For many youths in the US, schools are the most reliable entry point into health care—providing resources for nutrition, vision care, immunizations, and mental health. Many barriers to mental health care—cost, transportation, stigma, long waitlists, etc—can keep families from accessing community clinics, but those barriers are reduced when mental health professionals are embedded in schools. The data show these services matter: school-based mental health (SBMH) services reduce suicide attempts, improve emotional well-being, and even strengthen academic performance.1-3 And yet, despite clear evidence of benefit, SBMH programs are under increasing threat. As recent budget cuts and policy shifts demonstrate, these vital services remain vulnerable, even as demand for youth mental health care continues to grow. When SBMH supports disappear, the consequences ripple outward, not only harming the students who lose access to care, but also straining families, teachers, and communities who must fill the gaps. [JAMA Pediatrics]
The data are compelling. A landmark meta-analysis1 of more than 200 school-based programs involving more than 270 000 students found consistent improvements in social-emotional skills, prosocial behavior, and emotional well-being, alongside a significant gain in academic achievement. A systematic review and meta-analysis2 confirmed that these interventions yield small to moderate decrements in anxiety, depression, and conduct problems across diverse populations. More recent analyses3 show that school-based programs are not just supportive, but lifesaving: expansion of mental health services in schools has been linked to reductions in suicide attempts and greater use of outpatient mental health care. School health care professionals can see students much more frequently than community physicians, allowing them greater opportunities to identify students in crisis; additionally, school health services can facilitate referrals to community mental health care professionals, which can be particularly helpful for families with limited resources or low health literacy. These are not marginal gains—they are measurable impacts on child and adolescent health trajectories and, in some cases, survival.
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