Congressional Briefing on Children's Mental Health--October 10, 2007

Thank you for the honor to speak before you.

My name is Mark Weist. I am a professor at the University of Maryland, and have been working to bring effective mental health services to youth in schools since 1991.

As you have been hearing, child and adolescent mental health is one of the most, if not most neglected health care needs in our nation, with one out of five youth presenting significant emotional and/or behavioral problems, but less than a third of these young people receiving services, and far fewer receiving effective services.

As presented by the other panelists, youth who experience mental health problems that are not addressed often struggle in school, and are at risk for a range of negative outcomes, including academic failure, drop-out, the escalation of emotional and behavioral problems, involvement in violence, incarceration, lost contribution to the workforce and society, health problems, and early death.

There are many reasons for this failure to meet the mental health needs of youth, including barriers to care for families such as cost of services, bad experiences in systems, fear of negative outcomes, stigma, limited information, transportation problems and significant shame and blame.

A major reason for this systems failure that is occurring in all U.S. states and territories is that youth and families experience great difficulty in connecting to specialty mental health in traditional settings such as community mental health centers and private offices. A major part of the solution is to bring effective mental health promotion and intervention to youth “where they are,” such as schools -- the most universal natural setting. Data support this policy direction. For example, researchers from Vanderbilt University (Catron, Harris, & Weiss, 1998) found that 96% of students referred to a school-based mental health program actually received services, compared to 13% of students who were referred to community mental health centers.

We know that schools are already the “defacto” provider of 70 to 80% of all mental health services to children. We also know that schools are making investments in this agenda, as reflected by the critically important work of school psychologists, social workers, counselors, and other staff who are involved in mental health promotion and intervention such as nurses, special educators, school administrators and teachers. However, ratios of school-employed mental health professionals to students are way below recommended levels, and in many communities, the school mental health agenda is marginalized as school and community leaders fail to recognize the significant benefits of integrated approaches to reduce both academic and non-academic barriers to learning.

Importantly, we know what to do. First, this work must emphasize a shared agenda, with families, schools, mental health and other child serving systems working closely together, building and strengthening relationships, and pooling resources.

There should be an overarching emphasis on high quality programs and services, which includes many concepts such as needs assessment, resource mapping and planning; inclusive and genuine stakeholder involvement; selecting, training, coaching and supporting staff; promoting the effectiveness of coordinating teams; delivering a full continuum of empirically supported and culturally competent services; evaluating the impact of these services; and using evaluation findings toward continuous program improvement, and at the same time for policy and resource enhancement.

When school mental health is done the right way, a range of positive outcomes can be achieved, including improved student attendance and behavior, improved academic performance and graduation rates, and system cost savings--for example, through avoidance of inappropriate or unneeded special education referrals or restrictive placements.

On May 8th, I was privileged to provide testimony here as part of Children’s Mental Health Awareness Day, and a major theme discussed then and today is the limited and fragmented approach that is common in state and community services for children who struggle with emotional and behavioral issues. While we have made progress, the school mental health agenda in practically all U.S. communities is in need of growth.

The President’s New Freedom Commission on Mental Health has prioritized school mental health programs and services, and a number of pending legislative initiatives would provide critically needed policy support and resources. In particular, with my colleagues here from the American Psychological Association, I urge you to provide your strong support to the School Mental Health Act of 2007, sponsored by Senators Kennedy, Domenici, and Dodd. This act would expand the Safe School/Healthy Students federal program to support 200 school districts in building comprehensive school mental health initiatives, with strong emphases on school-community partnerships; high quality and evidence-based services; cultural and linguistic competence; and monitoring and documenting student, family and educational outcomes.

It is clear that the science has progressed to the point where we now know what to do to improve mental health and therefore school and life functioning for our nation’s children and adolescents. Your urgent advocacy and support of bills like the School Mental Health Act of 2007 will enable us to move toward Dr. Hoagwood’s cogent recommendation for a “delivery system to get this knowledge to youth and families on their own turf and in ways that are useful to them.”

Thank you.

Reference: Catron, T., Harris, V., & Weiss, B. (1998). Post-treatment results after two years of services in the Vanderbilt School-Based Counseling Project. In M. H. Epstein, K. Kutash, and A. J. Duchnowski (Eds.) Community based programming for children with serious emotional disturbances and their families: Research and evaluation (pp. 633-656). Pro-Ed: Austin, TX.

*Since 1995, our work in the school mental health field has been and is currently supported through a federal grant by the Office of Adolescent Health, Maternal and Child Health Bureau, Health Resources and Services Administration. The Center for School Mental Health at the University of Maryland has also received or is currently receiving support from the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration, the U.S. Department of Education, and numerous agencies and foundations in Baltimore and Maryland (see http://csmh.umaryland.edu, www.schoolmentalhealth.org, www.sharedwork.org).