A multi-tiered system of support approach begins with and prioritizes mental health promotion, highlighting the critical role that schools play in everyday wellness and to enhance student mental health literacy and leadership. This is often referred to as tier one support and is universally offered at the school and classroom level.

Educators, in particular, have tremendous opportunity to strengthen wellness as part of everyday practice, and to notice and support when students show signs of a mental health problem. Consistent, high-quality educator mental health literacy is a foundational part of the multi-tiered system of support approach at tier one. School and system leaders have a key role in creating the conditions for effective student mental health promotion.

Although classroom educators are often the first to note a change in emotions or behaviour that might signal a mental health disorder, any member of the school staff could be the one that a student chooses to connect with for emotional support. As a result, all school staff need some level of mental health awareness, and some, particularly those who support students in a special capacity (e.g., child and youth worker, coach, guidance teacher, special educator, GSA leader, grad coach) can benefit from specialized mental health literacy focused on early identification and support. In addition to learning how to recognize signs of a mental health problem, in a multi-tiered system of support model, student support staff are equipped with identity-affirming resources, tools, and programming that can be used to help students who might benefit from additional support and allyship.

When students are showing signs of an emerging or escalating mental health problem, tier two school-based prevention and early intervention services can be introduced. In Ontario, school mental health professionals who are registered with a professional college, such as school social workers and psychologists/psychological associates, are available to provide brief, evidence-informed interventions to help students with mild-to-moderate mental health problems.

Some students with significant, acute, or complex mental health needs require more intensive or urgent mental health services, referred to as tier three or tier four support. In these cases, school mental health professionals help with service pathways and clinical support. The collaborative vision for the system of care outlined in Right Time, Right Care highlights the critical need for clear and seamless transitions to, from, and through more intensive or specialized services when Ontario students require this level of support.

School mental health professionals can assist with these transitions, supporting students and their families with access, navigation, and care plans. When students are unable or unwilling to receive these services within community mental health, cultural/faith, or hospital settings, assessment and intervention is provided by school mental health professionals.

Every student

At the centre of the strategy is every student, and their unique strengths, identities, needs and natural supports. The strategy considers the whole child, as well as their family and community and experiences. Putting a focus on every student, rather than “all students” encourages strong consideration of each student’s unique identity when planning relevant mental health supports and services. 

Commitments to Truth and Reconciliation, and equity

The strategy emphasizes that school mental health supports must be grounded in commitments to Truth and Reconciliation, and equity to truly meet the needs of every student.

Equity, culture and mental health

The next layer of the strategy highlights the embedded Identity Affirming School Mental Health Frame. This has been co-developed with a diverse provincial working group to help describe and prioritize the intersection of equity and mental health. Using this Framework, Mental Health Leadership Teams reflect on and dismantle colonial systems and structures that provide uneven access to, and outcomes for, mental health services; to engage with culture/faith/community leaders and groups to learn more about available and needed identity-affirming mental health supports; to amplify perspectives of young people and communities who are racialized and marginalized in co-developing mental health services and supports; and to respond to student mental health needs through identity-affirming and culturally responsive approaches. The strategy prioritizes resources and professional learning in support of these actions. 

Parent, caregiver, and community connections and support

Students have a range of natural supports and protective influences in their lives, at home, school, and in their communities. Working together, the strength of these natural supports can be optimized. This aspect of the strategy focuses on explicit and intentional parent, caregiver, and community connections and support, with a view to strengthen relationships, build mental health literacy, co-develop collaborative mental health promotion initiatives, and reinforce common understandings and messaging for young people.

System, school, classroom mental health leadership

Effective and sustainable school mental health practice is dependent on system, school, classroom mental health leadership. Educators need the support of school leaders to confidently introduce identity-affirming classroom mental health resources and programming, in the same way that school leaders depend on the support of system leaders to lead mentally healthy schools. Strategy work in this area helps to ensure that leaders at all levels understand their role in supporting school mental health and have the tools and resources they need to perform this role.

