Disability Mandates Include School-Based Mental Health Services
By Alvin E. Doyle
As a nation, we strive to create educational environments in which students feel safe and can learn, and in which educators have the tools and strategies they need to educate all students. But when it comes to serving students with mental health needs, the challenge remains great.
Mental illness is quite common. The number of children and adolescents experiencing mental illness in the country – one in five– constitutes a public health crisis, according to the Surgeon General. One in ten children has a serious emotional disorder that affects his or her ability to function daily. According to the National Alliance on Mental Illness, more than 93,000 children in New Jersey live with serious mental health conditions.
50 years ago, President John F. Kennedy delivered a special message to Congress, launching a national conversation about mental health services.
…Mental illness and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonged treatment, cause more suffering by the families of the afflicted, waste more of our human resources, and constitute more financial drain upon both the public treasury and the personal finances of the individual families than any other single condition.
Kennedy proposed a new approach that emphasized research, education and the strengthening of community-based resources. Since that time, the nation has made great strides; public awareness has grown during the ensuing half-century, and the world’s body of knowledge about mental health has expanded exponentially, along with better methods of diagnosis and treatment.
Diverse Terminology: Toward a Definition
There is some confusion and controversy surrounding mental distress, which is reflected in the diverse terminology used in the field – mental health; mental illness; mental disorder; mental health problem; mental distress. While these terms are often used interchangeably, they actually derive from quite different philosophical, theoretical and ideological perspectives. Thus, the terminology tends to be grounded in the particular approach to understanding mental health by varied individuals, groups or organizations using the term.
The Individuals with Disabilities Education Act (IDEA) offered great promise for children and teens with disabilities. It is the most comprehensive law to affect students with disabilities, including mental health conditions, entitling them to a free appropriate public education from birth to age 21. Since its passage in 1974, it has opened doors to new possibilities for many with intellectual, physical, medical and learning disabilities. But for students with emotional and mental health conditions, the law has fallen short. In order to be eligible for special education and related services, a student’s disability must also interfere with his or her educational achievement. The interpretation of IDEA’s eligibility criteria has been blamed for consistent under-identification of students with mental illness, many of whom are able to function academically, but struggle in other areas of learning and life skills, such as social, organizational, self-management and self-direction.
According to the 2006 School-Based Mental Health report from the University of South Florida, there has never been more than one percent of the school-age population identified and served in special education programs for students with emotional and behavioral disturbances. But, because the study found prevalence estimates closer to five percent, the number of students in need of mental health services may be many times greater.
There is a long history in America since the end of the 19th century of providing mental health services in our schools. And interest has only increased in recent decades that school-based health centers (SBHC) should play a larger role in better meeting the needs of millions of children who have mental health issues or emotional disturbances. In a 1999 report, the U.S. Surgeon General considered schools to be the primary locations for recognizing potential mental health disorders in children.
Schools are a primary resource for students whose mental health care needs are already identified. According to the 2007 National Survey on Drug Use and Health, more than one-tenth (11.5%) of adolescents received mental health services in an educational setting, with 9.7% indicating they worked with a school counselor or school psychologist or through regular meetings with a teacher.
For children who meet eligibility under IDEA, special education needs may range from minimal support in a public school classroom, to placement in an out-of-district therapeutic day school or residential program. Related services may include psychological counseling, the implementation of behavioral plans based on functional assessments, and the inclusion of positive behavioral interventions and supports. Students with mental illness who do not meet the eligibility criteria of IDEA may benefit from services and accommodations under Section 504 of the Rehabilitation Act of 1973, including but not limited to extended time on testing, modified homework assignments, more frequent breaks, preferential seating.
School psychologists are in a unique position as school-based are mental health professionals who help children and youth overcome barriers to success in school, at home, and in life.
As the need for services and supports accelerate, schools will need new strategies to manage service delivery. School-based mental health professionals may need to leverage their skills and reach by recruiting, training and utilizing additional health professionals from schools and beyond, in order to extend mental health services. In the years ahead, school-based mental health professionals are seen as playing a closer and more collaborative role with community mental health service agencies.
The Georgetown University Center for Health and Health Care in Schools suggests that escalating demands could overload school psychologists and others, unless they distinguish between the majority of enrolled students’ social and emotional problems and the minority with diagnosable mental illness.
