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Spotlight 1: Prevalence of Mental Health Services Provided by Public Schools and Limitations in Schools’ Efforts to Provide Mental Health Services
(Last Updated: July 2020)

During the 2017–18 school year, about 51 percent of public schools (or 42,200 schools) reported providing diagnostic mental health assessments to evaluate students for mental health disorders. Approximately 38 percent of public schools (or 31,500 schools) reported providing treatment to students for mental health disorders.

It is estimated that, among children under 18 years old in the United States, approximately 16.5 percent had at least one mental health disorder. Of these children, about 49.4 percent did not receive needed treatment or counseling from a mental health professional (Whitney and Peterson 2019). Studies also show that school mental health resources may facilitate mental health service use for children with mental health disorders (Green et al. 2013).

Using the 2017–18 School Survey on Crime and Safety (SSOCS) data, this spotlight examines the prevalence of mental health services in schools, as well as the limitations on schools’ efforts to provide mental health services. In addition, this spotlight discusses whether the prevalence of mental health services in schools and the limitations on schools’ efforts to provide mental health services vary according to school characteristics. The 2017–18 SSOCS asked whether and where schools provided two types of mental health services: diagnostic mental health assessments1 to evaluate students for mental health disorders2 and treatment3 for mental health disorders. The 2017–18 SSOCS also asked about the extent to which various factors limited schools’ efforts to provide mental health services to students.4 For each factor, respondents could choose from the response options “limits in major way,” “limits in minor way,” and “does not limit.” In this spotlight, the discussion regarding limitations on schools’ efforts to provide mental health services focuses on the responses indicating that a particular factor limits such efforts in a major way.

During the 2017–18 school year, about 51 percent of public schools (or 42,200 schools) reported providing diagnostic mental health assessment services to evaluate students for mental health disorders (hereafter referred to as “diagnostic services”; figure S1.1 and table S1.1). In contrast, fewer public schools (38 percent, or 31,500 schools) offered mental health treatment services to students for mental health disorders (hereafter referred to as “treatment services”).


Figure S1.1. Percentage of public schools providing diagnostic mental health assessments and treatment to students, by selected school characteristics: 2017–18

Figure S1.1. Percentage of public  schools providing diagnostic mental health assessments and treatment to  students, by selected school characteristics: 2017–18

1 Primary schools are defined as schools in which the lowest grade is not higher than grade 3 and the highest grade is not higher than grade 8. Middle schools are defined as schools in which the lowest grade is not lower than grade 4 and the highest grade is not higher than grade 9. High schools are defined as schools in which the lowest grade is not lower than grade 9. Combined schools include all other combinations of grades, including K–12 schools.
NOTE: A diagnostic mental health assessment is an evaluation conducted by a mental health professional that identifies whether an individual has one or more mental health diagnoses. This is in contrast to an educational assessment, which does not focus on clarifying a student’s mental health diagnosis. Treatment is a clinical intervention—which may include psychotherapy, medication, and/or counseling—addressed at lessening or eliminating the symptoms of a mental health disorder. Schools were instructed to include only services provided by a licensed mental health professional employed or contracted by the school. Mental health professionals were defined for respondents as including providers of mental health services within several different professions, each of which has its own training and areas of expertise. The types of licensed professionals who may provide mental health services may include psychiatrists, psychologists, psychiatric/mental health nurse practitioners, psychiatric/mental health nurses, clinical social workers, and professional counselors. Mental health disorders refer to, collectively, all diagnosable mental disorders or health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. Responses were provided by the principal or the person most knowledgeable about school crime and policies to provide a safe environment.
SOURCE: U.S. Department of Education, National Center for Education Statistics, 2017–18 School Survey on Crime and Safety (SSOCS), 2018.


The percentages of public schools providing either diagnostic services or treatment services varied by school characteristics. For example, a greater percentage of high schools (61 percent) reported providing diagnostic services than did middle (56 percent), primary (49 percent), or combined schools5 (41 percent). The percentage providing diagnostic services was also higher for middle schools than for primary and combined schools. Similarly, a greater percentage of high schools (45 percent) reported providing treatment services than did middle (39 percent) and primary schools (37 percent).

