School-based mental health services can improve the well-being of children and adolescents

Mental health in young people across the U.S. is suffering: rates of anxiety, depression and other mental health challenges remain high, and suicide is the second-leading cause of death. To address these challenges, school-based mental health (SBMH) services are being offered by some school districts as a way to identify and treat children and adolescents who may not have access to other mental health services.

Schools may provide mental health support via school counselors, social workers and, in some cases, psychologists, but these resources are frequently limited, and many schools report lacking the capacity to deliver adequate services. The SBMH model aims to provide a higher level of support by placing licensed mental health clinicians who work for mental health agencies directly in schools, complementing the existing capacity of school counselors and social workers.

While proponents argue the SBMH model has several advantages — school staff can identify potential problems quickly; students can connect with services more easily; and students who are uninsured or face other barriers can access treatment, improving equity in access to care — evidence of the causal effects of SBMH services has been limited.

A new study from the University of Minnesota School of Public Health (SPH), published in the Journal of Human Resources, addresses this gap. Researchers studied data from 263 K-12 schools in Minnesota’s Hennepin County, many of which implemented SBMH between 2001 and 2019. The study found:

• The SBMH program increased students’ access to mental health services by 8%. 
• Rates of attempted suicide decreased by 15%, averting approximately 260 self-reported suicide attempts per year.

Recent estimates suggest approximately one in five U.S. adolescents in 2021 had a major depressive disorder and that fewer than half of adolescents who needed treatment were able to access treatment services.

“There is a clear need for additional mental health resources for children and adolescents in the U.S.,” says Ezra Golberstein, an associate professor at SPH and lead author of the study. “School-based mental health cannot solve all mental health, behavioral and learning challenges, but this study is evidence that it can be a valuable investment in the well-being of children and adolescents.”

The study noted that the annual cost of the SBMH program was about $117 per student, costs that were covered by state grant funds and health insurance (if the student was covered by insurance).

Study co-authors are Irina Zainullina from the University of Minnesota Department of Applied Economics, Aaron Sojourner from the W. E. Upjohn Institute for Employment Research and Mark A. Sander from Hennepin County and Minneapolis Public Schools.