Principals’ Perspectives on School Mental Health and Wellness in U.S. Catholic Elementary Schools

The current study examines principals?? perspectives on school mental health needs, professional development in relation to school mental health, and areas of successful practice, and does so within a specified domain of education: private, Catholic, elementary schools in the United States. The study draws on survey data producing some of the first representative estimates of mental health services and staffing in private schools. Principals from 346 elementary schools shared their perspectives on three key areas: challenges in meeting student mental health needs, what types of professional development they desire, and the kinds of effective practice that are currently operative in their schools.     

School law for the child psychiatrist: legal principles and case implications

Schools are evolving to support all students, including those with mental health issues. Clinicians can help patients and schools by providing diagnostic clarity about a child’s condition, how that condition interferes with school progress, and what interventions are needed in the school setting. State and Federal legislation supports timely response by schools to mental health issues emerging in students through special education laws and general education accommodations, such as Response To Intervention (RTI), which encourages schools to implement evidence-based interventions for students exhibiting mental health conditions. Case examples illuminate important legal considerations when clinicians are faced with issues such as therapeutic placements, home hospital forms, and substance abuse, and student misconduct.     

Telepsychiatry and school mental health

The provision of mental health services in schools has been one effective strategy for reaching out to a greater number of youth to identify and provide treatment for mental health issues. With the increasing challenges related to shortages in child and adolescent psychiatrists, it is critical to develop models of care that can maximize a full range of mental health services for all children and adolescents who need them. Telehealth offers an innovative distance technology strategy to effectively and efficiently provide access to psychiatric services in schools. Telepsychiatry has the potential to better link and enhance the provision of health services, and can be particularly beneficial in addressing geographic distance and/or capacity issues. This article describes the clinical, educational, and administrative uses of telemental health in the school environment with mental health professionals and staff.     

Future needs for psychiatrists and other mental health personnel.

Approximately 15% of the population suffers a diagnosable mental disorder, and with the increasing availability of community-based mental health services, growing demand is placed on the mental health specialty sector. Though the general health sector and nonmedical mental health specialists provide services to a large proportion of this case load, psychiatrists possess unique skills for the diagnosis and treatment of mental disorder and for the provision of consultation and liaison services to nonpsychiatric physicians. In spite of the need, a number of factors, including restrictions on foreign medical graduates and federal emphasis on the primary care specialties, have created an accelerating reduction in the production of psychiatrists. The federal government and medical schools are encouraged to devise strategies collaboratively to address issues to ensure an adequate supply of psychiatrists for the future.     

On the Fault Line: A Qualitative Exploration of High School Teachers’ Involvement with Student Mental Health Issues

School-based mental health (SBMH) research often underplays the crucial role that teachers play in supporting student mental health, even as teachers often find themselves encountering student mental health issues. Further, teachers’ and school-based mental health practitioners’ (SBMHPs) work with shared students has historically tended toward distance rather than collaboration. This article explores the virtual fault line where SBMHPs’ and teachers’ work intersect, concerning student mental health issues. Drawing on qualitative data gathered at three high schools that, to varying degrees, required teachers’ involvement with student mental health issues, this study analyzes the nature of teachers’ work in this area. In particular, the study identifies ways in which teachers provided psychosocial support, as well as how teachers’ and SBMHPs’ work intersected. Findings indicate that uncertainty existed at the three schools about teachers’ involvement with student mental health issues, and that this uncertainty was reinforced by organizational structures that promoted a separation of teaching from SBMH. Implications for practice, professional learning, and research are discussed.     

School-based mental health services in the united states: History,current models and needs

Children's mental health needs continue to be largely unmet, even when community services are provided. On-site mental health services in schools address unmet needs by improving access to, and relevance of services. As schools have increasingly been mandated to serve the needs of all children (including those who are emotionally disturbed) general health and mental health services have been increasingly placed in them. Although the provision of basic health care in schools began in the early part of the century, the concept of providing comprehensive services, in which mental health services are integrated into primary medical care, has only been implemented recently. We review the background of school-based mental health services, compare various models of service delivery, and highlight issues important to the future development and advancement of these services.     

Implementing Multi-level Programmes and Approaches that Address Student Well-being and Connectedness: Factoring in the Needs of the Schools

Implementation of effective school-level mental health promotion initiatives is challenging. This paper presents findings from the beyondblue schools research initiative, a cluster randomised trial which aimed to promote student mental health. It sought to implement emotional skills through curriculum, greater community linkages and whole-school environment change in 25 schools in three states of Australia. Using qualitative process evaluation data collected during the three years of the project, we describe key features of the intervention that, according to the project facilitators, influenced its implementation. Project design flexibility to meet individual school needs and provision of sufficient resources appeared to be crucial for successful implementation.     

Persistently Dangerous Communities and Schools in the United States: How Might School Mental Health Help?

