Mental Health in Schools: Emerging Trends
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Data on diagnosable mental disorders (based on community samples)
suggest that from 12% to 22% of all children suffer from mental,
emotional or behavioral disorders, and relatively few receive
mental health services. The picture is even bleaker when expanded
beyond the limited perspective of diagnosable mental disorders
to include all young people experiencing psychosocial problems
and who Joy Dryfoos defines as "at risk of not maturing into
responsible adults." The number "at risk" in many
schools serving low-income populations has climbed over the 50%
mark. Harold Hodgkinson, director of the Center for Demographic
Policy, estimates across the nation 40% of students are in "very
bad educational shape" and "at risk of failing to fulfill
their physical and mental promise." Because so many live
in inner cities and impoverished rural areas and are recently
arrived immigrants, he attributes their school problems mainly
to conditions they bring with them when they enter kindergarten.
These are conditions associated with poverty, difficult and extremely
diverse family circumstance, lack of English language skills,
violent neighborhoods, physical and emotional problems, and lack
of health care. One impact is that at least 12% fail to complete
high school, which leads to extensive consequences for them, their
families, and society. |
Few schools, of course, can afford the entire array of personnel
and activity outlined above. And, because so many young people
experience serious problems that interfere with learning and performing
in school, most schools indicate that they need much more than
they have.
The problem of at risk students has grown so great that educators find they must hold special national summits where the emphasis is not only on the academic plight of students, but also on how to make schools safe. Keith Geiger, President of the National Education Association, reflecting on the association's 1995 "Safe Schools Summit," laments:
How does a history teacher explain the relevance of the Emancipation Proclamation to students who feel enslaved by fear? How does a guidance counselor persuade a boy to study hard and aim for college if that boy, in his gut, doesn't expect to live past his 20th birthday?
Am I exaggerating? David Sachter, director of the U.S. Centers for Disease Control and Prevention, told the summit about a major new CDC survey of 16,000 students, grades 9 through 12 in both public and private schools.
Nearly 22 percent of those surveyed said they had carried a weapon in the previous month. Nearly one quarter (24.1%) of students had seriously considered attempting suicide in the previous 12 months; 8.6 percent had actually attempted suicide in that period. This study follows an earlier CDC finding that violence among young people has reached "epidemic" proportions (p. 14).
There is growing consensus about the crisis nature of the situation.
And it is widely recognized that failure to address the problems
of children and schools can only exacerbate the health and economic
consequences for society. The literature on mental health related
interventions in schools encompasses an enormous array of specific
practices and issues. In this limited space, we will simply outline
the state of the art and a few emerging reforms that are reshaping
the work of mental health professionals in the schools.
New directions call for functions that go beyond direct service
and traditional consultation. All who work in the schools must
be prepared not only to provide direct help but to act as advocates,
catalysts, brokers, and facilitators of systemic reform. Particularly
needed are efforts to improve intervention efficacy through integrating
physical and mental health and social services. More extensively,
the need is for systemic restructuring of all support programs
and services into a comprehensive and cohesive set of programs.
Comprehensive approaches recognize the role school, home, and
community life play in creating and correcting young people's
problems. From such a perspective, schools must provide interventions
that address individual problems and system changes. It is widely
recognized that social, emotional, and physical health problems
and other barriers to learning must be addressed if students are
to learn in ways that allow schools to accomplish their educational
mission (Dryfoos, 1994; Tyack, 1992). In this regard, there is
renewed interest in the notion that school-based and linked services
increase access to underserved and hard-to-reach populations.
An extensive literature reports positive outcomes for psychosocial
interventions available to schools.
This research can be characterized as promising, albeit restricted
in scope. It provides a menu of "best practices." Many
of the reports are from narrowly focused brief demonstrations
that by their very nature could only produce limited outcomes.
Still, a significant number of appropriately developed and implemented
programs have demonstrated benefits not only for schools (e.g.,
better student functioning, increased attendance, less teacher
frustration), but for society (e.g., reduced costs related to
welfare, unemployment, and use of emergency and adult services).
Thus, the literature is encouraging and also emphasizes that the
search for better practices remains a high priority and must reflect
the diverse demographics and conditions of a changing society.
