One-third of public schools mandate student mental health screening, but barriers persist

One-third of public schools mandate student mental health screening, but barriers persist | Image Credit: © Photographee.eu - stock.adobe.com.

Nearly one-third of US public schools require mental health screening for students, and most provide treatment or referrals when concerns such as depression or anxiety are identified, according to a study published in JAMA Network Open. However, significant barriers remain in ensuring students receive appropriate follow-up care.^1,2

The research, led by Jonathan Cantor, PhD, and colleagues from the RAND Corporation and other institutions, analyzed responses from 1,019 K-12 public school principals participating in the RAND American School Leader Panel. This nationally representative survey, conducted in October 2024, explored school policies and practices related to mental health screening and care.

The investigators found that 30.5% of principals reported their school district mandated mental health screening. Among schools conducting such screenings, 79.3% said parents are typically notified if a student screens positive for depression or anxiety. More than 70% offer in-person treatment services on campus, while 53% refer students to community mental health professionals.

Despite these efforts, many principals reported challenges in connecting students to care. Specifically, 40.9% said it was “very hard” or “somewhat hard” to ensure students received appropriate services, whereas 38.1% found it “very easy” or “somewhat easy.” The remainder indicated the task was neither easy nor difficult.

“Our results suggest that there are multiple barriers to mental health screening in schools, including a lack of resources and knowledge of screening mechanics, as well as concerns about increased workload of identifying students,” said Cantor, lead author and policy researcher at RAND.

The study also examined school characteristics associated with mental health screening mandates. Screening policies were more likely in larger schools (≥450 students) compared with smaller ones (<449 students) (OR, 1.32; 95% CI, 1.00–1.75; P = .048), and in schools where the majority of students identified as members of racial and ethnic minority groups (OR, 1.48; 95% CI, 1.12–1.96; P = .01). No significant differences were found based on school level (elementary, middle, or high school), neighborhood poverty, urbanicity, or regional location.

The authors noted that public schools are well-positioned to identify and support students with mental health needs, particularly in light of ongoing concerns following the COVID-19 pandemic and the 2021 declaration of a youth mental health emergency by the U.S. Surgeon General. Schools often serve as the primary access point for health services for children facing barriers to care in other settings.

“Policies that promote federal and state funding for school mental health, reimbursement for school-based mental health screening, and adequate school mental health staff ratios may increase screening rates and increase the likelihood of successfully connecting the student to treatment,” Cantor said.

The study’s authors acknowledged several limitations, including its restriction to public schools and the absence of data on early intervention services or treatment quality. However, they emphasized the value of these findings in highlighting current practices and gaps in the provision of mental health care in educational settings.

References:

1. RAND Corporation. One-third of U.S. public schools screen students for mental health issues. EurekAlert. July 18, 2025. Accessed July 18, 2025. https://www.eurekalert.org/news-releases/1091466
2. Cantor J, McBain RK, Rankine J, et al. Screening for Mental Health Problems in US Public Schools. JAMA Network Open. 2025;8(7):e2521896-e2521896. doi:https://doi.org/10.1001/jamanetworkopen.2025.21896

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