The Washington PostDemocracy Dies in Darkness

If Americans really cared about students’ mental health, these school ratios would be very different

Kristi Gilroy hugged a young woman at a police checkpoint near the Florida school where 17 people were killed by a gunman Wednesday. (Mark Wilson/Getty Images)

Grief counselors are always made available to help students when there is a traumatic event at a school, such as this week, when a gunman entered a Florida high school and fired a military-style assault weapon, killing 17 people. While health experts say counseling after a tragedy is vital, too many schools don’t have anywhere near enough health professionals to help students before the catastrophes.


In U.S. public schools today, it’s estimated there is one school psychologist for every 1,381 students. The National Association of School Psychologists recommends one psychologist for every 500 to 700 students (which itself makes very busy work days for psychologists).

Let’s turn to school counselors.

According to the latest available information from the American School Counselor Association, there was one counselor for every 482 students in 2014-2015. It’s nearly twice what the association recommends: one counselor for every 250 students (which makes for very busy days for school counselors.)

And then there are school-based nurses. The National Association of School Nurses and the National Association of State School Nurse Consultants recommend that every student have direct access to a school nurse, though some states have recommended there be one school nurse for every 750 students in the healthy student population (which makes for a busy day for school nurses).

Yet a 2017 survey by the National Association of School Nurses found that only 39 percent of private and public schools in the United States have full-time nurses. In North Carolina, for example, a new legislative study found that the state would need to spend up to $79 million a year in additional money to meet the 1 to 750 nurse-student ratio in public schools.

School-based psychologists, counselors and nurses do related but different things for students, but they are all professionals who are supposed to be part of the human scaffolding constructed around students to help them do their best in school.

According to the Association for Children’s Mental Health, addressing mental health needs in schools is vital because “1 in 5 children and youth have a diagnosable emotional, behavioral or mental health disorder, and 1 in 10 young people have a mental health challenge that is severe enough to impair how they function at home, school or in the community.” And it says that many estimates show that among kids aged 6 to 17, “at least one-half and many estimate as many as 80 percent” don’t receive the mental health care they require.

“It’s a huge issue,” said Amanda Nickerson, director of the Alberti Center for Bullying Abuse Prevention at the University at Buffalo Graduate School of Education, who is attending the annual convention in Chicago of the National Association of School Psychologists. “We do not have enough mental health professionals to meet the increasingly complex needs of the students that are walking through the door.”

Nickerson said the inevitable calls for immediate action after a shooting often miss the point.

“We are getting better providing, unfortunately in some ways, the crisis intervention, but that’s after something terrible happens,” she said. “As we look toward solutions after something like this happens, people automatically go to highly expensive hardware sorts of solutions. Why don’t we have metal detectors? Where are the cameras? Where are the guards?

“I’m not saying those things aren’t important,” she said. “But to create a safe and secure environment, we have to address psychological safety and connectedness and how we are resolving conflicts that doesn’t involve more conflict. That is critically important, and our school-based mental health experts are trained to do that. But there aren’t enough people and not enough hours in the day currently with the way our staffing is.”

Though research and common sense say that schools should be properly staffed with health professionals, that has not been the focus of modern school reformers, who have focused not on the health of students but on testing metrics.

That was true in Democratic and Republican presidential administrations, including the current one. President Trump’s statement about the shooting in South Florida, which left 17 people dead, said in part:

Our administration is working closely with local authorities to investigate the shooting and learn everything we can. We are committed to working with state and local leaders to help secure our schools, and tackle the difficult issue of mental health.

Yet on Monday, his administration released a 2019 budget proposal that mental health professionals said does not show a commitment to tackling the many issues affecting mental health.

The National Association of School Psychologists, for example, expressed “deep concern” with specific proposed items, including gutting significant programs in the federal K-12 law. The American Psychological Association said while the budget includes additional resources to address the nation’s opioid epidemic, improve veterans’ health care and fund scientific research, it “would decimate critical education, justice and behavioral health workforce programs if enacted.”

There is something else missing in the United States that affects the mental health of students, as explained in this Washington Post story about mass shootings at U.S. schools compared with other countries:

There’s also another crucial difference with the United States: extensive, mandatory health insurance, which allows schools to have direct and immediate access to psychologists and intervention teams.

Europeans had school shootings, too. Then they did something about it.

If schools are calling in grief counselors, it’s already too late to avoid disaster. And if Americans really cared about having the personnel in schools to address mental health needs, then schools would be adequately staffed with the professionals who students need to be healthy and do their best.