How are Schools Addressing Students’ Mental Health Needs? A Spectrum of Support Strategies Exist
In response to increased student mental health needs and their impact on academic achievement, many schools have become mental health providers, expanding their scope to include elements traditionally found in clinical settings, like mental health evaluation and intervention1.
In fact, since 2014, the number of adolescents who receive mental health services at school has equaled the number of students who are treated in specialty settings2. However, American schools were not designed with this purpose in mind. So, given limitations, like staffing, funding, and physical space, how exactly are schools addressing their students’ mental health needs?
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In 2021, Frontline surveyed over 7,000 school administrators and school health officials about their perceptions of student mental health management. The survey found that most respondents have seen an increase in student mental health needs and have responded by ramping up the mental health supports that are available to students.
More than 2,000 people who completed the survey wrote in response to the open-ended question, “What additional [mental health] supports have you put in place?” A qualitative analysis of those responses found that a spectrum of strategies to support students’ mental wellness exists. On one end of the spectrum are organizations that keep mental health supports separate from schooling by utilizing external resources. On the other end of the spectrum are organizations that integrate mental health supports and schooling by having their teachers conduct evaluations and deliver interventions. Other organizations that use school staff, like social workers and school psychologists, to deliver mental health support in the school and classroom settings fall in between. These varied strategies suggest that while organizations agree that students need increased mental health support, they differ in their beliefs about who should deliver them, when, and where.
Let’s dive into these points on the spectrum and some respondents’ comments:
Providing Mental Health Support Outside of School
Phone and Web-based Resources
Some organizations that have implemented new mental health supports have chosen to separate them from the physical school setting. Students can access hotlines or online pamphlets about mental health coping skills by phone or web-enabled device. Oftentimes, these resources are accessible to all students, from any location, at any time allowing students to recognize and address their own needs. One respondent explained:
"We have a hotline that students and staff can phone into for emotional support. It’s essentially counseling over the phone. We’ve printed the contact number on the back of all students’ ID’s. Because students always have their ID’s on hand, they always have access to that support. More resources are available on our district website."
Contracting Mental Health Experts to Provide Counseling In and Out of School
Many organizations reported that they have contracted mental health professionals who work for private agencies to provide counseling to their students. Some invite outside service providers into their schools to meet with students on a recurring basis while others, act as liaisons, connecting families to local mental health care providers, who provide services and support at their offices or online.
"We are utilizing a mental health referral system to pair families with providers. We are now collaborating with a private mental health provider who supports our students at their office or online."
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Supporting Students’ Mental Health Needs in the School
Hiring New Staff to Meet Students’ Growing Mental Health Needs
Many organizations reported that they had either created new positions, hired new staff, or were in the process of recruiting candidates to work in their schools for the purpose of supporting students’ mental wellness. Most of these new hires are not classroom teachers. Though they perform a wide range of duties, many work in the school setting, often pulling at-risk students out of their classes to a private space, like an office or wellness center, to provide them with mental health supports”. The variation in position title indicates that organizations are aiming to address students’ mental health needs from every possible angle.
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"We’ve added more school psychologists and social workers to assist with counseling needs. We’re discussing adding additional supports for next school year such as behavior technicians and more school psychologists."
Licensed Mental Health Professionals
The most frequently reported positions were those staffed by individuals who have been trained and licensed to assess and treat emotional and mental health challenges. These include:
- Licensed mental health professional (LMHP)
- Licensed mental health counselor (LMHC)
- Licensed specialist in school psychology (LSSP)
- Licensed professional counselor (LPC)
- Clinical psychologists
- School psychologists
- Social Workers
One respondent wrote,
"We are constantly adding mental health staff WHEN we can find them."
This response articulates a common grievance among participants: frustration resulting from a desire to increase the number of mental health professionals on staff but an inability to do so because of a limited candidate supply.
Why is the Pool of Mental Health Professionals so Small?
Because schools are non-specialty mental health settings there are many contextual factors that interfere with mental health professionals’ abilities to implement interventions and evidence based-practices3.
While the school’s traditional purpose is to facilitate academic gains, school-based mental health professionals’ primary aim is to address students’ mental health needs and provide them with coping strategies. Sometimes, these objectives compete. For instance, mental health support staff may be asked to forgo their counseling sessions to substitute for absent classroom teachers, or to conduct sessions in a space that wasn’t intended for that purpose, like the school library.
Too Many Cases, Not Enough Time
Many school-based mental health professionals find that the population they have been hired to serve has considerable mental health needs that have yet to be identified and addressed. The number of students on their caseload well exceeds that of those who work in private settings. The pressure to meet with all students on their caseloads as often as possible often leads to burnout and turnover. One respondent wrote:
"As a school psychologist, I have completed more suicide interventions this first quarter than I have in any other previous quarters. I am drowning in the amount of work I need to complete on a daily basis, because I can either respond to the mental health needs or the special education federally required assessments and paperwork, but I cannot do both during the school day. I work at least 3 additional hours every night, but that is still not enough."
