This Web site is a component of the SAMHSA Health Information Network
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This Web site is a component of the SAMHSA Health Information Network. |
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Chapter 66.0 Mental Health Problems and Services at the Elementary, Middle, and High School LevelsThis report has focused thus far on all public schools in the nation, with attention to variation by school and student characteristics. To make the results of this survey more tangible, this chapter examines the data by school level. In order to understand how schools were organizing and delivering school mental health services, school level―whether a school is an elementary, middle, or high school―was perhaps the most salient school characteristic. The staffing and services provided may vary according to the stage of development of the children and youth served. This chapter, where possible, describes the “typical” elementary, middle, and high school in terms of the school’s characteristics, mental health problems, and how schools delivered mental health services, and then explores differences and similarities in the survey findings by level. It describes school mental health for a typical elementary, middle, and high school (Exhibit 6.1) by using either (1) the majority response (reported by over 50 percent of schools), or (2) the most common response(s) to a question if there was not a majority response (see Exhibits 6.2–6.7). For questions that asked schools to report a percent or number, we used the median value rather than the average (mean) to describe the “typical” school. 6.1 Mental Health Problems and Services at the Elementary School LevelAccording to the findings from this survey, the typical elementary school had 440 students (Exhibit 6.1). The mental health problem category most commonly reported for both male and female elementary school students was social, interpersonal, or family problems (Exhibits 6.1 and 6.2). The second and third most commonly reported mental health problems differed for male and female elementary school students. Among males, aggression or disruptive behavior, and behavior problems associated with neurological disorders were the second and third most common problems. For females, the second most commonly reported problem was anxiety, and the third was adjustment issues. In the typical elementary school, all students, not just special education students, were eligible to receive mental health services. About one fifth of students had received one or more of the mental health services provided by their school (Appendix C, School Table 3). 21 Basic mental health services (assessment for emotional or behavioral problems, behavior management consultation, crisis intervention, and referral to specialized programs) were provided by the typical elementary school as well as services that require more staff time and involvement: case management, individual counseling/therapy, and family support services (Exhibit 6.3). The typical elementary school did not provide medication management or substance abuse counseling. In addition to its own staff, the typical elementary school had formal agreements with community-based organizations such as county mental health agencies (Exhibit 6.4). Elementary schools typically had two to four staff providing mental health services (Exhibit 6.5); most often, they were school counselors and nurses when they had only two staff. Schools with three or four staff typically had a psychologist and a social worker in addition to a counselor and a nurse (Exhibit 6.6). School counselors in elementary schools spent more of their time providing direct mental health services than did the other types of staff, and school nurses spent the least amount of time (Exhibit 6.7). Since school counselors were part of the typical team of mental health staff at schools and spent more of their time providing mental health services compared to other types of staff, we can infer that at the typical elementary school, school counselors provided most of the mental health services. However, we cannot infer the exact amount of services provided. Although the survey also included mental health counselors and other types of providers, few schools reported using them to deliver mental health services.6.2 Mental Health Problems and Services at the Middle School LevelThe typical middle school had over 600 students (Exhibit 6.1). The mental health problem category most commonly reported for both males and females was social, interpersonal, or family problems (Exhibits 6.1 and 6.2). The second and third most commonly reported mental health problems differed for male and female middle school students. Among males, aggression or disruptive behavior, and behavior problems associated with neurological disorders were the second and third most common problems. For females, the second most commonly reported problem was anxiety, and the third was adjustment issues. These findings are consistent with the most commonly reported problems in elementary schools. In the typical middle school, all students, not just special education students, were eligible to receive mental health services. About one fifth of students in the typical middle school had received one or more of the mental health services provided by their school (Appendix C, School Table 3). These types of mental health services at the typical middle school included basic services such as assessment for emotional or behavioral problems, behavior management consultation, crisis intervention, and referral to specialized programs and also included more intensive services such as counseling, family support, and case management (Exhibit 6.3). Substance abuse counseling was provided by the typical middle school, although medication management was not. The typical middle school had formal agreements with community-based organizations or individuals (in addition to staff) to provide student mental health services (Exhibit 6.4). Middle schools that engaged community providers for mental health services usually had