Celina Pierrottet remembers 2016 as the year when she and her colleagues at the high school where she taught noticed a significant change among their students.
We were just like, Is it just me, or are kids really nervous? recalls Pierrot. That year we had a lot of kids who were showing some kind of truancy and other behaviors that we didn’t see that much. I remember my colleagues and I looking at each other like, “It’s more this year, then fast forward to the pandemic.”
A surge in mental health needs among students since the start of the COVID-19 pandemic catalyzed the U.S. Surgeon General to declare a youth mental health crisis, and the federal government has since committed billions of dollars to help schools respond.
But Pierrottet, who now serves as assistant director of student welfare at the National Association of State Boards of Education, noted in a policy brief a major obstacle to getting students the help they need: an inadequate supply of mental health professionals, especially those who are credentialed to work in schools.
Here’s what she found standing in the way and how states are finding solutions.
One issue is that increasing the number of mental health professionals in schools takes time. Investments made to increase pipelines now will not pay off in terms of mental health workers in a few years.
During Pierrottets’ research, she discovered that Nevada State Board of Education officials noted last April that the state’s mental health specialist programs were graduating only 12 people each year. At the time, the state was short of 2,863 school mental health professionals.
It’s still a challenge because it’s a profession that requires advanced courses, says Pierrottet. No one is saying they should change those requirements, but it’s a slow investment.
There is also a need to ensure that school mental health professionals, whether school psychologists, social workers or counselors, reflect the demographics of the students they serve, she adds. One of the challenges is that, like their classroom teacher counterparts, mental health professionals in training must complete hundreds of unpaid practicum hours.
Pierrottet points to Virginia and Ohio as examples of states that have responded to that hurdle by creating programs that pay graduate students studying mental health to work in schools. A 2019 program in Virginia placed graduates in school district positions and provided 200 interns with financial incentives to work in schools, according to her report, and Ohio has a similar, decades-old program for school psychologist interns.
Slow and steady wins the race here to ensure that schools attract applicants who are diverse, who meet the diverse needs of their students, says Pierrottet.
But the immediate mental health needs have created huge workloads for counselors.
Pierrottet writes in his policy document that national trade organizations recommend a student-to-professional ratio of 1:250 for school social workers, 1:250 for school counselors and 1:500 for school psychologists.
There is a long way to go to lighten the workloads for all three types of positions. No state meets the recommended ratio for social workers, while Pierrottet found that only New Hampshire and Vermont have better caseloads than the recommendations for counselors. For school psychologists, only Idaho and Washington DC perform better than the recommended ratio.
Some states have gotten creative to increase the availability of mental health professionals in their schools, such as turning to telehealth for counseling services.
It’s no longer just school staff warning counselors that students need mental health support. One of the forces driving increased demand for services is simply that students are asking for them, she notes, as evidenced by the federal School Pulse Panel. The latest results show that 69 per cent of schools have reported an increase in the number of students seeking mental health support since the start of the COVID-19 pandemic.
Schools say there’s actually just a growing demand for more mental health services in schools from students themselves just expressing more anxiety in schools, Pierrottet says. Sometimes it can be a problem if students say, I need this, but I can’t get that connection at school or maybe even outside of school.
Footing the Bill
A win for increasing staffing levels is that states have received funding for school mental health services from huge federal cash infusions, Pierrottet says, such as $188 million from the bipartisan Safer Communities Act of 2022. The U.S. Department of Education predicts one of its grants will bring to more than 14,000 mental health professionals in schools, according to the policy document, and new federal guidelines make it easier for schools to bill Medicaid for mental health services instead of pulling money from their own budgets.
That’s not to say that getting states to fund mental health services was easy. Still, Pierrottet says the programs she highlights in her report have benefited from states having what one analysis called an all-time high level of financial cushion due to budget surpluses as a result of factors including COVID-19 relief funds and tax revenue. larger than expected. . States like Michigan and Texas, which are looking at billions of dollars in surpluses this year, are putting some of that money into mental health spending. Michigan hired more than 2,700 full-time licensed behavioral health providers in schools as of 2019, the report noted, while Texas earmarked $280 million for telehealth counseling in schools starting in 2024.
I think there’s been more success right now than in previous years because of this crisis, right? Pierrottet offers. It would be more difficult if there was no surplus in the budget now. I think the stars are aligning right now. There is a will, there is motivation, so at least in the last year there has been some progress towards funding.
Pierrottet added that it’s important not to think of students’ mental health needs as something that can only be addressed through funding. Instead, she described it as a multi-pronged issue. For example, some teachers are enthusiastic about additional training on how to support students’ mental health, she says, and those teachers also need support for their own mental well-being to be effective in the classroom.
It’s important to think about this holistically, she says. When students are healthy and don’t have those anxious feelings, they are present, they are able to learn. So it’s important for state leaders to think about this as not just, Oh, we need to provide more mental health staff. It’s about the whole continuum, the comprehensive school mental health system and looking at it through the lens of the whole child.
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