Students with disabilities often do not receive supportive services if they have coexisting mental health disorders. Students classified with emotional or behavioral disorders for an individualized education plan may be supported by a functional behavior assessment and, in some cases, a behavior intervention plan, but mental health is not included as a related service. Without appropriate mental health services, students face poorer outcomes. Results from a survey of special education teachers and behavior support specialists along with a secondary analysis of existing data revealed that respondents did not receive any mental health training that would allow them to support students with mental health needs. Moreover, funding, legal issues, and policies were emerging themes that likely contributed to the lack of appropriate mental health support in public school systems.
TopIntroduction
The Individuals with Disabilities in Education Act (IDEA) guarantees a free appropriate education for children who are classified with one or more of the thirteen disabling conditions. Children can receive services in areas that are significantly impacted by their disabilities, including reading, math, speech language and behavior. However, one area that may not be addressed and is often overlooked is mental health. The Education for all Handicapped Children Act of 1975 intended to grant the right to education, and accountability for local education agencies to provide educational services for all handicapped children, though not including the term mental health (Cataldo-Homes, 2018).
In the United States, there are over 70 million people impacted by mental illness. According to the Center for Disease Control (CDC) (2018), one in six children between the ages of two and eight (17.4%) was diagnosed with a mental health disorder. The number of children diagnosed with a mental health disorder is more than cancer, diabetes and AIDS combined (Child Mind Institute, 2015). Swick and Powers (2018) reported that approximately 30% of children under the age of 18 face a high probability of experiencing a mental illness (emotional, behavioral, or developmental) during their lifetime. Educators and policymakers agree that mental health care is a critical component for student success; however, it also recognized that schools may not primarily organized in a way that would allow mental health services to be successfully integrated into school programming (Reinke, Stormont, Herman, Puri & Goel, 2011). This could be due to several factors, including limited fiscal and human resources, a lack of understanding about the provision of mental health services, and the absence of universal screening and assessment measures (Dever & Raines, 2013).
“Despite evidence that mental health care is needed in schools, there has been relatively little systematic study of current therapeutic services provided in school settings or of resources and barriers related to providing evidence-based practice (EBP) of such services” (Kataoka, Forness & Miranda, 2014). While mental illness may affect as many as 80% of school-aged children, the provision of mental health care has been largely non-existent Cataldo-Holmes (2018). Students with mental health conditions have a higher likelihood of experiencing academic problems, making it difficult to provide services for one without also addressing the other (Climie, & Altomare, 2013). The CDC reported that approximately 10% of public-school students in the United States have academic deficits caused by mental or emotional health issues (Swick & Powers, 2018). A mental health illness can manifest itself as a significant behavior disorder, commonly classified as serious emotional disability (SED), emotional disturbance (ED) or behavior emotion disturbance (BED). Behavior problems are more common in children between the ages of six to 11(CDC, 2018), many of whom receive behavior services that focus reducing or eliminate problem behaviors. If a mental health issue is a correlating factor in a student’s behavior problems, the issue may not be addressed within the context of IEP-based behavior support.
Minnesota is one of the highest-ranking states that offers school-linked mental health treatment for the estimated 100,000 children from birth to age 21 years old who are diagnosed with serious emotional disturbances (Minnesota Department of Human Services, 2018). In their youth rankings, Mental Health America (2019) ranked states who have lower mental illness and higher rates for children’s access to care compared to states where children have higher prevalence of mental illness and lower rates of access to care. State rankings were determined by several factors, including:
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Experiencing one or more episodes of major depression.
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A diagnosis of severe major depression.
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A diagnosis of major depression, but no provision of mental health services
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Experiences with severe episodes of major depression and consistent treatment.
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Private insurance that did not cover mental health.
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A classification of emotionally disturbance on an IEP.