Celina Pierrotette remembers 2016 as the year she and her colleagues at the middle school where they taught noticed a marked change among their students.
“We were just like, ‘Is it just me or are the kids really nervous?'” Pierotet recalled. “That year we had a lot of kids who were showing truancy and other behaviors that we hadn’t seen as much. I remember my colleagues and I looking at each other like this.
The surge in student mental health needs since the start of the COVID-19 pandemic prompted the U.S. Surgeon General to declare a youth mental health crisis, and the federal government has since spent billions of dollars to help schools respond.
But Pierrotet, who now serves as associate director of student health at the National Association of State Boards of Education, noted in a policy brief a major barrier to students getting the help they need: work in schools.
Here’s what he found holding it back and how states are finding solutions.
Slim Pickings
One problem is that increasing the number of mental health professionals in schools takes time. Investing in increasing the pipeline now won’t pay off in the form of hired mental health workers for several years.
In Pierrotte’s research, she found that Nevada State Board of Education officials noted last April that only 12 people graduate each year from the state’s preparation programs for mental health professionals. At the time, the state had a shortage of 2,863 school mental health professionals.
“It continues to be a challenge because it’s a profession that requires advanced training,” says Pierrotette. “No one is saying they have to change those requirements, but it’s a slow investment.”
There is also a need to ensure that school mental health professionals, whether they are school psychologists, social workers or counselors, reflect the demographics of the students they serve, he adds. One challenge is that, like their classroom teacher counterparts, mental health professionals-in-training must complete hundreds of unpaid internship hours.
Pierrotet 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 care to work in schools. Virginia’s 2019 program “placed graduate students in school district positions and provided financial incentives for 200 trainees to work in schools,” and Ohio has a similar, decades-old program for school psychology interns.
“Slow and steady is winning the race here to make sure schools are attracting diverse candidates that meet the diverse needs of their students,” says Pierrotette.
Workload management
But urgent mental health needs have created a heavy workload for counselors.
Pierrotett writes in his policy that national trade organizations recommend student-to-professional ratios 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 workload for all three types of positions. No state met the recommended ratio for social workers, while Pierrotet found that only New Hampshire and Vermont did better than the counselors’ recommendations. For school psychologists, only Idaho and Washington do better than the recommended ratio.
Some states have gotten creative to increase the availability of mental health professionals in their schools, such as by turning to telehealth for counseling services.
It’s no longer just school staff alerting counselors that students need mental health support. One of the forces driving the growing demand for services is that students are simply asking for them, he notes, as evidenced by the federal school pulse panel. The most recent results show that 69 percent of schools report an increase in students seeking mental health support since the start of the COVID-19 pandemic.
“Schools are saying that there’s actually a growing demand for more mental health services in schools from students who are just reporting more anxiety in schools,” says Pierrotet. “Sometimes it can be a problem if students say, ‘I need this,’ but they don’t get that connection in school or maybe even outside of school.”
Implementation of the bill
A win for increasing staffing levels is that states have received funding from massive federal injections of money for school mental health services, Pierrotet said, like $188 million from the bipartisan Safer Communities Act of 2022. The U.S. Department of Education plans one of its grants will bring more than 14,000 mental health professionals to schools, according to a policy document, and new federal guidelines make it easier for schools to pay Medicaid for mental health services, rather than dragging them out. money from own budget.
That’s not to say that getting states to fund mental health services has been easy. However, Pierrottet says the programs he highlights in his report have benefited states that have what one analysis called an “all-time high” level of fiscal cushion due to budget surpluses; expected tax revenues. States like Michigan and Texas, both of which are looking at billions of dollars in surpluses this year, are putting some of those funds toward mental health spending. Michigan has hired more than 2,700 full-time licensed behavioral health providers in schools since 2019, the report noted, while Texas has earmarked $280 million for telehealth counseling in schools starting in 2024.
“I think because of this crisis there is more success at this time than in previous years, right?” Pierrottet suggests: “It would be more difficult if there was no surplus in the budget at the moment. I think the stars are aligning right now. There is the will, there is the motivation, and so, at least in the last year, there has been some movement toward funding.”
Pierrotet added that it’s important not to think of students’ mental health needs as something that can only be addressed with funding. Rather, he described it as a problem that needs to be tackled from multiple angles. For example, some teachers are excited to get more training on how to support student mental health, she says, and those teachers also need support for their mental well-being in order to be effective in the classroom.
“It’s important to think about it holistically,” he says. “When students are healthy and when they don’t have these anxious feelings, they’re present, they’re able to learn. So it’s important that state leaders think about this not just as, “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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