The Effects of School-Based Mental Health Services On Access to Mental Health Care Among Youth with Mental Health Need: A Multi-Level Analysis Examining Sexual Minority Status

Background and Purpose: Adolescents have a largely unmet need for mental health services and do not access services in proportion to their needs (Simpson et al., 2002). Research shows sexual minority youth (SMY) have significantly greater mental health needs and also use mental health services at significantly higher rates than their peers (McGuire & Russell, 2007; Williams & Chapman, 2009). Schools are a venue where youth can access counseling without the need for health insurance or the facilitation of a parent yet research suggests that SMY access school-based mental health services far less frequently than their peers (Williams & Chapman, 2009). Currently, there is a need to better understand how school-based policies, programs, and services influence youths' access to mental health services. With regard to SMY, research suggests that school policies and programs are directly associated with rates of at-school victimization, sexual health risk behaviors, and mental health risk (Blake et al., 2001; Goodenow et al., 2006). This paper presents findings from the National Longitudinal Study of Adolescent Health (Add Health), a school-based representative study, and addresses the following research questions: 1) Does the availability of school-based mental health services affect the probability that youth with mental health need will obtain mental health services over and above the influence of individual youth and family characteristics? 2) Does availability of such services moderate the relationship between sexual minority status and mental health service use among youth with mental health need? Methods: Data were taken from Wave I of Add Health, and consisted of a weighted subsample of 7,962 youth in grades 7 – 12 who reported having a mental health need, including 766 SMY. Add Health used a complex survey design that stratified schools by size, type, region, location, and percent white. Youth were selected with unequal probability from 132 schools. Using Mplus 5.0 and hierarchal linear modeling, this study examined whether availability of school-based mental health services predicted mental health service use among youth over and above individual and family characteristics. A cross-level test of moderation was conducted to determine whether availability of school-based mental health services moderated the relationship between sexual minority status and mental health service use. Results: This study found youth with mental health need had 40% higher odds of obtaining mental health services (in any setting) if their school offered such services. Similarly, with regard to SMY, this study found SMY with mental health need had 82% higher odds of accessing mental health services (in any setting) than NSMY with mental health need if services were available at school. Conclusions and Implications: Findings suggest school-based mental health services are an important gateway to mental health care for all youth regardless of sexual minority status. School-based mental health services play a key role in meeting mental health needs of youth by providing screening, referral, and direct counseling services. Thus, schools should consider their role as safe-guarders of youths' mental health and make efforts to educate all staff on needs of SMY as well as other diverse populations.