U.S. school-shooting sites lagged in mental-health staffing

Between 2017 and 2019, 180 U.S. schools that experienced shooting incidents had significantly lower rates of health-focused support staff such as nurses, psychologists and counselors — and a higher prevalence of security officers — than 11,063 similar schools that did not experience shootings. 

The finding, published in the journal Preventive Medicine, spotlights how the nationwide shortage of school-based mental-health professionals may affect schools that experience gun violence, said the study’s authors at UW Medicine in Seattle. 

“For as long as we have measured it, school mental-health staffing has been trending below the levels recommended by multiple professional organizations. This paper shows that schools that experienced shootings had an even lower rate of mental health staffing per student than similar schools without shootings,” said Keith Hullenaar, the lead author. He is a postdoctoral scholar in psychiatry and behavioral sciences at the University of Washington School of Medicine. 

Professional organizations recommend 4 counselors, 4 social workers and 2 psychologists per 1,000 students in K-12 schools. In the study, schools that experienced no shootings averaged 3.7 counselors, 1.0 social workers and 1.4 psychologists per 1,000 students. Schools that experienced shootings averaged 2.9 counselors, 0.7 social workers and 0.8 psychologists per 1,000 students. 

“Gun violence can be viewed as a public health problem. These results suggest we are not delivering a public health solution in schools,” Hullenaar said. “It’s epidemiological thinking that, if you know where bad events happen, you invest more resources across the board in those locations—both in security and health.”

The findings also raise the question of whether states’ and school districts’ strategies to reduce violence only by employing security staff are meeting that goal. 

The paper's authors noted that comprehensive support for student behavior and mental health are associated with greater school safety. 

“Seemingly emphasizing law enforcement over health support contrast(s) with evidence informed recommendations for creating safe school environments through comprehensive supports for student behavior and mental health,” they wrote. 

In the study, any incident in which a firearm was discharged on school grounds or at school events was counted as a shooting. The researchers did not consider outcomes of shootings.

Hullenaar and colleagues used 32 school and district characteristics, such as number of students enrolled, student demographic data, violent-offense rates, and community socioeconomic levels to match schools that experienced a shooting with other schools. The team then compared staffing patterns for schools with shootings versus the “matched” schools.

Beyond support-staff levels, schools that experienced shootings tended to share several characteristics:

• higher median enrollments
• urban locations
• communities with lower average socioeconomic statuses
• higher rates of prior violent incidents (both with and without weapons)
• higher proportion of students qualified to receive free or reduced-price lunch

In discussing funding shortfalls that confront many or most U.S. public schools, the authors suggested that districts “explore flexible staffing models that enable rapidly scaling mental health support during crises.” For example, regional (county- or citywide) response teams that include school-based or community mental-health providers could be deployed to address immediate needs after a shooting occurs.

Hullenaar acknowledged that he had expected to find that schools at higher risk for violence would be more prepared, not less, in terms of their mental-health staffing. 

“This finding makes me wonder how we, as a country,  are expecting to manage school violence: Is it more about security and policing, rather than mental health and well-being? Is that where we’re at?”

The research was funded by the National Institute of Child Health and Human Development (1K99HD112509).

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