Approximately 20% of children and teenagers experience the symptoms of a mental health disorder during the course of a year that significantly interfere their daily life.

Yet, less than one-third of the children under the age 18 with a serious disturbance receive adequate mental health services according to the Children Defense Fund.

In order to survive in a complex world, complex skills are required.  As a rule, children need to learn these skills in order to cope in the real world.  They require reading, social studies, science and math, but they also need to learn how to interact with others, solve problems, and decent mental health.

The follow through for children receiving mental health services in the school is much greater than those referred to other community services.   Of the percentage that receives mental health services, the majority of them get the care that they do in a school setting.  However, less than 10% of all school districts in the United States currently have an established School Based Mental Health Program.

Recently in the news (CNN), there was a report that Texas has responded to children with behavior problems in school by criminalizing the child.  The child with a behavior problem is given a ticket and has to appear in Court.  A fine or other punishment may be handed down.  Not surprising, the percentage of juveniles that commit grievances again is nearly 75%.

An alternative to the Texas solution is utilizing services in school to prevent acting out in the first place.  The School Based Mental Health organizational model includes therapists stationed in every school and full involvement of the therapists in the “life” found at the school.   The clinical model was based on the theory that mental and behavior health was the result of the interaction of each youth’s characteristics with those of the school, community, and home environments.

Therefore, the more the therapists interact with the kids in their environment, the more effective they will be.  Schools provided space and a coordinator/liaison, while the therapists, support staff, supervision, leadership, training, and infrastructure were provided by the mental health community. A computer infrastructure was developed so that the therapists could communicate with their offices when needed.   Caseload numbers were set so that therapists could have time to interact with the school and other agencies involved in the child’s life and family.

From 1999 to 2006, over 1,600 students were referred for services. Over 1,500 of them gave a reason for needing the services. Thirty-seven percent of the youth were referred because of symptoms of depression, a quarter due to family issues, 17% because of behavior problems, 8% for symptoms of anxiety, 6% for grief and loss issues,   5% for risk of self-harm, and 3% for other reasons.

The most referrals were seen at the beginning of the school year and after spring break.  Kids entering high school or junior high were also the ones most often referred.  Sources of referrals included school counselors (36%), family members (14%), student services teams (14%), teachers (10%), family liaisons (8%), student self-referral (6%), school administrators (6%), and other sources (4%).

Students participating in SBMH had significantly better school attendance (p < .05 to p < .0001) than students who were referred to the program, but chose not to receive services.  Students had a significantly fewer (p < .0001) disciplinary referrals and suspensions when compared to non-participants in years 2002-2003 and 2004-2005.

Parents reported that their children were having fewer problems after receiving services. Youth self-reported improved commitment to school, and their relationships, as well as a higher self-esteem. They also reported a higher ability to adjust to school situations and improved attitude towards parents and overall emotional health. It should be noted that there was no control group for this data set.

Collaborative programs, such as this one can make services more efficient and cost effective especially in these tough economic times. Many families of troubled youth are involved in more than one service, in addition to school services. Coordination of multiple services through SBMH can be beneficial to both the families as a whole, and the youth being treated.

This project demonstrated that school based mental health services improved student well-being, behavior and school success, while showing a significant decrease in violence and other behavior problems in nearly all environments. The study isn’t complete.  It also demonstrated that the cooperation between the school and mental health systems can provide a cost effective way to benefit both the children and the community that they are a part of.

Mental health clinics exist in nearly every county in the country.

This model involves a re-thinking of the traditional community mental health clinic, by placing the majority of the child and adolescent therapists in the schools, rather than the community clinic.  Some specialty services, such as psychiatry can still provided in the community based clinic.

mental healthDr. Kathy Seifert  has a degree in psychology from the University of Maryland, Baltimore County 1995.  She is the author of How Children Become Violent and founder of Dr. Kathy and she is a licensed psychologist in MD and specializes in trauma, violence, and behavior problems among youth and their families. Her second specialty is addressing the mental health of violently, sexually, and criminally offending men and women.