Mental Health in New York City Public Schools

Prepared for: Council Member Stephen Levin; Council Member Oliver Koppell, Chair of the New York City Council Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services; Council Member Robert Jackson, Chair of the New York City Council Committee on Education; Council Member Gale Brewer. Overview: Across the New York City Department of Education (DOE) system, schools lack the resources to adequately address the mental health needs of the citys school-aged youth. Untreated mental health conditions place a significant burden on the school system, reducing academic achievement among both students experiencing emotional and behavioral difficulties and their classmates, and placing unfair demands on administrators and teachers who lack the requisite training to respond appropriately. Only a fraction of New York City public schools offer comprehensive mental health services of the kind shown to be effective in addressing mental health conditions, improving academic achievement and reducing mental health care costs. Consequences of untreated mental health conditions among students: Students with untreated mental health conditions experience negative academic consequences, including reductions in test scores, school attendance and graduation rates.1 Furthermore, according to the Centers for Disease Control and Prevention, suicide was the fourth leading cause of death among 11 to 18 year olds in New York State in 2005.2 Additionally, students with mental, emotional, or behavioral disorders contribute to disruptive learning environments that make it difficult for teachers to manage classrooms. There is additional evidence that mental health conditions disproportionately impact economically marginalized populations. The Midtown Manhattan Survey of Psychiatric Impairment in Urban Children in New York City found that children and adolescents from families receiving public assistance were almost twice as likely to exhibit mental health disorders.3 These families are often poorly positioned to ensure proper treatment for their children, and therefore find themselves at the mercy of the available public treatment options. Mental health care in New York City public schools: Untreated mental health conditions pose a significant threat to the welfare of New York City youth. Studies suggest that upwards of 20% of children and adolescents experience a mental, emotional, or behavioral disorder each

Center for School Mental Health. (2012). The Impact of School Mental Health: Educational, Emotional, and Behavioral Outcomes. University of Maryland, Baltimore, School of Medicine, Department of Psychiatry, Last accessed on April 30, 2012 at: http://csmh.umaryland.edu/Resources/OtherResources/CSMHImpactofSMH.pdf
2 3

Outing, Alicia. (April 8, 2009). City School Confronts Mental Health. Columbia Spectator.

Center for School Mental Health. (2012). The Impact of School Mental Health: Educational, Emotional, and Behavioral Outcomes. University of Maryland, Baltimore, School of Medicine, Department of Psychiatry, Last accessed on April 30, 2012 at: http://csmh.umaryland.edu/Resources/OtherResources/CSMHImpactofSMH.pdf

year,4 yet only 30% receive treatment.5 With 1.1 million students in the New York City public school system, this suggests that over 150,000 New York City public school students struggle with untreated mental, emotional, or behavioral disorders annually. There are significant logistical challenges to the delivery of adequate mental health care for untreated students. DOE claims to house 300 school-based mental health programs,6 but the Departments published list of mental health program locations shows only 261 schools, meaning that fewer than 1 in 6 New York City public schools have access to school-based mental health programs. Moreover, many of these mental health programs locations serve multiple schools, potentially straining their operations. In total, there are only 203 school-based mental health programs serving the New York City public school system - almost one-third fewer than DOE asserts.7 Expanding mental health care in New York City public schools: Current operations notwithstanding, DOE is well positioned to address the mental health needs of New York City youth. School-based mental health programs currently in operation throughout New York City public schools are a valuable resource for the citys students. The programs offer a variety of services, including consultations, screenings, assessments and referrals. Such school-based mental health care programs remove barriers to access, increasing student utilization of metal health services relative to non-school-based programs. Indeed, over 95% of students referred for mental health services in a school setting will seek treatment, compared to only 13% among those referred to community health centers.8 Furthermore, school-based programs result in positive outcomes for students. Students are not only more likely to receive mental health services in a school setting, but also more likely to improve academically, with schools reporting fewer course failures and higher grade point

National Research Council and Institute of Medicine (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. M.E. OConnell, T. Boat, & K.E. Warner (Eds.), Board of Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington DC: The National Academies Press.
5

Greenberg, M., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58(6/7), 466-474.
6

NYC Department of Education. School-Based Mental Health Program: Eliminating Barriers to Academic Achievement. Accessed on February 13, 2012 from http://schools.nyc.gov/Offices/Health/SBHC/MentalHealth.
7

NYC Department of Education. List of Mental Health Program Locations (as of January 4, 2012). Accessed on February 13, 2012 from schools.nyc.gov/NR/rdonlyres/82CD4329-4E30-498C-ACDB4B287F10FCB8/0/SBMHProviders112.xls.
8

Catron, T., et al. (1998). Posttreatment results after 2 years of services in the Vanderbilt school-based counseling project. In M. Epstein, K. Kutash, & A. Ducknowski (Eds.) Outcomes for children and youth with behavioral and emotional disorders and their families: Programs and evaluation best practices. Austin, TX: Pro- ED, Inc.

averages among students accessing care.9 Finally, students with access to school-based health centers incur lower mental health care costs and lower total health care costs.10 School clearly constitutes the optimal setting for the provision of mental health services to children and adolescents, and there is significant room to expand these services in the New York City public school system. The need: The status of school-based mental health programs in the New York City public school system demands careful examination. Questions to be raised include: What mental health programs or services are currently offered in NYC public schools? Do the services offered vary from school to school? How effective are the programs? How is effectiveness measured? Have the programs or the scope of services offered changed over the past ten years? If so, how have they changed? How have funding levels for school based mental health programs or services changed over the past ten years? What is the process for choosing an organization to operate a mental health program in a school? Why do these school-based mental health programs operate in so few schools? Should school-based mental health programs be expanded? If a school-based mental health programs cannot be introduced in a school, what other programs can be offered? What is the quality of mental health services for schools that do not have school-based mental health programs?

Recommendations: We recommend that the Committee on Mental Health, Mental Retardation, Alcoholism, Drug Abuse and Disability Services, in cooperation with the Committee on Education, and Department of Education develop a plan to compile and disclose information about available programs to address mental health needs of New Yorks public school students.

Center for School Mental Health Assistance. (2003). CSMHA: Outcomes of Expanded School Mental Health Programs. University of Maryland. Baltimore, Last accessed on April 30, 2012 at: http://csmh.umaryland.edu/Resources/OtherResources/CSMHImpactofSMH.pdf

10

Guo JJ, et al. (2008). Impact of school-based health centers on students with mental health problems. Public Health Reports.123:76880.