Mental Health and Social Services: Results from the School Health Policies and Programs Study 2006

Article excerpt

According to the 1999 Surgeon General's Report on Mental Health (1) and the 2000 Report of the Surgeon General's Conference on Children's Mental Health, (2) 1 in 5 children and adolescents have emotional or behavioral problems sufficient to warrant a mental health diagnosis. In addition to those with diagnosable disorders, many young people, especially those living in urban areas, also experience psychosocial problems as a result of the difficult living conditions associated with poverty. (3,4) Because emotional, behavioral, and psychosocial problems can disrupt function at home, in school, and in the community, mental health has become an important public health concern. (5)

The gap between the mental health needs of children and adolescents in the United States and the services available to them is a widely recognized problem. Most children and adolescents with mental health problems do not receive mental health care. (1,6,7) There is increasing recognition that "specialty" mental health services, such as those provided through community centers, hospitals, and private offices, are unlikely to be accessed by most youth and families. Barriers to use of these services include limited knowledge of their availability, stigma, transportation, and financial constraints. (8) Even when staff in schools or primary care sites refer youth for specialty mental health services, the youth usually do not receive these services. (9) Further, schools often lack the resources to handle the full range of mental health conditions presented by students. This situation may lead to a marginalization of mental health issues by the education system, partly related to fear of assuming responsibility for what can be highly labor-intensive and costly challenges presented by students. (10, 11)

In response to the gap between mental health problems and services, the President's New Freedom Commission on Mental Health was created in 2002 to study the mental health service delivery system and make recommendations that would enable both children and adults with mental health problems to live, work, learn, and participate fully in their communities. In their final report, the Commission recognized the important role that schools can play in meeting the mental health needs of children and adolescents. (12) Because more than 97% of 5- to 17-year olds are enrolled in school, (13) schools are in a unique position not only to identify mental health problems but also to provide links to appropriate services. Further, because students' mental health is essential to learning as well as to social and emotional development, schools must play a role in meeting the mental health needs of students. (12) Schools are a natural setting for mental health services in that children and adolescents spend a large portion of their time there, and schools provide an avenue to reach parents and teachers, who can assist in the maintenance of improved cognitive, behavioral, and emotional functioning. (14)

The New Freedom Commission's recommendation to improve and expand school mental health programs (Recommendation 4.2) is reflected in the policy statements and guidelines of other organizations and agencies. For example, in 2004, the American Academy of Pediatrics (AAP) issued a policy statement on school-based mental health services that outlined the advantages of basing mental health services at school and provided recommendations to help health care professionals, educators, and mental health specialists work together to develop and implement effective school-based mental health services. (15) In 2005, the AAP and the National Association of School Nurses, with funding from the Maternal and Child Health Bureau of the Health Resources and Services Administration, published Health, Mental Health, and Safety Guidelines for Schools, (16) which includes detailed guidance to help schools implement quality mental health programs. Guidelines for school mental health and social services also have been developed by the Policy Leadership Cadre for Mental Health in Schools. …