Less than half of US public schools assess students for mental health

Just slightly more than half of all public schools in the United States conduct student assessments to identify mental health disorders, but the numbers get worse when rural and suburban areas are separated from the rest.

A study led by Washington State University researchers revealed among all public schools in the country, just 52 percent provide these assessments that aid educators in diagnosing kids with mental health issues.

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Schools in rural areas, however, are 19 percent less likely to offer these assessments, according to the study. Towns and suburban areas are 21 percent and 11 percent respectively less likely to provide these services.

“We’re seeing a pretty consistent pattern across the country that rural schools just don’t have the resources,” said Janessa Graves, an associate professor in the WSU College of Nursing and the study’s first author. “This is especially troubling given the rapid rise in youth suicide rates, which is disproportionally affecting rural areas.”

Funding and lack of access to qualified mental health professionals appear to be the major barriers to providing school-based mental health services, researchers concluded.

This was true for all schools but particularly for those in rural areas.

One positive finding that surprised Graves was that rural schools were less likely to identify a lack of community support a barrier – 30 percent less likely than urban school communities.

The opposite was expected by researchers.

“The fact that only 6.5 percent of rural schools called it (lack of community support) a major barrier gives me hope that communities are rallying behind this issue," Graves said. “There just aren’t enough services and kids’ lives are impacted as a result.”

Perceived major barriers to providing school-based mental health services identified by the study included lack of funding and lack of access to qualified mental health professionals, which was true for all schools but particularly for those in rural areas.

To get a sense of how the COVID-19 pandemic affected the availability of school mental health services, the researchers plan to repeat their analysis using not-yet-released data from a 2020 School Survey on Crime and Safety survey.

One thing that may have changed the availability of services during the pandemic is the more widespread adoption of telemental health, the use of telecommunications or videoconferencing technology to provide mental health services, Graves said.

A resident of rural northeastern Washington, Graves conducts research focused on rural disparities in access to and quality of health care. She started specifically looking at youth mental health after seeing the impacts of the youth mental health crisis on rural communities just as the COVID-19 pandemic started.

“Offering mental health services in schools—a place where kids are already congregating—makes sense and could have downstream impacts on substance use disorders, school-based violence and other societal issues,” Graves said. “Yet, many rural school districts barely have a school nurse and definitely don’t have a mental health therapist on hand.”

She said the way budgets are allocated to rural and small schools is one potential issue.

For instance, in Washington state, funding for school support staff is based on student numbers, she said.

For a school to get funding for one full-time nurse it would have to have 5,000 to 7,000 students. That means a small, rural school with only 150 students would receive funding for a tiny fraction of a nurse position.

Graves said she hopes that the study findings might compel policymakers to advocate for better funding for rural schools to reduce these disparities.

“I think we really need to support our schools more,” she said. “By providing these services to our kids, we are giving them tools in their toolkit to be able to get through life a little more smoothly. And we’re also serving our communities better at the same time.”

Published in the American Journal of Preventive Medicine, the study looked at geographic disparities in the availability of mental health services in a weighted, nationally representative sample of U.S. public schools.

The study is based on data from the School Survey on Crime and Safety for the 2017-18 school year, the most recent timeframe for which the survey data is available.