More Staff Addressing Mental Health in Schools Buffers Toll of Growing Up in Disadvantaged Communities

Children growing up in disadvantaged neighborhoods—communities with low rates of high school graduation and employment, low family income, and other measures of adversity—are at heightened risk of experiencing mental health conditions. But a new study from Mass General Brigham suggests that, while neighborhood environment plays a key role in mental health, having greater access to mental health staff in schools could help lower risk.

In a study of 30,000 high school and middle school students at 62 schools in Massachusetts, researchers examined neighborhood deprivation, mental health staffing patterns at school, and rates of mental health symptoms among students. They found that higher school mental health staffing ratios could protect against the effects of neighborhood deprivation when it came to anxiety and depressive symptoms, suicidal thoughts and behaviors, and substance use. Results are published in Journal of the American Academy of Child & Adolescent Psychiatry.

“Schools represent the best opportunity to uplift an equitable and preventive approach to mental health,” said senior author Randi M. Schuster, PhD, founding director of the Center for School Behavioral Health at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham health care system. “Students are more likely to receive behavioral health services at school than in any other system. It’s critical for us to identify the most effective strategies to support schools so that they, in turn, can support kids.” 

Schuster and colleagues recently launched the Mass General Center for School Behavioral Health, which empowers schools to implement youth-centered, equitable, and integrated universal and selective prevention and early intervention supports. In collaboration with schools across Massachusetts, Schuster’s team continues to research the most effective, evidence-based interventions that can help address adolescent behavioral health needs.

Students in the study completed the Substance Use and Risk Factors Survey, a school-wide survey which asked questions about psychiatric symptoms. Researchers looked at the Area Deprivation Index to measure neighborhood resources. They looked at staffing patterns, including general teacher ratios as well as mental health staff specific ratios, and other school characteristics that they thought might support students. In the study sample of Massachusetts schools, there was an average of one mental health staff to every 100 students. But 48 out of 50 states do not meet the recommended ratio of one mental health counselor per 250 students.

Growing up in disadvantaged communities exposes youth to more stress and fewer supports, increasing risk for mental health problems. Consistent with previous studies, the current study found that higher rates of neighborhood deprivation were associated with higher rates of psychiatric symptoms. However, higher mental health staff ratios counteracted this—students at schools with more mental health staff did not show this established link of higher neighborhood disadvantage and higher endorsement of psychiatric symptoms, anxiety and depressive symptoms, suicidal thoughts and behaviors, and substance use.

“This observation was unique to mental health staff—we did not see the same results for overall teacher ratios or other staffing changes. This suggests that dedicated mental health support, rather than just overall school resources, could be especially important for students in disadvantaged communities,” said lead author Teresa G. Vargas, PhD, a postdoctoral fellow in the Stress and Development Lab at Harvard University.

The authors note limitations to their survey-based study, which captures a snapshot in time. Following students over a longer period could show the students’ trajectory and whether mental health staff help change outcomes.

“We know that for mental health in general, early prevention and support can lead to better functioning in adulthood,” said co-author Meghan Costello, PhD, a postdoctoral fellow in the Center for Addiction Medicine at MGH. “Our study suggests that schools may represent a potent venue for mental health promotion.”

Authorship: In addition to Schuster, Vargas, and Costello, additional authors include Henning Tiemeier, Phoebe Lam, Tina Bollmann-Dodd, and Jasmeen Kaur.

Disclosures: None.

Funding: Funds for this study are provided by the Massachusetts Department of Public Health, Office of Youth & Young Adult Services’ federal award by the Substance Abuse and Mental Health Services Administration (INTF2400H78500224455; PI: Schuster), as well as the Patient Centered Outcomes Research Institute (AU-2022C1-26355; PI: Schuster). Funding support for Meghan Costello was provided by NIDA 5K12DA043490-07. This work was also supported by a diversity supplement to R37-MH119194l.

Paper cited: Vargas TG et al. “Neighborhood Deprivation and Adolescent Mental Health: The Protective Role of School Staffing Patterns” JAACP DOI: 10.1016/j.jaac.2025.06.003