Element 4: Mental Health Services
The focus of element 4 is to provide needed mental health services for students both within school and from community mental health providers. This brief for SS/HS project directors explains the importance of element 4 to the SS/HS Initiative and offers practical guidance and resources for providing mental health services in schools and the surrounding communities.
Impact of Element 4
One in five children and adolescents will experience a significant mental health issue during their school-age years.i Students with mental illness are at higher risk for negative outcomes, such as suicide, substance abuse, truancy, and dropout. With half of lifetime mental health disorders diagnosable by age 14,ii childhood and adolescence are an ideal time to assess and treat mental health problems among students, and to offer them the support and skills they need to become mentally healthy and resilient and to succeed in school and life.
Undiagnosed and untreated mental health problems among youth can have far-reaching negative consequences. Students with mental health issues have a harder time attending schools, may have conflicts with peers and adults, and have difficulty completing schoolwork. Adolescents with mental and emotional problems are four times more likely to be dependent on illicit drugs, and are twice as likely to drop out of school than youth with other disabilities.iii These students are less able to focus on learning, less connected to school, and more likely to suffer low self-esteem. Oftentimes, behavioral problems resulting from unaddressed mental health issues can affect other students and serve as barriers to learning for all students.
For students with these challenges to succeed in school, mental health services must be provided. Services can be provided in schools by guidance counselors, social workers, and health center personnel, as well as through community mental health providers and agencies.
Yet, it is equally important to promote mental health through a whole-school approach. Creating a positive psycho-social environment, developing mental health-promoting curricula and instruction, and providing mental health programs and services are all components of a whole-school approach to mental wellness. (Detailed information on the whole-school approach can be found in The National Center for Youth Violence Prevention and Mental Health Promotion’s guide Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools.)
This approach promotes a positive social environment for all students and staff, encourages healthy development and academic achievement, and reduces the stigma surrounding mental health issues. School-based mental health services and programs can do the following:
- Promote learning and boost academic achievement for all studentsiv
- Support teachers’ professional development
- Identify and address conduct problems among studentsv,vi that can serve as barriers to learning for all students
- Enhance students’ social competencies
- Reduce instances of delinquency
- Reduce the use of alcohol and other drugs
- Challenge widespread underachievement and raise academic standards, especially among boys, economically disadvantaged children, and racial and ethnic minoritiesvii
Integration with the Other Elements
Promoting mental health and treating students with mental health problems naturally complements the other four SS/HS elements. Students who are emotionally and mentally engaged and ready to learn are less likely to commit acts of violence or to abuse alcohol, tobacco, and other drugs.viii When creating and implementing programming to address element 4, project directors can think about how their objectives can be integrated with activities that address the other elements.
For instance, students who abuse substances often suffer from mental health problems, including depression and anxiety. It is a natural fit, then, to incorporate mental health promotion components, such as activities to strengthen self-esteem and coping skills, into programs designed to prevent substance abuse. Students who are screened for substance abuse can be simultaneously screened for underlying mental health issues.
Likewise, students with mental and emotional challenges may be more likely to contribute to unsafe school environments by committing acts of violence, including vandalism and bullying. Violence prevention initiatives can include activities to screen for mental health disorders, and referrals to mental health services.
Addressing Element 4
According to Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools, schools are an ideal venue for promoting mental health. With 52 million children spending 30 hours each week in school settings surrounded by caring professionals, many opportunities exist to provide supports and services to strengthen their mental health and resiliency, starting in preschool and continuing through high school graduation.
Linking with community mental health providers and other community services can strengthen mental health programming in schools by providing complementary activities and services to students and their families, and offering wraparound diagnostic and treatment services. Mental health programming should address the entire spectrum of prevention:
I. Universal Prevention—programs that promote mental wellness for all students. For example:
- Promoting social and emotional learning through specific curricula that reach all students
- Offering character-building education and workshops
- Providing teachers with professional development on interacting positively with all students, including those with mental health disorders
- Creating a safe, enriching learning environment in schools
- Implementing district-wide bullying-prevention curricula
- Offering classes to help parents learn how to promote their children’s mental health and other essential life skills
- Working with school-based health centers to implement systems for universal social, emotional, and behavioral screening
II. Selective Prevention—programs that focus on students who are at risk for mental or emotional problems, including those with early signs of mental health problems or who have survived trauma. For example:
- Assessing students’ mental health needs, both formally and informally
- Offering support groups for at-risk kids, such as those who have lost a loved one or have parents who recently divorced
- Creating district-wide policies for mental health assessment and referral
- Conducting small-group counseling sessions on anger management and social skills development
- Designing systematic consultation systems with parents and teachers of troubled students
- Providing mentoring programs and after-school programs for at risk students
- Providing short-term one-on-one counseling sessions
III. Indicative Prevention—programs for students who have exhibited mental health problems. For example:
- Providing early intervention for children who show high rates of aggression
- Delivering behavior programming, ongoing progress monitoring of individual student behavior, and remedial behavior plans
- Providing school-based services to students in need of mental health interventions, counseling, and support
- Referring students and families to community therapeutic mental health providers and comprehensive family services
- Working with community partners to provide wraparound mental health services to students in need
- Collaborating with legislative committees to promote the addition of budget line items for school mental health services
To choose the evidence-based programs (EBPs) that are appropriate and have the most potential for effectiveness with their students, SS/HS staff should conduct a needs assessment to identify the issues unique to their school district and surrounding community.
