Addressing the Rising Mental Health Crisis in Public Schools

Close-up shot of child with head on books looking out at camera with blank expressionMore than 50 million students are enrolled in public schools across the United States. Of those, one in five meet the criteria for a mental health condition. About 70-80% of these students won’t receive any kind of treatment or therapy. Because children and adolescents spend most of their time at school, teachers, administrators, school nurses, and other staff are often in a unique position to be the first to identify any problems or issues in a child’s life. Here are some ways for public schools to better address this rising mental health crisis.

Mental Health Screening in Public Schools

Most schools do not have any type of mental health screening in place for students. The National Association on Mental Illness supports mental health screenings for several reasons. Half or more of chronic mental health issues begin at or before age 14. Early identification and treatment can help prevent more serious problems down the road.

Just as screenings are done for a variety of physical health problems, mental health screenings in public schools could greatly benefit vulnerable students. Conducting mental health screenings in schools allows teachers to recognize the warning signs of various mental health issues, allowing for earlier identification and quicker connections to the treatment resources students might need.

The Role of Public School Nurses in Mental Health

The state of mental health in public schools infographic by

Click image to enlarge.

While school nurses are usually the most likely to catch any mental health issues early on, many schools only have one on-staff nurse, and many of these nurses only work part-time. It is not uncommon for entire school districts to share one nurse, meaning that one nurse may see hundreds or even thousands of students (depending upon the size of the district). This makes it more unlikely that a school nurse would be able to spot symptoms of mental health issues, as the nurse may not be available or have enough time with each student to address their needs.

According to the American Association of Pediatrics, schools function as the mental health system for approximately 80% of students. For this reason, school nurses play a critical role in identifying problems so they can be treated as soon as possible. Unfortunately, school nurses typically receive little to no training in mental health.

While nurses aren’t expected to be psychologists or therapists, they should be aware of emotional, physical, and behavioral warning signs for common mental health problems. Awareness and recognition of problems as soon as they arise could prevent a suicide.

Integrated Mental Health Strategy in Public Schools

Researchers suggest the best way to help students with mental health issues may be to have teachers, counselors, administrators, and school nurses work together to spot and handle mental health issues. Saddling this responsibility on one teacher or administrator is not likely to be effective because they typically do not have the necessary training or time. On average, school counselors see around 500 students. School nurses may see even more students, especially if they are the only nurse for an entire district. Teachers also see a significant amount of students, ranging from 20-30 in elementary schools to hundreds of students in middle schools and high schools where students change classes and teachers throughout the day.

Integrating mental health care and strategies in public schools can help all staff who encounter students. They will likely be better able to recognize mental health problems and provide early intervention as well as prevention for many issues, including thoughts of suicide, drug and alcohol use, and relationship abuse. To recognize these potential problems, some degree of training in mental health will likely be necessary.

Some signs that a student may be experiencing a mental health condition include:

  • Sudden changes in a student’s mood or behavior
  • Frequent mood swings
  • Behavioral problems such as aggression, temper tantrums, or lashing out in school
  • Poor academic performance
  • Poor hygiene
  • Frequent absences
  • No longer participating in extracurricular activities
  • Isolation from peers
  • Difficulty paying attention in class
  • Excessive worrying or anxiety
  • Hyperactivity
  • Difficulty relating to others
  • Somatic complaints (stomachaches, headaches) with no clear physiological cause

Providing Mental Health Services in Public Schools

According to the 2016 Children’s Mental Health Report, young people with access to mental health treatment and services in school are 10 times more likely to seek help for mental health and substance abuse concerns than those who do not have such programs available. Many schools are choosing to address the rising mental health crisis in the public-school system by hiring a professional psychotherapist, counselor, or psychologist on staff. Other schools have therapists come in from community mental health centers to see students who are struggling with mental health issues beyond the guidance counselor’s scope of expertise.

