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The University of California, San Francisco, recently published new research showing that costs for youth behavioral health care, including counseling and therapy, nearly doubled between 2011 and 2022 and now account for 40% of all health spending for U.S. children.
For those of us who work in schools, this isn’t a surprise. It is simply the data catching up to what we see every day: Our children are struggling, and too many are not getting the support they need.
Across the country, young people are facing unprecedented levels of anxiety, depression and trauma. This is true for children of every background. But as with nearly every social challenge in America, the burden is heavier in low-income communities of color like the one my school serves on Chicago’s South Side. Families here are more likely to face housing instability, food insecurity, community violence and untreated trauma — and they are less likely to have easy access to high-quality mental health care.
When behavioral health needs go unmet, the consequences ripple far beyond the child. We see it in classrooms when students can’t concentrate, regulate their emotions or trust adults. We see it in rising absenteeism, disciplinary issues and academic struggles. We see it in teachers stretched to their limits and families overwhelmed by crises that could have been prevented with earlier support. Mental health is not separate from learning; it is a prerequisite for it. As I tell my team, children cannot learn if they are not safe, warm, dry, fed and well.
The recent report also makes something else clear: Families are being asked to carry more and more of the financial burden. Out-of-pocket spending on children’s behavioral health care is growing at more than twice the rate of other health care costs, increasing by an average of 6.4% each year. Families with a child receiving behavioral health care are far more likely to experience severe financial strain. In practice, this means that getting help for a child increasingly depends on whether a family can afford it.
That is how a two-tier mental health system takes root. Families with money can access private therapy and specialists. Families without it are left to wait, to ration care or to reach the system only when their child is in crisis. While the study does not break down spending by race or income, it’s clear that in a country where wealth and healthcare access are deeply unequal, rising behavioral health costs will hit Black and low-income families the hardest.
That is why schools like mine have become something they were never designed to be: frontline providers of mental health care.
At Great Lakes Academy, a kindergarten through eighth grade public school on Chicago’s South Side, 28% of our students receive school-based mental health services. We partner with organizations like Touch of Wholeness, offer virtual coaching through Open Seat and employ multiple, full-time social workers because our students need these supports to succeed.
These services are not extras; they are as essential as textbooks and teachers. But providing them requires tradeoffs, and too often schools are forced to choose between academic programming and mental health care.
RelatedCommunity-Based Organizations Must Be Part of the Student Mental Health Solution
School-based services work because they eliminate the barriers that keep so many families from accessing help. There is no need to take time off work, find transportation or navigate an unfamiliar health system. Students receive support in a place they already know and trust. Problems are identified earlier, before they escalate into emergencies that lead to hospitalizations, school removals or long-term harm. In communities where mental health providers are scarce or unaffordable, schools have become the most reliable point of access.
But this role is not sustainable without public investment. Schools should not be propping up a broken healthcare system with education dollars.
If our leaders are serious about equity, they must fully fund school-based behavioral health services, especially in high-need communities. That means investing in counselors, social workers, psychologists and strong partnerships with community providers. It means creating stable, ongoing funding streams rather than short-term grants that disappear just as programs take root. And it means ensuring that Medicaid and other insurers reimburse schools directly for the care they provide, so schools are not forced to subsidize health care out of classroom budgets.
The data make clear that children’s behavioral health care has become a central part of what it takes for young people to thrive. As long as access to that care depends on a family’s income or ZIP code, the gap between those who get help and those who do not will continue to grow. Schools like Great Lakes Academy are doing everything we can to fill that gap. With the right public investment, schools can ensure that every child — no matter their race or family income — has the support they need to learn, heal, and succeed.
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