Four Ways to Improve Student Mental-Health Support
As school psychologists, we found the report by Connecticut's office of the child advocate on the 2012 shootings at Sandy Hook Elementary School both heartbreaking and frustrating.
Heartbreaking because of the horrible losses to so many families. Frustrating because, although we are not in a position to judge the report's specifics, the identified systemic barriers to effectively meeting children's mental health needs are all too familiar. We are also concerned that attention to this issue is due to extremely rare violence rather than the well-established needs of millions of students.
The analysis, released in November, provides an in-depth history of the Sandy Hook perpetrator's physical, social, and mental health from early childhood until he committed mass murder and suicide.
It also includes a review of the services and supports the 20-year-old gunman received through schools and the community and decisions made by his parents. While the findings are of special significance to Newtown, Conn., families and others directly involved, their broader value is in the attention they bring to the continued challenges in our mental-health system, a system in which schools and communities both play critical roles. These challenges include inadequate and inconsistent access to mental-health professionals, fractured service delivery, poor information-sharing, and barriers to seeking help. They are not unique to this situation, nor are they new.
A 2013 study by the federal Centers for Disease Control and Prevention found that 13 percent to 20 percent of American children "experience a mental disorder in a given year." In 1999, the U.S. surgeon general pointed to findings that one in five youths ages 9 through 17 suffer from a mental disorder. Very, very few of these young people become violent.
It shouldn't take a horrific tragedy for us to take seriously the imperative to support children's mental health. Nevertheless, the Connecticut report serves as a painful reminder that we have much to do, and it provides an opportunity to recommit to actually doing it.
Boiled down to its essential conclusions, the report calls for improving collaboration among schools, community providers, and families; and promoting more informed, effective, and sustained decisionmaking. As school psychologists, we have experience with practical realities and what it takes to shape systems that facilitate, rather than impede, effective service delivery. While not all-inclusive, the following recommendations provide a foundation for meaningful improvements to school and community mental-health services.
1. Offer a continuum of school and community mental-health supports. An increasing number of schools are providing mental-health services through a multi-tiered system of supports, or MTSS. At one end of this continuum is the universal promotion of mental health and wellness (such as programs that promote social-emotional learning and universal screening for mental-health problems). Providing universal wellness promotion serves to mitigate more intensive problems while at the same time improving overall achievement. At the other end is coordinated, individualized, and intensive school- and community-based mental-health treatment designed for those students who develop mental disorders.
School-employed mental-health professionals have the expertise to provide a range of mental-health services (assessment, counseling, and consultation, for example) to meet the needs of most students. However, for students with severe mental illness, it is critical to have seamless access to community-based treatment resources.
2. Broaden access to school mental-health supports beyond special education. Special education services are essential for students who have learning and emotional disabilities that prevent them from accessing the general education curriculum. But many students who need mental-health supports do not meet the criteria for having a "disability."
Relying solely on special education as a mechanism to provide mental-health services limits our reach and effectiveness. Moreover, it puts parents in the position of believing that the only way to get their child help is to argue for a special education placement, even if it isn't genuinely appropriate. This isn't good for anyone.
In contrast, when schools provide mental-health supports within an MTSS, all students have access to services, while special education is focused on those students with disabilities requiring intensive and specially designed instruction.
3. Improve school-community collaboration to provide integrated and coordinated mental-health care. Disconnects between school- and community-based mental-health providers create some of the biggest problems in mental-health care.
Lack of effective communication leads to confusion, contention, fractured decisionmaking and implementation, and, as the Connecticut report notes, missed opportunities. These disconnects are caused in equal parts by structural differences (e.g., separate privacy laws regarding students and health), use of different terminology (e.g., "emotional disturbance" has a very different meaning in special education versus clinical settings), and ignorance about (and perhaps a dismissal of) the other's systems and processes.
The reality is that, to improve our system of mental-health services, neither sector can afford to go it alone. Both are necessary elements of the continuum of mental-health care and must work in concert.
Steps toward building effective partnerships include establishing a leadership team composed of school and community mental-health professionals, conducting an assessment of needs and existing resources, clarifying roles and responsibilities, providing professional development, and making time for regular problem-solving and evaluation. Effective partnerships empower school and community providers to make more informed, efficacious decisions and best use of resources, and to make support over time more consistent and cohesive.
4. Empower families to manage the myriad decisions and resources they need to meet their child's mental-health needs. Parents should be the ultimate arbiters of their child's care and well-being. And they are often the primary, if not the only, bridge between school and community services.
Amid what can be a painful, surprising, or even frightening emerging reality for their child, they also face the daunting task of making difficult and sometimes confusing decisions. In some instances, this results in intensive advocacy on their part. In other cases, it results in inaction out of indecision, lack of understanding, or lack of resources. In still other cases, parents find themselves caught between conflicting recommendations or perspectives of different professionals, leaving them feeling overwhelmed and isolated.
Respecting the parent's role while also conveying critical information about needed services is a delicate but critical responsibility for school and community professionals. This responsibility includes reducing stigma and facilitating help-seeking. It requires providing information in clear and culturally appropriate terms. It also requires tenacity, compassion, and, perhaps most importantly, establishing a trusting relationship anchored by recognition that all parties want to do what is best for the child. In this regard, improved school-community collaboration that views parents as partners facilitates their ability to make good decisions and get the help their children need.
Improving our mental-health system requires a concerted effort among all of us. In addition to reframing our approach, increasing human and financial resources is essential. Current levels of both school-employed and community-based mental-health providers are grossly inadequate. Many of us are only able to serve children with the most intense needs, with little time to engage in critical prevention and early-intervention services.
When it comes to ensuring student success, mental health matters, and educators should be leaders, not bystanders, in this effort. Schools have the tremendous advantage of being a major hub in children's lives. Schools are already communities with interdisciplinary collaborative systems and supports. We can initiate conversations with local community providers and begin to take meaningful steps toward improving our mental-health systems so that all children are afforded the continuum of care they so desperately need.
Vol. 34, Issue 18, Pages 27, 32Published in Print: January 21, 2015, as Four Ways We Must Improve Student Mental-Health Services