Promoting the Mental Health of our Nation's

Youth through School-Based Programs¹

Mark D. Weist, Ph.D.

Center for School Mental Health Assistance*

University of Maryland School of Medicine

June 6, 2001

Related to the important efforts of the Surgeon General, leaders and policy makers at federal, state and local levels, and maturing advocacy efforts, there is unprecedented attention on the mental health of children and adolescents. Along with this attention is the increasing realization of significant gaps and problems in mental health systems, as well as the multiple advantages to developing effective programs for youth "where they are." Central in this context of growing awareness of and advocacy for child and adolescent mental health is the development of more comprehensive approaches to mental health promotion and intervention in the schools.

We use the term "expanded school mental health" (ESMH) to describe programs that deliver a range of services (prevention, assessment, treatment, case management) to youth in both general and special education, with strong collaboration between schools and community mental health agencies. ESMH is not a model, but a framework that reflects what we believe includes core elements of effective mental health programs in schools. "Expanded" conveys that we are building on programs and services that exist in almost all schools; for example, reflecting the work of school psychologists, social workers, counselors, and other pupil services, teaching and school health staff. ESMH programs augment the work of these staff, and reflect an effort by the school to fill in gaps and improve services in a collaborative and interdisciplinary team effort. Our emphasis on programs that involve significant collaboration between schools and community agencies (e.g., mental health centers, health departments) is based on recognition that schools cannot do all of this work, and in many cases are being overburdened with demands that should be addressed in other community systems. Strong school-community collaboration also moves a program toward a system of care, as linkages are established between schools and community agencies, and a mechanism and location (i.e., the schools) for developing more preventive programs is established.

Expanded school mental health programs present a number of advantages including significantly enhanced: access to care, productivity and efficiency of staff, and capacity to broadly promote mental health and address problems early. In addition, outcome evaluations from around the country are providing evidence that these programs remove barriers to student learning, improving attendance, grades and behavior, while helping to improve school climate and reduce costs (e.g., by reducing inappropriate referrals into special education). But estimates indicate that these programs are in their early phases, with the majority of schools and school districts still offering limited mental health services, and the majority of community mental health systems lacking capacity to adequately respond to even the most serious of youth mental health needs.

 Thus, there is much work to be done in many areas, including:

• Increasing public awareness and dialogue about child and adolescent mental health.
• Influencing policy, and growing funding mechanisms to support the full range of mental health promotion, early intervention, and intervention in schools.
• Moving toward best practice in all realms, embracing evidenced-based approaches and those that emphasize youth strengths.
• Systematically developing programs in areas of high need and responsiveness.
• Involving diverse stakeholders (e.g., youth, families, school and mental health staff, community and faith leaders) in all aspects of program planning and improvement.
• Coordinating services in schools, building school-community connections, and moving toward broad systems of care available to ALL youth.
• Ensuring that programs are sensitive to developmental, cultural, and personal differences in students, families and school staff.
• Advancing systems of quality assurance and evaluation.
• Moving toward truly interdisciplinary approaches and health-mental health care integration within school health programs and school-based health centers.
• Addressing areas of special need (e.g., substance-related problems, violence exposure).
• Increasing opportunities for networking between practitioners, researchers, advocates and government officials locally, across states, and internationally.
• Advancing the breadth and impact of coalitions and advocacy groups, and increasing communication and coordinated activity between them.

An emerging vision for this work is for public agencies such as education, mental health, and public health (and others such as juvenile justice and child welfare) to come together in an effort characterized by shared missions and the braiding together of resources to enable the development of a public mental health promotion and intervention system for youth. Decades of efforts at many levels have brought us to a point in history of unparalleled opportunities to enhance the learning, development and behavior of our nation?s youth. But our progress is early -- we must increase our investments to capitalize on the opportunities before us.