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Mental Health Referral Guide for School Counselors: Identifying At-Risk Students

Jemma Strain
Published: 03/29/2025 | Updated: 03/29/2025
Authored by: Jemma Strain, B.S. Psychology
Edited by: Emma Loker, BSc, PgDip
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There’s a growing need for school-based mental health services. 

Before the COVID-19 pandemic, there was a steady rise in teen mental health conditions such as anxiety and depression. Yet, after the pandemic, the mental well-being of students has declined further. In fact, Mental Health America estimates that millions of young Americans live with issues such as anxiety and depression, as well as a range of other mental health conditions.1

Of the school-age children who receive mental health treatment for their needs, 70-80% of them actually start this process at school. School counselors play a big role in this treatment, identifying, referring, and treating mental health concerns that prevent a teen from seeing and working toward a bright future.2

If you’re a school counselor, educator, or parent and are concerned about an at-risk student, mental health services are available to provide support and guidance. This article can also help by discussing:

  • A school counselor’s role in mental health referrals
  • How to identify at-risk students for mental health care
  • School counselor guidelines for mental health concerns
  • Mental health resources for school counselors
  • When to seek support in school mental health referral protocols
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School Counselor’s Role in Mental Health Referrals

School counselors are trained and licensed mental health professionals in the state they’re employed. Although the steps to becoming licensed can vary from state to state, in general, school counselors have master’s level training in education-based therapy. They also usually have to complete supervised training in a school setting and pass a comprehensive exam.1 

Due to their training and skillset, school counselors help to provide a continuum of support and interventions in a school-based setting to prevent, identify, and treat student mental health conditions. Their input can ease the challenges associated with psychological distress and promote teens’ well-being and academic success. 

The services a school counselor provides include:1,3

  • Collaborating with others to create an understanding school culture that promotes success for all students
  • Using information from groups of students to pinpoint needs
  • Advising educational staff and students on mental health services
  • Providing direct and indirect counseling services, including in both large and small groups, as well as one-to-one
  • Planning of mental health programs
  • Making referrals for students who require more intensive mental health support

School counselors act as a bridge between teens, families, schools, and mental health services. Therefore, they play an important role in mental health referrals for students with mental health conditions. 

If you’re a school counselor or an educator and are concerned about a student’s mental health, you may be wondering if it’s time to escalate a mental health concern. Professional mental health services can guide you in this process, but the following signs of at-risk students can also help. 

How to Identify At-Risk Students for Mental Health Care

Almost one-third of students in the U.S. experience the symptoms of serious mental illness. Referral to mental health services – either in school, community, outpatient, or residential programs – is essential for these students’ emotional and physical health and success.4

School counselors can identify the signs of at-risk students through a process of observation, communicating with teachers and parents, and conducting assessments. By identifying these concerns and making steps toward treatment, they can help protect the well-being of children struggling with challenges that can affect their education.5

The following are the signs of at-risk students that school counselors typically look out for:6

  • Drop in academic performance:     Mental health issues can lead to problems with motivation and concentration, often resulting in reduced performance on tests and assignments
  • Changes to personality in school: A sudden or extreme change in a teen’s emotions and actions may signal something deeper going on below the surface
  • Mood changes: Seeming persistently sad, agitated, or hopeless could indicate an issue
  • Loss of interest: Students with mental health conditions can show a lack of enjoyment or interest in activities they previously enjoyed
  • Frequent fatigue: Mental health conditions can lead to problems falling or staying asleep, causing a student to seem frequently exhausted
  • Changes to appearance: Sudden or drastic weight loss or gain can indicate a mental health problem. Also, wearing long sleeves or trousers, even in hot weather could be a sign of risky behaviors, such as self-harm
  • Withdrawal: Spending increasing amounts of time alone, such as during lunch break or before and after school, can indicate isolation due to mental health difficulties
  • Nervousness: Seeming constantly on edge or hypervigilant towards threat can be the result of mental health conditions such as anxiety and psychosis
  • Disconnection: Seeming removed from their environment, or acting like they’re “unreal”
  • Irrational thinking: Illogical beliefs or thinking in a way much younger than their age may indicate an underlying problem in a teen 
 

If a school counselor identifies a number of these issues in a teen – or is notified of them by another person in the student’s life – it may be time to escalate the concern. Community-based mental health professionals can advise on the appropriate actions to take in this process. We also discuss some steps to follow when concerned about a student’s mental health below. 

