PolicyLab

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Editor's Note: This post is part of our Blind Spots series, exploring how current and potential future policy changes will affect children, families, and communities, and what can be done to mitigate harm. 

Adolescence is an exciting time. Young people experience significant growth throughout this period as they develop into young adults. They deserve policies that serve their unique developmental needs. In this piece, we explore such policies in the context of school-based mental health services, which serve as critical resources for young people at a time when youth mental health needs are high.  

In 2023, one in five adolescents seriously considered attempting suicide; at the same time, adolescents face persistent barriers accessing outpatient mental health treatment. These trends highlight a pressing challenge for policymakers, educators and researchers: how can we build scalable systems that reach youth where they already are? Schools represent one of the most promising entry points for supporting youth mental health. Adolescents spend the majority of their waking hours in schools. This places school professionals in a unique position to recognize early signs of distress and connect students to services.   

School mental health services are needed more urgently than ever in light of federal policy changes that may affect access to behavioral health care in community and health care settings. And yet, the policy landscape supporting school-based mental health services is also uncertain: schools and districts face recent federal funding disruptions that affect programs designed to expand the school mental health workforce. 

Efforts to strengthen school-based mental health services often focus on expanding the number of counselors, psychologists and social workers available in schools. As researchers at PolicyLab, we focus our research on increasing behavioral health capacity with two additional groups who are often overlooked in this conversation: school nurses and teachers. One of us (Ancheta) examines school nursing policies nationally with an eye to improving standards for this critical workforce at the state level, and supporting them to meet student health needs—including mental health. The other (Lawson) researches teacher-delivered interventions relevant for student mental health to expand student mental health services in schools. In this post, we’ll make the case for how these key groups of professionals can serve as resources to support youth mental health. 

Broadening our thinking about the adults who can support student mental health 

Although school nurses and teachers do not have specialty training as mental health providers, their impactful, everyday interactions with students position them as key adults who can identify mental health concerns and ultimately support youth mental health and well-being.

As embedded health professionals, school nurses frequently encounter students whose emotional distress manifests as physical symptoms, like headaches, stomachaches or fatigue. A student who repeatedly visits the health office for unexplained reasons may actually be experiencing anxiety, depression or bullying. In these visits, school nurses can recognize warning signs, provide brief support, and help connect students to appropriate services or care.  

Similarly, as trusted adults who interact with young people daily, teachers are often the first to recognize student mental health concerns, and can serve as “front-line providers” to connect students with the appropriate support. And unlike other school-based professionals, like a school psychologist or social worker, who work with a smaller subset of students, school nurses and teachers often interact with the entire student body, making them critical access points for identifying students whose needs might otherwise go unseen. 

Research has documented a growing interest in expanding the roles these professionals can play in supporting student mental health. For example, school nurses have been trained to deliver brief cognitive behavioral skill–building strategies, such as teaching grounding techniques, reframing negative thoughts or practicing short relaxation exercises during office visits. A 2025 meta-analysis of school nurse-delivered anxiety interventions for adolescents found consistent symptom reductions following treatment.  

Similarly, with appropriate training and resources, teachers can deliver interventions to support student mental health and well-being. This can include universal social emotional learning programs, as well as interventions focused on more specific concerns, such as anxiety. Given the nature of teachers’ roles, many of these programs focus on the quality of everyday student-teacher interactions.   

Policy and research need to catch up to support this workforce 

Although funding and support for school counselors, social workers, psychologists, and related professionals is more important than ever, policies and funding for the broader school workforce—including school nurses and teachers—strengthens the capacity of schools to identify needs and provide supports to students across multiple settings.

For example, increased and sustained funding for school nurses at the district and state levels is essential to ensure students have reliable access to health professionals within schools. One opportunity for schools to increase their funding is to fully maximize Medicaid reimbursement for school-based health services for eligible students. States can expand their school Medicaid program to cover reimbursable care, such as individual and group therapy or counseling, for all students enrolled in Medicaid. Currently about 50% of states have expanded their school Medicaid program. 

Other opportunities include state or district-level staffing policies that account for student acuity. These would allow nurses the time and capacity to identify and respond to mental health concerns. The American Academy of Pediatrics and the National Association of School Nurses advocate for one school nurse in every building, and our recent research shows that most states have not even mandated that or any comparable standard. Similarly, teachers need adequate flexibility, resources, and support so they can build trusting relationships, incorporate activities to support youth well-being into the classroom, and help refer students to additional mental health services as needed.

Sustained investments in the broader infrastructure that support mental health and well-being, and that recognizes the roles of teachers and nurses, can expand schools’ capacity to support students overall. At a moment when the impacts of federal funding cuts and policy changes are generating uncertainty for school districts trying to better support adolescents, we recognize these dedicated staff are assets and look to explore new ways to support them.