Despite Increased Screening Rates, Mental Health Services Remain Challenging for K-12 Schools

Although nearly a third of U.S. K-12 public schools require mental health screening for students, it remains challenging to ensure the students receive appropriate care, according to a new study published in the JAMA Network Open journal.

“Our results suggest that there are multiple barriers to mental health screening in schools, including a lack of resources and knowledge of screening mechanics, as well as concerns about increased workload of identifying students,” said Jonathan Cantor, the study's lead author and a policy researcher at RAND.

In 2016, only 13 percent of school districts screened for mental health. Since then, more U.S. K-12 schools have added mental health screening requirements. A 2024 U.S. Centers of Disease Control and Prevention (CDC) survey, which underpins the latest RAND study, demonstrates that at least some progress has been made towards more screenings happening.

The CDC survey found that youth mental health improved slightly between 2021 and 2023. The CDC identified a decrease in the percentage of students who experienced persistent feelings of sadness or hopelessness, down from 42 percent in 2021 to 40 percent in 2023. The CDC argued that additional school screening and support would help students navigate these challenges.

The RAND study identified that most of the schools that provide mental health screening notify the student’s parents (79.3 percent), offer in-person treatment (72.3 percent), or provide a referral to a community mental health professional (53 percent) if the student shows signs of depression or anxiety. Telehealth treatment offerings were less common (less than 20 percent). Larger schools (with 450 pupils or more), and those in districts with mostly racial and ethnic minority groups as the student population, had higher rates of mental health screenings.

But 40 percent of the principals in schools that offer mental health screening said it was hard to ensure that students receive appropriate care, while 38 percent said it was relatively easy.

“Results of this study suggest that there are multiple barriers to mental health screening in schools including a lack of resources and knowledge of screening mechanics and concerns of increased workload after identifying students,” the journal article said. “Policies that promote federal and state funding for school mental health services, reimbursement for school-based mental health screening, and adequate school mental health staffing ratios may increase screening rates and successful connection to care.”

The U.S. Surgeon General declared a youth mental health crisis in 2021, given the disruptions and stressors of the COVID-19 pandemic. An advisory from the Office of the Surgeon General noted that between 2020 and 2021, 25 percent of youths experienced depressive symptoms and 20 percent experienced anxiety symptoms. Emergency department visits for suspected suicide attempts had jumped—especially for adolescent girls.

“Moreover, pandemic-related measures reduced in-person interactions among children, friends, social supports, and professionals such as teachers, school counselors, pediatricians, and child welfare workers,” according to the advisory. “This made it harder to recognize signs of child abuse, mental health concerns, and other challenges.”

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