The role of schools in Tier Three service delivery

Most young people continue attending school while they are waiting for, receiving or returning from clinical treatment. As well, some young people will not access community mental health, cultural/faith or hospital-based treatment, so schools become the only viable setting for care. 

What the research tells us  

• there are things that can be done while waiting for treatment that are helpful and lead to better outcomes
• schools play an important role in readiness to change
• integration after mental health care requires thoughtful school support

Why this is important

For some students, school may be the only consistent place of support. When thoughtful, coordinated school-based supports are in place, students are more likely to remain connected to learning, relationships and maintain a sense of stability – even while navigating significant mental health challenges.

School-based support helps: 

• maintain safety and emotional stability during vulnerable periods 
• reduce disruptions to learning and attendance 
• reinforce skills learned in treatment 
• bridge gaps between school, home and clinical care 
• ensure no student is left without support 

Schools are not clinics, but they are consistent, relational environments where early stabilization, compassionate response and coordinated care can make the difference between further escalation and sustained engagement.

When schools understand their role within the broader system of care, students with significant mental health needs are more likely to stay connected, supported and on a path toward recovery.

Assessment

Assessment in school mental health refers to a systematic and ongoing process of gathering and interpreting information about a student’s emotional, behavioural, and psychological functioning to guide understanding, inform intervention planning, and determine appropriate supports. This process is tiered and responsive, with the depth and complexity of assessment increasing alongside the level of student need.

What the research tells us

• Mental health assessment is a founda­tional component of a comprehensive approach school-based mental health services, enabling schools to identify student needs and deliver appropriate supports within a tiered framework.
• Early identification, combined with coordinated system pathways, is critical for improving access to appropriate intervention and supports for children and youth with complex needs.

Why this is important

As student needs become more complex, assessment becomes increasingly comprehensive to support understanding, planning, and decision-making. Information gathered through observation, consultation, standardized tools, and other assessment approaches can help clarify student needs, guide intervention planning, and inform referrals to more intensive supports and services when appropriate.

Across all tiers, assessment is an ongoing and collaborative process that helps school teams respond to student needs in a timely, coordinated, and responsive way.

Crisis response 

Mental health crisis support in schools refers to a structured, tiered approach to responding to students experiencing emotional distress or behavioural dysregulation, with the goal of ensuring safety, stabilizing the situation, and promoting recovery. This support is responsive and adaptable, with the intensity of intervention increasing alongside the level of risk.

What the research tells us

• Schools are critical settings for mental health service delivery, providing accessible opportunities for early identification, intervention, and response to children and youth experiencing distress because they allow timely access to services for at-risk youth, including those in distress or crisis.
• Mental health crises among youth are often shaped by contextual life circumstances, underscoring the importance of students having access to collaborative support involving family and relevant community systems.

Why this is important

Schools provide timely assistance to students experiencing mild to moderate distress through strategies such as psychoeducation, skill-building (e.g., coping and self-regulation techniques), and in-the-moment de-escalation. These supports are typically delivered within the school setting, with ongoing monitoring and adjustment to prevent escalation.

In acute situations involving significant or imminent risk to the student or others, the priority shifts to immediate safety, comprehensive risk assessment, and coordinated intervention.

Consultation classroom and school support 

Consultation supports educators and school teams to develop targeted strategies that can be implemented within the classroom or school and align supports across staff to ensure consistency. This can also serve to strengthen adult capacity to respond effectively before concerns escalate​.

What the research tells us

• Schools are often accessible and inclusive settings where integrated and consultative mental health supports can be deliveredin ways that reduce barriers and promote timely access to care.
• Through consultation with school staff, school mental health professionals can enhance educators’ confidence and provide individualized strategies to support student learning, behavioural and mental health outcomes.

Why this is important

Additionally, when a student is seeking, receiving or returning from treatment in a community mental health or hospital setting, school staff members can play an important role in providing ongoing compassionate support. This can be challenging, as mental health disorders may impact the student’s emotions and behaviours, sometimes leading to disruptions or misunderstandings. It is important to remember that the young person is doing their best under difficult circumstances and that there are things that can be done at school and in the classroom to make things easier for them and for those around them.

