Despite the mental health needs of children and adolescents, families may have a general reluctance to access care due to a perception of stigma. With >22% of children and youth being diagnosed with behavioral health needs in the United States before they are 18 years old,1  there is a critical need to ensure that these individuals access mental health services before a crisis. Several components can help with this: screening for mental health needs, facilitating referral, and addressing willingness to access care. In this issue of Pediatrics, “A School-Based Intervention for Mental illness Stigma: A Cluster Randomized Trial” by Link et al2  highlights the short- and long-term impacts of a middle school intervention on reducing stigma and social isolation and increasing the potential of help-seeking for mental health problems.

The American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry have both worked to increase screening of children and youth with mental health needs. There have been several studies showing the efficacy of completing that screening in the primary care provider’s office as well as in schools.3  Currently, the AAP’s Bright Futures recommends depression screening in adolescents ≥12 years old as part of routine preventive care.4  This is only the first step, but it is a critical one in treatment. The strength of screening impacting outcomes led the US Preventive Services Task Force to recommend screening children and adolescents for depression.5  Also, there is strong evidence of inequity in access to services by race and socioeconomic status.6 

Mental health is part of overall health, and children need to be healthy enough to learn. The AAP Council on School Health and the American Academy of Child and Adolescent Psychiatry Schools Committee assert that school-based mental health services can reduce barriers for students to access needed services, thus helping them stay in school and learn. However, offering services in schools will only help those who are willing to access those services, and it must be connected to interventions that are focused not only on mental health awareness and appropriate screening for students with behavioral health needs but also on reducing the stigma of seeking help.

Previous research has highlighted the importance of stigma reduction in school-based settings as a crucial component in changing the social norms about seeking help among diverse youth populations.711  This stigma is substantial across the cultural and demographic spectrum, and there are numerous institutional barriers to receiving appropriate care. Minimizing stigma can lead not only to an increased willingness to access behavioral health services but also a reduction in adverse outcomes from issues like social isolation and bullying.7  School-based interventions can have a substantial impact if there is a lasting effect across stakeholder groups. In the case of schools, the results can be impactful not only to students but also parents, staff, teachers, and administrators.10  “A School-Based Intervention for Mental illness Stigma: A Cluster Randomized Trial” focuses on a specific curriculum, “Eliminating the Stigma of Differences,” that shows promise through intervening early, addressing stigma, and advancing knowledge and attitudes that may facilitate seeking treatment for diverse youth in schools. Combined with screening and improved access to school-based mental health services, this curriculum could add a critical component to addressing the mental health needs of children and youth in the United States.

Opinions expressed in these commentaries are those of the authors and not necessarily those of the American Academy of Pediatrics or its Committees.

FUNDING: No external funding.

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-0780.

     
  • AAP

    American Academy of Pediatrics

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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.