School professionals are engaged in an increasingly wide array
of activity, Including promotion of social and emotional development,
direct services, outreach to families, and various forms of support
for teachers and other school personnel. There is enhanced emphasis
on coordination and collaboration within a school and with community
agencies to provide the "network of care" necessary
to deal with complex problems over time. As this article highlights,
counseling, psychological, and social services in schools are
expanding and changing rapidly. Schools' efforts to address psychosocial
problems encompass (a) prevention and prereferral interventions
for mild problems, (b) high visibility programs for high-frequency
psychosocial problems, and (c) strategies to address severe and
pervasive mental health problems.
Proliferation of psychosocial programs in schools tends to occur
with little coordination of planning and implementation. As awareness
of deficiencies has increased, major systemic changes have been
proposed. Four emerging trends are
Each trend has implications for what goes on in schools and for
the ways in which our Center will operate.
Based on our analysis of emerging trends, the range of functions
mental health specialists should perform for schools are
The relatively small number of mental health personnel available
to schools cannot provide much in the way of direct services.
The more their expertise is used at the level of program organization,
development, and maintenance, the more students they can help.
This fact is the basis for suggesting that the three areas of
function listed above be prioritized so school-based mental health
professionals can use their time to produce the broadest impact
(Adelman & Taylor, 1991). Used properly, such personnel can
play a potent role in creating a comprehensive, integrated approach
to meeting the needs of the young by interweaving what schools
can do with what the community offers. School mental health professionals
bring specialized understanding of cause (e.g., psychosocial factors
and pathology) and intervention (e.g., approaching problem amelioration
through attitude and motivation change and system strategies).
This knowledge can have many benefits. For instance, mental health
perspectives of "best fit" and "least intervention
needed" strategies can contribute to reduced referrals and
increased efficacy of mainstream and special education programs.
With respect to pre and inservice staff development, such perspectives
can expand educators' views of how to help students with everyday
upsets as well as with crises and other serious problems -- in
ways that contribute to positive growth. Specialized mental health
understanding also can be translated into programs for targeted
problems (e.g., depression, dropout prevention, drug abuse, gang
activity, teen pregnancy).
Despite the range of knowledge and skills they bring to a setting,
mental health professionals usually find their overwhelming caseload
of students restricts them to providing direct services. Even
then, they see a small proportion of the many students, families,
and school staff who could benefit from their efforts. This is
not surprising given the relatively limited cadre of specialists
school districts employ.
This lamentable state of affairs raises several points for discussion.
One often discussed idea is that greater dividends (in terms of
helping more people) might be forthcoming if such personnel devoted
their talents more to prevention. At an even more fundamental
level, it seems likely that larger numbers would benefit if these
professionals devoted a greater portion of their expertise to
creating a comprehensive, integrated approach for addressing barriers
to learning and enhancing healthy development. For this to happen,
however, there must be a shift in priorities with respect to how
they use their time. Specifically, this involves redeploying time
to focus more on functions related to
Used properly, such personnel can contribute greatly to creation
of a comprehensive, integrated approach.
Concluding Comments
Emerging trends are reshaping the work of mental health professionals
in schools. New directions call for going beyond direct service
and beyond traditional consultation. All who work in schools must
be prepared not only to provide direct help but to act as advocates,
catalysts, brokers, and facilitators of systemic reform. Particularly
needed are efforts to improve intervention outcomes by integrating
physical and mental health and social services. More comprehensively,
the need is for systemic restructuring of all education support
programs and services to improve the state of the art and provide
a safety net of care for generations to come. We will have more
to say about this in the next issue.
Note: a fuller discussion of this topic will be published later
this year. See L. Taylor & H.S. Adelman (in press), Mental
health in the schools: Promising directions for practice. In L.
Juszcak & M. Fisher (Eds.) Health care in schools. A special
edition of Adolescent Medicine: State of the Art Reviews.
Also, see H.S. Adelman (1995), Clinical psychology: Beyond psychopathology
and clinical interventions. Clinical Psychology: Science and
Practice, 2, 28-44.
School Mental Health Project-UCLA
WebMaster: Perry Nelson (smhp@ucla.edu)
