Recently, the Centers for Medicare and Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administration released a joint informational bulletin, Guidance to States and School Systems on Addressing Mental Health and Substance Use Issues in Schools.

This informational bulletin is an important step toward ensuring more children and youth are able to access needed care and is particularly timely given the concerning prevalence of mental health and substance use problems among young people. Newly updated data from the Centers for Disease Control and Prevention echoes the bulletin and paints a stark picture of young people’s mental health and substance misuse, including an alarming upward trend in suicide rates. These trends are especially worrisome for groups who are more likely to experience adversity or trauma. For instance, LGBTQ youth facing discrimination, harassment and barriers to accessing culturally competent care are more likely to experience suicidal ideation than their straight and cisgender peers. Migrant children detained at the United States border in squalid conditions and separated from their caregivers will also need access to mental health services to recover from these traumatic experiences.

Despite these challenges, there are opportunities to improve the health and well-being of young people. Since many children and adolescents spend a majority of their day in schools, we can increase access to care and improve outcomes by establishing policies that support school-based health services and foster supportive school environments. The guidance provides a variety of examples of how to do that, including the following:

  • Building Mental Health Literacy: A universal prevention strategy that schools can use with all staff and students to raise awareness and understanding of mental health issues. Examples include Mental Health First Aid and Youth Mental Health First Aid.
  • Peer Support: Peer support helps children and youth navigate mental health and substance use challenges by developing trusting relationships and sharing lived experience with young adults in recovery.
  • Medicaid Billing in Schools: In 2014, CMS reversed the long standing “free care” rule. This change allows school districts to bill for health services delivered to all Medicaid-enrolled children, including mental and behavioral health care. For more information, see the issue brief developed by Community Catalyst, Healthy Schools Campaign and Trust for America’s Health.

We offer one note of caution. The guidance discusses the use of resource officers as one possible method of addressing mental health in schools. As the ACLU’s recent report shows, schools with police officer presence reported 3.5 times as many arrests as schools without police, which disproportionately affected youth of color and youth with disabilities. Rather than leading to greater access to health care services, resource officers in schools resulted in more students entering the criminal justice system. Given this reality, we urge advocates to focus on incorporating mental and behavioral health providers into the school setting rather than relying on resource officers.

The new informational bulletin offers advocates an opportunity to check in with state Medicaid and Education agencies on access to mental health and substance use services in schools. Since we know that coverage is the foundation of access to care, advocates should begin the conversation with state officials by discussing enrollment data and strategizing on how to stop declines in enrollment in Medicaid and CHIP if that is occurring in your state. Advocates can then discuss the various options described in the bulletin and suggest ways that their schools can incorporate them or improve on any methods already in place. Reach out to us if you would like to brainstorm additional ways to use this bulletin in your advocacy.

This blog was developed in partnership with Healthy Schools Campaign. You can view the blog on their website here.