Schools and early care education (ECE) are in a particularly unique position to address youth mental health needs. Children spend most of their waking hours there, they are a hub of neighborhood life, and they offer the opportunity to introduce healthy behaviors at a young age. With the proper resources, schools and ECE can effectively provide mental health services to students in need and encourage the early development of emotional wellbeing and resilience.
One in five school-aged children and teenagers show signs of mental health disorders in a given year, but 80% of them have unmet treatment needs.1“Mental Health In Schools: A Hidden Crisis Affecting Millions Of Students,” NPR.org, accessed May 31, 2019, https://www.npr.org/sections/ed/2016/08/31/464727159/mental-health-in-schools-a-hidden-crisis-affecting-millions-of-students; Elinore McCance-Katz and Calder Lynch, “Guidance to States and School Systems on Addressing Mental Health and Substance Use Issues in Schools,” Joint Informational Bulletin (Substance Abuse and Mental Health Services Administration and Centers for Medicare and Medicaid Services, July 1, 2019).1 in 5
From 2007 to 2016, deaths from suicide among those under 17 years old rose 84%84%
Over a million adolescents aged 12-17 had a substance use disorder as of 2016>1 million
In an average-sized high school of 750 students, about 150 will experience a mental health issue that interferes with their learning.2Eric Rossen and Katherine C. Cowan, “Improving Mental Health in Schools,” Phi Delta Kappan 96, no. 4 (November 21, 2014), https://doi.org/10.1177/0031721714561438.150
Positive mental health and resilience are foundational conditions for learning – students learn best when they are calm, focused, and engaged, not when they are depressed, anxious, or angry.
Mainstream Universal Mental Health Promotion
A growing body of evidence finds that interventions integrated directly into the day-to-day functioning of schools (including universities) and ECE can improve mental health outcomes of all students and even prevent some mental health conditions from developing. Despite the availability of this research, many of these interventions are not effectively implemented. Federal policy can help direct resources toward the necessary infrastructure that can support the effective implementation of these programs.
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- The federal government should require that schools and universities select indicators related to student mental wellbeing, such as school culture and climate, as a core metric of school performance under federal education funding, and ensure that other federal education funding authorizes uses of funds to help schools perform well on the new indicators.
- The federal government should create incentives for the development of continuing education programs that build core competencies in addressing children’s mental health and wellness. Specifically, the U.S. Department of Education should issue guidance to states on how professional development funding can be utilized to support the development of both training programs and continuing education programs that address children’s mental health and wellness.
- The federal government should create incentives for teaching and childcare education programs to build core competencies in promoting classroom mental health and leading school-wide change, so that more teachers enter the workforce with these skills.
- The federal government should work to build the capacity of schools to understand the mental health needs of their students, and provide support for meaningful intervention. This could be through funding from Congress or guidance from the U.S. Department of Education. For example, providing guidance to schools on where they can access data to better understand student mental health needs and connect those needs with evidence-based interventions. The federal government should make funding available for schools to contract with quality improvement organizations that support schools and ECE programs to mainstream mental health promotion into their activities, evaluate outcomes, and learn over time.
- Congress should amend the Elementary and Secondary Education Act to highlight that training in mental well-being programs are allowable uses of Title II funding.
- Congress should amend the Head Start Act to direct the Department of Health and Human Services to prioritize implementation of trauma-informed programs and age-appropriate positive mental health interventions and supports.
- The federal government should encourage schools to respond to students with mental health issues with SEL lessons or with executive function training programs like the ACTIVATE program. State education agencies can do this by allocating Federal Title I education funds to these programs in schools. HHS can also research and implement methods to prevent suspension and expulsion in schools; or, HHS can issue guidance on the issue.
- The federal government should require private and public health plans to reimburse mental health screening during well-child exams. This screening should be based on SAMHSA’s Screening, Brief Intervention, and Referral to Treatment approach and it should include an adverse childhood experience component.
- The federal government should fund grants to assist schools without the resources for in-house therapists.
- The federal government should equip schools with school-based health centers and school health providers (e.g. school nurses, school psychologists, school social workers) to improve adolescent mental health outcomes, drive a decline in depression, and ensure a reduced likelihood of suicide ideation among students.
- The federal government should fund teacher trainings that promote general knowledge of child and adolescent mental health, verbal de-escalation skills, incorporating mindfulness into teaching practices, and Youth Mental Health First Aid.
- The federal government should require cross-agency collaboration to develop a guide for creating high-quality frameworks. Schools and districts should adopt a prevention, intervention, response, and treatment framework to ensure that children with different levels of need get appropriate care, which requires coordination across teachers, health providers, and families.
- The federal government should establish equity in access by providing education about mental health services, directly engaging students instead of waiting for them to come to a mental health counselor and maintaining confidentiality of treatment. Cultural competency in mental health support should also be included in teacher training on mental health issues.
