School Mental Health Project


The following document was in response to a request by the Commission for our recommendations related to mental health in schools.

The Policy Problem Related to Advancing an Agenda for Mental Health in Schools
Howard S. Adelman & Linda Taylor
Center for Mental Health in Shcools at UCLA

Any effort to enhance interventions for children's mental health must involve schools. Schools already provide a wide range of programs and services for all students who are not succeeding, many of which are relevant to mental health and psychosocial concerns. And, schools could do much more and will need to if the mandates of the No Child Left Behind Act are to be effective.

 The Policy Problem

 There is no cohesive policy vision for the role schools should play in addressing factors that interfere with learning and teaching, including mental health and psychosocial matters.

 The tendency in policy discussions related to mental health in schools is to focus on how to enhance availability and access to mental health services in schools. Factors usually discussed as barriers to doing more range from sparse resources to the proliferation of piecemeal and overspecialized interventions arising from categorical funding. The growing emphasis on evidence-based practices interacts with these matters, and there is increasing concern about how policy that mandates use of existing evidence-based practices may exacerbate rather than counter limited access and fragmented intervention.

 These are all important policy matters. However, they are not the most fundamental concern. For these matters to be addressed effectively, policy makers must pursue them from a perspective that fully appreciates the degree to which current school policies and practices marginalize the entire enterprise of providing student support programs and services. That is, the fundamental policy problem related to mental health in schools is that existing student support services and school health programs do not have high status in the educational hierarchy and in current health and education policy initiatives. The continuing trend is for schools and districts to treat such activity, in policy and practice, as desirable but not a primary consideration. Since the activity is not seen as essential, the programs and staff are marginalized. Planning of programs, services, and delivery systems tends to be done on an ad hoc basis; interventions are referred to as "auxiliary" or "support" services. Student support personnel almost never are a prominent part of a school's organizational structure. Even worse, student support staff usually are among those deemed dispensable as budgets tighten. This, of course, reduces availability and access.

 The marginalization spills over to how schools pursue special education mandates and policies related to inclusion. It also shapes how they work with community agencies and initiatives for systems of care, wrap-around services, school-linked services, and other school-community collaborations. It also negatively effects efforts to adopt evidence-based practices and to implement them with fidelity.

 Addressing the Policy Interface

All policy to enhance mental health in schools must interface with school improvement policy or it will be marginalized in daily practice at school sites. Schools are not in the mental health business. Moreover, many are leery of mental health, especially when the focus is presented in ways that equate the term only with mental disorders. The mission of schools is to educate all students.

 However, when students are not doing well at school, mental health concerns and the school's mission usually overlap because the school cannot achieve its mission for such students without addressing factors interfering with progress. In some schools, the number of students who are not doing well outnumbers those who are. Thus, it is especially the case in such settings that a school's mission overlaps with a variety of other public and private agencies and entities.

As the Carnegie Task Force on Education (1989) has stressed, School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge. From this perspective, the Center for Mental Health in Schools at UCLA and its Policy Leadership Cadre for Mental Health in Schools (2001) have stressed the value of embedding policy for mental health in schools within the concepts of addressing barriers to student learning and promoting healthy social and emotional development.

 Needed: Frameworks to Guide Development of Policy and Practice

 Linked (see below) are a figure, a table, and a set of guidelines (in pdf format) that provide basic frameworks for enhancing the agenda for children's mental health and mental health in schools. Based on these frameworks, we suggest that policy is needed to guide and facilitate the development of a potent component to address barriers to learning/development and support the promotion of healthy development at every school and in its surrounding community. The policy should specify that such an "enabling" or "learning support" component is to be pursued as a primary and essential facet of school and community improvement and in ways that complement, overlap, and fully integrate with direct efforts to facilitate learning and development.

 Guidelines accompanying such policy need to cover the following:

  1. Developing a Full Continuum of Interventions. Over time, schools and communities should strive to develop such a component by weaving family, community, and school resources into a cohesive and integrated continuum of interventions, encompassing systems for (a) promoting healthy development and preventing problems, (b) intervening early to address problems as soon after onset as feasible, and (c) assisting those with chronic and severe problems.
  2. Expanding Accountability. Accountability indicators for schools and community agencies should be expanded to ensure such a component is pursued with equal effort in policy and practice. The data also should be available for use in improving the evidence-base for school and community interventions.

  3. Restructuring at Schools, District-wide, and in Community Agencies.
  4. Boards of Education and School Governance Bodies. Governance bodies should establish a standing subcommittee focused specifically on ensuring effective implementation of policy for developing a component to address barriers to youngsters' learning and promote healthy development.
  5. Pre- and In-service Programs for School and Agency Personnel. As a key facet of capacity building, all such programs should include a substantial focus on the concept of an enabling/learning support component and its operationalization at a school and in the community.

Figure 1. A comprehensive, multifacted continuum of interconnected systems for meeting the needs of all students

Table 1. From primary prevention to treatment of serious problems: A continuum of community-school programs to address barriers to learning and enhance healthy development.

Exhibit. Guidelines for mental health in schools

Click here to see the Commission's final report on the state of the American mental health service system.


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