Editor’s note: This is the second in a two-part series advocating for schools to offer better mental health services for students—something that’s especially important after pandemic-related disruptions to schools and children’s routines. The first part discussed what such services look like, and ways that leaders can use federal pandemic aid to help fund them in the short term.
Schools have long needed comprehensive mental health supports for students and staff. According to the US Department of Health and Human Services, one in five children and adolescents experience a mental health problem during their school years.
At the most basic level, the best teacher in the world cannot effectively reach a student who is having a mental health crisis. For a long time, we have expected teachers to handle the mental health issues of students in their class in addition to teaching. We need to recognize that mental health is no different than physical health in that they are both real needs that require specially trained professionals to address—and that when left untreated, they can significantly inhibit the ability of a student to learn. Classroom teachers can provide some basic mental health support like comforting a student who is upset. However, asking teachers to run a classroom with students who have untreated mental health issues or asking them to figure out how to treat them is different. The fact that mental health issues are often more difficult to see, combined with years of mental health stigmatism, has led to these issues being largely ignored in education. However, recent efforts to advance the cause of mental health access for students have caused many schools to rethink their approach.
While some schools have found ways to add the required resources through complicated funding and staffing structures, others have struggled to get even one mental health professional on campus. With the sudden influx of federal Covid-19 relief funds, the financial barriers to providing these services in schools are disappearing, at least temporarily. As schools head into summer planning, they should be considering how and where to add these services—and even more importantly, how to ensure the long-term sustainability of funding that will let them remain in place after the federal relief dollars expire.
How to fund mental health services
The simplest and most effective way to provide comprehensive mental health services on campus is for schools to hire mental health professionals on staff. Many schools employ counselors—but they are often tasked with duties such as scheduling and college admissions. The best practice for schools is to have mental health professionals that are completely and singularly focused on providing mental health services to students. These individuals should be specially licensed. Some examples include licensed social workers (master’s or clinical), licensed professional counselor, or licensed psychologists. The current recommended ratio is one mental health professional for every 250 students. But with the increased needs in the wake of COVID-19, that may not be enough. While some schools already employ mental health professionals, others have not been able to make that possible due to budgetary constraints. Now, at least in the short term, thanks to three separate rounds of federal Covid relief funds, schools have an opportunity to hire these professionals.
While the best solution would be to simply add these individuals to staff, some schools and districts may run into concerns about the number of allowable full-time employees (FTEs) or concerns over what to do when the funding ends. For these schools, a good solution would be to contract with individual mental health professionals. Contractors allow schools the benefit of mental health support while not requiring the same resources as FTEs. In addition, many states may experience a talent pipeline issue because of a shortage of school-specialized mental health professionals combined with the increased demand for their services. Using contactors allows one individual to service multiple schools, slightly mitigating the talent pipeline concern. Contractors can also be useful if the school wants to provide a specialized type of mental health support, such as addiction, LGBT-related issues, family therapy, or a specialization in complex trauma. For these specializations, there may not be a large enough student population in need to justify employing a full-time specialist, but it may make sense for a school to contract for a limited number of hours.
While the federal Covid-19 relief funds can provide immediate resources to add these services, many schools may rightly be concerned about how to maintain this level of mental health access in the long term. The good news is that Obama-era changes to federal Medicaid guidelines opened up a potential pathway for long-term funding of these services. In 2014, Medicaid released updated guidelines known as the Free Care Reversal Policy that clarified that states can allow schools to bill Medicaid for mental health services for all students—not just those with IEPs, which is how Medicaid had previously functioned. This pathway has the potential to provide long-term sustainable funding for schools to provide these mental health services.
However, each state must go through a process to authorize this change, and to date, only thirteen have. If your school is in California, Colorado, Connecticut, Florida, Kentucky, Louisiana, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, North Carolina, or South Carolina, your state has taken steps to adopt this policy; Georgia and Oregon have begun the process and are waiting on approval. If you are in one of these states and have a Medicaid-eligible population, this funding method is open to you. Each of these states has its own unique rules and requirements, so if you have not as yet begun billing Medicaid this way, you should reach out to your state department of education for support. If you are in one of these states and are not yet set-up for this, your federal Covid-19 relief dollars could be used to help you do this long-term by purchasing billing software or hiring staff that can be paid for by these federal funds until the Medicaid reimbursement can be received.
In states that have not made this policy shift, schools should consider lobbying their departments of education (in conjunction with the entity that oversees Medicaid in their state) to work to implement the Free Care Reversal Policy and use federal Covid-19 relief dollars to support that work. Helpful resources for this can be found at the Healthy Students, Promising Futures Learning Collaborative. Fully implementing this policy will allow schools to continue providing these services long after the federal Covid-19 funds run out.
Access to mental health services is critical to student success in school. With students returning after a year of disruption, these services are going to be more important than ever. Fortunately, the federal Covid-19 relief dollars can provide the funding for those resources in the short term. And if used correctly, they also have the potential to provide sustainable funding through the Medicaid Free Care Reversal Policy. If this moment is leveraged well, it can be a profound turning point for mental health access in schools.
