In This Article Expand or collapse the "in this article" section The Growth of Effective Mental Health Services in Schools in the United States

  • Introduction
  • General Overview
  • Future Directions in School Mental Health

Education The Growth of Effective Mental Health Services in Schools in the United States
Mark Weist, David Riddle, Ashley Quell, Cameron Massey, Crystal M. Kremer
  • LAST MODIFIED: 26 June 2019
  • DOI: 10.1093/obo/9780199756810-0218


This chapter provides a review of the movement toward more comprehensive mental health systems in schools through mental health-education system partnerships. We review factors contributing to the growth of this field including experiences in school nursing, school-based health centers, regulations regarding special education, and progressively expanding federal support. We then discuss integration of these expanded school mental health (SMH) programs with multitiered systems of support (MTSS) in schools, such as Positive Behavioral Interventions and Supports (PBIS). Specifically, the Interconnected Systems Framework (ISF) for SMH and PBIS represents a platform for effective programs and services at Tier 1, involving promotion/prevention; Tier 2, involving early intervention; and Tier 3, more intensive intervention. Key strategies associated with the ISF and effective practices at each of these tiers are reviewed, including emphases on effective team and culturally responsive and evidence-based practices. The chapter concludes with a review of future directions for SMH.

General Overview

As presented above, the purpose of this chapter is to review school mental health (SMH) services with emphasis on the experience in the United States. There has been significant development of these services in the United States and in other countries (see Rowling and Weist 2004; Weist, et al. 2016) related to increasing recognition of significant unmet need for children and youth presenting emotional/behavioral (EB) problems. Merikangas, et al. 2010 and Merikangas, et al. 2011 indicate that one in every four to five children and youth presents concerning levels (consistent with diagnoses) of emotional/behavioral problems, yet less than a third of these youth receive any services. Burns, et al. 1995 found that far fewer receive effective services. This picture becomes even more disheartening when viewed through the lens of the almost universal experience of significant life stress and psychosocial difficulties experienced by almost all children and youth in their development (Adelman and Taylor 2006). Results from McLeod and Fettes 2007 show that children and youth experiencing more serious emotional/behavioral problems are less likely to graduate high schools and enroll in post-secondary education, attain lower academic achievement than peers without mental health concerns, and experience a greater likelihood of living in poverty. Negative outcomes such as these strengthen the urgency to bring mental health services to youth “where they are,” in schools as Weist and Murray 2007 reports. This article provides background and review key themes in school mental health (SMH) services, including reviewing origins and key developments, current initiatives, and evidence-based practices and culturally competent services within a multi-tiered framework of promotion/prevention, early intervention and intervention. Emphasis is placed on connection of SMH to systems of Positive Behavioral Interventions and Supports (PBIS) and an Interconnected Systems Framework for accomplishing the same. The chapter concludes with key directions for advancing the SMH field.

  • Adelman, H. S., and L. Taylor. 2006. Mental health in schools and public health. Public Health Reports 121:294–298.

    DOI: 10.1177/003335490612100312

    Discusses how individuals working in the public health arena are able to promote mental health and change public opinion regarding mental health programs. This article focuses on how schools can play an essential role in this process.

  • Burns, B. J., E. J. Costello, A. Angold, et al. 1995. Children’s mental health service use across service sectors. Health Affairs 14:147–159.

    DOI: 10.1377/hlthaff.14.3.147

    Utilizes the Great Smoky Mountains Study of Youth to examine the roles of different types of professionals who serve children in providing mental health services. The results show that while there is a high level of mental health care use being reported, there is still a significant number of people with unmet needs.

  • McLeod, J. D., and D. L. Fettes. 2007. Trajectories of failure: The educational careers of children with mental health problems. American Journal of Sociology 113.3: 653–701.

    DOI: 10.1086/521849

    This article presents a framework on understanding the connection between mental health and educational success in children.

  • Merikangas, K. R., J. P. He, D. Brody, P. W. Fisher, K. Bourdon, and D. S. Koretz. 2010. Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics 125:75–81.

    DOI: 10.1542/peds.2008-2598

    Uses cross-sectional surveys to develop a growing database on mental health prevalence rates in youth and adolescents.

  • Merikangas, K. R., J. He, M. Burstein, et al. 2011. Service utilization for lifetime mental disorders in U.S. adolescents: Results of the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry 50:32–45.

    DOI: 10.1016/.jaac.2010.10.006

    A study that provides critical information regarding the utilization of mental health services in youth and adolescents. Sheds light on the underuse of such services and provides vital information on why this is such an issue.

  • Rowling, L., and M. D. Weist. 2004. Promoting the growth, improvement and sustainability of school mental health programs worldwide. International Journal of Mental Health Promotion 6.2: 3–11.

    DOI: 10.1080/14623730.2004.9721925

    Reviews the mental health promotion-oriented network, International Alliance for Child and Adolescent Mental Health and Schools (Intercamhs) and discusses worldwide issues related to youth and adolescent mental health promotion and needs.

  • Weist, M. D., and M. Murray. 2007. Advancing school mental health promotion globally. Advances in School Mental Health Promotion, Inaugural Issue 2–12.

    DOI: 10.1080/1754730X.2008.9715740

    An introductory article from the inaugural issue of this journal that discusses current international efforts toward advancing school mental health. Highlights barriers that are experienced on a global level and provides a review of various efforts and initiatives from around the world.

  • Weist, M. D., K. Short, H. McDaniel, and A. Bode. 2016. The School Mental Health International Leadership Exchange (SMHILE): Working to advance the field through opportunities for global networking. International Journal of Mental Health Promotion 18.1: 1–7.

    DOI: 10.1080/14623730.2015.1079420

    Discusses SMHILE and how this group of international leaders, researchers, and practitioners come together to discuss initiatives to promote school mental health and share findings from various countries on the promotion of mental health and well-being.

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