BACKGROUND: Schools play a central role in addressing the youth mental health crisis, and principals play a key role in allocating school resources.

METHODS: A statewide survey assessing principals’ perceptions of their schools’ mental health services was completed by 1,347 principals in spring 2022. Quantitative data were analyzed using descriptive statistics and data from two open-ended questions about supporting student mental health were analyzed using thematic analysis.

RESULTS: Nearly all respondents reported increases since the prior year in students’ mental health needs (95%), demand for school-based mental health (SBMH) services (94%), and the prioritization of student mental health by school/district staff (85%). Although 75% of principals also reported that SBMH services and supports had increased at their schools, only one-quarter (26%) agreed that their schools provided adequate counseling and support services for students with mental health needs. Moreover, although nearly all schools implemented programs to improve mental health and wellness, the lack of funding for providers and the lack of available school-based and community providers were consistent barriers to adequate services. Less commonly reported barriers were stigma and parental cooperation/consent. Respondents reported that schools needed to expand mental health services for students by hiring providers, implementing school-wide programs, and collaborating with community partners.

CONCLUSIONS: School principals reported an increased need for student mental health services, willingness to address these needs, and requests for specific resources. Improving school-based mental health services requires advocacy for funding, adoption of more school-wide programs, providing accessible services, and establishing partnerships with community-based providers.

In Texas, one out of three children experience at least one mental health disorder, 350,000 children yearly experience severe mental health needs, and over 75% of children, youth and young adults with serious mental health needs do not receive adequate treatment. Over 40% of the Texas population (13 million) live in Mental Health Care Health Professional Shortage Areas. Improving access to mental health care is a critical public health issue for Texas.

In 2019, the Texas Legislature through the Texas Child Mental Health Care Consortium (TCMHCC) developed the Texas child health access through telemedicine (TCHATT) initiative, a statewide program that provides free in-school measurement based behavioral telehealth care to children and adolescents. TCHATT is now available to 4.3 million Texas students (78% of the Texas student population), has received over 91,000 mental health referrals (3,500 average monthly), and has provided 249,000 service sessions (up to 10,000 per month). When appropriate, TCHATT links students to community programs for ongoing mental health needs. Reasons for referral include anxiety (41%) depression (28%), anger (25%), and suicide concern (14%), among many others. Only 7.5% of the sessions require any medication management. TCHATT receives high satisfaction from families and school personnel who indicate positive outcomes, including less adverse symptoms and improved school performance. The program piloted several initiatives, including substance use disorders treatment and collaborations with community mental health clinics to increase the scope of services and follow-ups after discharge. TCHATT has transformed access to high-quality mental health services for Texas students.

Background: School absence is considered a vital sign for child health, but limited research has examined its links with mental well-being. This study evaluated cross-sectional associations between absence and child mental health, as well as longitudinal impacts on adult mental health over a 24-year period.

Methods: Participants were 3,082 children in the 1997 Panel Study of Income Dynamics Child Development Supplement who completed biennial surveys from ages 18-28 in 2005-2021. Caregivers reported total days children missed school due to illness or injury in the past year. Early risk of chronic absence was defined as missing ≥5 days. Child mental health was evaluated using parent-reported internalizing and externalizing behavior subscales of the Behavior Problem Index. Psychological distress was assessed in young adulthood using the Kessler-6 Psychological Distress Scale. Linear regression models evaluated associations with standardized (per 1-SD) behavior scores in childhood and Poisson regression models evaluated prospective associations with high levels of psychological distress in young adulthood. All analyses adjusted for sociodemographic confounders.

Results: 21% of children missed ≥5 school days. Chronic absence risk was associated with a greater likelihood of high child internalizing (Prevalence Ratio [PR]=1.19, 95% CI=1.08-1.32) and externalizing behavior problems (PR=1.13, 95% CI=1.02-1.26). Associations with young adult psychological distress were modest (PR=1.25, 95% CI=0.93-1.67), but sub-group analyses pointed to stronger associations among those with lower levels of parental education (PR=1.45, 95% CI=1.02-2.05).

Conclusion: Mental health challenges are more common among children at risk for chronic absence compared to those without attendance problems. For some, these risks may extend into adulthood.