Progressive but maybe not enough: the gaps in school’s mental health support systems
By: Heather Mooney
On March 1, 2022, as the world watched the crisis unfolding in Ukraine, the White House issued a statement that went almost unnoticed in the fog of war. But it was more than another routine communique. The White House acknowledged that there is another emergency at home, much less visible than the war and much less discussed than the pandemic: the national state mental health crisis among children and adolescents. Still, during the State of the Union address that took place later that day, president Biden mentioned Ukraine 20 times and only three times - mental health.
Meanwhile, more than half of parents are worried about their children’s mental well-being in today’s America. However, it’s only partially a consequence of the pandemic - the crisis had been accumulating for the entire decade prior to it.
According to the CDC, in 2019, one in three high school students and half of female students experienced sadness and hopelessness for a prolonged period of time, with one in six teenagers - a 44% increase compared to 2009 - making a suicide plan during the previous twelve months.
Local providers sound the alarm, too. Hospitals such as the Children's Hospitals Association have called for urgent action citing an increase in mental illness among adolescents met with a severe lack of treatment options and therapists.
New York is known as a blue state, taking a progressive stand on many issues, including reproductive rights. Mental health is no exception. New York is ranked №9 among all states, based on low prevalence of mental health illnesses and access to mental health care.
But does it mean that New York is doing enough? In actuality, on the front of mental health supports, these attempts may not be adequate enough to resolve the crisis.
For starters, many mental health programs are geographically based. While there is an overlap between the state and local efforts, the system is not easy to navigate. This adds another layer of complexity to the overall sophisticated insurance-based healthcare system. In most difficult cases when a child needs hospitalization, the wait may take weeks and even months. In 2022, the City reported that as a result of former governor Andrew Cuomo’s attempts to “transform” mental health care that took place in 2014, the state “has cut nearly a third of state psychiatric hospital beds reserved for children” - and that continues to affect the teenage population.
New York City is the most populous metropolitan area of the state. The city contributes millions of dollars annually towards school support systems, but there are massive gaps including the extent of the schools reached, the content of the programs, and other limits of these contributions.
According to NYC Open Data there are seven programs currently in place in New York City public schools. The most widely used one is the School Mental Health Specialist program reaching 215 schools. This program, funded by the department of education, has specialists host educational workshops with multiple different New York City schools aiming to, “shift school culture toward being more knowledgeable and accepting of mental health care”. They stated that 8,156 students took part in psychoeducational workshops with 33 students referred for services, 74 enrolled in RISE groups, and 52 “advisements for a child or family provided to school staff by the School Mental Health Specialist''. While it does take an important step toward spreading awareness and knowledge about mental health, it fails to supply schools with on-site mental health specialists that can work directly with students in need. For these reasons, many people find this program to be limiting. 82% of teachers reported “an insufficient number of school mental health professionals''. Teachers' unions such as the American Federation Of Teachers share additional concerns. President of the Federation, Randi Weingarten reported that “we must respond to the need for more mental health professionals and social and emotional supports”.
School-based mental health clinics are theoretically one of optimal solutions as they provide schools with on-site counselors and therapists available to help struggling students directly. There are several non-profit organizations such as Henry Street Settlement and The New York Foundling that provide on-site mental health clinics to partnering schools. However, they are only capable of reaching the few schools they are partnered with, limiting their impact.
A portion of all of NYC schools are additionally supported by school-based health centers, financed by state and local funds. They serve as medical health centers within schools that “help students manage their illnesses during the school day”. This does include mental health aid but only at “certain schools”, as NYC Health and Hospitals – the city’s integrated system of healthcare providers – specifies. Service is available in Coney Island, Lincoln, Metropolitan, and North Central Bronx, excluding most NYC school districts.
The list of mental health organizations available within the city’s boundaries also includes Community Schools Manhattan which offers success mentoring, individual counseling, and family support. Another related incentive is Prevention Intervention Program Manhattan which provides on-site PIP staff to work with students and faculty. Additionally, the School Response Team works with staff and administration to help prevent crises, and NYC Health and Hospitals provide public schools with mental health clinics.
All these services are beneficial for students and staff and spread awareness and sensitivity around mental health. However, almost all of them reach only certain schools or districts, weakening their influence. The combination of all schools covered by the seven existing programs, even if we assume they do not overlap (in fact, they do), leaves over 30% of NYC schools without any form of mental health support.
Bard High School Early College health educator, Drew Miller, expresses concerns. “Health education in its best form should be taught in every grade, sequentially building off each other,” he says. According to Miller, this way kids are introduced to these topics from “kindergarten or even before”. However, as he puts it, we are “a long way away from that ideal form of mental health education”.
Miller originally planned to become a gym teacher. He studied Physical Education, with an undergrad in health and PE. However, in the process he found the subject of health to be “so much more important and relevant” to students than he expected that he pursued a career as a health teacher instead. Miller recalls that when he first taught health education, mental health only took up two days of study - in contrast to the current month spent studying it as the “centerpiece of the curriculum”. Now, he focuses on developing skills that students can utilize to get or provide others with help when facing mental health challenges, “getting past that just knowledge base to actually access information and developing skills.” Summarizing his approach, Miller says, “I try to give kids what I think they need but also what our generation wishes we had”.
But not all schools have this support, and the lack of mental health assistance is prominent. Miller said that although every school in NYC is required to teach health, a lot of them just lump it in with other classes, not requiring trained teachers or a full curriculum. He believes that many other localities follow the same pattern: “You maybe get it in middle school, you maybe get it in high school.” In other words, according to Miller, kids are not guaranteed to receive any mental health education at all, let alone a fully structured class.
