Advancing equity in access to school mental health through multiple informant decision-making

The Perniciousness and Promise of School-Based Mental Health Service Delivery for Youth

Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.

Promoting equity and justice in school mental health

Advancing equity and justice in school mental health can address inequities in school-based services and outcome disparities. The purpose of this special issue is to promote equitable and just systems and practices in school mental health to promote change in institutional practices that have produced and reproduced inequities over time. The four articles in this special issue clarify a process for advancing equity in school mental health by addressing justice-centered variables to promote connections across and within systems to realize a vision of comprehensive and integrated school mental health.