Timothy D. Easley/AP Photo
A student at Lakewood Elementary School in Cecilia, Kentucky, uses her laptop to participate in an emotional check-in at the start of the school day, August 11, 2022.
In July, the Biden administration announced historic investments in mental health services for public schools. The Bipartisan Safer Communities Act leverages $1 billion over the next five years to double the number of school counselors, social workers, and other mental health professionals. The first allocations of this funding flow through two competitive grant programs: The Mental Health Service Professional Demonstration Grant provides $143 million to support investments in education. The School-Based Mental Health Services Grant offers $144 million to states and school districts, and increases the number of providers for school-based mental health services for students in schools with demonstrated need.
But this legislation, which Congress passed in the wake of the Uvalde school massacre, only begins to skim the surface of a crisis stemming from the heightened anxiety that children and youth have suffered since the onset of the pandemic. Last fall, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association, along with dozens of other national and state organizations, sent a letter to the White House requesting a federal national emergency declaration in children’s mental health. Such a move would potentially unleash more funding to ensure that many more children can access school-based mental health screening and treatment, address regulatory issues, and improve access to telemedicine.
The groups warned that suicide rates for children and teenagers have dramatically increased. Suicide is now the second leading cause of death among young Americans. Black children under 12 and Asian American youth are at the greatest risk for self-harm. During the pandemic, more than 1 in 3 high school students have experienced poor mental health. Nearly half of students felt persistently sad or hopeless, according to a March 2022 Adolescent Behaviors and Experiences Survey.
School districts that are already reeling from students’ academic challenges still have major budget challenges and lack the school-based mental health professionals and services that they need to respond to these new crises. California is only beginning to improve access to mental health care. New Jersey faces threats to existing programs, while Kentucky continues to struggle.
School-based health centers like those in Kentucky and California offer a variety of services, like eye exams, behavioral health care, and referrals to specialists if needed. One of the most important aspects of school-based health services is their mental health services, which can include counseling for mental health and emotional issues without leaving the school premises. New Jersey allows schools to create their own campus-based programs within the school-based youth services program that also offer services to the wider community.
Seventy percent of California's students who receive mental-health services obtain those services in their schools. If students feel that their school is a comfortable environment, with adults they have trusting relationships with, “that makes it much easier for them to be open and willing to connect with a provider on the campus,” says Amy Blackshaw, the director of the Behavioral Health Project at the California School-Based Health Alliance.
But California ranks near the bottom when looking at national student-to-counselor ratios, averaging 572 students to every counselor for the 2020-2021 school year. (The American School Counselor Association recommends a 250-to-1 ratio.) That translates into large caseloads for California school psychologists and counselors, who tend to do sessions in groups or in classrooms rather than individually. “The ability to know every kid’s name, their face, their story is impeded when you have high caseloads,” says Loretta Whitson, the executive director of the California Association of School Counselors. “You cannot have that personal touch.”
Schools must address the mental health crisis stemming from the heightened anxiety that children and youth have suffered since the onset of the pandemic.
To help remedy the staffing shortage, California Gov. Gavin Newsom announced a Master Plan for Kids’ Mental Health in August. The $4.7 billion investment in mental health and substance use services includes 40,000 new mental health workers in the state, in addition to hiring 10,000 more school counselors. (In California, Proposition 98 established a minimum funding level for schools. The state’s 2022-2023 roughly $310 billion spending plan provides $95.5 billion for K-12 schools.)
California also does not have a single funding stream for its school-based health centers, which are primarily funded through different sources, such as reimbursements from Medi-Cal—California’s Medicaid program—private foundations, and corporate grants. Schools also partner with community organizations, Blackshaw says. Yet as the need for school psychologists grows, it is unclear whether the new program can keep up with the demand.
In New Jersey, the existing mental health program, School-Based Youth Services, barely staved off funding cuts. In October, New Jersey Gov. Phil Murphy proposed the New Jersey Statewide Student Support Services (NJ4S) network, which would have effectively ended the mental health services based at individual schools, programs that have existed since the 1980s, in favor of a “hubs and spokes” model that would force students or parents to call and schedule mental health services at a community health center, rather than having students obtain services in their schools. The administration abandoned the proposal after protests from the community and extended the current system until 2024.
Despite the funding renewal, Suzanne Keller, the director of the Red Bank Regional High School’s Source program—a school-based program in Red Bank, New Jersey, that provides counseling services, in addition to medical, dental, and eye care—is concerned that the state has not given up on the hub-and-spokes model.
In Kentucky, there are three main channels for funding Kentucky’s school-based mental health services, according to Eric Kennedy, the director of advocacy for the Kentucky School Boards Association. They include Medicaid, recent state legislation like the School Safety and Resiliency Act, which strengthened schools’ abilities to meet the physical and mental needs of students, and property taxes.
More than 650,000 Kentucky children enrolled in Medicaid during the 2021 fiscal year. Kentucky school districts have the option of participating in two Medicaid school-based programs: school-based health services and an administrative section that helps identify and enroll eligible children and families.
The school-based health services program, which includes mental health services, allows Kentucky school districts to enroll as health service providers for eligible children under Medicaid and the Individuals With Disabilities Education Act. The state also invested $7.4 million in school-based mental health provider positions on a Medicaid reimbursement basis for 2022. However, there are 171 school districts in Kentucky, meaning each school district receives roughly only $43,000 after Medicaid and other funding disbursements, Kennedy says. (The state’s biennial budget will provide nearly $915 million in the 2023 fiscal year and $983 million in the 2024 fiscal year for students in preschool through high school.)
Kentucky also has a severe shortage of mental health professionals. The state meets the mental health clinician needs of only 24 percent of its overall population, according to the Kaiser Family Foundation. Kennedy, the state school boards official, noted that Kentucky could improve the marketing of available job opportunities and benefits to recent college graduates seeking positions in the mental health sector.
As students chart new paths out of the waning pandemic, state lawmakers should boost programs that currently work rather than eliminating them completely. Recruiting paradigms have changed and states must market pay, benefits, and community attributes accordingly. The Bipartisan Safer Communities Act funding is key, but many communities stand to lose out on grant dollars since they do not have the administrative resources to handle competitive grant processes. The Biden administration must look ahead toward securing new funding for systems of care that connect students to behavioral health and prevention services in their own schools to foster trusted systems of support.
Correction: This story has been corrected to reflect that in California, most students who obtain services receive in-school care.
