Currently, more than two thirds of school- aged children with mental health needs do not receive treatment (U.S. Depart- ment of Health and Human Services [USDHHS], 1999). By exploring the numerous barriers that limit children's access to mental health care, we argue that school psychologists have a key role to play in supporting comprehensive mental health services for children. This article provides a ra- tionale for collaboration between medical and school professionals in order to best address children's mental health needs. Various social and economic barriers limit children and adolescents' access to specialized mental health services. Still other barriers, including state legislation and time constraints, influence the degree to which school psychologists are able to engage in mental health service provision and collaboration. While recog- nizing these obstacles, a model of collaborative service provision that closes the gap between current and best practices of mental health service provision in the schools is proposed.
BARRIERS TO SPECIALIZED MENTAL HEALTH SERVICES
There is a clear need for comprehensive mental health services for youth who experience social, emotional, or functional impairments resulting from psychological disorders. According to Mental Health: A Report of the Surgeon General, approximately 21% of children and adolescents meet diagnostic criteria for any mental health disorder, with 11% experiencing significant impairment in their home, school, or interpersonal functioning (USDHHS, 1999). An epidemiological study of children and adolescents indicates the following prevalence rates of externalizing disorders: attention deficit hyperactivity disorder (3%~5%), oppositional defiant disorder (i%-6%), and conduct disorder (i%-4%) and the following rates of internalizing disorders: depression (5%), anxiety disorders (13%), and eating disorders (3%; Shaffer, Fisher, & Dulcan, 1996). Ninety percent of all adolescents who complete suicide have a mental disorder, and suicide is the third leading cause of death among adolescents (Shaffer et al).
Unfortunately, more than two thirds of youth with mental health needs do not receive specialized mental health treatment (USDHHS, 1999). The most prominent barrier is the shortage of trained professionals to treat emotional, behavioral, and developmental disorders in American youth. The national mean student to school psychologist ratio is 1,681.5:1 although the National Association of School Psychologists (NASP) recommends a ratio of 1000:1 (Curtis, Hunley, & Grier, 2004). There are limited numbers of clinical psychologists available to provide care for children and adolescents, with less than 1% of clinical psychologists working primarily with children (Tuma, 1989). Similarly, the number of available child psychiatrists varies greatly from state to state, with a mean of only 8.67 child psychiatrists per 100,000 youth (Thomas & Hölzer, 2006). Furthermore, there are significantly fewer child psychiatrists, clinical psychologists, and school psychologists in rural locations and areas with high rates of poverty where there are higher rates of mental health problems among youth (Curtis et al.; Thomas & Holzer; Tuma).
CURRENT TRENDS IN MENTAL HEALTH TREATMENTS FOR SCHOOL-AGED YOUTH
Among those children and adolescents under the age of 20 who do receive treatment for mental health problems, the use of psychotropic medications has increased significantly over the past decade, with approximately 6% of health-insured youth reporting the use of psychotropic medication in 1996 (Zito et al., 2003). Stimulant and antidepressant medications are the most commonly prescribed psychotropic medications among minors. Recently, however, the Food and Drug Administration (FDA) issued black box warning labels for both medications due to concerns that antidepressants maybe associated with increased suicidality and that stimulants maybe associated with increased cardiovascular risks among children and adolescents (American Academy of Child and Adolescent Psychiatrists [AACAP], 2004; AACAP, 2006; Zito et al. …