The main reason for these gaps and inadequacies in mental health support and education is a lack of funding. There has been no shortage of complaints and activism against the system for funding NYC schools through property taxes, giving more school funding to richer areas. This allows wealthier neighborhoods and neighborhoods with a higher ownership rate to enjoy a larger budget for mental health support and education. Consequently, wealthier areas can afford school-based health centers with mental health support and on-site counselors while other, less wealthy school districts cannot.
It was not until New York City entered the second year of the pandemic that Mayor De Blasio announced a “historic expansion” of mental health support for all New York City schools. This included the integration of mental health support systems into the Summer Rising program, a school-run organization offering arts and recreation, and various forms of support whether it be social, emotional, or academic to local communities. This also encompassed a mandatory social-emotional screening and the hiring of 500 new social workers for New York City public schools. This meant that every school would have at least one full-time social worker, totaling “over 6,000 social workers, guidance counselors, and school psychologists”. But most of these measures were COVID-related. “These conversations are more important than ever as [students] manage the grief, anxiety, and trauma triggered by the pandemic,” said former New York City’s first lady Chirlane McCray.
Now, it’s not quite clear if Mayor De Blasio’s efforts are going to be upheld. Current mayor Eric Adams has not prioritized mental health as part of his agenda. Adams has highlighted his universal child care program, UCare, that includes “Mental Health and Substance Use Disorder Services”. Other than that and stating that “we will provide mental health and trauma support to those who need it” after the shooting in Sunset Park, Adams has not mentioned mental health, or more specifically mental health education.
Wayne Partnership in Upstate New York offers a different approach - a localized form of mental health support systems. Funded by “private and federal grants”, this nonprofit coordinates with schools and businesses in Wayne County and provides training and seminars in order to educate people on Mental Health First Aid and how to serve as a first aider.
Mental Health First Aid is an international program that began in Australia, working with The National Council For Mental Health to “help you assist someone experiencing a mental health or substance use challenge or crisis” by introducing people to warning signs of mental illness and educating them on how to address it. Melanie Frauel, a first aid trainer, said that what makes Mental Health First Aid unique is that its “designed for the general community, teaching skills for how to access, notice, listen, and reassure others” in order to connect them with professional help. This kind of system familiarizes the community with the same form of mental health support, employing it to be self-reliant and aware of the resources it has to offer. The program works to enable teachers and school staff “to help an adolescent who is experiencing a mental health challenge” creating a school environment that is aware of students' mental health challenges and is actively supporting them.
New York City could, theoretically, mimic a similar program only on a larger scale, supplying NYC with seminars following the Mental Health First Aid program. This would create aware school environments with both students and staff that know how to recognize and respond to mental health challenges. Coordinating with all NYC schools would mean all schools have access to at least some form of mental health education and on top of the several non-profit organizations already in place.
However, while this would be a beneficial approach, it has its drawbacks. While this program does help a community respond to mental health challenges, it doesn’t provide the second step in the action plan, “professional help”. Psychologists and counselors can be very difficult and expensive to access, and having this staff on-site is necessary to improve mental health support systems in schools. Additionally, obtaining enough funding to work with all 1,722 NYC schools based on federal and private grants is highly unrealistic.
If NYC, with its large economic contributions and efforts, can’t even form an acceptable solution, what of the rest of the U.S.? Other states that receive significantly less federal funds and are less progressive than New York will have considerably worse mental health outcomes..
In response, The American Federation Of Teachers proposes America address the issue “as a nation”. Leader Randi Weingarten commended President Biden for “stepping up” by including one billion dollars towards hiring school physiologists, counselors, and mental health professionals in his 2023 budget. Federal funding aims to eliminate the inequality of the property tax system and provides NYC schools with sufficient mental health support and education.
But the promised federal resources are insufficient. One billion dollars seems like a lot. However, when distributed among the 130,930 U.S K-12 schools, it proves deficient. Each school would be given only about $7000 once dispersed if we assume it will be distributed equally. This would barely cover a school hiring a single employee on NYC’s minimum wage for 3-4 months. School psychologists and other mental health workers in the U.S have an average salary of $77,430, or about $6,500 a month. Meaning these federal funds could not even supply a school with an onsite psychologist or counselor for longer than one month. According to The National Association For School Psychologists, in order to meet their recommended student-psychologist ratio, “ it would cost our [the United State’s] public education system between $2.7 and $4.9 billion annually”, quadrupling the 2023 federal funds. In comparison, the 2023 Department of Defense’s budget request is $773 billion.
As NYC and all of the United States grapples to give students the support they need, adolescents are becoming increasingly burdened with mental health struggles. Mental health illnesses can have long-term effects on teens and adolescents, especially when unaddressed, undiagnosed, or untreated. According to Childhood and Adolescent Mental Health: understanding the lifetime impacts, a study done by The Mental Health Foundation in 2004, mental health disorders often have long-lasting effects on employment and physical health. The study shows children who had mental health or behavioral development difficulties are at a higher risk of poverty by age 30 and a lower chance of employment. Counseling and treatment don't eliminate these mental health challenges but they can help the affected learn how to manage their conditions, decreasing the long-term effects and contributing to better outcomes. By making these support systems available in schools, adolescents and teens have a much greater chance of receiving help. Whether it be on a federal, state, or local level, the in-school mental health support systems need to be improved. It's time to take into account the future of this generation's youth and prioritize one of the most present struggles – mental health.