School-based mental health services

Why they are not the answer to the teen mental health crisis

I’m assuming you have all heard that we are in the midst of a teen mental health crisis. It’s possible that teenagers are struggling more, or that we’ve become better at identifying, diagnosing, and treating their problems. More likely than not, it’s a combination of the two. Regardless, I strongly support increasing the accessibility of mental health services for all.

So it might sound strange that I don’t support the push to expand mental health services in schools. Here’s why:

Therapists are governed by a set of ethical standards that are meant to provide the highest possible standard of care in treatment. Two important ethical standards are confidentiality and avoidance of multiple relationships.

• Confidentiality means that therapists are required to keep clients’ information private. Clearly, clients can only be open and honest with therapists if they are confident information will not be shared with outsiders.

• Avoidance of multiple relationships means that a therapist cannot be in a non-therapeutic relationship with a client or in a therapeutic relationship with a person closely associated with a client. In theory, multiple relationships can impair therapists’ objectivity and effectiveness.

School-based mental health services violate both of these ethical standards.

• Therapy that takes place in school is never totally confidential. It is almost impossible for students to attend therapy sessions in school without peers noticing. And the sheer threat of a kid’s classmates finding out that they are in therapy is enough of a barrier to prevent many kids from attending in the first place.

• It is virtually impossible for school-based therapists to avoid multiple relationships. Not only do school-based therapists oftentimes wear many hats (e.g. learning specialists, educational diagnosticians, teacher consultants, group therapists), but they are also bound to treat lots of kids who are closely associated with one another.

Therefore, school-based mental health services are inappropriate solutions to the teen mental health crisis, and their effectiveness is limited.

That’s not to say that school faculty do not serve a crucial role on the front lines. Led by school psychologists and social workers, they have an important role in identifying and screening kids at risk and referring to outside mental health services. But they should not enter into quasi-therapeutic relationships directly with the students themselves.

Moreover, schools are already stretched to their limits. We can’t keep expecting them to be everything for everyone.

Instead, we need to make psychotherapy accessible for more kids. Specifically, we must increase insurance reimbursements for licensed providers in clinical settings. After all, this is a healthcare problem, so we need a healthcare solution.

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I clicked a few links to decide on my favorite version of “Skid Row.” Scroll to 2:05 for a familiar face!