Nearly one-third of K-12 public schools in the United States now require mental health screening for students, but ensuring that they receive adequate follow-up care after a diagnosis is often much harder, concludes a recent study from RAND, a nonprofit research organization.
The study, based on a nationally representative survey of 1,019 K-12 public school principals conducted in October 2024, found that 30.5% of respondents said their school required screening students for mental health problems.
If a student is identified as having anxiety or depression, most principals reported their school typically notifies their parents (79%), offers in-person treatment (72%), and/or refers the student to a local mental health care professional (53%), according to the report. Less than 20% offer telehealth treatment.
About 40% of principals surveyed said it was very hard or somewhat hard to ensure that students receive appropriate care, while 38% said it was easy or very easy to find adequate care for students, the report found.
The findings, published in the journal JAMA Network Open on July 18, come as young people struggle with record-high rates of depression and anxiety. Youth mental health has become a top policy priority for school, district, state, and federal leaders over the past few years.
The RAND results show that barriers remain for schools to provide appropriate mental health care for students or ensure they receive it, but educators and school-based mental health professionals who spoke with Education Week said the results are encouraging.
“It actually was a little bit better than I anticipated,” said John Gies, the principal of Shelby High School in Shelby, Ohio. “You wouldn’t have gotten those numbers five years ago. There’s still a lot of work to be done, but it looks like we’re making some progress.”
Kelly Vaillancourt Strobach, the director of policy and advocacy for the National Association of School Psychologists, said that while the percentage is lower than what NASP would like to see, “it represents an increase in the number of districts that indicate they’re doing some type of universal screening, which is a positive.”
Indeed, an EdWeek Research Center survey conducted in the fall of 2023 found that just 10% of district and school leaders said their district used universal mental health screenings for students in every grade level.
While the RAND report found that most schools offer in-person treatment or refer students to community-based resources, it didn’t ask about the quality or effectiveness of those services or whether the available resources match student demand.
Jonathan Cantor, a policy researcher at RAND and the lead author of the study, said the results provide researchers with a baseline and that there needs to be more research into the barriers schools face when addressing mental health challenges.
“Data is really important for trying to answer these questions,” Cantor said. That means having comprehensive longitudinal data, to identify disparities, where there’s growth, where there are declines [in services offered], and which areas of the country are struggling, he said.
The barriers schools face in addressing student mental health
Screening students for signs of poor mental health is one of the best strategies schools can use to support students, according to experts. But districts have been slow to adopt screenings due to a lack of resources, and, in some cases, because of parent pushback.
“One of the challenges in deciding whether or not to do a screener is looking at, do we have the capacity, and do we have the resources to support the students who are at risk?” Strobach said. “We know that there is a shortage of school mental health professionals. I’ve heard from some district leaders that they would love to do this, but they don’t want to tell a parent, ‘Hey, your child has been flagged for potential mental health concerns, but we can’t help you.’”
Often, whether districts have access to appropriate mental health services depends on their location, experts say. Districts near big cities tend to have more access to these services than those in more rural areas or smaller towns. Some districts are turning to telehealth to provide services to students, but that comes with its own challenges.
Even if schools have mental health professionals, their workloads are often overwhelming, experts say. The NASP recommends a ratio of 500 students to 1 school psychologist, but the national average ratio for the 2023-24 school year was 1065 to 1. The American School Counselor Association recommends a ratio of 250 students to 1 school counselor, but the national average ratio for the 2023-24 school year was 376 to 1.
Gies, the principal at 400-student Shelby High School, said the school has two counselors whose responsibilities are wide-ranging. They don’t just check in on students’ mental health. They also ensure students are meeting graduation requirements, help students with picking classes, and talk to students about post-high school plans.
“Sometimes they don’t get the opportunity to just be counselors, and so we have to be aware of that and try and take some things off of their plates,” Gies said.
Principal organizations in Ohio and nationally are pushing policymakers for more resources, Gies said.
So far, only two states have laws that provide funding and resources for schools to implement mental health screenings. Illinois is the first state to require schools to offer universal mental health screening for students in grades 3-12. New Jersey has a grant program for schools to provide mental health screening. Colorado had a law that created a mental health screening program for students in grades 6-12, but it was repealed during the 2025 legislative session, with the bill sponsors citing concerns that the law infringed on parents’ rights.
“Even though we’re making some strides, we still need help,” Gies said. “We need continued funding to help us with this mental health crisis in our schools.”