The percentages of public schools providing either diagnostic services or treatment services were generally higher for schools with larger enrollment sizes. In terms of the provision of treatment services, the percentage providing these services was higher for those with an enrollment size of 1,000 or more students (44 percent) than for those with 500 to 999 students enrolled (37 percent) and those with less than 300 students enrolled (35 percent).

Figure S1.1 also shows differences in the percentages of public schools by school locale and region of the country in the provision of diagnostic services or treatment services. The percentage of public schools that reported providing diagnostic services was higher for schools in cities (58 percent) than for schools in towns (46 percent) and in rural areas (44 percent). The percentage providing diagnostic services was also higher for schools in suburban areas (53 percent) than for schools in rural areas. A lower percentage of schools in the Midwest (42 percent) reported providing diagnostic services than did schools in the other three regions. There were fewer measurable differences in the percentages of public schools that reported offering treatment services by school locale and region. The percentage of public schools providing treatment services was higher for schools in cities (42 percent) than for those in suburban areas (36 percent); the percentage was also higher for schools in the Northeast (43 percent) than for schools in the West (35 percent).

Differences in the percentage of public schools providing diagnostic services were observed by percentage of minority students enrolled at the school and percentage of students eligible for free or reduced-price lunch (FRPL) at the school. The percentage of public schools that provided diagnostic services was lower for schools with a minority student enrollment of 25 percent or less (43 percent) than for schools with a minority student enrollment of greater than 25 percent (ranging from 52 to 58 percent).6 Additionally, when looking at schools by poverty level, a higher percentage of schools where 76 percent or more of the students were eligible for FRPL (59 percent) provided diagnostic services than did schools where 75 percent or less of students were eligible for FRPL (ranging from 46 to 50 percent).

Differences in the percentage of public schools providing treatment services were observed by percentage of students eligible for FRPL, but not by percentage of minority enrollment. Lower percentages of schools in which 25 percent or less and 26 to 50 percent of students were eligible for FRPL provided treatment services (34 percent and 35 percent, respectively) than schools in which 76 percent or more of the students were eligible for FRPL (43 percent).

The 2017–18 SSOCS also collected information on where schools provided mental health services. Among schools providing diagnostic services, 52 percent provided diagnostic services both at school and outside of school. A higher percentage of schools provided diagnostic services at school only (32 percent) than provided diagnostic services outside of school only (12 percent; figure S1.2 and table S1.1).7 Similarly, among schools providing treatment services, 55 percent provided treatment services both at school and outside of school. A higher percentage of schools provided treatment services at school only (33 percent) than provided treatment services outside of school only (10 percent).


Figure S1.2. Percentage of public schools providing diagnostic mental health assessments and treatment to students and, among schools providing these services, percentage providing them at school and outside of school: 2017–18

Figure S1.2. Percentage of public  schools providing diagnostic mental health assessments and treatment to  students and, among schools providing these services, percentage providing them  at school and outside of school: 2017–18

NOTE: A diagnostic mental health assessment refers to an evaluation conducted by a mental health professional that identifies whether an individual has one or more mental health diagnoses. This is in contrast to an educational assessment, which does not focus on clarifying a student’s mental health diagnosis. Treatment is a clinical intervention—which may include psychotherapy, medication, and/or counseling—addressed at lessening or eliminating the symptoms of a mental health disorder. Schools were instructed to include only services provided by a licensed mental health professional employed or contracted by the school. Mental health professionals were defined for respondents as including providers of mental health services within several different professions, each of which has its own training and areas of expertise. The types of licensed professionals who may provide mental health services may include psychiatrists, psychologists, psychiatric/mental health nurse practitioners, psychiatric/mental health nurses, clinical social workers, and professional counselors. Mental health disorders refer to, collectively, all diagnosable mental disorders or health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. Responses were provided by the principal or the person most knowledgeable about school crime and policies to provide a safe environment. Percentages do not sum to 100 percent because some schools reported providing assessments or treatment but did not specify the location at which these services were provided.
SOURCE: U.S. Department of Education, National Center for Education Statistics, 2017–18 School Survey on Crime and Safety (SSOCS), 2018.