For students with an underlying, undiagnosed mental health need, help may be on the way. President Obama has called for Mental Health First Aid Training. The youth version of the program, focusing on ages 12 to 25, “…is an evidence-based training program to help citizens identify mental health problems in young people, connect youth with care, and safely deescalate crisis situations if needed,” explained Linda Rosenberg, Pres. and CEO of the National Council for Behavioral Health. “This groundbreaking training is critical for anyone who spends time with young people,” she said.
And such initiatives may become indispensable for those in the student population whose development is typical, but then manifest a mental health disorder later in life. “The first onset of severe mental illness typically occurs in late teens or early twenties,” Rosenberg explained. “The adult Mental Health First Aid program has already been delivered to nearly 100,000 Americans though a network of more than 2,500 instructors,” according to Rosenberg. Congressman Ron Barber of Arizona echoed this approach in proposed legislation (H.R. 274) promising $20 million in Mental Health First Aid grants to states and communities. Pres. Obama also recommended funding to train more than 5,000 additional mental health professionals to serve students and young adults.
Statistics:
- From the National Institute for Healthcare Management Research and Education Foundation’s 2005 Issue Paper, four out of five children who need mental health services do not receive them.
- The National Institute of Mental Health estimates that one of every four Americans 18 years and older experience a diagnosable mental disorder.
- The National Association of School Psychologists states that a startling 60 – 70% of those in the juvenile justice system have a mental disorder, and recommends that special education and Health and Human Services should partner with the Department of Justice.
- In 2005-2006, 15% of U.S. children aged 4 – 17 years had parents who talked to a health care provider or school staff about their child’s emotional or behavioral difficulties. This included 18% of boys and 11% of girls. About 5% of children had been prescribed medication for these difficulties and 5% received treatment other than medication. (Source: The National Center for Health Statistics)
- The 2000 Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda states that “recent evidence compiled by the World Health Organization indicates that by 2020, childhood neuropsychiatric disorders will rise proportionately by over 50% internationally, to become of the five most common causes of morbidity, mortality and disability among children.”
- Of the $113 billion spent on mental health care nationwide, 28% was through Medicaid. In 2005, public sources funded $66 billion in mental health spending, which was 58% of all mental health care spending. About half of that public spending – nearly $34 billion – was spent by states.
- Among children 18 months to 17 years old involved with the child welfare system, 22.6% suffered behavioral health problems in 2008 (Mental Health, United States, 2010 from the Substance Abuse and Mental Health Services Administration).
Tables:
| Percentage of schools that provided mental health or social services – 2006(1) | |
|---|---|
| Alcohol or other drug use treatment (1) | 53.8% |
| Counseling after a natural disaster or other emergency or crisis | 94.2% |
| Counseling for emotional or behavioral disorders (e.g., anxiety, depression, ADHD) | 86.2% |
| Crisis intervention for personal problems | 95.4% |
| Eating disorders treatment (2) | 46.2% |
| Identification of emotional or behavioral disorders (e.g., anxiety, depression, ADHD) | 81.7% |
| Identification of or referral for physical, sexual or emotional abuse | 93.8% |
| Identification of or referral for students with family problems | 94.0% |
| Services for gay, lesbian, or bisexual students (2) | 59.0% |
| Stress management | 83.6% |
| Method of service delivery – 2006(1) | |
|---|---|
| Case management for students with chronic health conditions (e.g., asthma, diabetes) | 40.3% |
| Case management for students with emotional or behavioral problems (e.g., anxiety, depression, ADHD) | 83.7% |
| Comprehensive assessment or intake evaluation | 65.1% |
| Family counseling | 49.7% |
| Group counseling | 78.6% |
| Individual counseling | 92.9% |
| Peer counseling or mediation | 67.9% |
| Self-help or support groups | 64.4% |
1. Services provided by mental health and social services staff, such as counselors, psychologists and social workers. Did not include activities by teachers in the classroom or activities by nurses or physicians.
2. Only asked in middle schools and high schools.
Source: Mental Health, United States, 2010 from the Substance Abuse and Mental Health Services Administration.
Alvin E. Doyle, Jr. is the principal at the Y.A.L.E. School’s Northfield Campus. He has more than three decades of experience in the areas of special education, school administration and professional development. He has taught self-contained classrooms in both public and private school settings. He holds a master’s degree in Education from Lehigh University, and holds certifications as a Principal in New Jersey and as a Teacher of the Handicapped in both New Jersey and Pennsylvania.
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