The Effect of School-Based Health Centers on Adolescent Mental Health and Behavior

Adolescent mental health has experienced significant declines in the past decade, yet take-up of mental health services has remained low among adolescents. This paper examines whether localized access to mental health services has meaningful impacts on adolescent mental health and behavior. I study the effect of school-based health centers — full-service clinics located in K-12 schools that offer physical, mental, and reproductive health services at low to no cost — on suspensions and dropouts, two outcomes that may be linked to untreated mental health issues. Using a staggered difference-in-differences analysis that leverages the timing of health center openings in California and a propensity-score matched control group, I find that the opening of a new school-based health center decreases suspension rates by around 1.1 percentage points, an 18% decrease relative to matched schools. The effects are concentrated in middle schools and high schools which experience decreases of 4.9 and 0.8 percentage points respectively. This decrease is primarily driven by a decrease in suspensions from “disruptive behavior”, rather than weapon possession, violence, or drug use. In addition to the extensive margin decrease in share of students suspended, SBHCaccess also decreases number of suspensions per suspended student by 10-26% depending on the grade level. There is no effect on dropout rates, indicating that the decline in suspensions is unlikely to be caused by crowd-out of delinquent behavior by an increase in dropping out. These results suggest large potential impacts of school-based health centers on treating behavioral issues that cause suspendable behavior, especially in middle and high schools, and motivates further study of SBHCs as a tool for improving access to mental health services for adolescents in low-income communities.