Mental Health

Nationwide, One in Five Youth Suffers from a Diagnosable Emotional, Mental, or Behavioral Disorder

Yet the majority of youth who need care do not receive it.1 Barriers to access include lack of or limited health insurance for mental health care, social stigma, and lack of problem recognition by adults, including teachers and parents. Under-identification is of particular concern in schools and primary care settings—two systems with which nearly all children interface and where identification should be most likely to occur.2 Minority youth, in particular, are less likely to receive needed mental health care.3 Even when they do receive care, there is great variation in the quality of care they receive compared to their peers.4 The consequences of untreated mental health disorders are profound, including greater risk for poor academic outcomes, suicide, substance use, and unemployment in adulthood.5

Seventy percent of children who receive mental health services access those services at school.6,7 The school environment is often a place of protection and security for students struggling with mental health disorders.

SBHCs Eliminate Barriers to Accessing Mental Health Care Among Children and Adolescents

School-based health centers (SBHCs) are the ideal location for primary care and mental health staff to collaboratively address students’ physical and mental health needs—leading to greater success in school and in life. Their proximity to students and ability to provide mental health care in a safe, private, and confidential environment allows for the development of ongoing relationships between practitioner, patient, and family to support positive behavioral change.

  • Seventy-five percent of SBHCs have a mental health provider.9
  • In studies of SBHC service utilization, mental health counseling has been repeatedly identified as the leading reason for visits by students.10
  • One 1998 study found that adolescents who had access to SBHCs were ten times more likely to make a mental health or substance abuse visit than those without access to an SBHC.11
  • In one study, inner-city students were 21 times more likely to make mental health visits to SBHCs than to community health centers.12
  • A national survey of SBHCs found the following mental health and counseling services are provided at SBHCs where mental health professionals are included as center staff: crisis intervention, mental health assessment, grief and loss therapy, substance use therapy, mediation, and others.9
  • SBHCs offer high quality mental health care by using an integrated strategy for addressing health and mental health issues. Several studies have shown that the barriers experienced in traditional mental health settings—stigma, non-compliance, inadequate access—are overcome in school-based settings.10,13
  • One study found that students served by SBHCs had fewer discipline problems, course failures, and school absences.14

To have the greatest positive impact, school-based mental health services should be fully integrated into the everyday functioning of the school by following these best practices:

  1. Mental health services build from and complement a positive school climate.
  2. Mental health services, especially prevention and early intervention services, are available to all students.
  3. Mental health providers work with school staff in teams.
  4. Mental health providers serve as a resource to teachers and other school staff.
  5. School districts partner with county and community agencies to provide mental health services.
  6. Mental health services are organized into a three tier system: universal, targeted, and intensive.
References
(1)  Merikangas KR, He JP, Burstein M, et al. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry. Jan 2011;50(1):32-45.
(2) Jensen, P. S., E. Goldman, et al. (2011). Overlooked and Underserved: Action signs for identifying children with unmet mental health needs. Pediatrics 128(5): 970-979.
(3)  Alegria M, Vallas M, Pumariega AJ. Racial and ethnic disparities in pediatric mental health. Child and Adolescent Psychiatric Clinics of North America. Oct 2010;19(4):759-774.
(4) Fortuna LR, Alegria M, Gao S. Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety. May 2010;27(5):485-494.
(5) Fergusson DM, Woodward LJ. Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry. Mar 2002;59(3):225-231.
(6) Rones, M. & Hoagwood, K. (2000). School-Based Mental Health Services: A research review. Clinical Child and Family Psychology Review, 3, 223-241.
(7) Burns, B.J., Costello E.J., Angold, A., Tweed, D., Stangl, D., Farmer, E.M., and Erkanli, A. (1995). Children’s Mental Health Service Use Across Service Sectors. Health Affairs, 14(3), 147-159.
(8)  Schelar, E., Lofink Love, H., Taylor, K., Schlitt, J., & Even, M. (2016). Trends and Opportunities for Investment in Student Health and Success: Findings from the 2013-2014 Census of School-Based Health Centers (SBHCs). Washington, D.C.: School-Based Health Alliance.
(9) Strozer J, Juszczak, L, Ammerman A. 2007-2008 National School-Based Health Care Census. Washington, DC: National Assembly on School-Based Health Care;2010.
(10) Waszak C, Neidell S. SchoolBased and School-Linked Clinics: Update 1991. Washington, DC: Center for Population Options; 1991.
(11) Kaplan D, Calonge B, Guernsey B, Hanrahan M. Managed Care and Schoolbased Health Centers: Use of Health Services. Archives of Pediatric and Adolescent Medicine. 1998;152:25-33.
(12) Juszczak L, Melinkovich P, Kaplan D. Use of Health and Mental Mealth Services by Adolescents Across Multiple Delivery Sites. Journal of Adolescent Health. Jun 2003;32(6 Suppl):108-118. 5.
(13) Anglin TM, Naylor KE, Kaplan DW. Comprehensive SchoolBased Health Care: High School Students’ Use of Medical, Mental Health, and Substance Abuse Services. Pediatrics. 1996;97(3):318- 330.
(14) Jennings J, Pearson G, Harris M. Implementing and Maintaining School-Based Mental Health Services in a Large, Urban School District. Journal of School Health. May 2000;70(5):201-205.
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