School-Based Mental Health Programs: Why They’re Needed and How to Fund Them
By Effective School Solutions
A recent New York Times article reported on the escalating mental health crisis among America’s youth. This was just the latest in a spate of media reports on our nation’s mental health emergency. The article shared the stories of several struggling young people and highlighted a number of alarming statistics:
“In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.”
The numbers are impossible to ignore, and the concern has reached the highest levels of government. President Biden’s State of the Union address in January and Surgeon General Vivek Murthy’s special advisory issued in December both called attention to the crisis and outlined ways to begin to address it. Putting the situation front and center is a critical step in tackling the problem and devising solutions that will make a lasting difference.
There are reasons to be hopeful. The vast majority of mental health issues — especially among children and teens — are responsive to interventions by skilled and caring professionals. And by addressing these challenges early on, before issues become deeply entrenched, young people can get a handle on their challenges, develop coping strategies, and move on to happier and fully engaged lives.
In their recommendations for addressing the current crisis, the President, and the Surgeon General both point to the role schools have to play in meeting the mental health needs of our young people.
Meeting Kids Where They Are
One obvious reason it makes sense to provide mental health services at school is because school is where kids are. For most of the year, young people spend the bulk of their day at school, spending more hours there than anyplace other than home. This daily contact means teachers and other school staff regularly interact with students and get to know them. These adults are in a prime position to identify student behaviors that could signal mental health issues.
Particularly as kids get older and spend less time with parents and caregivers, teachers and school staff are often the first to identify behaviors that suggest students may be struggling. And while teachers and staff aren’t themselves equipped to handle these issues, having comprehensive mental health services in place gives staff the tools to identify early warning signs and the clear steps to follow to ensure that no student slips through the cracks.
Mental Health Is a Foundation for Learning
Students’ mental wellness is a prerequisite for participation, learning, and a sense of belonging at school. Left untreated, depression, anxiety, and other mental and emotional issues can have devastating consequences on young people’s wellbeing — not only in the moment but far into the future. Mentally healthy young people are more successful in school and in the rest of life.
The National Association of School Psychologists reports on research demonstrating that “students who receive social–emotional and mental and behavioral health support achieve better academically. School climate, classroom behavior, engagement in learning, and students’ sense of connectedness and well-being all improve as well. . .. Left unmet, mental health problems are linked to costly negative outcomes such as academic and behavior problems, dropping out, and delinquency.” Other studies have shown that developing comprehensive school mental health programs help students achieve academically and to engage in experiences that build social skills, leadership, self-awareness, and caring connections to adults in their school and community.
We all want kids to learn, grow, and realize their full potential. Making school the hub for mental health services can help ensure that more of them do.
In recent years mental health issues have become less stigmatized in our society. But while we’ve made definite progress, we still have a long way to go. The force of stigma is powerful, and it can prevent kids from getting the help they desperately need. According to the DC Family Policy Seminar, a report issued by the Georgetown Public Policy Institute in 2015, “One of the leading causes of missed appointments at community mental health centers is the stigma attached to mental illness. Many parents and children do not want to be seen entering a mental health clinic.” The same report cited a survey in which 71 percent of respondents said that mental illness is caused by emotional weakness, and 65 percent said that it’s caused by bad parenting. It’s no wonder families are ambivalent about admitting they need help!
But school-based interventions significantly 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 causes of mental health issues, reducing embarrassment, guilt, and shame.
And it turns out, young people are more receptive to receiving these interventions in a school setting. A study by the U.S. Department of Health and Human Services Office of Adolescent Health found that adolescents are more comfortable accessing health care services through school-based clinics, and they like the idea of accessing a range of health and social services in the same place.
Access and Equity
We know that major disparities exist among young people when it comes to issues of mental health. Students of color and young people from low-income families are more vulnerable to mental health challenges and are less likely to have access to appropriate services.
The Center for American Progress cited a 2021 survey by Education Week which found that 77 percent of Black and Latino students reported experiencing more mental health struggles since the beginning of the pandemic. That figure is significantly higher than the number of white or Asian students who said they were having difficulties.
Yet Black and Latino students often face the greatest barriers to receiving care. Apart from lingering stigma, these kids and their families often experience financial constraints and logistical challenges, such as transportation issues getting to and from appointments.
By locating services in schools, we can overcome some of these barriers and make mental health care available and accessible to large numbers of young people who might otherwise go without them.
Care Through Multi-Tiered Systems of Support
It’s clear why school is the logical location for these services, but how exactly should this care be provided? One proven model is the Multi-Tiered Systems of Support (MTSS) framework. The MTSS framework encompasses the entire school community — students, teachers, school staff, and families. The focus is on wellness and prevention, as well as providing interventions tailored to specific student need. Typically, MTSS includes three tiers of support.
Tier 1 is the largest. It includes mental-health wellness and prevention services that are woven into all instructional materials, including the district’s chosen Social Emotional Learning curriculum, and school activities. Universal mental health screening is done at the beginning of each school year to identify students who may need support that goes beyond Tier 1 activities.
Tier 2 focuses on the needs of students who have either self-identified or have been determined to have mild to moderate mental health symptoms, either by the school’s screening process, or by observations of parents, teachers, or other school staff.
Tier 3 services are the most intensive. These are reserved for the smaller group of students with severe mental health challenges. Tier 3 programs include a variety of components to preserve student safety, to address trauma, and to build self-regulation and other skills to manage the symptoms of serious mental health disorders. These services are typically provided daily within a comprehensive wrap-around or self-contained setting.
An MTSS Playbook can serve as a guide for districts that are interested in creating a mental health MTSS. The playbook lays out how a school district will implement MTSS according to best practices.
Funding the Services Kids Need
The Federal government’s COVID relief packages in 2020 and 2021 provided roughly $122 billion to the Elementary and Secondary School Emergency Relief (ESSER) fund for the nation’s schools. But that money runs out in September 2024. The urgent needs of our kids, however, will remain beyond this expiration date. It’s crucial that schools develop strategies to fund mental health services in the post-ESSER era.
In its guide on School Mental Health Funding, the National Center for School Mental Health (NCSMH) advises that schools use funding from different levels to fund essential mental health services, leveraging funds at the school level to the federal level: “Districts should incorporate a variety of types of funding from grants, private foundations, third party reimbursement, among others.”
Seek Federal, State, Local and Private Sources of Funding
As NCSMH’s guide points out, funding streams are regularly changing. That means states, districts, and schools must develop strategies that are diverse enough to weather economic and political shifts.
- At the federal level, funding sources include block grants, Title funds, project grants, legislative earmarks, Individuals with Disabilities Education Act (IDEA) grants, and direct payments and fee-for-service (Medicaid).
- State funding sources vary by state. In certain states taxes from select sources are used to fund mental health and education. Some states dedicate a line item in their budget for mental health services. State grants and Children’s Health Insurance Program (CHIP) are other viable sources.
- At the local level, school districts can allocate a portion of their budget for school mental health funding. Principals’ discretionary funds, and PTA funding are also potential sources. Tier 3 school-based programs can provide their own source of funding. These programs reduce the number of out-of-district placements, and this savings can cover the cost of the school-based program.
- Lastly, consider private foundations. According to NCSMH, this funding can be very flexible and may provide funding for pilot projects or mental health prevention and promotion activities.
If there’s any good news amid this ongoing crisis, it’s that people are paying attention, and they recognize it’s time to act. Following President Biden’s State of the Union address, twelve governors, in both red states and blue, voiced their own commitment to increasing investment in the mental health of our kids.