Flaws in Mental Health Supports Point to Needed MTSS Enhancements

Source: Ormiston, H. E., Nygaard, M. A., & Husmann, P. (2025). School‐Based mental health practices within a multi‐tiered system of support: A mixed methods investigation of targeted and intensive services. Psychology in the Schools, 62(4), 1087–1099. https://doi.org/10.1002/pits.23380

Criteria for selection: This mixed methods study of MTSS (Multi-Tiered Systems of Support) is widely supported as an effective framework for addressing students’ academic, behavioral, and socioemotional needs. It is considered an ideal model for delivering school-based mental health (SBMH) services, yet how it is applied in practice for mental health remains under-studied. Peer reviewed.

LEARN Brief Credits: Dr. Adanays Diaz Aranda, Dr. Jeannie Haubert, Ashlea Sovetts, MFA

Overview: 

This article highlights the current challenges and inconsistencies in implementing Multi-Tiered System of Support (MTSS) for school-based mental health (SBMH) services. While most school mental health professionals (SMHPs) report using the MTSS framework, variability in how students are identified and receive support creates a barrier to its effectiveness. Universal screening is rarely utilized, leading to delayed or inadequate referral processes. The study also reveals a significant gap in the availability of intensive Tier 3 supports. Over half of the study’s participants indicated insufficient Tier 3 services, with individualized mental health counseling being the most endorsed but least available Tier 2 intervention. Moreover, many SMHPs still equate Tier 3 services with special education, potentially leaving students with significant mental health needs who don’t qualify for an Individualized Education Program (IEP) without adequate support. Despite recognizing the importance of preventative measures and dedicated system-level roles, SMHPs are largely overwhelmed by crisis response. School mental health professionals are often viewed as gatekeepers of a “hodgepodge” and “broken” system, with a disproportionate focus on crisis intervention over the preventative services MTSS was designed to provide. This underscores the urgent need for clearer guidelines, increased resources, and a shift towards more preventative and comprehensive SBMH service delivery within an MTSS framework.

Key Insights:

1. A Multi‐Tiered System of Support (MTSS) can be an effective delivery method of school-based mental health (SBMH) support, integrating both academic and behavioral services.

2. MTSS beyond special education is still relatively new and service delivery is often variegated.

3. Successful student academic, behavioral, and socioemotional outcomes are achieved when schools fully adopt MTSS and SBMH and are consistently implemented with fidelity.

Action Steps:

1. Implement Universal Mental Health Screening to develop clear standardized referral processes
2. Invest in Dedicated MTSS-SBMH Implementation Leaders
3. Redefine and Differentiate Tier 2 and Tier 3 Services
4. Prioritize Preventative Mental Health Services
5. Increase Funding and Personnel for SBMH Services
6. Enhance Collaboration with Community Mental Health Providers

Full Study:

https://doi.org/10.1002/pits.23380