Education Director, The Kennedy Forum, and Duncan Young, CEO, Effective School Solutions
Our nation is at a critical inflection point when it comes to school-based mental health. Just this past December, U.S. Surgeon General Vivek Murthy issued an official advisory, “Protecting Youth Mental Health,” warning that America’s youth mental health crisis is, “a critical issue that we have to do something about now. We can’t wait until after the pandemic is over.” The COVID-19 pandemic has had a profound impact on America’s youth, causing increases in stress, symptoms of depression and anxiety, eating disorders, and mental health emergency room visits. As a result of COVID-19 and associated school closures, the realities of the mental health struggles young people face have now come to the forefront.
Against this backdrop, the role of schools as a point of delivery for mental health services is just now being fully realized. While many districts are doing great things when it comes to mental health, significant inconsistencies still exist from state to state and from district to district in terms of how best practices for school-based mental health are defined and services are delivered. In many ways, school-based mental health is still very much “the wild west.” At a time when clearer guidance is needed, now is the time for both State Education Associations and Local Education Associations to take a more proactive and prescriptive approach in putting mental health best practices into action.
Fortunately, there are key policy steps that both states and districts can put in place to ensure that resources can be used in the most effective and efficient way to get teachers, students, and families the support and services they need.
Embrace MTSS. One of the most fundamental actions that a state or district can take is to fully embrace Multi-Tiered Systems of Support (MTSS). MTSS is a proactive, holistic tiered system of support designed so that all students have equitable access to high-quality instruction and interventions to meet all student needs. Through MTSS, different levels of care are delivered to students based on the intensity (or tier) of need. MTSS approaches are being adopted by most states, but in many locations the exact definition of appropriate interventions and strategies by tier are loose or non-existent. States can help by adopting more prescriptive guidance for what support at each tier needs to look like.
Universal Mental Health Screening. Another policy that should be implemented at the state level is the development of universal mental health screening programs in schools. These screenings should be prioritized at a level equally important as screenings for vision, hearing, dental, or academic needs. When schools provide universal mental health screenings for students at key transition points throughout their education, they can increase the likelihood of success.
In addition, some states are creating programs that allow community-based mental health providers to deliver mental health services in schools. These programs help address the inequities and disparities associated with access to healthcare, particularly for students of color.
Identifying Sustainable Funding Paths. Unfortunately, as we all know, proposing and advocating for these types of policy solutions is only half the battle. We also need to help ensure that there are enough clinical staff to deliver the support and services, enough funding to sustain the programs, and an effective and data-driven way to measure success.
Mental health is too important to be subject to the inconsistencies of temporary and grant-based funding sources. More permanent and sustainable funding streams for mental health service delivery should be established, and the use of Medicaid reimbursement for mental health services expanded to the maximum extent possible. States can and should take advantage of the Centers for Medicare and Medicaid Services’ reversal of the free care policy to bill Medicaid for health services delivered to all Medicaid-enrolled children, not just those with an Individualized Education Plan (IEP). Implementing the reversal of the free care policy would allow state Departments of Education and local school districts to expand school-based Medicaid programs which would benefit all children. Leveraging these Medicaid dollars is one way to provide mental health services to children in schools.
Embrace Data. Finally, states and districts should adopt a more data driven approach for measuring the implementation of mental health action steps and mental health outcomes. This should begin with the creation of a School-Based Mental Health Scorecard to measure key performance indicators by district across the state. The data should be reported out on par with other more prevalent forms of achievement data such as literacy scores, math scores, etc.
Now, more than ever, young people are experiencing a collective mental health crisis. However, by not maximizing the extent to which the school can support them, we are failing them. School-based mental health can and should play a vital role in addressing America’s youth mental health crisis. We need to start investing time and money in policies and programs that will truly make a difference — and we can’t afford to wait.