The Mental Health Crisis In Public Schools

In the United States, nearly 5 million children have some type of mental health challenge that significantly interferes with daily life (Salamat et al., 2015). 1 out of 7 American children between the ages of 2 and 8 years have a diagnosed mental, behavioral, or developmental disorder (MBDD) (Center for Disease Control and Prevention [CDC], 2017). As children from poorer families are more likely to have an MBDD (CDC, 2017), an emerging practice area is addressing mental health in schools (American Occupational Therapy Association [AOTA], 2011). Occupational therapy practitioners (OTP) in schools are equipped to address mental health through prevention, promotion, and intervention (Salamat et al., 2016). Mental health needs are not limited to diagnosed disorders, as OTPs can promote positive mental health by developing and facilitating mentally healthy habits in students. This results in positive affect, positive social interactions, and the ability to adapt to change and cope with challenges (Bazyk, Demirjian, LaGuardia, Thomspon-Repas, Conway & Michaud, 2015). When there is an investment in mental health and other resources to support children in schools, the more marginalized populations will have access to the resources they need.

Legislative History

One of the external influences in the school system is the legislation that governs it. The Elementary and Secondary Education Act of 1965 (ESEA) was passed by Congress and introduced standards, accountability and equal access in education. Congress has reauthorized the act several times with the more recent reauthorizations being in 2002 (No Child Left Behind Act [NCLB]) and in 2010 with the Every Student Succeeds Act (ESSA). Major shifts in policy came as a result of these acts, in which the purpose was to improve the internal process of schools by increasing the accountability and closing the achievement gaps (Case-Smith & O’Brien, 2014). Full implementation of NCLB had the potential to help schools to identify larger numbers of students with mental health needs, and build the capacity for meeting those needs (Daly, Burke, Hare, Mills, Owens, Moore, & Weist, 2006). Additionally, through No Child Left Behind’s connection to the Individuals with Disabilities Education Act (IDEA)(reauthorized in 2004), funding was available to support school mental health (Daly et al., 2006). Unfortunately, the complexities of NCLB made it difficult for stakeholders and mental health professionals to understand the interface between NCLB and school mental health (Daly et al., 2006).

Over time, NCLB’s complicated requirements became increasingly unworkable for the stakeholders involved. Starting in 2007, Congress began working on the next reauthorization of the ESEA-NCLB. The ESEA was reauthorized again in 2010 with the Every Student Succeeds Act (ESSA). Where NCLB had a narrow view of the school’s role, ESSA provided resources through funding comprehensive services so that students could be healthy, and able to learn. These services could include more collaborative efforts in addressing students’ mental health.

More recently, The Mental Health in Schools Act of 2015 has been introduced and sent to committee for review (Mental Health in Schools Act of 2015, 2015). This proposed law provides more resources by funding more comprehensive school-based mental health services and supports (Mental Health in Schools Act of 2015, 2015). The intent is to improve the outcomes of students by helping them access the services they need, as oftentimes school is the only option to receive these services (Mental Health in Schools Act of 2015, 2015).

Impact

Occupational therapy has been impacted by these policies in several ways. The resources have been impacted, as funding is now needed to account for compliance with ESSA, which cuts down the funding for direct services. The internal process for how therapy is delivered in schools has been impacted. As service delivery is directly connected to resources and funding, services have been cut back substantially. This limits access to services. The time allowed for full classroom collaboration and service delivery has been cut completely due to lack of resources (funding). If enacted, mental health in schools legislation could be revolutionary in the future. Over the past two decades, school mental health has grown substantially in the United States (Bazyk et al., 2015). With proper funding and support from stakeholders, school mental health programs could be properly developed. Given the interdisciplinary nature and knowledge base of the human resources in schools (psychologist, social worker, etc.), there is an opportunity for OTPs to advocate to ensure that occupational therapy has a seat at the table. In schools, OTPs are often overlooked, as many mental health professionals do not fully understand the scope of occupational therapy’s role in mental health. Additionally, stakeholders are weary of duplication of services and have the tendency to limit the range and scope of occupational therapy as to not overlap with other services. However, OTPs can be valuable members of the school mental health team.

If the stakeholders are invested, a school mental health team could collaborate to improve the process for addressing the needs of this population as well as the outcomes. OTPs also could maximize the use of available resources such as technology (via the school website) to educate the stakeholders involved (administrators, school staff and parents) on the importance of prevention, positive mental health promotion, and the role of occupational therapy. Lastly, OTPs can participate in advocacy efforts for legislation that will continue the mental health in schools movement.

References

American Occupational Therapy Association [AOTA]. (2011). Broader scope in schools. Retrieved from https://www.aota.org/Practice/Children-Youth/Emerging-Niche/Broader-Scope-in-Schools.aspx

Bazyk, S., Demirjian, L., LaGuardia, T., Thomspon-Repas, K., Conway, C., & Michaud, P. (2015). Building capacity of occupational therapy practitioners to address the mental health needs of children and youth: A mixed-methods study of knowledge translation. American Journal of Occupational Therapy, 69(6), 3–10. http://dx.doi.org/10.5014/ajot.2015.019182

Centers for Disease Control and Prevention (CDC). (2017). Children’s mental health. Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html

Case-Smith, J., O’Brien, J., (2014). Occupational Therapy for Children and Adolescents (7th Ed.). St. Louis, Missouri: Elsevier Mosby. https://www.cga.ct.gov/2013/rpt/2013-R-0081.htm

Daly, B. P., Burke, R., Hare, I., Mills, C., Owens, C., Moore, E., & Weist, M. D. (2006). Enhancing No Child Left Behind-school mental health connections. Journal of School Health, 76(9), 446+. Retrieved from http://libraryproxy.quinnipiac.edu/login?url=http://go.galegroup.com.libraryproxy.quinnipiac.edu/ps/i.do?p=AONE&sw=w&u=a13qu&v=2.1&it=r&id=GALE%7CA154004003&sid=summon&asid=4ccabf90fbde1ec58d1f60fbd552bc55

Mental Health in Schools Act of 2015. (2015). Retrieved fromhttps://www.congress.gov/bill/114th-congress/housebill/1211/text?q=%7b%22search%22:%5b%22mental+health+schools%22%5d%7d&resultIndex=2

Salamat, A., Javaherian-Dysinger, H., Krpalek, D., Parikh, S., Lee, K., Christensen, B., Liu, A., Ngo, K., Goya, Y. (2016). Perspective of school-based occupational therapy practitioners in addressing students’ mental health needs. American Journal of Occupational Therapy, 70 (4 supplement 1),1.