Teen Mental Health and School-Based Services in California

California has made large investments in recent years to bolster school-based resources for mental health and well-being. Both the California Department of Education and the California Department of Health Care Services have targeted initiatives and investments to support schools in expanding the role they play in providing mental health services to students (Technical Appendix B).

Since schools are readily accessible to youth and families, they have been an access point for health services and have increasingly been involved in promoting wellness (Shelton & Owens 2021). Embedding services directly into the school environment has proven to be an effective way to increase access and meet students where they are (Golberstein et al. 2024). Moreover, early intervention and treatment in schools have been shown to reduce mental illness and have been linked to some improvement in academic outcomes (Hoover & Bostic 2021). As awareness grows around the connection between mental health and academic success, schools are increasingly embracing integrated mental health supports as a strategy to foster well-being and improve educational outcomes (Hoover & Bostic 2021). Many implement universal programs to improve student mental health.

Schools address a wide range of mental health concerns, including stress, anxiety, depression, bullying, family issues, and substance use. Students often seek help for problems related to school, friends, or home. According to national survey data, just over one-third of adolescents receiving mental health care—especially those with public insurance, from low-income families, or from racial/ethnic minority groups—do so exclusively through schools (Ali et al. 2019). And for those with high mental health needs or specific diagnoses, school-based mental health services account for the largest single share of service use compared to other settings (Duong et al. 2021). However, for more serious conditions like suicidal ideation or diagnosed disorders, students are less likely to rely solely on school-based treatment and often receive services in combination with other outpatient mental health providers (Ali et al. 2019).

School-based mental health services can include a broad range of interventions—from universal supports like screenings and social-emotional learning programs to targeted and intensive services such as therapy, crisis intervention, and medication management (Technical Appendix B). Services may be provided exclusively by outside community providers or by school or district personnel—sometimes in combination with outside providers. Public schools typically employ various mental health professionals, including school counselors, psychologists, social workers, and nurses. According to national data, 84 percent of public schools provide individual-based interventions such as one-on-one counseling or therapy, 70 percent offer case management to help coordinate services, and 66 percent make referrals to external mental health providers when needed (Pan et al. 2023).

In a 2021–22 statewide survey of 1,347 California school administrators, most respondents (93%) reported that their school implemented at least one program to improve student mental health—social-emotional learning curricula and Positive Behavior Intervention and Supports being the most common (CDE & UCSF 2022). These types of programs have shown positive effects on student academic, emotional, and behavioral outcomes (Bradshaw et al. 2012; Greenberg 2023).

Some Schools Have More Targeted Resources to Support Student Mental Health

School-based health centers (SBHCs), school wellness centers, and community schools are examples of specific investments and programs that are well-positioned to provide structured school-based mental health programs to California adolescents in public schools. These specific services, however, represent only a small subset of the supports available in schools. Even in the absence of these specific resources, many schools have school-based professionals such as psychologists, counselors, and school nurses who provide mental health services. In this section, we analyze how these resources are distributed across California public schools relative to potential need based on poverty (proxied by percent of students eligible for free or reduced-price lunch, or FRPM) and urbanicity, and describe how these investments correlate with mental health outcomes. We focus on poverty and urbanicity because these characteristics are readily observable and also factor into things like school funding formulas, making them practical levers for targeting resources, and because our earlier findings show that teens in high-poverty and rural schools report worse mental health outcomes.

Community schools

Community schools represent a “whole child” school improvement strategy, where educational institutions collaborate closely with teachers, students, families, and community partners to align resources and enhance student outcomes (California Department of Education 2024). Well-implemented community schools help in improving student outcomes (Swain et al. 2025) and developing a positive school climate, which is associated with positive student mental health outcomes (Germain and Klevan 2025).

The California Community Schools Partnership Program (CCSPP) is a major initiative, allocating $4.1 billion to provide significant funding to enhance and expand community school models. CCSPP implementation grants for community schools began in 2021–2022 and were expanded to 1,468 schools by 2023–2024. These grants serve districts with a large percentage of high-need students or those with higher-than-state-average dropout, suspension, or expulsion rates. In total, an estimated 800,000 students are in schools that received the grants (Technical Appendix Table A31); nearly all are in high-poverty schools and around 83 percent are in cities and suburban areas (Figure 9).

The 2022–23 progress report for the initial CCSPP cohort found that participating schools improved their capacity to support student mental health by increasing clinician staff and fostering school environments that normalize conversations about mental health (Boal et al. 2023).

School-based health centers and wellness centers

School-based health centers (SBHCs) and wellness centers (WCs) are clinics or other physical spaces located on or near school campuses that offer students a range of health services. Around 400,000 of California’s 5.8 million students attend schools with SBHCs/WCs; 72 percent of these students are in high-poverty schools and 92 percent attend schools in cities and suburban areas (Figure 9). Out of the 365 SBHCs and WCs, 296 offer mental health services.

SBHCs typically provide primary care, mental health counseling, and other services such as dental care, optometry, and health education. They play a key role in reducing barriers to care such as stigma, cost, transportation, and limited provider availability. Evidence suggests that SBHCs can help reduce disparities in mental health care by serving diverse populations—including gender-diverse, LGBTQ+, and students of color (Soleimanpour et al. 2024). Wellness centers primarily focus on behavioral health services.