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States Take Action to Address Children’s Mental Health in Schools

The COVID-19 pandemic has exacerbated rising mental health needs among children and youth. In addition to experiencing the human cost and social isolation brought upon by COVID-19, many children have lacked consistent time in classrooms. School closures and shifts to online learning have limited access to educational and social opportunities as well as mental health services. Since the onset of the pandemic, 38 states have enacted nearly 100 laws focused on supporting schools in their role as one of the primary access points for pediatric behavioral health care. These laws provide funding for school-based mental health services, strategic planning to improve school mental health systems, training and resources for school staff and students, and guidance for school policies. As children navigate the lasting impacts of the pandemic and policymakers prioritize youth mental health, states are certain to continue investing in and strengthening school-based mental health systems. 

Background

In 2019, 16.5 percent of US children were estimated to have at least one mental health disorder, and the rates of adolescents who experienced persistent sadness or considered suicide both rose substantially from 10 years prior. The COVID-19 pandemic has only amplified these decade-long trends. The Centers for Disease Control and Prevention (CDC) has reported sharp increases in the proportion of children’s emergency department visits that are related to mental health. At the same time, youth utilization of mental health services has decreased, which may reflect families’ concerns in seeking non-emergency, in-person care given the risk of COVID-19 and shortages of available health care professionals working in children’s mental health.

The Biden Administration and key national organizations representing providers have intensified their focus on children’s behavioral health. In December 2021, U.S. Surgeon General Vivek H. Murthy issued a youth mental health advisory and released guidance for states in elevating policies to improve children’s behavioral health. The advisory included allocating more resources and technical assistance to school mental health systems as a key recommendation for state officials. In addition, in October 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association released a joint statement declaring a national emergency of child and adolescent mental health, calling upon federal and state policymakers to address key priorities for improving the state of children’s mental health. 

School-based mental health care can improve access to mental health services, reduce risk, and improve mental health and academic outcomes for students. Additionally, when effectively designed, school mental health services may help to reduce racial and ethnic disparities in access to mental health care. Ideally, these services are delivered through a comprehensive school mental health system (CSMHS) which supports prevention, early identification, and provision of services and treatment for students with mental health needs. These systems are increasingly important to help address children’s mental health needs, particularly during the pandemic.

Federal initiatives that support CSMHSs include the Health Resources & Services Administration’s School-Based Health Centers, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Project Advancing Wellness and Resilience in Education (AWARE), and the Department of Education’s School-Based Mental Health Services Grant Program. Additionally, SAMHSA and the Centers for Medicare and Medicaid Services (CMS) have developed joint guidance to support states in implementing effective payment and delivery models for school-based behavioral health services.

State Laws Enacted During the Pandemic to Support School Mental Health Systems

Based on a national scan of state legislation introduced during the pandemic (March 2020 to December 2021), NASHP identified 92 state laws that were enacted to support children’s mental health through schools. States have pursued a range of approaches including 26 states allocating federal and state funding to increase school-based mental health services, 12 states supporting strategic planning to improve school mental health systems, 24 states providing education and resources for school staff and students, and 10 states guiding school mental health policies. See the table below for a list of states that have enacted laws to support these strategies.

Supporting strategic planning to improve school mental health systems

Schools often face a range of challenges in supporting students’ mental health, including identifying and implementing best practices and coordinating across agencies. During the pandemic, 12 states enacted laws that support strategic planning to identify barriers and approaches to increase access to school-based mental health services.

  • Arkansas’s HB 1689 (Act 802) established the Arkansas Legislative Study on Mental Health and Behavioral Health, which is required to study and develop a report on mental health screening and suicide prevention policies for children in schools. (Enacted October 1, 2021)
  • Connecticut’s HB 6621 (Public Act No. 21-95) established requirements for the School Emotional Learning and School Climate Advisory Collaborative, which will develop a strategy to initiate collaborations with community-based mental health providers and support school staff in mental health and social-emotional learning. (Enacted June 24, 2021)

Allocating funding to increase school-based mental health services

Schools report that the most common limitation to providing mental health services for students is inadequate funding. Relatedly, many schools face challenges in engaging mental health providers, and few meet the recommended ratios of students to counselors, psychologists, and social workers. To alleviate this barrier, 26 states enacted laws to increase financial support for school-based mental health services. These measures include funding to reimburse and support school telemental health services and to hire school-based mental health providers.

