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Removing Roadblocks to Effective Recognition and Treatment of Adolescent Mental Illness

By June Naureckas, CEI Intern

An Under-Treated Epidemic

Mental illness in American children is chronically under-treated and under-diagnosed. According to the National Alliance on Mental Illness (NAMI) 2015 report, 21.4% of youth ages 13-18 experience a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%. However, the same report indicates that less than half of mentally ill youth receive treatment and health resources are unevenly distributed, with Latino/a and uninsured youth most at risk of not receiving treatment.

Keeping an eye out: Teachers and Parents

CEI’s Executive Director Dr. Christine Mason notes that, “Teachers and parents spend a lot of time with their kids, but may not have the knowledge or training to recognize warning signs.”

  1. Parents often assume that symptoms are “moodiness” or phases that will pass quickly, but this assumption can prove dangerous.

  2. Mental health symptoms can have a rapid onset and quickly become serious, so parents need to communicate with schools as soon as they suspect something is wrong (Anderson & Cardoza, 2016).

  3. Teachers sometimes spend even more hours per day with students than parents do, but can be equally unprepared to identify risk signs.

  4. NAMI reports that teachers need training both to identify mental health concerns in students and to interface with counselors and mental health professionals within the school (NAMI, 2015).

In-School Treatment: Social Workers and Counselors

Unlike parents and teachers, social workers, counselors, and school psychiatrists do have the training to recognize mental health symptoms in their students. However, they can still fail to identify and treat at-risk students due to overwork, under-funding, and insufficient staffing:

  1. The National Association for Social Workers (NASW) recommends a ratio of 1 social worker for every 250 general education students, or 1 for every 50 students who need more intensive support, but notes that some school districts have no social worker positions at all (NASW, 2012, 2018).

  2. According to the American School Counselor Association, each school counselor should provide services to about 250 students (ASCA, 2014-2015). Schools that fail to meet this ratio have lower graduation and school attendance rates as well as higher rates of disciplinary incidents (Lapan, et al., 2012).

  3. School psychologists can be best qualified to support mentally ill students and help them find resources, but also take on the largest caseloads, with nearly 1,400 students for every school psychologist. (Anderson & Cardoza, 2016).

  4. The National Association for School Psychologists (NASP) recommends that caseloads be cut at least in half, with each school psychologist providing care to between 500 and 700 students (NASP, 2016).

In all of these professions, the actual ratios of providers to students often fall well below the recommended ratio, and both faculty and students are suffering for it. As a short-term solution, NAMI recommends linking school faculty to community mental health resources to  improve the quality of care students received.

What do students need right now? Ending the Silence

  1. In a study of ten schools, comparing students who went through a 50-minute Ending the Silence class and students from a control group, knowledge and stigma towards mental illness improved in the Ending the Silence group but not in the control group.

  2. Ending the Silence provides seminars for school staff as well as families. Seminars provide accurate facts and statistics on mental illness issues – locally and nationally; help participants learn to identify warning signs; and offer advice on best practices in discussing mental health concerns between staff and families as well as with students.

To schedule an Ending the Silence seminar, find your local NAMI.


American School Counselor Association (2014-2015). State-by-state student-to-counselor ratio report.

Kataoka, S. H., Stein, B. D., Jaycox, L. H., Wong, M., Escudero, P., Tu, W., … & Fink, A. (2003). A school-based mental health program for traumatized Latino immigrant children. Journal of the American Academy of Child & Adolescent Psychiatry42(3), 311-318.

Lapan, R., Gysbers, N., Stanley, B., & Pierce, M. (2012). Missouri professional school counselors: Ratios matter, especially in high-poverty schools. Professional School Counseling,16(2), 108-116. doi:10.5330/psc.n.2012-16.108

National Alliance on Mental Illness. (2015). Ending the silence.

National Association for School Psychologists. (2013, January). Recommendations for comprehensive school safety policies.

National Association of Social Workers. (2012). NASW standards for school social work services.

National Association of Social Workers .(2018, March 27). NASW highlights the growing need for school social workers to prevent school violence.

National Research Council and Institute of Medicine. (2009) Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: The National Academic Press.


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