School-Based Mental Health Initiatives: Challenges and Considerations for Policymakers

The focus of this report is on mental health interventions delivered in K-12 neighborhood public schools. A vast array of commercially available programs, conceptual frameworks, and approaches to school-based mental health are not unanimously recommended, applied, or agreed upon. This poses a challenge to any comprehensive description or evaluation of school-based mental health. Key findings include: (1) There is a lack of high-quality evidence to support school-based mental health initiatives. Rigorous evaluations of universal programs on mental health literacy, awareness, prevention, and screening--and of many social-emotional learning programs--find neither reduced rates of mental health conditions nor improved academic outcomes; (2) The concept of school-based mental health, as currently delivered in typical neighborhood public schools, is incoherent because it primarily serves youth who are not specifically in need of mental health treatment, while insufficiently serving those with mental disorders; (3) While some youth can benefit from high-quality mental health services, universal mental health programs carry underestimated potential harms: directly, through poor-quality care, overdiagnosis, and misallocated spending; and indirectly, through wasted class time and reduced accountability in the mental health and education systems; and (4) Federal agencies responsible for school-based mental health programs provide no meaningful or coordinated guidance on essential questions such as what it means for a program to be effective, what expectations exist in "mental health deserts," and how schools should sort through numerous overlapping initiatives.