One in five children has a diagnosable mental health problem, but nearly two-thirds get little or no help. An estimated 13% of children and adolescents worldwide have significant mental health problems, such as anxiety or depression. Over 15% of high school students have seriously considered attempting suicide. These statistics, plus the many school shootings make it clear that our children and adolescents have mental health needs. Since most children spend much of their time at school, it offers an excellent opportunity to reach many of them with mental health education, prevention and treatment.

There have been attempts to provide mental health services in the schools. For many years, schools have had school counselors on-site. Unfortunately, they have often been given administrative duties that limited their time to do actual counseling. At times, schools have contracted with clinical mental health professionals so that students with identified diagnoses could be seen on the school campus during the school day. This service does increase the availability of treatment, but many students can slip through the cracks, and insurance or Medicaid has to be billed for the treatment.

There have been several examples of more comprehensive school-based mental health programs. A recent review in the Harvard Review of Psychiatry evaluated the effectiveness of eight such programs. The research linked those programs to benefits such as reducing anxiety, improving reading scores, reducing bullying in school, and lowering rates of substance abuse in young adults. Altogether, the programs reached over 27 million students over the last ten years.

These comprehensive programs provide a combination of mental health education, social skills building, small-group activities and when needed, individual therapy. The education components are sometimes taught by specially trained teachers, and sometimes by mental health professionals. Services are made available to all students, regardless of insurance coverage.

The Harvard Review authors concluded that school-based programs continue to be one of the most promising types of preventive mental health interventions for children. Of course, such programs will cost money, but considering the prevalence of mental health programs in our children and adolescents, and the recent incidents of school violence, we may not have a choice.