School Counselor Guidelines for Mental Health Concerns

School counselors often start the process of ensuring children are supported in their mental health needs by taking a ground-up approach to mental health education. This means they help students and teachers recognize the signs of mental health issues and what these can mean for their health and performance. By doing so, children and teachers often better understand when to reach out to counseling services. 

Once a school counselor is made aware of or has witnessed the signs of at-risk students, they can take steps to protect their welfare and academic performance. 

To help students get the support they need for their mental health concerns, school counselors may…7-9

1. Arrange an Assessment Meeting:

Meeting with a student they’re concerned about allows school counselors to assess symptoms, the barriers faced, strengths, and mental health needs. Gently questioning how they’re coping through open-ended questions can help a counselor get to the root of the problem. 

Additionally, school counselors may use screening assessments to get a better picture of a teen’s view on their mental health issues and ability to function. These screeners include:

  • Kutcher Adolescent Depression Scale (KADS)
  • Columbia Depression Scale
  • Patient Health Questionnaire
  • Center for Epidemiological Studies Depression Scale for Children

2. Ask Students How They Would Like to Be Supported:

School counselors understand that, for treatment to be effective, teenagers need to have an opinion on how they would like to be supported. They may help teenagers pinpoint their strengths and how to use these in treatment, as well as discuss appropriate therapy options for their needs. 

3. Collaborate Between the Family and School:

School counselors play an important part in communicating between families and the school. They often help to advocate for a student’s needs in school and collaborate with the stakeholders in their lives to ensure that teens and their families receive the support and treatment they need. Additionally, school counselors may act as a mediator in tricky situations – such as if a student wants to withdraw from a certain class. 

4. Provide Short-Term Therapy

School counselors can provide school-based short-term therapies to help teens manage their immediate symptoms. This counseling can also focus on issues that might contribute to mental health conditions, such as transitions and grief. Additionally, a school counselor can also lead group therapy sessions, such as peer support groups. These groups allow teens to share common challenges and problem-solve together, building social support and improving symptoms. 

5. Make Referrals to Mental Health Services

School counselors play an important part in communicating between families and the school. They often help to advocate for a student’s needs in school and collaborate with the stakeholders in their lives to ensure that teens and their families receive the support and treatment they need. Additionally, school counselors may act as a mediator in tricky situations – such as if a student wants to withdraw from a certain class. 

6. Take Steps to Arrange Mental Health Leave and Reentry

A school counselor can help discuss the option of mental health leave from school for residential treatment and how to create a reentry plan. By doing so, they ensure that mental health issues impact a child’s academic success and well-being as little as possible. 

Mental Health Resources for School Counselors

By this point, it’s likely clear that school counselors play a multidisciplinary role in childrens’ care. They often act as an advisor, collaborator, mediator, educator, observer, facilitator, and supporter – the list goes on. 

However, another role a school counselor often fills is that of a therapist. While, in general, school counselors cannot provide diagnoses for a student’s issues, they can still guide them on the best therapy options for their needs. These options may include the following.  

Therapy Resources for School Counselors

Cognitive behavioral therapy (CBT):

School counselors may be able to provide on-site CBT or make arrangements for it in the community. CBT helps teens identify and challenge negative thoughts, build healthy ways of coping with them, and transition these skills into the world outside of therapy. 

