To articulate recommendations that promote student mental health as a critical component of school improvement efforts.
The National Institute of Mental Health states that in the United States today, one in ten children suffers from a mental disorder severe enough to cause some level of impairment. Mental health disorders affecting children and adolescents include attention deficit hyperactivity disorder, autism, depression, eating disorders, and schizophrenia, to name just a few. Students suffering from these ailments are at serious risk of academic failure and are more likely to drop out.
School leaders, therefore, have an important stake in promoting mental health on their campuses. As they do so, however, they face a daunting array of challenges:
- Paucity of research surrounding mental health issues. The roots of mental health problems exist on a wide continuum ranging from social environment factors to internal pathology. According to the UCLA Center for Mental Health in School, problems experienced by most students are psychosocial (caused by their social and psychological environment), not psychopathological (caused by internal factors), and often can be countered through promotion and prevention. Yet they are routinely diagnosed as serious disorders requiring expensive and, at times, inappropriate treatments. Authors of the Center for Mental Health in Schools report argue that "the overemphasis on classifying problems in terms of personal pathology has skewed theory, research, practice, and public policy."
- Limited capacity to address mental health issues. Schools have historically used their resources to hire a substantial number of student support professionals. These school staff members have been the core around which programs have emerged. With increased accountability for academic results under No Child Left Behind, school counselors, who represent the majority of student support professionals in schools, have seen their responsibilities shift away from mental health toward an academic focus, leaving an even wider gap in support services. In addition, it is estimated that the current ratio is one counselor for 488 students. Data from the Center for Mental Health in Schools suggest that, on average, school districts spend 7% of their budget to pay the salaries of mental health personnel, who often must rotate among schools. Few schools come close to having enough resources. Too often, support service personnel operate in isolation of each other. Little systematic inservice development is provided for new support staff.
- Shortage in funding and uneven distribution of resources. Nationally, the top federal sources of funding for school mental health intervention services are the Individuals with Disabilities Education Act, reported by 63% of districts; state special education funds (55%); local funds (49%); and state general funds (41%). In December 2007, the Centers for Medicare and Medicaid Services (CMS) issued a rule that cut Medicaid reimbursements to schools by approximately $700 million. The new rule, which was blocked by Congress in April would have eliminated reimbursement to schools for transporting students with disabilities to and from school. Schools would no longer be reimbursed for certain administrative activities performed by school employees or contractors, such as planning student immunizations and outreach efforts aimed at identifying students who are eligible for Medicaid.
- Title IV (the Safe and Drug-Free Schools and Communities program) is most frequently reported by districts as a prevention resource (57% of districts), followed by local funds (43%) and state general funds (39%).
- Title I of the Elementary and Secondary Education Act of 1965, Improving Academic Achievement of the Disadvantaged, was reported by 20% of districts as an intervention resource and by 22% of districts as a prevention resource. Since secondary schools only receive a fraction of Title I funds, they do not benefit from this source of revenues. Other funding sources are inaccessible to middle level and high schools. In its 2007 report to Congress, the Government Accountability Office stated that funding for school counseling programs can be awarded to secondary schools only if grant funds exceed $40 million. In FY 2007, grants for these programs totaled just under $40 million, essentially depriving secondary schools from much-needed resources. In addition, schools serving students from immigrant and refugee families or those living in poverty, are less likely than affluent schools to have the resources necessary to address their students' mental health needs.
- Traditional stigma surrounding mental health issues. For historical and cultural reasons, mental illness has persistently been stigmatized in our society. This stigma is manifested by bias, distrust, stereotyping, fear, embarrassment, anger, and avoidance. Addressing psychosocial and mental health concerns in schools typically is not assigned a high priority, except when a high-visibility event occurs, such as a shooting on campus, a student suicide, or an increase in bullying. Efforts continue to be developed in an ad hoc, piecemeal, and highly marginalized way.
- These challenges underscore the need for a comprehensive effort to build the capacity of schools as they help all their students reach their maximum potential.
NASSP Guiding Principles
- NASSP believes, and recent research has confirmed, that school leadership affects student achievement (second only to instruction, particularly for at-risk students). Principals and assistant principals play a critical role in leading schools' efforts to serve each student, particularly those who are at risk.
