National report card details student mental health needs, recommendations

Schools play key roles in addressing the mental health needs of children, but all 50 states are failing to implement at least some of the policies that would enable schools to fulfill those roles, according to a new national report card developed by the Hopeful Futures Campaign — a coalition of 17 school mental health groups.

For example, schools are in a position to support early detection and intervention, as half of all mental illness presents itself before age 14. Yet the vast majority of states severely lack the recommended ratios of school mental health professionals, including counselors, psychologists and social workers, and no state meets the recommended ratio of one social worker for every 250 students.

In addition to understaffing in schools, rarely do states require regular mental health screenings or fully leverage Medicaid dollars to fund certain services, according to the report card. States are also inconsistent in their teacher training and school climate requirements.

All of the above is problematic, as one in three high schoolers already reported persistent feelings of sadness or hopelessness — a 40 percent increase from 2009. The pandemic has only exacerbated the problem, with more students experiencing trauma than before. From 2019 to 2020, the rate of mental health-related emergency department visits increased by 24 percent for children ages 5–11 and 31 percent for adolescents ages 12–15. About 7.7 million young people in the U.S. experience a mental health condition annually. Suicide is the second-leading cause of death among people ages 10 to 24.

Despite how common mental health conditions are in youth, many do not get the services they need, which can lead to worsened conditions that are harder to treat and to poorer life outcomes, explained Sharon Hoover, co-director of the National Center for School Mental Health and professor in the University of Maryland School of Medicine’s Division of Child and Adolescent Psychiatry. However, when children have better outcomes when they get support early on.

“One of the most effective approaches to get youth the help they need is to meet them where they’re at — in schools — with comprehensive mental health systems … [that] work in partnership with youth, families, and communities to promote a positive school climate, to help develop life skills, enhance knowledge of mental health, and to provide more intensive services for youth with greater challenges,” Hoover wrote. “School mental health services lower barriers to care and reduce inequities for underserved youth. We need to invest now in creating hopeful futures for our nation’s youth. States can take a critical step by adopting policies that support comprehensive school mental health systems.”

Where California stands

The Hopeful Futures Campaign school mental health report cards score each state in eight policy areas that, together, help support comprehensive school mental health services. Policy areas include ratios of students to school mental health professionals, school-family-community partnerships, teacher and staff training, funding, well-being checks, healthy school climate, skills for life success and mental health education.

For each policy area, the scoring guide includes a policy goal and specific types of policies researched, as well as a scoring rubric with the criteria used to assign a score on a zero-to-three.

California currently excels in policies that support and enable schools to engage with families and community partners, as well as those that help support funding of school mental health services for Medicaid-eligible students.

The state scored low in several areas, but particularly in mental health staff to student ratios. For instance, California has one school psychologist for every 998 students (the recommended ratio is 1:500); one school social worker for every 6,132 students (the recommended ratio is 1:250); and one school counselor for every 612 students (the recommended ratio is 1:250). Policymakers can support schools’ abilities to hire additional staff by significantly investing in incentivizing careers in mental health and promoting telehealth partnerships, according to the report.

“As our nation struggles to keep children in school, parents and educators alike are confronted with the increasingly complex mental health needs of children who are stressed out, anxious, depressed, and worse,” wrote Bill Smith, founder of Inseparable, one of the organizations that makeup the Hopeful Futures Campaign. “Their needs are overwhelming our educators, who themselves are often overworked, underpaid, and don’t always have the training and supports to adequately help children who are struggling. As big as these challenges seem, they are not insurmountable. We have an opportunity to do something about it.”