School-Based Mental Health Professionals’ Supervisors May Not Have Expertise of the Work They Are Performing
While many administrators and school leaders have had experience as classroom teachers, the majority have not held jobs as mental health professionals. Though their training has prepared them to oversee the teachers who will execute their school’s primary mission, they may be less prepared to oversee the implementation and buy-in of mental health interventions, which is the main work of school-based mental health professionals.
To help school-based mental health professionals manage their bulging caseloads, calendars, outside referrals, and the mountain of paperwork that accompanies counseling record-keeping, some organizations indicated that they hired case managers, social workers, liaisons to behavioral health agencies, and administrative assistants.
Academic Support Staff
Acknowledging the negative impact that compromised mental health can have on academic achievement, some organizations indicated that they have instead invested in academic support staff. Many noted that they had either hired or were in the process of recruiting more guidance counselors, academic interventionists, special educators, and paraprofessionals.
Health Care Providers
Some districts increased or were in the process of increasing their school nursing staff. School nurses often collaborate with school staff and external health professionals as part of an interdisciplinary team. Their role includes responsibilities such as assisting in the assessment, identification, referral, and follow-up of children in need of mental health support (National Association of School Nurses, 2017).
In some districts, the expanding network of mental health professionals, and the students it serves, has necessitated the hiring of an administrator for management, oversight, and efficacy evaluation purposes. One respondent wrote:
"Several new administrators were hired over the summer, including Director of Counseling and Social Work, a Community Liaison, and a director to oversee the implementation of a district-wide mental health intervention. However, these additions are only the start. Much more is needed at the building level to address the overwhelming number of students who need mental health supports."
Some organizations have implemented a hybrid approach, both hiring new staff and contracting professionals from private agencies to meet their students’ needs:
"We’ve hired an additional counselor to maximize time with students and an in building mental health professional from an outside agency."
Devoting School Space to Mental Wellness
Many respondents indicated that their schools have dedicated physical space within the school, but outside of the classroom, to be used by students for purposes related to mental health. At some schools, counselors use this space to conduct counseling sessions with individual students or small groups. One respondent explained:
"We have a meditation and calming room housed in the Freshman Hall. There, a permanent Therapeutic Crisis Interventionist leads group and individual therapy, has drop-in timeslots, and provides homemade food, tea, soups, and other snacks. She sees hundreds of students each month."
At other organizations, it serves as a quiet space for any student to visit and self-regulate before returning to class.
"We created a Student Wellness Center. The goal is to offer a safe space for students to drop in and decompress during the day as needed."
Though these spaces serve similar purposes across organizations, their titles vary. Some districts call them:
- Calm room
- Sensory room
- Meditation room
- Wellness room
- Quiet room
- Relaxation room
- Decompression room
- Wellness center
- Support center
- Counseling center
- Social-emotional learning center
In the Classroom but Not the Teacher: School-Based Mental Health Specialists Pushing Into Classrooms
In addition to pull-out counseling sessions, many organizations reported that their school-based mental health professionals push into classrooms for two main purposes:
School-based mental health specialists administer, or train school staff to administer, mental health screening tools.
"Our counselor has trained staff members to administer the social-emotional and behavioral screen. Every student is screened and those who are identified as at-risk are pulled for further assessment and counseling."
The frequency of these screens, and thus the amount of instructional time their administration takes, varies by organization. One respondent indicated, "Students’ stress and anxiety levels are assessed weekly" whereas another reported, "We have a mental health survey that students take three times a year."
Whole class lessons.
In between counseling sessions, school-based mental health specialists at many of the participating organizations also visit classrooms to facilitate lessons related to mental health topics.
“We’re seeing increased counselor push-in for special presentations about social-emotional learning topics.”
Integrating Mental Health Supports with Classroom Practice: Classroom Teachers Delivering Mental Health Interventions
Many organizations also named teacher professional learning as a key component of their strategic plan to address students’ increasing mental health needs. Classroom teachers have consistent access to a somewhat unchanging group of students and, because of the social nature of their job, they get to know their students well. Many organizations have positioned teachers as the first line of defense, providing them with training to identify mental health warning signs and at-risk students and to embed social-emotional learning into their classroom practice.
“Our staff has been educated to recognize mental health issues in students.”
Though researchers and practitioners have long been exploring the different ways in which schools can address student mental health, the COVID-19 pandemic intensified this focus. The stressors placed on students during this time exacerbated mental health needs and government funding enabled schools to implement a variety of strategies to address them.
- Regier, D. A., Goldberg, I. D., & Taube, C. A. (1978). The de facto US mental health services system. The Archives of General Psychiatry, 35, p. 685-693.
- Powell, B. J., Proctor, E. K., & Glass, J. E. (2014). Strategies for implementing empirically supported mental health interventions. Research on Social Work Practice, 24(2), p. 192-212.
- Wolk, C. B., Arnold, K. T., & Proctor, E. K. (2022). Implementing evidence-based practices in nonspecialty mental health settings. Families, Systems, & Health. Advance onlin publication. http://dx.doi.org/10.1037/fsh0000506