Providing mental health services in a school setting can be difficult. Weist et al. (2012) reported that challenges in offering school mental health services may arise due to ineffective instructional delivery, lack of administrative support, inadequate staffing, budget needs, and lack of regular feedback on the implementation and effectiveness of programs. The 2017–18 SSOCS collected data on limitations in public schools’ efforts to provide mental health services regardless of whether the school actually provided mental health services. Figure S1.3 shows that the majority of schools (52 percent) reported their efforts to provide mental health services to students were limited in a major way by inadequate funding. Another 41 percent reported inadequate access to licensed mental health professionals as a major limitation. The reported rates for other categories of major limitations are shown in Figure S1.3 and Table S1.2.


Figure S1.3. Percentage of public schools reporting that various factors were major limitations in their efforts to provide mental health services to students: 2017–18

Figure S1.3. Percentage of public  schools reporting that various factors were major limitations in their efforts  to provide mental health services to students: 2017–18

1 Licensed mental health professionals may include psychiatrists, psychologists, psychiatric/mental health nurse practitioners, psychiatric/mental health nurses, clinical social workers, and professional counselors.
2 A diagnostic mental health assessment is an evaluation conducted by a mental health professional that identifies whether an individual has one or more mental health diagnoses. This is in contrast to an educational assessment, which does not focus on clarifying a student’s mental health diagnosis. Treatment is a clinical intervention—which may include psychotherapy, medication, and/or counseling—addressed at lessening or eliminating the symptoms of a mental health disorder.
3 Examples of legal issues provided to respondents were malpractice, insufficient supervision, and confidentiality.
4 Mental health disorders refer to, collectively, all diagnosable mental disorders or health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.
NOTE: Respondents were asked to indicate the extent to which each factor limited the school’s efforts to provide mental health services to students. For each factor, they could select “limits in major way,” “limits in minor way,” or “does not limit.” Estimates in this figure represent only those schools reporting that a factor limited their efforts in a major way. Responses were provided by the principal or the person most knowledgeable about school crime and policies to provide a safe environment.
SOURCE: U.S. Department of Education, National Center for Education Statistics, 2017–18 School Survey on Crime and Safety (SSOCS), 2018.


The types of factors that schools reported as limiting their efforts to provide mental health services varied by school characteristics. This spotlight focuses on the top two limiting factors, (1) inadequate funding and (2) inadequate access to licensed mental health professionals, and examines differences by school characteristics in the percentages of public schools citing each factor as limiting in a major way their efforts to provide mental health services.

The percentage of public schools reporting that inadequate funding limited their efforts in a major way was higher for schools with an enrollment size of 300 to 499 students (58 percent) than for schools with enrollment sizes of 500 to 999 students (50 percent) and 1,000 or more students (46 percent; figure S1.4 and table S1.2). Inadequate funding was reported as a major limitation similarly across locales except that schools in rural areas (57 percent) were more likely to report this than schools in suburban areas (47 percent). Further, there were few differences between regions of the country, with only schools in the Northeast (44 percent) reporting a lower rate than schools in the West and the Midwest (55 and 56 percent, respectively). Similarly, the only difference by student FRPL eligibility was that a lower percentage of schools with 25 percent or less of students eligible (44 percent) reported inadequate funding as a major limitation, compared with schools where 51 to 75 percent of their students were eligible (58 percent).


