Mental health care in a high school based health service

Adolescence, Spring, 1998 by Lisa Jepson, Linda Juszczak, Martin Fisher

In nearly all of the cases, the primary diagnosis was easily ascertained. As no chart contained more than one type of crisis (e.g., suicidal ideation, psychosis, rape, abuse), each crisis could be recorded as the reason for treatment. Substance abuse and pregnancy (no student had been seen for both) were ranked immediately after crises. Where several psychosocial problems were equally weighted and no crisis had occurred, a primary diagnosis of multiple psychosocial stressors was recorded. Multiple psychosocial stressors included such combinations of ongoing difficulties as general familial discord, nonviolent peer conflict, occasional truancy, and general academic difficulties.

Based on the findings of this study, a group for children of substance abusers was formed. Identified students were invited to participate in weekly meetings lasting the length of one class period (40 minutes). Teacher cooperation was enlisted through the use of student contracts guaranteeing that course work would be completed on time. The contract protected confidentiality by divulging only that students would be participating in a group conducted by clinic staff Data from these students are presented as an example of use of the group process in mental health treatment provided at a school-based health center.

Student Visits to the School-based Health Center

Students have increasingly sought mental health services (see Table 2). Five years after the inception of the center, the number of mental health visits had quadrupled, while the percentage of visits for mental health services had nearly doubled. Between January and December 1992, there were a total of 4,852 visits to the center, 1,002 of which were for mental health services.

Mental health issues represent 17% of all clinic diagnoses generated during 1992 (see Table 3). Of the 265 students who sought mental health services during that year, 253 were referred by the center's medical staff, while 12 came on their own or were referred by school personnel. These students used the mental health services an average of four times during the year. The majority of visits were from females (79%). The ethnic background of students using the mental health services (72% African American, 21% Hispanic, 7% other) was generally representative of the center and school as a whole. Most of the visits were made by 16-year-olds (29%), followed by 17-year-olds (19%) and 18-year-olds (17%).

Primary Diagnoses of Mental Health Service Users

Table 4 shows the primary diagnosis for each of the 265 students who visited the clinic between January and December 1992. Table 5 presents three principal clusters into which many of the primary diagnoses may be divided: pregnancy and sexuality, dysphoria and depression, and conflict and violence. Together, these three diagnostic clusters represent 65.4% of all mental health visits.

Issues related to pregnancy were the leading reason for seeking mental health services. This category refers to actual pregnancies only and therefore does not include preventive services, parent training, or issues related to sexuality and intimacy. Pregnancy-related services include options counseling, family intervention, referrals for prenatal care or termination of pregnancy, and grief counseling for miscarriages or terminated pregnancies.