- The federal government should advance research and practices locally, and organize strategies into widely recognized frameworks, integrate mental health practices into schools’ academic missions, introduce integrated models into schools, keep the needs of each specific community in mind, and facilitate communication across teams and providers.
- The federal government should scale existing state
- Mental Health in School Curricula (NY and VA): The federal government should establish a pilot program that funds technical assistance for integrating mental health programming into school curricula. The Department of Education should issue a report evaluating the impact of curricula changes in NY and VA. Finally, while school curricula is not typically set at the federal level, Congress should pass a resolution encouraging states to follow the NY or VA model.
- Additional Funding for School Mental Health clinicians (CA, DC, NC, SC): The Department of Education should provide guidance on best practices for funding additional mental health counselors in schools.
- Adapting Medicaid for Better School-Based Coverage (KY, MI, LV): Centers for Medicaid and Medicare Services should offer technical assistance to states that wish to improve Medicaid coverage of school-based mental health.
- Suicide Prevention (CO, IL, KY, ME): The Department of Education should issue a report evaluating the effectiveness of these laws in reducing suicide and/or self-harm rates.
- Congress should support introduced
- Elementary and Secondary School Counseling Act
- Mental Health Services for Students Act of 2019
- RISE from Trauma Act
- Academic, Social, and Emotional Learning Act of 2015
- Caring Start Act of 2015
- Student Support Act
Increase Access to Mental Health Resources
Schools can be an important place for learning about mental health, screening for problems, and even accessing services directly. Some teach about mental health in health classes, but a more consistent, comprehensive, and evidence-based approach could better prepare students to access effective help. Although some school districts employ providers with mental health training, the need is great and often a provider’s time is split between other duties. School-based health centers also show promise — showing improvements in adolescent mental health outcomes, a decline in depression, and a reduced likelihood of suicide ideation among students.3Samira Soleimanpour et al., “The Role of School Health Centers in Health Care Access and Client Outcomes,” American Journal of Public Health 100, no. 9 (2010): 1597–1603, http://dx.doi.org/10.2105/AJPH.2009.186833. However, the majority of schools do not have access to well-equipped school-based health centers. Federal policy can help schools integrate adequate mental health resources to identify and address students’ needs.
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- The federal government should fund the evaluation of school mental health curricula and create a center for dissemination and technical assistance for implementing effective programs.
- The federal government should provide planning grants and fund a learning collaborative for states to implement Medicaid waivers or state plan amendments that increase reimbursement for mental health screening and services in schools and ECE, either through providers employed by the school or through partnered school-based health centers, and including streamlining regulations for providing tele-mental health services in schools.
- The federal government should make available funds for training school-based health providers in evidence-based mental health early intervention, giving enough capacity for addressing mild-to-moderate needs when mental health providers are otherwise not accessible.
- The federal government should require cross-agency collaboration to build out a list of evidence-based mental health interventions. For example, ESSA requires schools to implement evidence-based interventions in response to findings from needs assessments, and the U.S. Department of Education’s What Works Clearinghouse is a go-to resource for school districts on evidence-based interventions, but mental health interventions are largely absent.
- The federal government should further increase incentives for providers to practice in school and ECE settings through loan repayment programs.
- The federal government should fund learning networks and formal evaluations of student-led initiatives to improve mental health in schools and on campuses.
Establish Linkages with Community
While schools and ECE are an important site of intervention, children need a coordinated system of services and supports after they go home. Children with serious emotional disturbance who are receiving Individualized Education Programs (IEPs) under the Individuals with Disabilities Education Act (IDEA) in particular need such coordination, but presently community mental health resources and in-school IEP resources are siloed, and stressed families are left to play the role of coordinator.
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- The Department of Education and/or Health and Human Services should make available model forms that navigate HIPAA-FERPA privacy issues and the federal government should increase the federal match in Medicaid for health information technology investments when used to integrate data systems between community providers and educational systems.
- The federal government should provide planning grants and fund a learning collaborative for states to implement Medicaid waivers or state plan amendments that align Medicaid, early intervention, and IEP services to create coordinated continuums of care for children.
- CMS should offer guidance or issue a state Medicaid Director letter on the topic of credentialing of mental health clinicians in schools as there is often confusion and inconsistencies on the topic.
- The federal government should set aside funds to support local community providers and educational partnerships in developing innovative payment and delivery models that coordinate health care and other services for whole families (including the parents) and teachers and staff through schools and ECE. These models could then be considered by the Centers for Medicare and Medicaid Innovation for potential further scaling.
Tailored Policies for Unique Needs
To be effective, mental health solutions need to address individuals' range of identities based on race, ethnicity, language, gender, or gender identity, sexual orientation, disability, veteran's status, or life circumstances. We recommend meaningful policies to combat a harmful legacy of one-size-fits-all solutions.Explore our recommended policies for focus populations