Congresswoman Grace Napolitano is currently working on implementing the Mental Health in Schools Act, which would provide $200 million in funding through competitive grants of $1 million each to 200 public schools across the country. This funding would help them provide on-site licensed mental health professionals in public schools. Napolitano has been executing these programs since 2001 in 14 public schools in her congressional district. This approach has proven successful and will be expanded nationwide through the funding provided by the Substance Abuse and Mental Health Services Administration.


  1. Anderson, M. & Cardoza, K. (2016, September 7). A silent epidemic: Our public schools are struggling to handle millions of students with mental health problems. Retrieved from
  2. Association for Children’s Mental Health. (n.d.). Problems at school. Retrieved from
  3. Cardoza, K. (2016, September 3). School nurses can be mental health ‘detectives’ but they need help. Retrieved from
  4. Child Mind Institute. (2016). 2016 children’s mental health report. Retrieved from
  5. Facts on the Mental Health in Schools Act. (n.d.). Retrieved from
  6. Firth, S. (2015, February 20). Hospitals see alarming increase in suicidal children. Retrieved from
  7. National Alliance on Mental Illness. (n.d.). Mental health screening. Retrieved from
  8. Shefall, A., Asti, L., et al. (2016, September). Suicide in elementary school-aged children and elderly adolescents. doi:10.1542/peds.2016-0436

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Jonas

    November 7th, 2016 at 10:22 AM

    I personally think that we put too much on the schools and teachers and administrators already. They are not trained mental health professionals nor should we expect them to be put into roles w here they have to do that job.

    I am sure that most of them if this is the field that they would have liked to work in they would have gone into that. But they have chosen education and this is what they should be allowed to do. Educate and teach.

    I think that when we start placing these very unreal expectations on them that the leaders of the classroom today are very easily going to get burnt out before tomorrow.

  • Teri

    November 18th, 2017 at 6:28 AM

    TOTALLY agree with Jonas. Let your local mental health agency see their child clients at school. Train school counselors/social workers in assessing. Let teachers teach!

  • Terrell

    November 7th, 2016 at 11:16 AM

    Wouldn’t you say that the classroom teacher would be the one most likely to catch an early issue, not the school nurse?

  • Jack

    November 8th, 2016 at 7:54 AM

    Would there be that many families who would actually consent to having a mental health testing one on their child? And even if something did pop up, I have a bad feeling that this isn’t the best place to address this.
    These are things that will definitely require medical help and intervention and I just don’t see that there are all that many schools who would be equipped to make the necessary referrals and provide options for care.

  • mary kate

    November 8th, 2016 at 1:34 PM

    Is there really this much of an upswing in the number of children who need mental health care versus the numbers from years ago or is it that we are just now more aware of these illnesses and have better lines of prevention for them? I just can’t believe that there is something that is genuinely causing the numbers to increase in this way and the need to grow like this without something else being at play.

    My suspicion which is not a bad thing is that we are now just more in tune to the needs of more children than ever before and we have more resources to direct them toward when they do need a little bit of help.

  • Ashlyn

    November 10th, 2016 at 12:36 PM

    When you think about the fact that there are scores of children in our public school system who have no access to health care of any kind unless it comes in the form of the ER, then yes, schools can be a wonderful place to start. I am not sure where the money comes from because I think that this would take a huge investment to get the right kind of care, but aren’t our children worth that?

  • carter

    November 11th, 2016 at 11:28 AM

    School nurses are great don’t get me wrong but please tell me that lots of referrals out would be made if there was something that was dangerously wrong or off with a student.
    These are not always things that will simply be able to be handles in house.

  • Joe

    November 14th, 2016 at 10:26 AM

    I have a fear that with the incoming administration that mental health care is once again going to be relegated to the back burner.

  • Simran

    March 13th, 2019 at 2:55 AM

    The Signs mentioned by you would really help a lot to understand the child’s situation better. Thanks for sharing.

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