Volunteer Spotlight: A Case Study on Mental Health Resources in the US vs. the UK in High School and University

My name is Pratim and I am an intern with Listen to Act, working on mental health advocacy for young people. I am a student from the US, in the IES London: Health Practice and Policy program.

I have been given the opportunity to write about a cause I care about as part of my internship with Listen to Act. I have decided to do this topic because as an American student who has now studied in the UK as well, I have a unique perspective to compare and contrast the two countries.

To evaluate each of the health systems, I will be utilizing the World Health Organization (WHO) Health Systems Framework:

High School

Leadership and Governance

In the United States, it is mainly up to local school leaders, making it very variable. This can include: principals, teachers, superintendents. Some policies may come from the local, state, or federal government (Department of Education)

In the United Kingdom, there is a Senior Mental Health Lead (SMHL). This is a senior leader/staff member who influences strategic decisions in the lens of leading a school’s mental health and well-being.

Health Care Financing

In the United States, it is very difficult to find funding. Half of school administrators identified funding as a top concern for mental health, and 55% state that they don’t know how to access it (Effective School Solutions). Some funding opportunities include: AWARE, Title I, Title II, Title IV, and IDEA funds

In the United Kingdom, the Department of Education provides a grant to pay for SHML training. NHS provides funding through Child and Adolescent Mental Health Services (CAMHS).

In the United States, 68% of public schools have a school or district-employed mental health professional. 51% employ a 3rd party. But, there is a shortage of psychologists and counselors. At the national level, the current ratio of students to psychologists is 1:1211 and the current ratio for students to counselors is 1:415. 19% of schools reported vacancies for mental health professionals going into the 2022-23 school year.

In the United Kingdom, there is a lack of suitable workforce. By 2037, the NHS estimates that there will be a shortage of 15,800 full-time mental health nurses.

Service Delivery

In the United States, 96% of public schools offer at least one type of mental health service. But only 34% provide outreach services including mental health screenings. The percentage is so low due to lack of funding and lack of buy-in from school administration. 17% of schools utilize telehealth, an online form of healthcare service. For example, this could be a Zoom call between a patient and a mental health professional. This is more often in rural areas where provider shortages exist.

In the United Kingdom, there are Mental Health Support Teams (MHSTs), CAMHS, and school-based interventions. 

MHST:
1. To deliver evidence-based interventions for mild-to-moderate mental health issues

2. Support the senior mental health lead (where established) in each school or college to introduce or develop whole school or college approach and

3. Give timely advice to school and college staff, and liaise with external specialist services to help children and young people to get the right support and stay in education.

CAMHS:

Free mental health services run by the NHS, outside of the hospital. Can assess, treat, provide support, diagnose conditions, and often work with schools.

University

Leadership and Governance

In the United States, it falls to university leadership and federal and state governments oversee this through:

  • Higher Education Mental Health Act of 2021

  • Americans with Disabilities Act (ADA) protects mental health disabilities

  • Mental Health Parity and Addiction Equity Act (MHPAEA) forces insurance companies to cover mental health services

In the United Kingdom, there is a Senior Mental Health Lead (SMHL). This is a senior leader/staff member who influences strategic decisions in the lens of leading a school’s mental health and well-being. Same as high school.

Health Care Financing

In the United States, funding is through the Department of Education and Department of Health and Human Services (HHS) as well as school funding.

In the United Kingdom, it is funded by the government through the NHS.

Health Care Workforce

The same shortages mentioned above in high school are apparent in university.

Service Delivery

In the United States there are a few resources for college students including: counseling, peer support, crisis resources There is also Active Minds: A non-profit organization that provides student-led groups and peer-to-peer support. Finally there is the Suicide and Crisis Lifeline: Call, text, or chat 988 for a free confidential conversation with a trained counselor 24/7

In the United Kingdom, the following programs exist:

Student Space: A mental health and wellbeing platform that offers text and web chat support 

Funding for transition to university: Additional support for students moving from school or college to university 

Partnerships between universities and NHS: To help students access local support services 

Guidance for universities on responding to suicides: In partnership with PAPYRUS Prevention of Young Suicide and Samaritans 

National Review of HE Suicides: By academic experts from the National Confidential Inquiry into Suicide and Safety in Mental Health 

University Mental Health Charter: A program that universities can sign up to 

Funding to develop innovative practice: To understand and share effective practice

So what can the UK learn from the US?

  • Having a district or school-employed mental health professional

  • More student clubs in universities to support mental health, similar to Active Minds

So what can the US learn from the UK?

  • Having a trained professional to lead mental health strategy at school

  • Nationwide young people mental health service, similar to CAMHS

  • More effective and reliable sources of funding

Alex Weston