The mental and behavioral health of students is a necessary, appropriate, and critical focus of education. Mental and behavioral wellness is directly linked to overall positive student achievement, school climate, high school graduation rates, and the prevention of risky behaviors, disciplinary incidents, and substance abuse. Providing ongoing access to mental health services creates a positive learning environment in which students feel connected to their school community. The continuum of school mental health includes promoting wellness, resiliency, skill-building, and help-seeking behaviors. These are critical to student well-being and safety, and to identifying students who may need more intensive services or for those who require immediate intervention.
It is estimated that 1 in 5 students suffer from a mental health disorder, and roughly 80 percent of children and youths who are in need of mental health services do not receive them. Of those students who do receive services, the vast majority receive them in the school setting. For many of our nation’s students, schools have become the de facto mental health service provider and are often students’ only source of support and services. Luckily, schools have the ability to provide multitiered systems of mental and behavioral health supports, in which a continuum of services (e.g., universal, targeted, intensive) are provided to address the needs of all students, including those with and without identified education disabilities.
Comprehensive Mental and Behavioral Health Services
Mental and behavioral health services are essential components of comprehensive learning supports, as students’ mental and behavioral health underlies every aspect of learning. Comprehensive school mental and behavioral health service delivery systems must include:
- Adequate access to school psychologists and other school-employed mental health professionals (e.g., school counselors and school social workers)
- Universal screening for all students, coupled with the availability of appropriate early intervention services for students identified as being at risk
- A continuum of interventions that include mental wellness promotion, early intervention, and a continuum of more targeted and intensive interventions for students with increasingly significant needs
- Professional development (e.g., mental health, first aid) for school staff, parents, and community members to help them recognize signs of mental health concerns in students and ways to connect them with the appropriate supports in the school and community
- Evidence-based threat assessment and suicide risk protocols and teams
- Collaborative partnerships with community agencies and providers to help students with the most significant needs
Comprehensive mental and behavioral health services are most effective when integrated with all school improvement efforts and delivered through multitiered systems of support (MTSS) that include universal (Tier 1), targeted (Tier 2), and intensive (Tier 3) services that meet the needs of all students.
Universal services are part of a schoolwide effort to promote mental and behavioral wellness and prevent mental and behavioral health problems for all students. Key elements of Tier 1 include:
- Universal screening for academic, behavioral, and emotional learning barriers to ensure early identification and early intervention
- Infusion of social-emotional learning into classrooms/curriculum
- Staff development related to identification of mental health concerns and referral processes
- Schoolwide positive behavior interventions and supports (PBIS) with a focus on creating a positive school climate
Targeted services address identified or emerging mental and behavioral health problems, prevent risky behaviors, and increase protective factors for students and their families. Evidence-based Tier 2 services include:
- Suicide risk/threat assessment
- Individual/group counseling and skill-building groups
- Development and monitoring of individual student behavior intervention plans
- Consultation with teachers and/or families to address mental and behavioral health problems
Intensive services focus on direct and indirect services to address identified mental and behavioral health problems. Evidence-based Tier 3 services include:
- Direct therapeutic services to all students in need, including individual and group counseling, even in the absence of a clinical diagnosis or identified educational disability
- Psychological assessment of social, emotional, and behavioral problems
- Crisis intervention/crisis response
- Facilitation of collaboration among school providers with community agencies and other outside mental and behavioral health providers
It is important to note that partnerships with community providers or school-based health centers can provide important resources for individual students. However, these partnerships should not be a substitute for enabling access to school-employed mental health professionals such as school psychologists, school counselors, and school social workers. Successful school-community partnerships integrate community supports into existing school initiatives, utilizing a collaborative approach between school and community providers that enhances effectiveness and sustainability.
Federal Funding Streams
The Every Student Succeeds Act (ESSA) recognized the critical importance of providing comprehensive mental and behavioral health services in schools, as well as providing professional development for school staff on how to recognize and refer students in need. ESSA authorizes various funding streams (e.g., Title I, Title II, Title IV-A), including funds specifically reserved for schools identified for targeted support and improvement in order to support state and district efforts to improve access to coordinated comprehensive school mental health services. These funds could be used to:
- Implement MTSS, PBIS, or other schoolwide tiered models to address the social-emotional, behavioral, and mental health needs of all students.
- Administer universal mental and behavioral screening and provide early intervention for at-risk students.
- Increase access to comprehensive school mental and behavioral health services, including wellness promotion.
- Improve quality and effectiveness of family engagement and school community mental health partnerships.
- Provide mental health first aid and other professional development and training for relevant school staff to:
- Facilitate early identification and referral of students who may be in need of mental health supports.
- Implement suicide prevention policies and practices, including suicide risk and threat assessment.
- Support the implementation of trauma-informed practices.
- Increase knowledge of culturally competent practices.
- Support evidence-based efforts to prevent school violence, bullying, and harassment; improve school safety; and foster safe and supportive learning environments.
Federal Effort to Increase Access to Services
Discussions are underway about how the federal government can support the delivery of comprehensive school mental health services. One such bill is the Mental Health Services for Students Act of 2018. This bill provides funds to support comprehensive staff development in mental health, first aid, and other mental health awareness training programs; support universal screening to identify students with unmet needs; and facilitate school community partnerships to improve mental health service delivery.
Adequate access to school psychologists and other school-employed mental health professionals is critical to any effort to implement comprehensive services. Unfortunately, many states and districts have a marked shortage of school psychologists, social workers, and counselors, making it impossible for these professionals to provide the full range of services for which they are trained—including schoolwide preventive services (e.g., bullying, violence, dropout prevention), safety promotion, individual and group service delivery, and sustained school improvement. As a result of these shortages, many districts go without prevention and early intervention services that effectively link mental health, school climate, school safety, and academics instruction. The National Association of School Psychologists, in collaboration with our national partners, is currently working with several congressional offices to examine ways that we can improve efforts to train, recruit, and retain these professionals so that every school has adequate access to a school psychologist, a school counselor, and a school social worker who are vital to ensuring that the mental and behavioral health needs of students are met.
Kelly Vaillancourt Strobach, PhD, NCSP, is the director of policy and advocacy at the National Association of School Psychologists.