Kearney Christopher A
Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, Las Vegas, NV, 89154-5030, USA.
Res Child Adolesc Psychopathol. 2025 May;53(5):609-624. doi: 10.1007/s10802-024-01253-2. Epub 2024 Sep 30.
Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.
儿童和青少年精神障碍的发病率急剧上升，而许多家庭仍然难以获得社区心理健康护理服务。社区心理健康护理存在大量且持续的障碍，促使多个利益相关方寻求一种在生态上合理且更易获得的环境中强调健康促进和干预措施的方法。其中最突出的环境是学校，学校可以作为包括心理健康护理在内的各种服务的本地集中接入点。然而，基于学校的心理健康服务提供系统的迅速扩张，既存在有害的风险，也在有效和公平护理方面有着重大前景。本文总结了围绕基于学校的心理健康服务提供系统的关键问题，包括非善意和伤害、支持差距、不可持续的实施、压抑的学校氛围以及与惩罚性和歧视性做法的联系。针对这些问题，还提出了广泛的建议，以帮助实现为有心理健康和行为挑战的学生提供有效和公平护理的前景。与此同时，为充分发挥基于学校的心理健康服务提供系统的潜力，需要解决分配给学校的各种任务之间以及学校与其周边社区之间自然存在的紧张关系。
