School mental health (SMH) programs and services have grown progressively in the United States in the past two decades, related to increased acknowledgement of their advantages and prominent federal initiatives (e.g., No Child Left Behind Act President's New Freedom Initiative; 2003). Nonetheless, SMH is an emerging and tenuously supported field with many issues in need of attention. In this article nine immediate challenges to the advancement of innovative and successful SMH policies and programs are highlighted. Considered together, these challenges suggest a picture of current SMH programs and providers, and their educator partners, operating under often untenable circumstances. As the field moves forward, enhanced commitment to a true public mental health promotion approach provides a framework for concrete actions to be taken to advance an interconnected policy-training-practice-research agenda in school mental health.
The unmet mental health needs of youth have been well documented. Between 20% and 38% of youth in the United States (U.S.) need mental health intervention, and 9-13% have serious disturbances (Goodman et al., 1997; Grunbaum et al., 2004; Marsh, 2004). However, as few as one-sixth to one-third of youth with diagnosable disorders receive any treatment, and, of those who do, far less than half receive adequate treatment (Burns et al., 1995; Leaf et al., 1996; Weisz, 2004).
Although the idea of developing a comprehensive continuum of mental health supports for children in U.S. public schools dates back to the early 20th century (Breckenride, 1917 and Hunter, 1904 as cited in Flaherty & Osher, 2003), in the past two decades a national movement began to take hold and school mental health (SMH) programs have grown progressively (Flaherty & Osher, 2003). This growth has been spurred by recognition of the crisis of youth mental health, appreciation of the fact that many more youth can be reached in schools, and acknowledgement of the benefits to schools of SMH programs and services in reducing barriers to student learning (Adelman & Taylor, 2000). The growth of the field also has been supported by significant federal attention (see National Institute of Mental Health, 2001; U.S. Department of Health and Human Services, 1999; U.S. Public Health Service, 2000). More recently, the final report of the President's New Freedom Commission on Mental Health (www.mentalhealthcommission.gov) highlighted unmet needs and barriers to care, including (among others) fragmentation and gaps in care for children and lack of a national priority for mental health and suicide prevention (President's New Freedom Commission on Mental Health, 2003). In its proposal for transformed mental health care in America, the commission made a specific recommendation to improve and expand school mental health programs. The 2004 American Academy of Pediatrics Policy Statement on School-Based Mental Health Services (Committee on School Health, 2004) also concluded that "school-based programs offer the promise of improving access to diagnosis of and treatment for the mental health problems of children and adolescents" (p. 1), that they improve opportunities for coordination of services (especially coordination with educational programs) and that they offer strong potential for prevention as well as intervention efforts.
Schools offer unparalleled access as a point of engagement with youth to address their interrelated academic and mental health needs (President's New Freedom Commission, 2003). In fact, studies suggest that for the small percentage of youth who receive mental health services, most actually receive them within schools (Rones & Hoagwood, 2000; U.S. Department of Health and Human Services, 1999, 2001). In addition to enhancing access to services for youth (Weist, Meyers, Hastings, Ghuman, & Ham, 1999), SMH can reduce the stigma of help seeking (Nabors & Reynolds, 2000), promote generalization and maintenance of treatment gains (Evans, 1999), enhance capacity for prevention and mental health promotion (Elias, Gager, & Leon, 1997; Weare, 2000), foster clinical efficiency and productivity (Flaherty & Weist, 1999), and promote a natural, ecologically grounded approach to helping children and families (Atkins, Adil, Jackson, McKay, & Bell, 2001). …