To support a student who is experiencing a mental health disorder:

• Create safe, supportive, welcoming environments.
• Encourage a sense of belonging and care by checking in with the student as they arrive each day.
• Develop a predictable routine and clear expectations.
• Provide extra academic support and modify assignments as needed, understanding that the student may not be able to concentrate for long periods and could become easily frustrated.
• Support coping strategies that the student identifies as helpful, and/or have been recommended by the school mental health professional or family.
• Notice and respond when the student shows signs of increasing distress – see ONE-CALL Desk Reference).
• Follow clear protocols for suicide prevention and crisis response.
• Work alongside regulated school mental health professionals.
• Partner with families, community agencies and health services.

This shared responsibility helps ensure students are supported without placing undue stress on any one part of the system.

Service pathways

The coordination of mental health supports and services within the school board can be brief to moderate in duration. These internal pathways are designed to respond to students with moderate or emerging needs and focus on access to supports that are school-based and relatively streamlined. When students are experiencing challenges that reflect a higher level of complexity and risk, service pathways often involve multiple systems or sectors beyond the school, including community and healthcare partners. Interventions tend to be more intensive, longer-term, and may be delivered outside of the school setting.

What the research tells us

• When challenges are identified early, service pathways promote access to support.
• Coordination and collaboration between programs and agencies reduces barriers and improves quality and consistency of care.
• Support from professionals, in conjunction with family and peers, positively influences students returning to school.

Why is this important

Pathways, both internal and external, help to reduce barriers and promote access to support and services. Referrals, bridging and coordination between programs are important aspects of supporting students with mental health needs.  Students with complex mental health needs often have multiple programs involved, resulting in an increased need for coordination and clear pathways.

Direct support to students

When students are experiencing intensive mental health challenges, schools can play an important role in helping them stay connected, supported, and engaged in learning. While community and hospital services provide treatment, school mental health professionals and school staff can offer stabilization supports before, during, and after care.

What the research tells us

• Students report that having an adult at school to support their mental health is helpful
• Assisting students in returning to school is a collaborative effort involving everyone. 
• Schools can provide a safe and familiar environment where students explore mental health supports for mild or moderate mental health challenges.

Why this is important

There are many supportive functions that school mental health professionals can offer while students are seeking, receiving, or returning from treatment in community or hospital settings. This includes, for example:

• Readiness for treatment activities: techniques to build readiness for change (e.g., motivational interviewing strategies), help with problem identification and related psychoeducation, and support assertiveness and help-seeking skills.
• Bridging to treatment activities: assistance with service navigation, building understanding about treatment and warm connections with community service providers.
• Return from treatment activities: collaboration with service providers to develop and implement a school-based care plan, reinforcing skills and understandings from therapy. This may also include safety planning following suicidal or violent behaviour.
• Ongoing stabilization: when students are unable or unwilling to receive assessment and treatment services in the community or hospital setting, school mental health professionals can provide ongoing supportive care to help students stabilize enough to return to learning.

Stabilization in this context involves creating conditions that help the student maintain a sense of safety, emotional regulation and engagement in school while community care is pending, working to improve attendance or re-entering the school setting. Stabilization in school does not imply that the student’s needs are fully addressed, but that the school environment can support the student’s ability to cope with day-to-day experiences and remain engaged in learning until community services begin.

This involves drawing on a range of clinical approaches, within a therapeutic relationship, to attend to the student’s immediate needs, such as:

• relaxation/calming skills
• behavioural activation
• cognitive restructuring from CBT
• distress tolerance from DBT
• acceptance strategies from ACT

It may also involve environmental modifications such as:

• adjusting classroom routines
• establishing safe spaces
• creating predictable schedules

School-based stabilization does not replace treatment but may help the student to better manage within the school environment.