agreements with county mental health agencies, community health centers, and the juvenile justice system. Middle schools typically had between two and six staff providing mental health services (Exhibit 6.5). Most commonly, they were school counselors, psychologists, social workers, and nurses (Exhibit 6.6). School social workers and school counselors spent more of their time providing direct mental health services compared to the other types of staff, and school nurses spent the least amount of time (Exhibit 6.7). Although the survey did not ascertain the amount of service provided by each type of staff, we can infer from these data that school counselors provided most of the mental health services at the typical middle school.6.3 Mental Health Problems and Services at the High School LevelThe typical high school generally enrolled 700 students (Exhibit 6.1). The mental health problem category most commonly reported for both male and female high school students was social, interpersonal, or family problems (Exhibits 6.1 and 6.2). The second and third most commonly reported mental health problems differed for male and female high school students. Among males, aggression or disruptive behavior and alcohol/drug problems were the second and third most common problems. For females, the second most commonly reported problem was depression/grief, and the third was anxiety. In the typical high school, all students, not just special education students, were eligible to receive mental health services. However, less than one fifth of students in the typical high school had received one or more of the mental health services provided by their school (Appendix C, School Table 3). The types of mental health services at the typical high school included basic services such as assessment for emotional or behavioral problems, behavior management consultation, crisis intervention and referral to specialized programs. Also included were more intensive services such as therapy and case management (Exhibit 6.3). Substance abuse counseling was provided by the typical high school, although medication management was not. The typical high school had formal agreements with community-based organizations or individuals (in addition to staff) to provide student mental health services (Exhibit 6.4). High schools that engaged community providers for mental health services usually had agreements with county mental health agencies, community health centers, and the juvenile justice system. High schools typically had between three and eight staff providing mental health services (Exhibit 6.5). Most commonly, they were two school counselors and a nurse when they had three staff. When there were four or more staff, there was also a psychologist and a social worker (Exhibit 6.6). School social workers spent more of their time providing direct mental health services compared to the other types of staff, and school counselors spent the least time (Exhibit 6.7).Exhibit 6.1 Enrollment and Provision of Mental Health Services in Typical Elementary, Middle, and High Schools, 2002 –2003
Exhibit 6.2 Top Mental Health Problems by School Level, 2002 –2003
Exhibit 6.3 Percentage of Schools Providing Various Mental Health Services by School Level, 2002 –2003
Exhibit 6.4 Percentage of Schools with Agreements With Community-Based Organizations: Of Those, Percentage With Agreements With Various Types of Community-Based Organizations by School Level, 2002 –2003
Exhibit 6.5 Percentage of Schools Reporting the Number of Staff Providing Mental Health Services by School Level, 2002 –2003
Exhibit 6.6 Percentage of Schools With Various Combinations of Staff (Regardless of Number) Providing Mental Health Services in Schools by School Level, 2002 –2003
Exhibit 6.7 Percentage Time Spent by Selected Staff Delivering Mental Health Services by School Level, 2002 –2003
6.4 SummaryThis chapter attempts to describe the “typical” elementary, middle, and high school in terms of students’ top mental health problems, the services the schools provide, and the staff members who provide those services. Given the diversity of schools in this national survey, these results cannot be interpreted to be representative of public schools in the United States; rather, they represent the median, or the report of the majority of schools. Social, interpersonal, and family problems were most frequently cited at all levels, but there were some differences of note. Problems reported for males and females were consistent in middle and high school, although the frequency with which problems such as behavioral problems associated with neurological disorders (for males) decreased in middle school. High schools reported two problems in the top three that were not cited to this degree by middle or elementary schools: alcohol/drug problems for males and depression/grief for females. Schools at all levels reported they provided a wide array of services, but the majority also reported they had arrangements with community-based providers. This reliance on collaborating agencies and providers is striking and could be attributable to factors such as recognition among educators of the need to coordinate education with behavioral health and health care to maximize educational achievement. Education and other child-serving systems may also recognize the need to share resources and responsibility in response to child mental health needs. The most common number of staff providing mental health services in elementary schools was 2–4, but the ranges were much wider in middle schools and high schools, which makes it difficult to pinpoint the “typical” school in this regard. The most common types of staff at all levels were school counselors, psychologists, and nurses, followed by social workers. While counselors spent more of their time providing mental health services than other staff in elementary schools, they spent much less time in high schools on mental health services. In high school, social workers spent more time providing mental health services than did other staff.
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