Multilevel Factors of School-Based Mental Health Service Utilization Among Middle and High School Students

Evidence suggests that youth progressively experience mental health needs and discover mental health symptoms for the first time in adolescence. Schools have come to the forefront of providing mental health services, as adolescents spend most of their day in the academic setting. The current study aimed to examine individual and school-level factors related to school-based mental health service use. This study employed data from the National Longitudinal Study of Adolescent to Adult Health, sampling students between 12 and 17 years old across 172 schools (N = 14,464). The dependent variable was use of school-based mental health services (SMHS) in the past year. Individual-level predictors included sociodemographic characteristics, enabling factors, and need. School-level factors were then included. We conducted a multilevel logistic regression model clustering at the school level. The study found that approximately 11% of variation in SMHS utilization is explained at the school-level. The odds of SMHS use was significantly associated with anxiety, depressive symptoms, and risk-taking behaviors. The odds of SMHS was higher for females, Black compared to White students, and public assistance recipients. SMHS use was negatively associated with school connectedness. The racial breakdown of student enrollment and location of services were significant factors that predicted service use. This study is among the first empirical studies providing important evidence regarding individual and school-level predictors of SMHS utilization. The study has implications for the continued need for school-based mental health professionals and school institutions’ efforts to meet students’ mental health needs and increase their access to services.