- Breaking Ranks II and Breaking Ranks in the Middle provide school leaders with a framework for raising awareness of mental health issues in their schools and strategies to help students facing those issues.
- NASSP is committed to the concept of providing all students with equitable educational opportunities, regardless of their language, cultural background, race, or socioeconomic status.
- NASSP believes only a focused effort to invest resources in mental health at the local, state, and federal levels will address the issue at hand.
- The federal government and states must provide financial support to enable local communities to implement a comprehensive culturally and linguistically appropriate school mental health program that incorporates positive behavioral interventions and supports to foster the health and development of students.
- The federal government and states must also provide funding to enable schools to lower the counselor-to-student ratio to levels recommended by the National Association of Student Counselors. This would allow counselors to devote more quality time to help students on issues that are not exclusively academic. The federal government should also increase funding for the Elementary and Secondary School Counseling Program from $40 million to $80 million to ensure that middle level and high schools have access to this resource.
- The federal government should block the special rule adopted by the Center for Medicare and Medicaid in December 2007, which would have eliminated $700 million in reimbursement to schools for certain costs, including health costs, incurred to benefit students who are eligible for Medicaid.
- States and local governments should facilitate community partnerships among families, students, law enforcement agencies, education systems, mental health and substance abuse service systems, family-based mental health service systems, welfare agencies, health care service systems, and other community-based systems. State-funded school-based wellness centers would provide students with a comprehensive health support system that would include mental health services.
- In Title I, the U.S. Department of Education should promote a systematic focus on learning supports to address barriers to learning and teaching, provide guidance to schools for strategically addressing barriers to learning and teaching and for ending the tendency to generate learning supports in a fragmented manner.
- With appropriate funding, superintendents and school boards should promote comprehensive school-based mental health programs that address:
- The promotion of the social, emotional, and behavioral health of all students in an environment that is conducive to learning
- The reduction in the likelihood of at-risk students developing social, emotional, or behavioral health problems
- The treatment or referral for treatment of students with existing social, emotional, or behavioral health problem
- The early identification of social, emotional, or behavioral problems and the provision of early intervention services
- The development and implementation of programs to assist children in dealing with violence.
- With appropriate funding, school leaders should offer comprehensive staff development for school and community service personnel working in schools including training in:
- The techniques and supports needed to identify early students with, or at risk of, mental illness
- The use of referral mechanisms that effectively link such students to treatment and intervention services in the school and in the community
- Strategies that promote a schoolwide positive environment
- School system organization, operations, and functioning
- Models for school-based collaboration, coordination, and consultation.
- School leaders should promote mental health in their schools by:
- Setting high performance expectations for teachers and students
- Establishing an effective school leadership team
- Encouraging quality involvement of parents and community members in the school
- Modeling and promoting positive interpersonal and professional relationships between teachers and students
- Cultivating student self-discipline and respect for others
- Strengthening the school curriculum, instruction, and assessments
- Promoting service programs and student activities as opportunities to extend academic learning.
- Center for Disease Control. (2007). Reframing school dropout as a public health issue. Retrieved from www.cdc.gov/PCD/ issues/2007/oct/07_0063.htm
- Government Accountability Office. (2007). School mental health: Role of the substance abuse and mental health services administration and factors affecting service provision. Washington, DC: Author. GAO-08-19R
- Hunter, L., Hoagwood, K., Evans, S., Weist, M., Smith, C., Paternite, C., Horner, R., Osher, D., Jensen, P., &the School Mental Health Alliance. (2005). Working together to promote academic performance, social and emotional learning, and mental health for all children. New York: Center for the Advancement of Children's Mental Health at Columbia University.
- National Association of School Psychologists. (2003). Mental health services in the schools. (Position Statement) Bethesda, MD: Author.
- National Association of School Psychologists. An overview of school-based mental health services. Retrieved from www.nasponline.org/advocacy/ researchmain.aspx
- Skalski, A., &Smith, M. (2006). Student Services: Responding to the mental health needs of students. Principal Leadership 7(1), 12–15.
- UCLA Center for Mental Health in Schools. (2008). Mental health in schools and school improvement: Current status, concerns, and new directions. Los Angeles: Author.
Adopted November 8, 2008