January 24, 2025 Read Time:
Mental Health
Read Craig's first blog in the series here.
In 2021, the U.S. Surgeon General issued a stark warning; following the COVID19 pandemic, youth mental health was in rough shape. It turns out that living in unprecedented times for most of your life is a major stressor. A staggering 30% of students identifying as female reported suicidal ideation in the 2021 Youth Risk Behavior survey, while nearly half of LGBTQ+ youth reported thoughts of suicide. It’s been three years since most of these data points and still the youth mental health crisis shows no sign of slowing down. Anyone who works in schools can attest that things are rough out there.
School districts have always been on the front lines when it comes to mental health. Yet, most are faced with a grim reality. We all want our students to succeed. We all want students to get the services they need and deserve in school. At the same time, there simply are not enough hours in the day, not enough school mental health staff, and not enough zeros in budgets to effectively reach every student. We can and should advocate for more funding and more mental health positions for our students and there are indeed organizers working towards this on the state and federal level.
We also need to do something right now to better our school mental health systems. Schools can still have a tremendous positive impact on youth mental health, even with imperfect systems. As school staff, we must ask ourselves a number of hard questions, such as:
- How do we identify the students who need the most support?
- How do we provide effective services for the most students?
- How do we make sure our systems are equitable in their service?
- How do we phase out services in order to empower youth to independently problem solve?
What will follow are a series of articles intended for school support teams to answer these questions. These staff members are the ones often stuck in the middle of these imperfect systems–acting as both gatekeepers and as interventionists, tasked with being proactive while also attempting to put out fires every day. The goal for these articles is to highlight areas that school systems can work better, without unrealistically increasing workload for staff in a way that is manageable. Working smarter, not harder, is the plan. It is also the hope that these will be catalysts for discussion; there is no miracle tip or trick that will work in every school system and therefore these strategies will need to be adapted to local conditions. Finally, these ideas are designed to be actionable above all; the goal is to give a number of thoughts that can be rapidly put into place so they will do the most important thing: make a difference in the lives of our students.
The Three R’s of School Support Systems
In an important article target mental health through a public health lens, Herman et. al. starts by outlining five strategies that do not work; these are critical to state before figuring out what is effective:
“First, waiting for youth with mental health concerns or their parents to present themselves for services, or hoping that school personnel will spontaneously identify and refer them, does not work.
Second, individual and/or group counseling alone is not the solution. Simply providing more mental health services to youth will not, in itself, address the problem.
Third, the use of exclusionary discipline practices in U.S. schools do not support youth mental health.
Fourth, training teachers and other school professionals to be more knowledgeable about identifying mental health concerns also will not reduce their population prevalence.
Fifth, even systemic approaches that only focus on one setting are unlikely to reduce the prevalence of youth mental health concerns”
With these in mind, we can begin to articulate what will work in schools. Key to any school support system is what I call the three R’s: proactively finding the right students who need support, giving them the right services, at the right time (and for the right amount of time!). In these articles, I will delve deeper into each topic, giving an actionable blueprint for developing a proactive school support system.
Right Students
It’s easy to find students with behavior issues or externalizing conditions in school–just wait until the chairs start flying across the room. It’s much harder to find students with internalizing problems such as anxiety and depression. We often wait until teachers notice or students seek out help. Yet, research has consistently shown that teachers often significantly underreport internalizing concerns until there is significant dysfunction. Likewise, if we wait for students who are anxious or depressed to seek resources, we may be waiting far too late; due to their mental health, they are often incapable of the exact self-help actions that we expect them to use to access resources.
We have the tools to find these students before they start showing significant dysfunction. Additionally, we can create systems that proactively match students to specific support depending on their level of need, rather than waiting on a one-size fits all system. By identifying problems earlier, proactive interventions can be put into place that will stop things getting bigger – I know as a practitioner, I’d much rather work with an anxious student who missed 3 days of school than one who has already missed a month. Finally, by having a nuanced understanding of which student needs what, over time this can lead to shaping school-based services to be better aligned to what the student body as a whole tends to need, and therefore more responsive to serve all students. It’s much easier to run an anxiety group for 10 students than figure out how to schedule 10 individual students for counseling around anxiety!
In the next series of articles, I will detail how to create early warning systems, what data you can reliably use to predict issues, discuss implementing mental health screening, and outlining a referral system to identify these students.
Right Services
When a student needs support, we often turn to individual counseling. It’s seen as the gold standard and the thing that will be most effective. Staff and students alike are most comfortable with doing this type of work in a one-on-one setting. Additionally, it’s usually the easiest logistically for staff and students to organize–that is, until over a third of the student body is getting some sort of individual counseling.
It is essential to ask–does the services that your school offers match the needs of your students? Are staff using evidence based methods? Are services deployed in a way that balances the needs of the most acute students while also providing support to the most students possible? What even does your school offer? What issues are outside the scope of what your providers can support and how can you connect them to community-based resources?
Knowing and mapping services is an essential first step for building a comprehensive mental health support system. Almost as important is having a system to track and manage cases coming out of many different referral paths. Finally, knowing a school system cannot manage all cases, it’s key to know community resources that can be complimentary in serving student needs.
In these “Right Services” articles, I will detail how to first map the resources your school has to offer. Then I will outline several evidence based methods that may be particularly relevant to schools. I will also discuss tracking cases and case management, in addition to linking to community supports. A section will also discuss the necessary link between disciplinary cases and mental health services and some practical thoughts about handling these cases.
Right Time
As mentioned earlier, timing is essential for schools. We must move at the speed of our students, which is usually a lot faster than we’re prepared to go. Oftentimes in schools, the right time is right now; a crying or tantruming student has a particular kind of unmatched urgency. However, getting out of reaction mode where everything is an emergency is important for every stakeholder. For students, it means we trust that they are capable of solving their own problems and don’t need an adult for every situation. For staff, it translates to predictable schedules where they get to engage in the deeper work beyond soothing students. Linked with the previous sections on identifying students who are in trouble, this should mean that students get what they need faster, leading to needing less intensive services. Another important aspect is monitoring the impact of services and knowing when we can lessen services so other students are able to access what they need.
In order for students to get the right service at the right time for the right amount of time, there needs to be critical pieces of infrastructure in place. In these ‘Right Time’ articles, I will discuss data systems, managing staffing, and progress monitoring. This will also cover moving students towards independence and how these systems blend into a Multi-Tiered System of Supports (MTSS).
Bringing It All Together
School support teams are tasked with doing the impossible, with less resources and with higher sets of needs each year. But there are ways that we can rise to meet the current moment. By identifying the students who fly under the radar, giving them the right services for the right amount of time, we can build a system that works better for everyone involved. In the upcoming months, two articles focusing on each ‘R’ will be published, starting with the right student. These will introduce several ideas that support teams can discuss, as well as supporting information, visuals, and tools. The hope is that any school that accesses these resources will be able to take away at least one practice and implement it in a way that makes a significant impact to their student body.
1 https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
2 Keith C. Herman, Wendy M. Reinke, Aaron M. Thompson, Kristin M. Hawley, Kelly Wallis, Melissa Stormont & Clark Peters (2021) A Public Health Approach to Reducing the Societal Prevalence and Burden of Youth Mental Health Problems: Introduction to the Special Issue, School Psychology Review, 50:1, 8-16, DOI: 10.1080/2372966X.2020.1827682
3 La Greca, A. M., Silverman, W. K., & Lochman, J. E. (2009). Moving beyond efficacy and effectiveness in child and adolescent intervention research. Journal of Consulting and Clinical Psychology, 77(3), 373–382. https://doi.org/10.1037/a0015954
