School-Based Mental Health Services Making a Difference

Schools play an important part in identifying the one child in ten who has a mental health problem. A large part of a child’s life is spent in school, which means teachers play an important role in all areas of children’s development. In a pair of articles in The Lancet Psychiatry, the case has been made that schools are essential in identifying and helping children with mental health problems.

David McNamee, writing for Medical News Today, says that peer relationships, social interactions, academic attainment, cognitive process, emotional control, behavioral expectations, physical development, and moral development are all exhibited at school and have to be dealt with at school and all these areas are affected and/or exacerbated by mental health struggles. Problems such as behavioral disorders and anxiety are common in elementary school, and depression becomes common in the later years of high school.

Untreated, any of these problems can affect a young person’s development, and could result in failure in school, dropping out of school, and later, relationship and career troubles. Approximately 10-20% of children and teens globally would benefit from help with their mental health disorders, according to the authors of the articles. Some parents, however, are afraid that mental health screening in schools could stigmatize or label students.

“If 10% of children had diabetes,” responds lead author Dr. Mina Fazel, a child psychiatrist at the University of Oxford in the UK, “we wouldn’t be saying that screening was a bad thing. Schools provide a platform to access large proportions of young people, and the vast majority of children picked up by screening would not need complex interventions.”

The authors say that the psychiatric community knows what to do to help young people, but implementing these practices on a large scale in schools is not working. She adds that national policies are needed. She continues by saying:

“The evidence shows that children prefer to be seen in school rather than outside school. But right now, health and education are very different systems.

The reality is that we are not maximizing on the opportunities to work in these environments. We need to have an approach that is child focused and to do this, health and education must become more closely aligned.”

India has a program that could help other resource-poor countries address mental health problems as well.  SHAPE  trains lay persons, who are school health counselors, to promote physical and mental health, and to screen for visual, weight, and bullying. Whole-school interventions and one-on-one counseling are used, reports Medical Xpress.

One state that seems to be doing things the right way is Wisconsin, according to Kelly Meyerhofer, reporting for the Milwaukee-Wisconsin Journal Sentinel. When, eight years ago, a Fox Valley Medical Associates community health report found that one in four local high school students were experiencing depression, and one in ten had attempted suicide, people started taking action. Soon, licensed therapists were placed in elementary, middle, and high schools. The results were that, four years later, almost three-quarters of students served reported their symptoms had been reduced. Eight in ten had improved academically.

Several school districts are involved in this game-changing initiative, but many are not. But about  year ago, the Department of Public Instruction created a procedure to allow clinics to apply to be in schools. Now, 116 clinics are concentrated in the northwestern portion of the state, where clinics are few and far between. The assessment process is only allowed with parental consent.  Children cannot be referred without parental permission. Parental involvement and the cost of expanding mental health service are two big barriers.

Some solutions which have been proposed include: a 24-hour hotline; community anti-stigma campaign; applying for more grants.  Several studies have found that students with mental health issues have lower levels of school performance and are more likely to drop out. Some argue that districts cannot afford not to provide these services.