Mental Health Services in Schools: The New Normal?
By Effective School Solutions
Earlier this year, the chief science officer of the American Psychological Association, Mitchell J. Prinstein, made the case for greater investment in mental health services for our country’s youth. His argument came on the heels of similar appeals by President Biden and Vivek Murthy, the country’s Surgeon General. To make his point, Prinstein notes that, on average, there are two students in every American classroom who are experiencing mental health issues severe enough to affect “their ability to concentrate and learn — and potentially threatening their lives.” In the United States, he adds, the suicide rate is the highest among all wealthy nations. In fact, suicide is the second leading cause of death among teens and young adults in this country.
Prinstein is right to refer to “students” and “classrooms,” because school is where young people spend the bulk of their day. It’s where they engage in the activities, learning, and relationships that play a role in shaping their futures. At the same time, mental well-being is virtually a prerequisite for a rewarding school experience. It’s hard to engage academically when anxiety, depression, or other emotional challenges are syphoning off all your energy. This is why mental health services and schools are natural partners. And it’s why President Biden and Dr. Murthy called on schools to step up and help meet the current challenge.
School-Based Services: A Solution That Makes Sense
In many ways today’s young people live in a climate of unease. They face heightened pressures to achieve in school, the always online culture of social media, the psychological toll of constant school shootings, anxieties around climate change and its impact on the future, the pain of racial injustice, and, of course, the lingering aftermath of the Covid-19 pandemic. These broad, external factors don’t even take into account interpersonal dynamics within families or the specific brain chemistries of individual young people. Kids are by nature resilient, but with so many complex factors at play, it’s not hard to see how we’ve arrived at our current mental health crisis.
School-based mental health services offer an effective and workable response to this enormous challenge and address the greatest obstacles to access. For many families, the sheer cost of a private therapist is prohibitive, and getting to and from appointments can pose logistical nightmares. Even for families for whom these issues aren’t a problem, access can still be a challenge; we’re currently facing a shortage of private therapists who are qualified to meet the unique needs of children and teens.
Another barrier to access is stigma. In recent decades our culture has become much more open about and accepting of mental health issues, but individuals and families may still experience shame when they’re the ones in need of support. School-based interventions can serve to normalize the experience of seeking mental health services — both for young people and their families. By bringing mental health issues into the school setting, schools have an opportunity to educate students and families about the pervasiveness of mental health difficulties and their causes, reducing embarrassment, guilt, and shame.
In addition to solving issues of access, schools and school personnel may also be in the best position to recognize students’ mental health struggles early on because they see and interact with students on a daily basis. Early identification of social and emotional problems can lead to faster resolution and reduce the burden of suffering. By implementing strategies like universal screening, schools can often head off troubles before they have a chance to develop and escalate.
Easing students’ suffering may be the most immediate benefit, but studies have shown that developing comprehensive school mental health programs have a number of ripple effects: stemming absenteeism and helping students achieve academically, building students’ social skills, developing their self-awareness and leadership skills, and fostering warm and caring connections to adults in their school and in their community. In short, school based mental health services are a workable solution that can promote healthy skills for school — and for life.
A Multitiered System of Supports
Evidence shows that school-based mental health services are most effective when they exist within a multitiered system of supports (MTSS). An MTSS framework encompasses the continuum of need, enabling schools to promote mental wellness for all students, from the most resilient to the most vulnerable. Tier 1 programs focus on schoolwide wellness, employing a Social Emotional Learning curriculum and universal mental health screening. Tier 2 services address the needs of students with mild to moderate mental health symptoms; and Tier 3 services are the most intensive, reserved for the smaller group of students with severe mental health challenges.
Implementing tiered programs makes it possible to identify and address problems before they escalate or become chronic and to provide increasingly intensive, evidence-based services for the individual students who need them.
Are Schools Ready?
It’s clear that yesterday’s strategies aren’t suited to today’s complex reality. School staffing solutions that might have sufficed twenty, ten, or even five years ago are no longer adequate to meet the current needs of our young people to allow them to flourish. But are schools ready and equipped to provide the supportive, evidence-based care that can help kids thrive?
Citing a study by the National Center for Education Statistics (NCES), the Pew Research Center reports that during the 2019–20 school year just over half of the country’s public Schools (55%) provided mental health assessments to diagnose mental health issues. Far fewer, however, actually provided services or treatment for students who needed them. Just 42% of K-12 schools offered mental health treatment to lessen or eliminate symptoms, the survey reported.