With increasing pressure on schools in the United States to address violence and school safety, school mental health (SMH) programs and services are well positioned to assist school administrators, teachers, and other school staff to prevent and/or reduce inappropriate and violent student behavior in schools. It is a struggle for persistently dangerous schools to provide educational environments that are safe and supportive for all students, and their academic achievement is threatened. The process of identifying and reforming these schools is explored briefly, followed by the ways in which school mental health strategies and programs can reduce suspensions and expulsions. Finally, opportunities are highlighted in which school mental health professionals can work with school administrators to produce effective change to promote safe schools and communities.     

Implementation quality of whole-school mental health promotion and students' academic performance

BACKGROUND: This paper argues for giving explicit attention to the quality of implementation of school-wide mental health promotions and examines the impact of implementation quality on academic performance in a major Australian mental health initiative. METHOD: Hierarchical linear modelling was used to investigate change in standardised academic performance across the 2-year implementation of a mental health initiative in 96 Australian primary (or elementary) schools that was focused on improving student social-emotional competencies. RESULTS: After controlling for differences in socioeconomic background, a significant positive relationship existed between quality of implementation and academic performance. The difference between students in high- and low-implementing schools was equivalent to a difference in academic performance of up to 6 months of schooling. KEY PRACTITIONER MESSAGE: Given the known relationship between student academic achievement and mental health, many nations are mounting school-based mental health interventions: however, the quality of program implementation remains a concernThe Australian KidsMatter primary school mental health intervention enabled the development of an Implementation Index allowing schools to be grouped into low- to high- implementing schoolsThe quality of implementation of KidsMatter appears to be positively associated with the level of student academic achievement, equivalent to 6 months more schooling by Year 7, over and above any influence of socioeconomic background.     

Problems and issues in community mental health service delivery in the 1990s

With the repeal of the Mental Health Systems Act by the Reagan administration in 1980, the amount of federal dollars allocated to community mental health agencies declined. Perlman and Hartman (1982) surveying mental health administrators' and professionals' perceptions on the major issues to be faced in the 1980s, found that budget reductions were to have the greatest impact on mental health service delivery. To explore problems and issues in mental health service delivery in the 1990s, 272 mental health administrators in county level, public sector organizations from Wisconsin and Michigan were surveyed. Budget effects on service, staff and administration are discussed.Paul Ebben and David Bliss received their MS degrees in Psychology with a Clinical Emphasis. Dr. Perlman is a Professor in the Psychology Department     

Commentary: Taking steps to reduce school exclusions: child and adolescent mental health trajectories in relation to exclusion from school from The Avon Longitudinal Study of Parents and Children (ALSPAC) – a commentary on Tejerina-Arreal et al. (2020)

The mental health of young people and exclusion from school are both topics of current interest. The Avon Longitudinal Study of Parents and Children (ALSPAC) brings these two themes together and, in doing so, sheds light on the links between exclusion rates and young people’s mental health. Separate consideration is given to what has been happening in the United Kingdom as regards mental health and education; education and exclusion; and alternative provision (AP) and excluded pupils, before these strands are drawn together. The ramifications of the government’s plans for improving provision for young people’s mental health are seen in a positive light as it gives schools a pathway from support in the classroom through to access to CAMHS. It is suggested that closer working between health and education should lead to earlier intervention and that this should include pupils being placed in specialist or AP without the need to be excluded before this happens.     

School nurses' perceived prevalence and competence to address student mental health problems

Due to under-identification of student mental health problems and limited specialty mental health providers in schools, school nurses are often faced with identifying and addressing student mental health needs. This exploratory study assessed prevalence and types of student mental health problems encountered by school nurses, as well as their prior training, perceived competence and levels of comfort addressing such problems. Data collected at a 2010 National Association of School Nurses conference from 78 school nurses suggest that in their view, 31% of students present with mental health concerns as their ‘primary’ presenting issue. School nurses reported moderate levels of comfort identifying specific problem areas, but limited comfort in mental health intervention and pre-service training to identify, assess, make referrals and/or intervene. Perceived competence identifying mental health concerns overall was predictive of perceived competence to make referrals. Implications and recommendations for professional development are presented.     

The administration of school-based mental health services.