Eye movement desensitization and reprocessing (EMDR):

Sometimes, a teen may be more prone to developing mental health issues if they experience negative events such as trauma. While a school counselor may not be trained in EMDR, they can still explain how it changes the way trauma is stored in the brain and helps a teen build more positive self-beliefs and ways of coping with life’s challenges. If EMDR is suitable for a teen’s needs, a school counselor may arrange community-based treatment.

Interpersonal therapy

A teen’s relationships can contribute to feelings of depression. Some school counselors may be trained in interpersonal therapy, so can help teens work through these issues and figure out better ways of coping to improve their mental health.

Transcranial magnetic stimulation

TMS can be effective in treating treatment-resistant mental health conditions. It’s a non-invasive treatment that uses magnetic fields to activate nerve cells in targeted areas of the brain – improving outlook and mood. A school counselor can talk teens and their families through the option of TMS.

Group therapy

School counselors can lead group therapies which can help teens build social support and an understanding that other people their age experience similar issues. Through these groups, a teen can also reduce the effects of stigma and self-blame. Further, a school counselor may direct a student to community-based support groups.

Aside from these therapy options, a school counselor can also talk to students and parents about the potential benefits of outpatient or residential treatment for a child’s needs. If one of these options is suitable for a student’s symptoms, a school counselor can start the referral process – keeping families in the loop every step of the way. 

School counselor

When to Seek Support in School Mental Health Referral Protocols

If you’re a school counselor, teacher, or parent and are worried about the signs of an at-risk student, you likely want to ensure you take the right steps to protect their mental health. Early intervention can improve a teen’s emotional and physical well-being, relationships, academic performance, and outlook for the future. 

Mission Prep is familiar with collaborating with school-based mental health professionals in providing suitable treatment for teens’ symptoms and recovery. We treat a variety of mental health conditions in various locations – offering both outpatient and residential treatment based on a teen’s needs. If you have any questions about referring an at-risk teen to mental health services, our team of trained professionals is available to answer your concerns. Contact us to learn more. 

References

  1. Zabek, F., Lyons, M. D., Alwani, N., Taylor, J. V., Brown-Meredith, E., Cruz, M. A., & Southall, V. H. (2022). Roles and Functions of School Mental Health Professionals Within Comprehensive School Mental Health Systems. School Mental Health, 15(1), 1. https://doi.org/10.1007/s12310-022-09535-0
  2. Atkins, M., Hoagwood, K. E., Kutash, K., & Seidman, E. (2010). Toward the integration of education and mental health in schools. Administration and Policy in Mental Health, 37, 40–47. https://pmc.ncbi.nlm.nih.gov/articles/PMC2874625/ 
  3. Warren, J. M., Blount, T. N., & Belle, G. (2024). Implementing Effective School-Based Mental Health Services: A Guide for School Counselors. Professional School Counseling. https://doi.org/10.1177_2156759X241283769
  4. Platt, L. M. (2014). Identifying students at risk for mental health problems. NASN School Nurse, 29(6), 299–302. https://doi.org/10.1177/1942602×14550402
  5. Mental Health America. (n.d.). Early identification of mental health issues in young people. Retrieved March 25, 2025, from https://mhanational.org/position-statements/early-identification-of-mental-health-issues-in-young-people/
  6. American Psychiatric Association. (n.d.). Warning signs of mental illness. Retrieved March 25, 2025, from https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness
  7. Megginson, A. J., & Maddox, R. P. II. (2018). Upgrading your needs assessment. American School Counselor Association. Retrieved March 25, 2025, from https://www.schoolcounselor.org/newsletters/october-2018/upgrading-your-needs-assessment
  8. Millacci, T. S. (2021). What is school counseling? 14 roles & goals of counselors. PositivePsychology.com. Retrieved March 25, 2025, from https://positivepsychology.com/what-is-school-counselor-role/
  9. American School Counselor Association. (2020). The school counselor and student mental health. Retrieved from https://www.schoolcounselor.org/Standards-Positions/Position-Statements/ASCA-Position-Statements/The-School-Counselor-and-Student-Mental-Health