Adolescent utilization of school based mental health services in the United States

Background: Over 14 million adolescents have a diagnosable mental, behavioral, or emotional disorder yet only 20% receive adequate mental health services. There is a critical need to identify accessible and effective pathways to treatment. School based mental health services (SBMHS) are an optimal setting for timely identification, effective management, and convenient delivery of evidence-based mental health care. Methods: Using data from the 2019 National Survey on Drug Use and Health, we employed structural equation modeling to examine the relationships between utilization of SBMHS and school and academic engagement, religiosity, self-reported depressive symptoms, and parental monitoring and support. Results: Higher levels of parental monitoring and support (ß = -0.044, p < 0.05) and religiosity (ß = -0.027, p < 0.05) along with lower levels of school and academic engagement (ß = 0.069, p < 0.001) were associated with decreased adolescent utilization of SBMHS. Adolescents reporting a higher number of depressive symptoms on a scale of 1 to 9 (ß = 0.221, p < 0.001) were more likely to utilize SBMHS compared to their counterparts. Self-reported depressive symptoms mediated the relationship between all latent variables (parental monitoring and support [ß = -0.222, p < 0.001]; religiosity [ß = -0.051, p < 0.001]; school and academic engagement [ß = -0.067, p < 0.001]) and adolescent utilization of SBMHS. Conclusion: Findings from this study offer psychologists, teachers, counselors, school nurses, and administrators specific determinants of service use that can be used to develop strategies for adolescent mental health assessment, increase SBMHS utilization among those in need, and support overall emotional well-being.