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Think in tiers about student mental health

Thinking in tiers is common in education and is an internationally recognized method for planning and understanding the continuum of mental health supports and services within schools and the community.

Why this is important

  • A multi-tiered system of support highlights the critical role that schools have in everyday wellness and helps systems and schools to identify and respond to students’ mental health needs in a comprehensive and integrated manner.
  • It emphasizes that most of the work of schools is, or should be, focused on tier 1 (mental health promotion) and tier 2 (prevention) services.
  • Clarifying the roles of various staff members in supporting student mental health is important in ensuring that services are delivered effectively and efficiently. Tiers can help clarify these roles and ensure that staff members work together to support students.
  • The tiered model helps ensure that students receive the appropriate level of support they need. This approach can reduce the over-identification of students with mental health concerns and ensure that those who require more intensive support are identified and receive it.

Offering support across the tiers

While students may require different levels of support at different times, universal tier 1 support is foundational for every student. At times, some students may require additional tier 2 prevention and early intervention services, and a few may need tier 3 intensive mental health or crisis support.

A triangle graphics showing three levels of support. Tier 1 is green at the bottom of the triangle; tier 2 is blue in the middle; tier 3 is purple at the top point of the triangle.

Tier 1: The first level is designed to be good for all.

This is the foundational everyday work that educators and school staff do within and beyond the curriculum to welcome and include every student, to understand them, to build knowledge of mental health, to promote mentally healthy habits, and to partner with families, students, other staff, and community to create a supportive environment. Most of the mental health work in schools is at this level.

Tier 2: The second level is necessary for some.

Some students will need additional support. Educators and school staff can help by reinforcing skills and working to remove barriers to learning. Regulated school mental health professionals and others with specialized skills provide intervention services, like school-based, evidence-informed, brief intervention protocols.

Tier 3: The third level is essential for few.

Small numbers of students will require more intensive support beyond what is available in schools. School mental health professionals help students to access appropriate community or health services and coordinate the ongoing care students need while at school. In some cases, regulated school mental health professionals will provide intensive assessment and therapeutic services when students cannot or will not access outside support or will manage crisis events as they arise.

Tailoring multi-tiered systems of support for equity and reconciliation

A multi-tiered system of support will be most effective and impactful for every student when it is tailored to the unique cultures and communities served at each school. The resources and services that make up a system of support need to be selected and implemented with commitments to reconciliation and equity, and identity-affirming school mental health practice, at the heart.

When the multi-tiered system of support rests on a strong, anti-racist and anti-oppressive mentally healthy school environment, and programming across the tiers appreciates and amplifies identity-affirming elements and strategies, every student benefits.

In contrast, systems that rest only on white, Western ways of knowing perpetuate oppression and elevate mental health risks for racialized and marginalized students and their families, while missing an opportunity to promote flourishing and wellness for every student.

Considerations and approaches

When considering the multi-tiered system of support at your school, and the range of services available at tier 1 (mental health promotion), tier 2 (prevention and early intervention), and tier 3 (interventions and pathways to care), take time to reflect on the nature and scope of offerings considering the students that you serve in your community.

Identity-affirming school mental health means working to ensure that service delivery across the tiers of intervention includes an assessment of student needs within the local board/school context.

Working with students, families/caregivers, and the community will help ensure that resources and services meet the identified needs in ways that are affirming and responsive.

Working alongside board mental health leadership teams, equity leads, and community partners, school-level mental health leadership teams have an important role to play in supporting every educator, student support staff member, and school clinician to adopt an identity-affirming approach to school mental health and student wellness.

  • Use an anti-racist and anti-oppressive lens when determining and responding to individual needs.
  • Continuously reflect on who is not being served well with the existing tier 1 mental health literacy and wellness supports offered, and then work to remediate the barriers.
  • Consider the degree to which available tier 2 and 3 services offered through board mental health services meet students’ needs. Engage with service providers to adapt or update supports.
  • Be aware of your power and privilege as gatekeeper of tier 2 and 3 supports.

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