  • California’s AB 133 (Chapter 143) established the Children’s Behavioral Health Initiative, which includes grant funding for school-linked behavioral health services. (Enacted July 27, 2021)
  • Massachusetts’ H 4002 (Chapter 24) appropriated funding for a pilot program for telebehavioral health services through schools. (Enacted July 29, 2021)
  • North Carolina’s SB 105 (SL 2021-180) allocated funding from the American Rescue Plan Act to establish a grant program for schools to hire psychologists in response to COVID-19. (Enacted November 18, 2021)

Providing mental health education and resources for school staff and students

Teachers and school staff can often be more effective in supporting students’ mental health when equipped with information on mental health and best practices for prevention and early identification. Seventeen states enacted laws to provide mental health training and resources for school staff.

  • Rhode Island’s SB 31/HB 5353 (Chapter 131) requires that school staff and students receive education on suicide awareness and prevention. (Enacted April 22, 2021)
  • Virginia’s SB 1288/2299 (Chapter 452) requires that school counselors receive training in mental health, including mental health disorders, depression, trauma, and youth suicide, in order to be licensed and to renew their license. (Enacted March 30, 2021)

States have also supported schools in providing mental health education and resources directly to students and their families. Thirteen states enacted laws to support schools in providing mental health education and resources for students.

  • Illinois’ SB 818 (Public Act 102-0522) requires that health education courses for students include information on mental health. (Enacted August 21, 2021) Illinois also adopted HJR 1, which encourages schools to provide mental health training and education for students. (Adopted June 1, 2021)
  • Texas’ SB 279 requires schools to include crisis line contact information on all identification cards for students in grades six through twelve. (Enacted May 28, 2021)
  • Washington’s HB 1373 (Chapter 167) requires all school websites to provide access to information and resources on behavioral health, including mental health. (Enacted May 3, 2021)

Guiding school mental health policies

While local school districts often have autonomy in implementing and administering policies and programs, states can provide guidance for these policies by issuing requirements and recommendations. Ten states have enacted laws to support schools in adopting innovative policies to address many of the unmet needs and gaps in youth mental health services exposed during the pandemic. These include requiring that schools allow mental health days or excused absences related to students’ mental health needs, delineate protocols around providing mental health services, and develop plans for responding to a student experiencing a mental health crisis.

  • Connecticut’s SB 2 (Public Act No. 21-46) requires local boards of education to allow students to take up to four mental health days per school year. (Enacted June 16, 2021)
  • Florida’s SB 590 (Chapter 2021-176) requires that school health services plans, which are jointly developed by county health departments and local school boards, indicate that school and law enforcement staff must attempt to contact a mental health professional for a student in crisis, and that behavioral health providers and school resource officers must attempt to verbally de-escalate crises. (Enacted July 6, 2021)

Conclusion

Children’s mental health has been and will continue to be a top priority for state leaders across both legislative and executive branches of state government. With COVID-19 exacerbating the challenges children are facing, there is much more work to be done. This blog summarizes the actions many states have taken from March 2020 through December 2021. However, many more states continue to consider legislation during the 2022 session. The National Academy for State Health Policy will continue to track state policies to support children’s mental health during and beyond the pandemic.

Summary of State Laws Enacted During the COVID-19 Pandemic to Support School Mental Health Systems (March 2020-December 2021)

Approach States
Supporting strategic planning
Work group/task forceAR, CA, CT, HI, MA, MI, TX, VA
Data/assessment of needsAR, CA, CT, MN, TX
Recommendations and standardsAK, CA, CT, HI, LA, ME, VA
Allocating funding to support school-based mental health services
Mental health services*AZ, CA, CO, CT, DE, IN, KS, MA, MD, ME, MI, MN, MT, ND, NJ, NY, OH, OR, PA, TN, VA, WA
Telemental healthCO, FL, IL, MA, MN
ProvidersAZ, DE, KY, MI, NC
Providing mental health education and resources
School staffAK, AR, CA, CO, DC, IL, IN, KY, LA, MA, MN, ND, NY, OK, OR, RI, VA
Students**CA, CT, IL, KY, RI, UT, WA
Crisis hotline printed on student IDsAR, IL, IN, NJ, NV, SC, TX
Guiding school mental health policies
Mental health days/excused absenceAZ, CA, CT, IL, NV, UT
Crisis response policiesFL, MA, NE, NV, OR

Note: The states listed here have enacted laws during the COVID-19 pandemic that support these approaches. These laws may be sustaining existing programs/policies, or enacting new ones, and states may vary in their implementation progress. Other state laws may have been enacted that support school-based mental health, but the language of the act did not specify as such. Additionally, other states may have implemented these approaches through other policy mechanisms.

*This category does not include state laws that specifically fund telemental health services (these laws are included separately in the row below).

**This category does not include state laws that require crisis hotlines to be printed on student IDs (these laws are included separately in the row below).

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