State lawmakers have made student mental health a top priority in the past year by passing legislation and expanding existing programs to boost schools’ capacity to serve students, according to a new report.
Inseparable, a nonprofit that advocates for better mental health outcomes, released the report through its Hopeful Futures Campaign, which aims to promote school-based mental health priorities. The report is the second of its kind and acts as a legislative guide for state lawmakers and a roundup of recent actions to support mental health.
National leaders, including President Joe Biden, U.S. Surgeon General Vivek Murthy, and Secretary of Education Miguel Cardona, have all labeled mental health as a crisis among American youth. In 2021, 40 percent of high school students reported feeling persistently sad or hopeless, and over 20 percent considered attempting suicide, according to the Centers for Disease Control’s Youth Risk Behavior Survey.
In a 2022 survey, the Hopeful Futures Campaign found that 88 percent of parents support schools providing student mental health resources and services, and a January survey from the Pew Research Center found that 4 in 10 parents are very or extremely worried their child might struggle with anxiety or depression.
Kids want to see action, too. In a 2020 survey from 4-H and The Harris Poll, 76 percent of teens said their school should offer more outlets for students struggling with mental health.
But schools can’t do it alone. While some districts have the resources to connect with nearby hospitals and universities to hire mental health professionals, others are left without the funding or community support to give students the school-based care they need.
That’s where states come in.
Medicaid proves a valuable tool
One of the most effective ways states can support student mental health quickly is by extending Medicaid to cover school-based mental health services, said Angela Kimball, senior vice president of advocacy and public policy at Inseparable.
“Every state needs [Medicaid] resources to sustain these services,” Kimball said. “This is not a nice-to-have. This is now an essential.”
The federal government has used Medicaid since the late 1980s to pay for in-school medical services provided to students with an individualized education program, or IEP. And since 2014, states have been able to receive reimbursement for all students enrolled in Medicaid, regardless of their special education status.
The federal government took that a step further in May, when the U.S. Department of Education announced a proposal to remove a requirement for schools to receive parental consent before billing Medicaid. The requirement has long confused and alienated Medicaid-enrolled families, according to special education administrators.
Twenty-one states have extended Medicaid programs to cover more school-based services, including mental health care. Three states—Connecticut, New Jersey, and Rhode Island—enacted those laws in the past year.
The Connecticut and New Jersey laws specifically require the states’ human services commissioners to implement Medicaid reimbursement for school-based behavioral health services. And the Rhode Island law requires that services provided by school social workers and certified school psychologists be eligible for Medicaid reimbursement.
But no state has done as much as Colorado, which recently passed a law that allows Medicaid-enrolled youth up to age 21 to access the program for mental health services without requiring a formal mental health diagnosis. It’s a policy that every state should duplicate, Kimball said.
“There are a lot of youth who need some help early, but don’t necessarily have a mental health condition,” Kimball said. “And we want them to get help early before something actually progresses to being a diagnosable condition.”
The laws are a game changer for students in those states because they provide those who have the hardest time accessing mental health resources with a starting point for receiving care.
In order to maximize Medicaid’s impact, experts say district and school leaders will need to be diligent about ensuring eligible students are enrolled in the program, especially as pandemic-era enrollment policies that kept people automatically enrolled end and result in up to 4 million children falling off Medicaid rolls for logistical reasons.
States work to get more mental health professionals in schools
There has long been a national shortage of school-based social workers, counselors, and school psychologists. In the 2021-22 school year, there were 1,127 students for every school psychologist, according to the National Association of School Psychologists.
That number is far above the association’s recommended ratio of 500 students to every psychologist. Only one state—Utah—meets that standard, while eight have more than 2,000 students for every school psychologist, according to the association: Alabama, Arkansas, Georgia, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas.
Some of those states have worked to combat that shortage through investments and strategies to expand the professional pipeline of school psychologists. Georgia invested $26.9 million in its appropriations bill for the fiscal 2023-24 year to help schools hire more school counselors with a goal of reaching a ratio of 450 school counselors to every student.
In February, Colorado enacted a law that creates two funding streams to boost the ranks of school-based mental health professionals.
The first creates a nearly $15 million grant program to provide more funding to hire behavioral health professionals in schools or to help schools connect with community mental health providers. The second develops a $12.3 million grant program that funds school counselor positions and provides professional development for school counselors.
The state also passed a law this year that allows mental health professionals to provide services in schools without having to get a special license from the state’s education department, removing a potential barrier for mental health workers.
In June, Nevada lawmakers addressed a limited pipeline of school-based mental health workers by passing a law to establish a Behavioral Health Workforce Development Center, which will include a main location at one of the campuses in the University of Nevada system with regional locations throughout the state. The state allocated $2 million to the center, but it will be able to accept gifts, grants, and donations to create a plan for recruiting, educating, and retaining a diverse and qualified behavioral health workforce in the state, including school based behavioral health workers.
Other states have approached the problem by expanding telehealth offerings for students. A law enacted in May in Washington provides $500,000 annually to districts for two years to pay for virtual mental health services to students in rural areas, where it’s hard to find mental health professionals.
“Students in rural areas typically don’t have access to those services,” Kimball said. “This is a way of sort of bridging that gap because telemental health obviously allows you to tap into a workforce that may reside in urban areas and not in frontier counties.”
Implementation matters, too
States highlighted in the report have both Republican and Democratic legislative majorities, which indicates that the priority of tackling youth mental health challenges crosses party lines, Kimball said.
“Legislators across the aisle are seeing the need,” she said. “They’re hearing from children’s hospitals about really dire situations. They’re hearing from school officials, they’re hearing from pediatricians. They know that children are struggling.”
But the laws are only a start. States need to be diligent in ensuring they fully implement the policies lawmakers have enacted, Kimball said. Inseparable and the Hopeful Futures Campaign would like to see states hire coordinators to work with multiple agencies and districts to ensure that new policies and programs are effective.
“If you want to see implementation happen the way it’s intended, you need to create some structure at the state or regional levels that helps schools understand the intent, understand best practices, and get the support that they need to actually achieve the goal of helping students,” Kimball said.
