Executive Summary

It is now well documented that, insofar as children receive any mental health services, schools are the major providers. However, precisely what is provided by schools under the rubric of mental health services…is largely unknown (Rones & Hoagwood, 2000).

Recent research points to public schools as the major providers of mental health services for school-aged children. The current study, School Mental Health Services in the United States, 2002–2003, provides the first national survey of mental health services in a representative sample of the approximately 83,000 public elementary, middle, and high schools and their associated school districts in the United States.

The purpose of the study was to identify―

The mental health problems most frequently encountered in the U.S. public school setting and the mental health services delivered
The administrative arrangements for the delivery and coordination of mental health services in schools
The types and qualifications of staff providing mental health services in schools
Issues related to funding, budgeting and resource allocation, and use of data regarding mental health services

The findings of the study provide new information about the role of schools in providing mental health services, and how these services are organized, staffed, funded, and coordinated.

The survey methodology included two mail questionnaires. The school questionnaire collected data on the types of mental health problems encountered in schools, the mental health services provided, the types and qualifications of staff providing services, the type and degree of care coordination, and the arrangements for delivering mental health services. The district questionnaire collected data on funding sources for mental health services and issues related to funding. The report also includes impressions from school administrators and mental health personnel concerning issues affecting school mental health services. Questions concerned services and supports delivered to students who have been referred and identified as having psychosocial or mental health problems.

Key Findings

Nearly three quarters (73 percent) of the schools reported that “social, interpersonal, or family problems” were the most frequent mental health problems for both male and female students.
For males, aggression or disruptive behavior and behavior problems associated with neurological disorders were the second and third most frequent problems.
For females, anxiety and adjustment issues were the second and third most frequent problems.
All students, not just those in special education, were eligible to receive mental health services in the vast majority of schools (87 percent).
One fifth of students on average received some type of school-supported mental health services in the school year prior to the study.
Virtually all schools reported having at least one staff member whose responsibilities included providing mental health services to students.
The most common types of school mental health providers were school counselors, followed by nurses, school psychologists, and social workers. School nurses spent approximately a third of their time providing mental health services.
More than 80 percent of schools provided assessment for mental health problems, behavior management consultation, and crisis intervention, as well as referrals to specialized programs. A majority also provided individual and group counseling, and case management.
Financial constraints of families and inadequate school mental health resources were the most frequently cited barriers to providing mental health services.
Over half of schools (55 percent) used contracts or other formal agreements with community-based individuals and/or organizations to provide mental health services to students. The most frequently reported community-based provider type was county mental health agencies.
Districts reported that the most common funding sources for mental health services or interventions were the Individuals with Disabilities Education Act (IDEA), State special education funds, and local funds. In 28 percent of districts, Medicaid was among the top five funding sources for mental health services.
One third of districts reported that funding for mental health services had decreased since the beginning of the 2000–2001 school year, while over two thirds of districts reported that the need for mental health services increased.
Sixty percent of districts reported that since the previous year, referrals to community-based providers had increased. One third reported that the availability of outside providers to deliver services to students had decreased.

While survey findings indicate that schools are responding to the mental health needs of their students, they also suggest increasing needs for mental health services and the multiple challenges faced by schools in addressing these needs. Further, more research is needed to explore issues identified by this study, including training of school staff delivering mental health services, adequacy of funding, and effectiveness of specific services delivered in the school setting.

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