The pandemic, of course, changed the landscape considerably. With the return of in-school instruction for the 2021–22 schoolyear, it came as news to no one that the mental health needs of students had risen dramatically. In response, schools across the country scrambled to beef up their mental health services. Research conducted by the National Center for Education Statistics and the U.S. Census Bureau found that in the 2021–22 school year as many as 96% of public schools reported offering at least some form of mental health intervention to their students. A majority of schools (67%) said that they’d increased their mental health services; fewer than half, however, (41%) said they’d hired additional staff to meet the overwhelming need. What’s more, only a third of schools said they were providing outreach services and mental health screenings, which are effective tools for early intervention and prevention.
In both of these research studies, the main reasons schools gave for failing to provide the necessary services for their students were insufficient funding and lack of access to qualified mental health professionals.
Effective School Solutions Can Help Sustain Mental Health Services for the Long Haul
School-based mental health services are not a passing trend. The challenges young people face are not going away. By reducing stigma and increasing access, in-school services can help ensure that all students — not just the fortunate few — get the support and help they need to reach their true potential.
So how will school districts across the country expand services for their students? And how will they pay for them? On the staffing front, one answer is partnering with outside experts. As a leader in in-school mental health services, Effective School Solutions (ESS) works with districts around the country that are struggling to meet the rising needs of their students. By implementing an MTSS framework and providing qualified practitioners, ESS consistently helps schools expand and improve care, strengthen academics, and maintain students in-district.
To help district leaders secure the resources to pay for these essential services, ESS has devised a 7-part framework to guide districts as they seek to obtain long-term funding for mental health services: SUSTAIN . . .
Seize the opportunity to prioritize school-based mental health. First and foremost, supporting students through school-based mental health programs is the path for helping young people succeed in school and beyond, and districts must make it a priority.
Utilize traditional federal funding sources like Title funds and IDEA to fund mental health services. The federal Mental Health Service Professional (MHSP) Demonstration Grant Program and the School-Based Mental Health (SBMH) Services Grant Program allocate monies to increase mental health support services in schools.
State specific mental health funding. State appropriations fund student mental health supports and services. Recent state actions have focused on awarding monies to support and develop school-based mental health programs and services, mental health and wellness curricula, staff training and professional development, mental health screenings, suicide prevention programs and other core services. ESS works with state legislators on an ongoing basis to advocate for the inclusion of mental health services in state appropriations.
Take advantage of Medicaid. The federal government now allows school districts to bill Medicaid for health services delivered to all children enrolled in Medicaid. Some states can update this policy change administratively, while other states need to submit a state plan amendment (SPA) to the Centers for Medicare and Medicaid Services. ESS partners with many districts to provide reporting on service delivery that enables this reimbursement to take place.
Adjust out-of-district placements/non-public schools spending. Districts often spend millions of dollars to send students to private therapeutic day schools and other outside placements. While some students need the specific skills a specialized school offers, many students who are sent out of the district because of behavioral or emotional challenges could be supported in the “least restrictive” environment of the public-school system if the right supports existed. ESS offers great quality clinical support in schools at a fraction of the cost of an ODP or NPS. Strengthening mental health supports in a district can be a significant cost savings.
Integrate new federal funding sources. In addition to traditional federal funding sources, a new piece of legislation signed in July 2022 — the Bipartisan Safer Communities Act (BSCA) — authorizes $1.7 billion in mental health services to schools and communities.
Navigate COVID-19 relief funding. The government’s COVID-19 relief package allocated over $263 billion into state and institutional recovery and rebuilding efforts via the Education Stabilization Fund (ESF), which is managed by the Department of Education. The ESF includes distinct emergency relief funds relating specifically to mental health service provision through the Elementary and Secondary School Emergency Relief (ESSER) Fund, the Governor’s Emergency Education Relief (GEER) Fund, and the Emergency Assistance to non-Public Schools (EANS) Fund.
For school-district leaders, using the funding before it expires is critical. When it comes to ESSER funds, the greatest hurdle to spending the monies is having enough staff members to do it. ESS can supplement school staff and grow capabilities, assisting districts in implementing programming funded by ESSER dollars. Similarly, ESS can help districts make use of GEER funding, which may be distributed to public agencies or private entities that coordinate or directly provide early intervention services under the Individuals with Disabilities Education Act (IDEA). ESS programming falls under this programming bucket.
For many districts, expanding and fine-tuning school-based mental health care is a work in progress. But this model of care is clearly the way forward. This is a new normal that benefits students, their families, and the entire school community.
