An estimated 16.5 percent of children and youth ages 6-17 have at least one mental health disorder, yet nearly 50 percent do not receive needed treatment or services. This rate is higher for children and youth of color and those who live in rural areas and face disproportionate barriers to accessing these services. As states have faced pediatric mental health workforce shortages, children experiencing a mental health crisis have been increasingly served by emergency departments, which are often limited in their ability to provide psychiatric treatment and support services including referrals to community-based services. During the COVID-19 pandemic, mental health crises among children and youth have risen, and emergency departments have seen increasing proportions of mental health-related pediatric visits.
The pandemic has exacerbated students’ needs for mental health services, particularly given the stress and social isolation associated with the shift to virtual learning. Comprehensive school mental health systems are critical to the prevention, early identification, and provision of services and treatment of mental health needs among children and youth. Always a first-line opportunity for access to mental health care, these systems are increasingly important, as the percentage of adolescents receiving mental health services in schools has increased from 12 to 15 percent from 2011 to 2019. However, students’ access to these services and supports was limited during the COVID-19 pandemic as schools shifted between in-person and virtual learning.
During the pandemic, the federal government allocated funding to the ESSER Fund and the Governor’s Emergency Education Relief (GEER) Fund to support state and local K-12 education agencies in addressing learning loss among students caused by shifts to virtual learning. This funding allowed for investment in a variety of services and supports, including those for mental health needs of students. Such investments included $16.2 billion through the Coronavirus Aid Relief, and Economic Security (CARES) Act in March 2020 and $58.3 billion through the Coronavirus Response and Relief Supplemental Appropriations Act in December 2020.
States now have the opportunity to leverage an additional $122.8 billion that ARPA allocated to the ESSER Fund to further support students in returning to school, including by strengthening school mental health systems. This funding is available for all states, which are required to allocate at least 90 percent of the funding as sub-grants to local educational agencies, which can then use the funding for a variety of activities. At least seven percent of the remaining ten percent allocated to the state must be used for activities to address learning loss, summer programs, and after-school programs. The amount awarded to each state is proportionate to the funding allocations under Title I, Part A of the Elementary and Secondary Education Act, which provides grants to LEAs based on the number and percentage of low-income families and the cost of education in the state.
To receive the funding, SEAs are required to submit plans that detail how they will use ARPA ESSER funds to the U.S. Department of Education for approval. As of July 16, 40 states had submitted plans, all of which describe how they will support students’ social, emotional, and mental health. Most of the plans indicate that they will implement strategies to support school mental health services. Examples include:
- Developing and supporting partnerships between state education and health agencies. The Ohio Department of Education holds bi-weekly meetings with the Ohio Department of Mental Health and Addiction Services to strategically plan for the distribution and use of ESSER funds, including the new allocation of ARPA funding. These meetings serve as an opportunity to discuss shared initiatives and resources for schools to support the mental health needs of students.
- Supporting partnerships between schools and community-based mental health agencies to increase access to services. The District of Columbia will use ARPA ESSER funding to expand access to school mental health providers through the Comprehensive School-Based Behavioral Health System. Partnerships between schools and community-based organizations that provide prevention, early intervention, and treatment services are central to this initiative, which is operated through the DC Department of Behavioral Health.
- Increasing the school mental health provider workforce. Georgia is aiming to increase access to mental health services for students to reduce barriers to learning. The state plans to use state ARPA ESSER funding to increase the number of school mental health providers including psychologists, social workers, and counselors. This funding will also be used to establish school-based health clinics, which provide a range of services including those to support mental health needs.
- Providing mental health-related training for school staff. Delaware plans to use ARPA ESSER funding to provide resources and training to support schools in meeting the needs of students by extending the Delaware Strategy for Social, Emotional, and Behavioral Wellbeing Plan. This includes training in mental health literacy initiatives, a Community of Practice on trauma-informed and culturally responsive practices, and statewide Youth Mental Health First Aid training.
- Providing guidance for local educational agencies in implementing comprehensive school mental health systems. The West Virginia Department of Education (WVDOE) operates the Technical Assistance Center (TAC) for Behavioral and Mental Health to support mental health programs in schools. In partnership with the state Department of Health and Human Resources and the TAC, the WVDOE will provide guidance and highlight models to demonstrate how schools can use ARPA ESSER funding to implement or expand a school-based mental health program.
NASHP will continue to track how states are using ARPA funding, including strategies that are implemented to improve school-based mental health systems. For more information on school-based mental health systems, see these other related NASHP resources: State Approaches to Improve Comprehensive School Mental Health Systems; States Expand Medicaid Reimbursement of School-Based Telehealth Services; Michigan’s Caring for Students Program Leverages Medicaid Funding to Expand School Behavioral Health Services; and Through Coordination and Investment, Arizona Substantially Increases Access to School-Based Behavioral Health Services.
Acknowledgements: This issue brief was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number U2MOA39467 the National Organizations of State and Local Officials co-operative agreement. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US government.