Exploring self-referral as a low-burden, universally administered strategy to connect adolescents to mental health supports following anonymous school-based screening.

Abstract

Integrating widespread, low-burden approaches to facilitate connection to school-based care may be helpful in expanding mental health reach in schools. The present study describes students' use of a single-item self-referral process following a school-wide anonymous screener of mental health and substance use. The Substance Use and Risk Factor Survey included a school-based referral request item in 47 Massachusetts public middle and high schools in fall 2023 (N = 16,236; 47% girls; 4% gender diverse; 41% racially or ethnically marginalized or minoritized). Students who self-referred, in comparison to those who did not self-refer, endorsed more symptoms of depression and anxiety (M_{self-referral} = 3.7 [SD = 3.8], M_noReferral = 3.0 [SD = 3.3], p = .0001), psychoticlike experiences (M_{self-referral} = 1.1 [SD = 1.6], M_noReferral = 0.9 [SD = 1.4], p = .0004), emotional reactivity (M_{self-referral} = 24.4 [SD = 23.7], M_noReferral- = 20.8 [SD = 20.8], p = .001), and inattention and hyperactivity (M_{self-referral} = 0.8 [SD = .8], M_noReferral = 0.7 [SD = 0.7], p = .001). Students who self-referred were more likely to endorse a past-year suicide attempt (6.6% among self-referral group, 3.1% among the no-referral group; OR = 1.7, p = .02) and not talking to anyone (formal or informal mental health supports) about their mental health in the past year (31.4% self-referrals, 21.9% no referral; OR = 1.7, p < .001). Students who self-referred were also more likely to hold a minoritized gender identity (6.9% self-referrals, 3.9% no self-referrals; OR = 1.8, p = .012). School staff (N = 15) noted that the self-referral process was helpful (M = 3.87/5, SD = 1.27), and approximately half of the students requesting support (53.7%) were not already engaged in school-based mental health support. Self-referral requests following school-wide screeners may be a useful strategy to identify students experiencing mental health distress without supports in place. (PsycInfo Database Record (c) 2026 APA, all rights reserved).