The number of students experiencing poor mental health is growing, especially among LGBTQ+, female, and Black students. An analysis by the National Center for Education Statistics found that 69 percent of public schools have seen an increase in students requesting school mental health services, and 76 percent of schools reported that their staff have expressed increased concerns about student mental health. In addition, CDC data show that 70 percent of LGBTQ+ students reported persistent feelings of hopelessness and 25 percent of female students have made a suicide plan. Further, whereas 96 percent of public schools report providing mental health services to students, 87 percent did not strongly agree that they are able to provide those supports to all students who need them, citing insufficient funding and a lack of qualified mental health professionals in schools. Youth who have mental health problems are more likely to experience violence, engage in risky behavior, and struggle with school which can have longer-term impacts on their schooling, career, and life trajectories.
The U.S. Department of Education has recognized the need to increase funding for student mental health and has provided more than $286 million in funding to 264 grantees in 48 states and the District of Columbia to support student mental health in schools. Unfortunately, the demand for support services is outpacing the available resources and capacity of providers. One way to increase access to mental health supports in schools is to take advantage of school nurses’ expertise and existing connections to students.
In the wake of the COVID-19 pandemic, it is clear that schools need more structures and supports to identify, triage, and address student needs. The federal government, along with a number of state governments, recognized this need and enacted legislation to support student mental health. The federal Student Support and Academic Enrichment grant program provided $1.28 billion in 2022, an increase of $60 million from 2021, to school districts. This funding focuses, in part, on providing a safe and healthy school environment and can be used for both hiring and professional development to school counselors. Feelings of belonging and school connectedness can have a protective effect against mental and behavioral challenges. This makes it all the more critical that schools are well resourced and staffed to intervene in times of crisis and provide preventative care, particularly for students whose parents may struggle to provide the level of care they need.
School nurses, who are sometimes overlooked in the broader conversation about student mental health, are already integrated into the fabric of the school community and provide multifaceted support to students, their families, and the communities. Mathematica and the National Association of School Nurses (NASN) recently partnered to better understand the role that school nurses play in supporting the mental health of students, families, schools, educators, and communities. Here’s what we learned.
School nurses are in a unique position to provide direct care and build connections with students. School nurses are among the first school staff to identify potential mental health concerns. These issues can manifest in physical ways like frequent visits to the school nurse for stomachaches, nausea, or dizziness. A child who is struggling might be more comfortable confiding in a nurse during such a visit than in a school counselor or other adults. These touchpoints enable school nurses to build connections with students and advocate for their care. In addition to caring for students’ physical health needs, school nurses can provide coaching and counseling, and educate students on self-care and coping skills.
School Nurse Snapshot
“When students come to me with anxiety or stress, I can offer a wide range of options, from addressing basic needs like food and hydration to referring them to the school counselor. I often teach students coping skills like breathing exercises or offer them a weighted blanket for comfort. Sometimes if a student is just having a bad day, I’ll call a friend to come sit and chat with them.”
– Lynne Signore, a school nurse in Maine
School nurses play a critical role in coordinating care and making referrals to school- and community-based providers.
When school nurses have frequent contact with students, they also are likely to have frequent contact with their family caregivers, which puts them in a unique position to build trusted relationships with the student and their family to help them manage care. School nurses can support students’ access to care at school (such as to school counselors) and are aware of other community-based providers, resources, and services that fit the student’s needs and identities. School nurses are also well positioned to collect and manage health data, which can include information related to attendance and social determinants of health to help build a complete picture of the student’s health needs and inform referrals.
School Nurse Snapshot
“We had a student whose teacher was concerned about their behavior and mental health. After an initial assessment, I gathered the school’s mental health team, connected with the student’s parents, and helped the student access crisis support services. On their last day as a senior, the student came into my office and shared a heartfelt thank you for listening to them that day two years ago.”
– Gloria E. Barrera, a school nurse in Illinois
School nurses routinely support Individualized Education Program accommodations and implement Individualized Health Care Plans (including Section 504 plans and safety plans), participate in universal and targeted mental health screenings and follow-up, and contribute to crisis response planning and emergency preparedness. School nurses also educate and enhance school and district teams by offering their expertise in planning, intervening, and evaluating emergencies, including behavioral health crisis events. Finally, in collaboration with the interdisciplinary education team, school nurses provide critical links to prevention, early identification, interventions, and referral for students with mental health concerns.
School Nurse Snapshot
“I participate in a weekly Student Assistance Team meeting with school counselors, social workers, a substance abuse counselor, administrators, and a student resource officer. We discuss student referrals, come up with plans for the students, and follow up with one another as the situation requires. In these meetings, we raise concerns about students who need additional support, students I should keep an eye out for or who may need a little TLC. I feel extremely lucky to have the resources we have in our school.”
– Lynne Signore, a school nurse in Maine
School nurses need more support to continue serving in these critical roles.
The many ways that school nurses regularly interact not only with students but with parents, school administrators, counselors, educators, and outside health providers puts them in a unique position to support student mental health, especially given the shortage of licensed mental health professionals in schools. However, to take full advantage of school nurses’ positioning and significant expertise, state education entities and districts need to ensure that school nurses have a formalized, well-funded role in school-based services broadly and mental health supports in particular. In addition, school entities can incorporate nurse perspectives in planning processes to ensure their critical roles are incorporated clearly and consistently.