Figure S1.4. Percentage of public schools reporting inadequate funding limited in a major way their efforts to provide mental health services to students, by selected school characteristics: 2017–18

Figure S1.4. Percentage of public  schools reporting inadequate funding limited in a major way their efforts to  provide mental health services to students, by selected school characteristics:  2017–18

1 Primary schools are defined as schools in which the lowest grade is not higher than grade 3 and the highest grade is not higher than grade 8. Middle schools are defined as schools in which the lowest grade is not lower than grade 4 and the highest grade is not higher than grade 9. High schools are defined as schools in which the lowest grade is not lower than grade 9. Combined schools include all other combinations of grades, including K–12 schools.
2 Percent combined enrollment of Black, Hispanic, Asian, Pacific Islander, and American Indian/Alaska Native students, and students of Two or more races.
NOTE: Respondents were asked to indicate the extent to which each factor limited the school’s efforts to provide mental health services to students. For each factor, they could select “limits in major way,” “limits in minor way,” or “does not limit.” Estimates in this figure represent only those schools reporting that a factor limited their efforts in a major way. Schools were instructed to include only services provided by a licensed mental health professional employed or contracted by the school. Licensed mental health professionals may include psychiatrists, psychologists, psychiatric/mental health nurse practitioners, psychiatric/mental health nurses, clinical social workers, and professional counselors. Responses were provided by the principal or the person most knowledgeable about school crime and policies to provide a safe environment.
SOURCE: U.S. Department of Education, National Center for Education Statistics, 2017–18 School Survey on Crime and Safety (SSOCS), 2018.


Patterns in the percentages of public schools reporting limitations due to inadequate access to licensed mental health professionals by locale, region, and student FRPL eligibility were similar to those observed for the percentages of schools reporting inadequate funding. Different patterns in the percentages of schools reporting these limitations were observed for other school characteristics. For example, traditional public schools (41 percent) were more likely to report inadequate access to licensed mental health professionals as a major limitation than public charter schools (28 percent), and combined and primary schools (48 and 42 percent, respectively) were more likely to report this than high schools (35 percent; table S1.2). Schools with an enrollment size of 1,000 or more students (32 percent) were less likely to report this as a problem than smaller-sized schools.


This spotlight indicator features data on a selected issue of current policy interest. For more information: Tables S1.1 and S1.2.


1 A diagnostic mental health assessment refers to an evaluation conducted by a mental health professional that identifies whether an individual has one or more mental health diagnoses. This is in contrast to an educational assessment, which does not focus on clarifying a student’s mental health diagnosis. Schools were instructed to include only services provided by a licensed mental health professional employed or contracted by the school. Mental health professionals were defined for respondents as including providers of mental health services within several different professions, each of which has its own training and areas of expertise. The types of licensed professionals who may provide mental health services may include psychiatrists, psychologists, psychiatric/mental health nurse practitioners, psychiatric/mental health nurses, clinical social workers, and professional counselors.
2 Mental health disorders refer to, collectively, all diagnosable mental disorders or health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.
3 Treatment is defined as a clinical intervention addressed at lessening or eliminating the symptoms of a mental health disorder. This may include psychotherapy, medication treatment, and/or counseling.
4 These seven limiting factors were included in the survey: Inadequate access to licensed mental health professionals; Inadequate funding; Potential legal issues for school or district; Concerns about reactions from parents; Lack of community support for providing mental health services to students; Written or unwritten policies regarding the school's requirement to pay for the diagnostic mental health assessment or treatment of students; Reluctance to label students with mental health disorders to avoid stigmatizing the child.
5 Primary schools are defined as schools in which the lowest grade is not higher than grade 3 and the highest grade is not higher than grade 8. Middle schools are defined as schools in which the lowest grade is not lower than grade 4 and the highest grade is not higher than grade 9. High schools are defined as schools in which the lowest grade is not lower than grade 9. Combined schools include all other combinations of grades, including K–12 schools.
6 Minority student enrollment refers to the combined percentage enrollment of Black, Hispanic, Asian, Pacific Islander, and American Indian/Alaska Native students and students of Two or more races.
7 Percentages do not sum to 100 percent because some schools reported providing assessments or treatment but did not specify the location at which these services were provided. For at school and outside of school, mental health services were provided by a school-employed or -contracted mental health professional.