Mental Health and Behavioral Health
Scope and role
The school nurse identifies, refers, and supports - the nurse does not conduct psychotherapy or long-term counseling. Core knowledge includes adverse childhood experiences and trauma-informed practice, developmental and behavioral screening, suicide risk, depression and anxiety, eating disorders, ADHD, bullying, substance use, and crisis response.
Suicide risk
Know the difference between screening (a brief validated instrument such as the ASQ or PHQ-A given broadly) and assessment (a clinical evaluation of intent, plan, means, and protective factors). If a student discloses suicidal ideation: stay with the student, do not leave them alone, remove means where possible, notify administration and parents/guardians per protocol, and refer to a trained mental health professional or crisis service (988). Never promise confidentiality in a safety situation.
Behavioral health in the school day
- Functional behavioral assessment and behavior intervention plan; the nurse contributes health data.
- De-escalation: calm voice, space, reduced stimuli; restraint and seclusion are legally restricted.
- Psychotropic medication monitoring: watch for sedation, weight change, and akathisia; build a teacher feedback loop.
- Substance use: screening tools such as CRAFFT; know minor-consent and mandated-reporting rules.
- Mandated reporting: suspected abuse or neglect is reported to child protective services on reasonable suspicion, not proof.
Traps
Items that have the nurse "counsel" a student long-term or diagnose depression. Items that skip parental notification for a safety concern. Items confusing screening with assessment. Items that break confidentiality casually - share on a need-to-know basis only.
Rule of thumb
Safety first, then notify, then refer, then document. Confidentiality yields to imminent risk.