In the middle of her third grade year, eight-year-old Katie learned that she was transferring to an elementary school across town. As the new kid, she didn’t have anyone to play with at recess—Katie felt lonely and would make excuses to stay inside and finish work with her teachers. As the year went on, Katie lost hope. She began self-harming, and eventually developed an eating disorder. These mental health struggles caused her to miss school and fall behind on her work, only adding to her anxiety; eventually, Katie was hospitalized after expressing suicidal ideations. Mental health problems, left untreated, can become an unbearable hardship for young students. But if Katie had a comprehensive mental health treatment system in her school—one that intervened and provided support early on in her life—she may have avoided reaching desperation. For students to succeed academically and personally, it’s imperative that schools treat juvenile mental health just as seriously as physical health.
Mental Health and School Success
The Center for Disease Control estimates that, at any given time, 1 in 5 American youth are struggling with at least one mental health disorder. In a classroom of 25 students, that means that an average of 5 will be facing mental health challenges—these disorders can hinder academic success if left untreated, even causing failure and school dropout. Though half of all lifelong mental illnesses have begun by age 14, the average delay between symptom onset and beginning treatment is 8-10 years, leaving almost a decade for the effects of mental illness to impede on academic and personal wellbeing. These effects are not to be taken lightly: the American College Health Association reports that medically diagnosed mental health problems have a greater impact on academic performance than any other non-academic factor, including physical pain. Mental health issues may hinder students from attending class, forming meaningful relationships and studying effectively. This can lead to higher rates of drop out; in fact, a study from the University of Michigan found that university students suffering from depression were over twice as likely as their peers to drop out of school.
But college students aren’t the only young people affected by mental health issues. Beginning as early as the elementary level, children diagnosed with mental, emotional or behavioral disorders often face chronic absences, lower academic achievement and higher rates of suspension and expulsion. Almost 1 in 5 high school students have considered committing suicide, and youth with mental health issues are more likely to become involved with the juvenile justice system and develop a substance abuse disorder. In many ways, schools offer an ideal context for treating mental illness: they are trusted by families, have consistent contact with students and are accessible for all populations. Yet oftentimes, schools don’t have the proper resources and staffing to provide comprehensive mental healthcare for all students.
Who Can Help?
When a child first begins displaying signs of mental illness, there are many staff at school who can identify them. Teachers see students most throughout the day, yet with increasing class sizes and pressure to raise test scores, they are often too busy to speak one-on-one with students. Counselors can work with students who need support, but as more emphasis is placed on college preparedness and academic success, school counselor responsibilities are shifting away from ensuring the personal wellbeing of students and towards ensuring their academic achievement. Special education teachers often teach students whose mental illness has affected their schoolwork, yet less than 2% of all children with an emotional or behavioral disorder meet the qualifications to see a special educator.
The only administrator with a full-time role dedicated to mental health is the school psychologist, though nationally, one school psychologist is responsible for an astounding average of 1,653 students, oftentimes across multiple school buildings. In some states, there are not enough qualified psychologists for hire; in others, school districts facing budget cuts choose to hire only one psychologist per district, fulfilling the minimum federal requirement. Yet when school psychologists are overworked, they often only have enough time for student assessments—a lengthy process that requires individual interviewing and a written evaluation. This leaves less time to address mental health training for teachers—those who are best situated to notice behavioral shifts among students—and comprehensive prevention services for the entire school. Overworking psychologists can put school districts on the defensive as mental health providers, rather than becoming positive support systems that work to prevent the onset of mental illness itself.
A Better Way
Following the example of universities across the country, school districts have slowly begun shifting their focus to a comprehensive treatment model of mental health. Rather than a single psychologist working with students who’ve demonstrated symptoms of mental illness, comprehensive services also involve full-school preventative measures, like teacher training and early screening for disorders. They often involve a school-community partnership, building on existing school resources with outside professional help as well as facilitating connections for student referrals. Comprehensive treatment focuses on evidenced-based, universal prevention that creates an inclusive, supportive environment within schools while proactively addressing mental health. This type of service structure often manifests itself as a three-tier system: universal prevention, selective intervention and indicated intervention. Universal prevention is the largest tier; it includes school-wide screening for behavioral and emotional disorders, administered by professionals to all students. Selective intervention takes the form of larger group therapy for potentially at-risk students, identified by teachers or by the screening process; indicated intervention is one-on-one therapy for demonstrated high-risk students.
A successfully implemented three-tier system in the Boston Public School diaspora has reduced the strain on school psychologists, produced a more supportive climate in schools and reduced the number of students referred out to mental health providers. In this comprehensive model, all-school behavioral screenings are administered by local mental health professionals twice a year. At-risk services are group interventions led by school psychologists; they cover topics like anger management, organization and coping skills. Finally, intensive treatment involves individual counseling and involvement with the family. This three-tiered system is designed to identify at-risk students early, ensuring their symptoms don’t affect academic success or personal wellbeing. Providing this type of effective, thoughtful mental health services to students throughout their academic career is imperative, because a comprehensive prevention program in schools can be the difference between lifelong mental health struggle and successful management of disorders.