Strength-based mental health promotion

Strength-based mental health promotion, as part of daily classroom practice, is a key cornerstone for the MTSS. This includes, for example, a warm welcome for every student each day to create a strong sense of belonging at school, everyday mental health practices that reinforce a sense of wellness and a range of culturally responsive ways of coping with stress, and reminders about individual gifts, strengths and the power of self-love. In this 3-year strategy, more wellness-promoting classroom resources will be shared and supported.

Mental health literacy and stigma reduction

When students have accurate and current information about mental health, they gain a sense of agency for their own well-being and are better equipped to help themselves, or a peer, when mental health problems arise. In addition, knowledgeable young people can be ambassadors for stigma reduction, as they normalize the experience of mental health distress and help-seeking. Findings from #HearNowON 2021 indicate that students want to learn about mental health at school. Participants also highlighted the need to ensure strong mental health literacy for educators who support this instruction. In response, the strategy focuses on greater roll-out of MH LIT for educators and associated classroom resources, alongside implementation support for Student MH LIT secondary student mental health learning.

Student leadership, participation and agency

Through #HearNowON 2021, students expressed a strong desire to become more engaged in mental health initiatives in their school and board so that they can play a more active role in wellness promotion. Young people have a unique perspective and powerful voice in this work. Strategy work will continue to focus on ways to support student leadership, participation, and agency, safely, effectively, and authentically. The ThriveSMH reference group will continue to provide input to SMH-ON activities and will continue to co-lead the development of student-facing resources. Particular emphasis will be placed on encouraging the participation of “quiet leaders” through a range of diverse opportunities and on magnifying the reach of student-facing resources and forums through web and social media platforms.

Early identification and student support

Although classroom educators are often the first to note a change for a student that might signal a need for mental health support, other student support staff often have a key role in early identification and student support (e.g., coach, guidance teacher, special educator, gay-straight alliance leader, grad coach). The 3-year strategy includes expanded role-specific learning opportunities and resources, so that more caring adults at school can be equipped to support students with emerging or escalating mental health needs.

Prevention and early intervention

School mental health professionals in Ontario schools provide prevention and early intervention services when students have mild-to-moderate mental health needs that would benefit from brief, targeted intervention. Over the next 3-year period, through the Innovation and Scale Up Lab at Western University, more identity-affirming evidence-informed protocols will be selected for testing and potential scale up. At the same time, work with the Offord Centre for Child Studies / McMaster University will help with the development of measurement-based care tools for SMH clinicians to help guide therapeutic decision-making. Training on brief protocols will continue (e.g., Brief Intervention for School Clinicians, Brief Digital Interventions, Supporting Transition Resilience of Newcomer Groups), and professional learning for front-line clinicians and supervisors will be expanded in key areas (e.g., substance use prevention, eating disorders prevention). An updated Culturally Affirming CBT module will be piloted and scaled out over this period, in collaboration with colleagues at CAMH Health Equity Office.

Intensive supports and service pathways

Over the past two years, School Mental Health Ontario has partnered with the Lead Agency Consortium, the Knowledge Institute on Child and Youth Mental Health, and Children’s Mental Health Ontario to develop a shared vision for an integrated and coordinated system of care for child and youth mental health. This work culminated in a vision paper, Right Time, Right Care: Strengthening Ontario’s mental health and addictions system of care for children and young people that summarizes the relative roles of schools and community mental health organizations with respect to service delivery. While schools have a primary focus on mental health promotion, prevention, and early intervention, community mental health organizations take a lead role in more intensive service delivery when young people are experiencing more severe, complex, or acute mental health problems. The strategy includes support for the Right Time, Right Care implementation plan, as well as collaboration related to other key partners in the system of care.

The outside framing of the strategy references the recently released Canadian Healthy Schools Standards led by the Canadian Healthy Schools Alliance. The language is slightly adapted to highlight a focus on the Standards for (Mentally) Healthy Schools: Mentally Healthy Environments, Teaching and Learning, Engagement and Allyship, and Partnerships and Services.