Where missing teens can be found

As anxiety and depression continue at alarming levels among teenagers in the U.S., fewer than a third of public schools in the nation perform mental health screenings, and a considerable number of those that do report challenges in addressing students’ needs, based on a recent survey of principals.

With personnel that includes counselors and nurses, public schools are ideally situated to assist in tackling the youth mental health crisis announced in 2021 by the U.S. surgeon general, as stated by Harvard Medical School’s Hao Yu, a co-author of the research.

“Child mental health represents a serious public health concern in our nation,” he remarked. “Even before the pandemic, approximately 25% of children dealt with varying degrees of mental health issues, and during the pandemic, the situation has only intensified.”

The research, released last month in JAMA Network Open, is the first to survey public school principals regarding children’s mental health since 2016, noted Yu, an associate professor of population medicine. The years in between have witnessed COVID-related interruptions, increasing concerns about screen time, and a rise in artificial intelligence in daily life, he pointed out.

$1B

Cut from previously approved federal funding for school mental health support

One encouraging outcome from the survey, funded through a grant from the National Institute of Mental Health, is that the proportion of public schools in the U.S. performing mental health screenings has significantly increased over the last nine years, albeit from just 13 percent to 30.5 percent. The survey posed three questions to 1,019 principals: Do you assess student mental health issues? What measures are taken for students identified with anxiety or depression, two of the most prevalent youth mental health concerns? And how challenging is it to find sufficient mental health care for students in need?

The answers reveal that the most frequent action taken for students distressed by anxiety or depression is to inform parents—almost 80 percent of schools did this. Seventy-two percent provide in-person treatment, while about half refer to external mental health providers. Fewer than 20 percent offer telehealth options.

Answers to the final question underscore the difficulties faced by those trying to tackle the issue, with 41 percent characterizing the process of obtaining care as “hard” or “very hard,” a finding Yu said, while alarming, is not surprising given the nationwide lack of mental health providers.

The survey, carried out with colleagues from the Medical School, the nonpartisan research organization RAND, Brigham and Women’s Hospital, the University of Pittsburgh, the Harvard Pilgrim Health Care Institute, and Brown University, also indicated that school-based screening programs tend to be more prevalent in larger schools, with 450 students or more, and in districts with higher populations of racial and ethnic minority students.

Assisting young people in overcoming mental health obstacles is a multi-faceted process, Yu stated.

“We need to make child psychiatry an appealing profession and we need to train more mid-level providers—social workers, school nurses, and counselors—since these mid-level providers play an essential gatekeeping role, identifying children experiencing mental health issues and guiding children and their families into the healthcare system,” he explained.

It’s also crucial, Yu emphasized, to get policy correct at all governmental levels. For instance, he observed that while it’s evident that meeting this challenge will necessitate additional resources, the federal government recently cut $1 billion from previously sanctioned school mental health funding. A potentially encouraging trend, he stated, is the nationwide move toward restrictions on smartphone usage.

“I don’t believe any other institution can replace schools in recognizing and addressing child mental health concerns,” Yu remarked. “If mental health issues are treated, their severity can be significantly lessened. Untreated mental health issues in childhood can have enduring consequences into adulthood. That’s not an ideal scenario for our society.”