Challenges and proposed solutions in the administration of school-based mental health services have been addressed. Differences depend on whether the services are provided by the mental health component of an SBHC or by an ISBMHP. Seven common elements relevant in developing and administering school-based mental health services, whether in an SBHC or ISBMHP, have been identified: funding, assessment and resources, program structure, staffing and training, partnership and collaboration, quality assurance, and evaluation. How these elements are addressed varies from school district to indivdual school to individual principal to agencies providing services to specific clinicians. One of the most important lessons learned is that the ecosystem of each school is different; one size does not fit all. When external agencies enter a school, they are in the best case guests, in the worst case foreigners or invaders. Agencies and their clinicians must be respectful, adaptable, flexible, and competent professionals. With such attributes, the chance for an effective collaboration is enhanced. Contributions of school-based mental health services to the child and adolescent mental health delivery system include (1) access to services for disadvantaged and underserved youth, (2) system-wide collaboration, (3) prevention of acute psychiatric intervention, (4) gate-keeper role for more acute or specialized care, (5) systematic program evaluation in a "naturalistic" setting, (6) professional training in working with a range of systems and cultures, and (7) outreach and community-based care. With the emphasis on partnership and collaboration, school-based programs have the potential to benefit the children and families, schools, communities, and managed care organizations. The provision of access and early intervention is cost effective in the long run, and findings indicate that school-based mental health service is as effective as that of a central clinic. With the emphasis on collaboration, partnership, and bridging systems and cultures, the provision of school-based mental health care may be able to offer tools and experience to create integrated systems of care. This is a reciprocal process and an ongoing dialectic, however. Providers and planners of a school-based mental health programs, schools, and managed-care leaders can learn from one another, and all have major contributions to make to the overall delivery system. Schools and mental health service providers contribute knowledge and skills in working with this population; managed care organizations bring administrative and fiscal expertise and a focus on and mandate for quality and cost-effective care. For-profit and not-for-profit agencies must enter into a dialogue to educate and understand each other so that they may become collaborators in the underutilized service for children and youth.     

Taking evidence-based practices to school: using expert opinion to develop a brief,evidence-informed school-based mental health intervention

School-based mental health services offer unparalleled opportunities for providing accessible care to children and adolescents. Research indicates that services available in schools are rarely based on evidence of effectiveness and are typically disconnected from the larger school context. To address these issues, the current paper presents initial studies to inform the development of a brief, evidence-based, flexible mental health intervention that fits the school context while maintaining clear structure. Results from two qualitative research studies – key informant interviews with school mental health experts and a nominal group decision-making process with stakeholders – are presented, both of which were aimed at informing intervention development and testing assumptions about how best to design an effective, context-specific mental health intervention that can be flexibly applied in educational settings. An explicit focus on educational outcomes within the context of mental health service delivery was identified as a key component of this integration. The paper concludes with a discussion of how this research has influenced the ongoing development of the intervention protocol, exemplifying a collaborative and iterative approach to developing school-based programmes.     

Qualitative analysis of key informant interviews about adolescent stigma surrounding use of school mental health services

Given the increased access to mental health services that schools provide, there has been a growing consensus among mental health professionals for the delivery of services for youth in schools. Building the capacity of schools to provide evidence-based socio-emotional supports across a continuum of care has been prioritized in recent decades. However, despite policy changes to implement more mental health services in schools, these services still remain widely underutilized by adolescents experiencing mental health problems. Understanding the factors impacting students’ decisions to seek help or use resources provided in a school setting is crucial for actually increasing utilization of care. Yet, little is known about the role of stigma in students’ underutilization of school mental health services. The current study examined stigma about mental health and services in schools through a qualitative analysis of 15 school personnel and student interviews at three high schools in South Carolina. Thematic analysis of interviews indicated that students have a negative outlook of mental health services because of fear of being stereotyped or embarrassed as a result of receiving school counseling. Data from this exploratory study directly contribute to the field of education by providing a model for professionals to implement strategies to eliminate the stigma that causes underutilization of school mental health services.     

Schools' mental health responses after Hurricanes Katrina and Rita

OBJECTIVE: After the displacement of students following Hurricanes Katrina and Rita, schools in several states enrolled many students with potential mental health needs. This study sought to understand how schools perceived the mental health needs of these students and what mental health programs they implemented. METHODS: Mental health personnel at 19 public schools or school systems and 11 private or parochial schools in Louisiana, Alabama, Texas, and Mississippi were interviewed at two time points (spring and fall-winter of 2006). RESULTS: Schools undertook diverse approaches to interventions, depending on the preexisting mental health infrastructure and personnel, the perceived needs of students, and the barriers or facilitators in each system. Interviewees described a rapid and comprehensive approach to the crisis in the immediate aftermath. Shortly afterward, some schools perceived little need for mental health services and refocused on their academic missions. Other school systems perceived student need but were unable to implement trauma-focused programs because staff were not prepared to deliver such services and funding was lacking. However, some systems and schools were able to implement new programs or extend programs to displaced students. Implementation challenges included difficulty communicating with parents, burnout among staff and program implementers, and efforts to balance the needs of the displaced students with those of the preexisting student population. CONCLUSIONS: Despite significant efforts to support students affected by the hurricanes, schools were limited in their ability to implement disaster-focused programs. Extension of crisis plans to include precrisis training in mental health programming for students and staff who have ongoing difficulties after a disaster or crisis may be beneficial.     

Direct costs and expenditures for mental health care in the United States in 1980

Estimates of direct costs and expenditures for mental health care in 1980 are presented in this analysis. Besides estimates for the specialty mental health sector, the general medical sector, and the human service sector (schools and the criminal justice system), the authors include transportation costs and expenditures for transfer payments. They obtained a low total estimate of $19.2 billion and a high total estimate of $22 billion. Comparisons with previous estimates indicate an annual growth rate in real costs for mental health care of about 1.7 percent since 1971.