Objectives

To determine whether the New York City Department of Education (DOE) is providing mental health instruction to students as required by law. In addition, we also sought to determine the extent to which DOE proactively ensures schools have the mental health supports and services they need, including mental health awareness training for school staff. Our audit covered the period July 2018 through March 2022 and included general education students only.

About the Program

According to the Centers for Disease Control and Prevention (CDC), mental health is an important part of overall health and well-being. Being mentally healthy in childhood means reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities. However, many children struggle with mental health challenges that impact their full access to and participation in learning.

Rates of childhood mental health concerns, including self-harm and suicide, have been increasing steadily since 2010, and the most current statistics are alarming. According to a 2022 research report published by the CDC:

• Among high school students in 2019, 37% reported persistently feeling sad or hopeless in the past year and 19% seriously considered attempting suicide.
• Approximately seven in 100,000 persons aged 10 to 19 years died by suicide in 2018 and 2019.
• Approximately one in four children and adolescents aged 12 to 17 years has ever received mental health services.

Furthermore, according to the CDC, among the New York State high school student population in 2017 (approximately 808,150 according to State Education Department data), 17.4% (140,618) seriously considered suicide and 10.1% (81,623) made non-fatal suicide attempts. With the stress brought on by the coronavirus 2019 disease (COVID-19) pandemic since then, not to mention traumatic societal events, the mental health crisis for youth has reached a critical point and has become a significant public health issue.

To help confront the mental health crisis among youth in New York State, the Mental Health Association in New York State, Inc., a non-profit organization, led a call to action for a State law that would require mental health instruction in the kindergarten–Grade 12 health education curriculum. With the passage of the legislation, which amended Section 804 of the New York Education Law (Education Law), effective July 1, 2018, New York became the first state to require that health education in schools must include instruction in mental health. The Education Law mandates all schools to ensure that their health education programs recognize the multiple dimensions of health by including mental health and the relation of physical and mental health to enhance student understanding, attitudes, and behaviors that promote health, well-being, and human dignity.

While instruction is the cornerstone for promoting students’ mental health, a holistic, comprehensive approach would also include mental health awareness training for school staff and ready access to in-school mental health supports and services for all students (currently, these are only required if specified in a student’s individualized education program). Especially given the ongoing challenges of the COVID-19 pandemic and the greater need for mental health supports and services, schools are an ideal setting for this type of comprehensive prevention and early intervention program available for all students.

The New York City Department of Education (DOE), the nation’s largest school system, serves approximately 900,000 students at over 1,500 elementary, middle, and high schools. DOE also recognizes the importance of mental health well-being in the school setting, stating on its Mental Health webpage that “Mental health impacts all of us ... not only our students but our families, schools, and communities.” DOE also acknowledges that students are underserved, stating that “approximately one in five students who could benefit from additional mental-health supports does not get them.”

Key Findings

• DOE does not proactively ensure schools’ compliance with the Education Law in providing mental health instruction.
• DOE does not require training for its school staff to identify and address mental health needs of its students.
• DOE schools do not have the recommended number of mental health professionals to address their students’ mental health-related needs.
• DOE does not have a dedicated centralized data system for collecting and analyzing mental health data, either for individual students or in the aggregate, which would enable it to assess program appropriateness and success and identify emerging issues.

Key Recommendations

• Develop a mechanism for monitoring schools’ curriculum to ensure compliance with the Education Law.
• Require schools to ensure all staff who interact with students daily attend mental health awareness training.
• Explore ways to maintain appropriate mental health professional staffing levels at all schools.
• Explore ways to utilize a dedicated information system to collect, document, and analyze mental health-related information, such as referrals, services, and outcomes, which will allow data-driven decision making.