Partnering to Provide Mental Health Services
SS/HS staff can work with school staff, community leaders, and families to promote mental health and provide screening, assessment, and services for students with mental health problems. To facilitate this collaboration, some SS/HS grantees have created a universal consent form and data-sharing agreement to address multiple issues, maintain communication between agencies, and better serve students.
The Core Management Team
A community mental health representative is an obvious link to community mental health providers, who can integrate their services with school efforts and provide wraparound mental health services to ensure that children are receiving the support they need to succeed academically, socially, and emotionally.
The school leadership representative should understand and support the importance of providing mental health promotion and prevention programs in schools, and promoting a positive school climate that enriches students’ mental health and well-being.ix
Community groups can partner to address element 4 by participating in program planning and evaluation, offering support, cultural competence guidance and providing services and referrals to ensure that students and their families receive comprehensive mental health promotion, prevention, and treatment services, in both schools and the community.
For instance, if a school does not have counselors who can serve families, partnering with a social service agency that provides family counseling allows the school to provide appropriate referrals. Other good community partners include daycare providers, early childhood educators, social service agencies, and community substance abuse prevention and treatment providers. Throughout, it is important to provide culturally and linguistically competent programs in order to most effectively work with children, youth and their families.
Parents are the biggest influence on children’s mental wellness and play one of the largest roles in determining a child’s sense of self. Research shows that the relationship between families and schools affects both mental health and academic outcomes, xexemplifying how critical it is to work hand in hand with parents on element 4.
Parents and other family members should be equal partners with school and community representatives around selecting, implementing, and evaluating culturally and linguistically competent mental health programming.xi In addition to engaging parents in program planning, mental health promotion and prevention programs can be specifically targeted toward serving parents and families, with the goal of increasing positive outcomes.i
Project directors should begin planning how to sustain their mental health efforts as soon as SS/HS funds are received. It is not as important for programming to remain in its current form as it is for the successful functions to continue. Project directors can evaluate which SS/HS practices and activities have been the most successful in addressing element 4. These effective efforts can then be institutionalized in schools and communities, and the work can continue to be carried out by the partnership.
When thinking about sustainability for element 4, securing ongoing funding is important, but it is not the sole way to sustain good work. Other strategies, such as strategic planning, enhancing and continuing partnerships, and capacity building, can help sustain the mental health programs begun with SS/HS funding.i For instance, many services provided in schools and by community mental health agencies are reimbursable through private and public insurance agencies, including Medicaid.
The National Center’s School Mental Health Sustainability Guide for SS/HS Project Directors provides detailed information on sustaining school mental health programming and can guide PDs in their efforts to sustain these important programs and activities.
- Realizing the Promise of the Whole-School Approach to Children’s Mental Health: A Practical Guide for Schools
- Engaging Families in Safe Schools/Healthy Students Initiatives
- Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health)
- SAMHSA Child and Adolescent Mental Health Information
- Responding to the Mental Health Needs of Students
- The Elementary and Secondary School Counseling Program
- The UCLA Center for Mental Health in Schools
- The Center for School Mental Health Analysis and Action
iU.S. Public Health Service. (1999). Mental Health: A Report of the Surgeon General. Washington, DC: U.S. Department of Health and Human Services.
iiKessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.
iiiU.S. Department of Education. (2007). Twenty-Seventh Annual (2005) Report to Congress on the Implementation of the Individuals with Disabilities Education Act, Vol. 1. Washington, DC: U.S. Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs.
ivGreenberg, M. T., Weissberg, R. P., O’Brien, M. U., Zins, J. E., Fredericks, L., Resnik, H., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58, 466–474.
vBattistch, V., Schaps, E., & Wilson, N. (2004). Effects of an Elementary School Intervention on Students’ “Connectedness” to School and Social Adjustment During Middle School. The Journal of Primary Prevention, 24(3), 243–262.
viWilson, D. B., Gottfredson, D. C., & Najaka, S. S. (2001). School-based prevention of problem behaviors: A meta-analysis. Journal of Quantitative Criminology, 17, 247–272
viiWeare, K., & Murray, M. (2004). Building a sustainable approach to mental health work in schools. The International Journal of Mental Health Promotion, 6(2), 53–59.
viiiBeets, M. W., Flay, B. R., Vuchinich, S., Snyder, F. J., Acock, A., Li, K-K., Burns, K., Washburn, I., & Durlak, J. (2009). Use of a social and character development program to prevent substance abuse, violent behaviors, and sexual activity among elementary school students in Hawaii. American Journal of Public Health, 99(8), 1438–1445.
ixSkalski, A. K., & Smith, M. J. (2006, September). Responding to the mental health needs of students: Schools are often where students’ mental health needs are discovered and where support is provided. Principal Leadership. Bethesda, MD: National Association of School Psychologists. Retrieved from www.nasponline.org/resources/principals/School-Based%20Mental%20Health%2...
xOsher, T., Osher, D., & Blau, G. (2008). Families matter. In T. P. Gullota & G. M. Blau (Eds.), Family influences on child behavior and development: Evidence-based prevention and treatment approaches (pp. 39–63). New York, NY: Taylor Francis.
xiSubstance Abuse and Mental Health Services Administration, Center for Mental Health Services. (2007). Promotion and Prevention in Mental Health: Strengthening Parenting and Enhancing Child Resilience. DHHS Publication No. CMHS-SVP-0175. Rockville, MD: U.S. Department of Health and Human Services.