Nearly one-third of the nation’s K-12 U.S. public schools mandate mental health screening for students, with most offering in-person treatment or referral to a community mental health professional if a student is identified as having depression or anxiety, according to a new study.

About 40% of principals surveyed said it was very hard or somewhat hard to ensure that students receive appropriate care, while 38% said it was easy or very easy to find adequate care for students. The findings are published in the journal JAMA Network Open.

“Our results suggest that there are multiple barriers to mental health screening in schools, including a lack of resources and knowledge of screening mechanics, as well as concerns about increased workload of identifying students,” said Jonathan Cantor, the study’s lead author and a policy researcher at RAND, a nonprofit research organization.

In 2021, the U.S. surgeon general declared a youth mental health emergency. Researchers say that public schools are strategic resources for screening, treatment and referral for mental health services for young people who face barriers in other settings.

Researchers wanted to understand screening for mental health at U.S. public schools, given increased concerns about youth mental health following the challenges posed by the COVID-19 pandemic.

In October 2024, the RAND study surveyed 1,019 principals who participated in the RAND American School Leader panel, a nationally representative sample of K-12 public school principals.

They were asked whether their school mandated screening for mental health issues, what steps are taken if a student is identified as having depression or anxiety, and how easy or difficult it is to ensure that such students received adequate services.

Researchers found that 30.5% of responding principals said their school required screening of students with mental health problems, with nearly 80% reporting that parents typically are notified if students screen positive for depression or anxiety.

More than 70% of principals reported that their school offers in-person treatment for students who screen positive, while 53% of principals said they may refer a student to a community mental health care professional.

The study found higher rates of mental health screenings in schools with 450 or more students and in districts with mostly racial and ethnic minority groups as the student populations.

“Policies that promote federal and state funding for school mental health, reimbursement for school-based mental health screening, and adequate school mental health staff ratios may increase screening rates and increase the likelihood of successfully connecting the student to treatment,” Cantor said.