This report describes common models of school-based mental health (SBMH) programs, summarizes research on the effectiveness of such approaches, and discusses considerations for Congress. School-based mental health activities refer to policies, initiatives, models, programs, or services in school settings that address students’ emotional, behavioral, or social functioning. SBMH programming exists on a spectrum that includes the promotion of mental wellness, the prevention of mental and behavioral problems, and treatment of existing behavioral health conditions. SBMH activities are carried out by an assortment of school personnel. The availability of mental health programs or services in schools varies widely. Funding usually occurs through school budgets determined at the state and local levels, though some services may be paid for by private health insurance and state Medicaid programs. Federal support for SBMH activities can come from a variety of mandatory and discretionary funding mechanisms (see Table A-1). School-Based Mental Health Models SBMH activities often follow a multi-tiered system of support (MTSS) that includes universal mental health promotion activities for all students, targeted intervention services for students at higher risk for problems, and treatment for students with more intensive needs. Tier 1 programs are used among the general student population without regard for individual risk level. Tier 2 interventions target students with identified risk factors for certain issues, or those with emerging problems. Tier 3 interventions offer more intensive services to students exhibiting symptoms of mental or behavioral health disorders. SBMH programs often have theoretical bases and empirical support for their effectiveness. Studies show that when implemented properly, many SBMH programs can promote healthy development and mental well-being, and prevent or reduce an array of social, emotional, and behavioral problems. The benefits for academic achievement, however, appear less clear. Simply offering any SBMH programming does not guarantee positive results; certain program characteristics matter for achieving desired outcomes. For schools and other stakeholders, identifying appropriate programs can prove challenging. Resources to help stakeholders identify applicable evidence-based programs and practices (EBPs) include federal clearinghouses, among other resources. School-based mental health programs can help prevent school violence and ameliorate the mental health consequences of school violence. For example, for students who have made threats of school violence, the threat assessment model is designed to evaluate the severity of the threat and triage students into appropriate services with mental health or criminal justice professionals. Considerations for Congress Determining whether and how schools should offer SBMH programs raises both logistical questions regarding the capacity of schools to deliver services and philosophical questions about the purpose of public education. Proponents of SBMH activities believe that to meet individual and societal needs, schools should include social and emotional development activities. Others assert that, for practical reasons, schools offer an ideal environment for promoting healthy emotional development and providing beneficial services. Detractors argue that conducting behavioral health-related activities in school settings is neither feasible nor consistent with the purpose of the formal education system. Many believe that any efforts to improve youth mental health necessitates some involvement of schools in the continuum of mental health care, such as collaboration between schools and community providers. Implementing SBMH activities can be challenging. According to stakeholders, common barriers to widespread implementation of SBMH programs include time, resources, costs, and an inadequate supply of qualified behavioral health professionals. Some argue that the SBMH field should look beyond efforts to increase the number of direct clinical service providers and instead focus on prevention and collaborative service integration. Offering SBMH programs may not be the only way to promote good mental health. Creating environments where youth can thrive or addressing the factors contributing to poor mental health can also influence mental wellness. Alternative strategies include increasing child-led free play, limiting smartphone or social media use, improving access to green spaces, providing mentoring programs, offering activities in sports and art, and connecting students to civic institutions and youth-serving organizations, among others. The federal government supports several SBMH programs and activities. Table A-1 identifies relevant federal school-based mental health programs and recent funding levels.
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