Feb 2, 2023 - Health

The funding cliff for student mental health

Illustration: Annelise Capossela/Axios

Public school districts that received a windfall of COVID relief funds for mental health services are confronting a new dilemma: How to sustain counseling, screenings, teletherapy and other programs when the money runs out.

Why it matters: The youth mental health crisis is not getting better, and schools are increasingly being pressed into service as first responders amid rising rates of suicidal ideation, overdoses and gun violence.

The big picture: Advocates, researchers and administrators told Axios the schools will be hard-pressed to retain qualified mental health personnel after the funding expires at the end of fiscal 2024.

  • It's not just the inability to pay counselors but the sheer magnitude of the problem in some regions, said Mary Windecker, executive director of Behavioral Health Alliance of Montana, a coalition of Medicaid-state-approved youth mental health providers.
  • "There's so many needs in the schools and the teachers are struggling with so many issues with coming out of COVID that in many ways, it wasn't enough money," Windecker told Axios. "The kids are just deteriorating rapidly from a mental health standpoint."
  • "It will be extremely challenging to prioritize mental health services," said Sasha Pudelski, director of advocacy at AASA, the School Superintendents Association. "That doesn't mean they're not going to try ... but it's an ominous challenge."

Driving the news: Effective School Solutions, which provides mental health services to schools across the country, launched an effort Thursday to help districts tap 13 different funding sources to establish sustainable mental health programs.

  • The suggestions include turning to Medicaid to help cover eligible students and utilizing some of the $1 billion in last summer's bipartisan gun safety legislation that's designated for mental health support.
  • A new team of former administrators will also serve as funding consultants for schools in at least nine states, including New Jersey and California.
  • More than half of school administrators responding to a December survey from ESS said they needed more information about alternate funding sources. Help is fragmented, said Effective School Solutions CEO Duncan Young.

Catch up quick: The 2020 CARES Act and follow-on pandemic relief and spending bills designated a total of $190 billion for the Elementary and Secondary School Relief Fund, or ESSER, to help districts step up investments in mental health support.

  • The catch is the funds expire in September 2024, putting schools in "use it or lose it" mode, without assurances of a future funding stream.
  • Behavioral health is already facing an unprecedented squeeze, with a shortage of qualified workers creating to barriers to care. Nearly half of the U.S. population — 47% or 158 million people — lives in a mental health workforce shortage area, per KFF.
  • More than a third of spending plans from 5,000 local education agencies envision using the final batch of ESSER funds that expire next year on mental health workers, according to an analysis from FutureEd at Georgetown University’s McCourt School of Public Policy.

Be smart: Schools that can't find mental health workers — or may not be able to afford to keep them once the aid runs out — are likely to shift focus to academic needs to avoid losing the money, Pudelski told Axios.

  • "Teachers and schools have said for years that they need more support on the mental health side, but there hasn't really been the money for it," said Phyllis Jordan, associate director at FutureEd. "And suddenly there's money for it but there weren’t necessarily people trained to do it."

By the numbers: More than 60% of public schools reported insufficient mental health staff to manage the need as a barrier to providing mental health services, according to an April survey from the Institute of Education Sciences.

  • Close to half said a factor was inadequate funding.
  • The national school psychologist-to-student ratio is 1,127 students for every psychologist, according to data from the National Association of School Psychologists. The recommendation is 500 to 1.

What we’re watching: Some advocates are pushing the Department of Education to extend the spending deadline so schools don’t have to cut off mental health services amid a growing need unlikely to abate by next year.

  • The Department of Education hasn't signaled yet whether it will allow an extension past the 120 days grace period from Sept. 30, 2024.
  • A senior administration official told Axios that any decision would be made closer to the expiration date.

Yes, but: Appeals for more mental health funding could also draw scrutiny as some conservatives bristle at letting schools teach social and emotional skills. Some districts have allocated relief dollars in that direction.

Go deeper