School-Based Health Centers and Mental Health Services: The Implications of Mental Illness Stigma and the COVID Pandemic

• In Event: Analyzing the Relationship Between School-Based Health Centers and Schools

Abstract

Objectives/Purposes:
School-Based Health Centers (SBHCs) offer healthcare services to youth in an effort to facilitate health equity in vulnerable student populations. Although one in ten children and adolescents experience mental health issues at any given time, only one-third actually seek treatment (Kaushik et al. 2016), with adolescents potentially less likely than children to seek help (Nearchou et al. 2018). Poverty, and related issues like childhood adversity and family/neighborhood instability, are top risk factors for mental health issues (O’Connell et al. 2009; Alegria et al. 2015; Dashiff et al. 2009). Students who receive mental health services experience improved academic success as well (Satu et al. 2017). In this study, we explore how SBHCs in Oregon provide mental health resources to underserved populations and how the events of the COVID-19 pandemic threatened service delivery capacity just as mental health needs skyrocketed.

Theoretical Framework:
Mental health is influential for people's social relationships and overall well-being (Wulsin and Singal 2003; Scott, Von Korf, and Angermeyer et al. 2011; Kessler, Walters, and Forthofer 1988; Breslau et al. 2011), yet meeting the mental health needs of children and adolescents can be difficult, particularly for youth in socially marginalized groups or contexts. We use the Coordinated School Health framework to describe the founding, mission, and practices of SBHCs. Next, we apply Link & Phelan’s (2001) framework for mental illness stigma to describe how stigma surrounding mental health services, particularly for youth, complicates the work of SBHCs, in terms of funding, resources, and student willingness to access services. Finally, we document how the pandemic accelerated the need for mental health services, while forcing SBHCs to pivot their approach to meeting students’ mental health needs.

Data Sources:
This study relies on data collected through semi-structured interviews with 17 SBHC coordinators and 19 of their educator partners across Oregon.

Analytic Methods:
Interviews were recorded and transcribed using Zoom, with transcripts coded both deductively and inductively by a team of researchers using the Dedoose analytic software.

Preliminary Results:
Our findings indicate that youth access to SBHC mental health services is negatively affected by stigma, and that innovations that resulted from the pandemic (e.g., telehealth, staff-sharing) simultaneously improved and reduced youth access to SBHC mental health services.

Significance:
The findings from this study demonstrate the centrality of SBHCs for public health more broadly and detail how Oregon SBHCs specifically met youth’s mental health needs during the pandemic by integrating established best practices with innovative and flexible approaches, approaches that are likely to endure beyond the pandemic.

Authors

• Dara Shifrer, Portland State University
  Presenting Author

• Suzy Fly, Portland State University
  Non-Presenting Author

• Rachel Springer, Portland State University
  Non-Presenting Author

• Kaitlin Yeomans, Portland State University
  Non-Presenting Author