Clinical Psychology Review, Vol. 19, No. 2, pp. 131–135, 1999 Copyright © 1999 Elsevier Science Ltd Printed in the USA. All rights reserved 0272-7358/99/$–see front matter PII S0272-7358(98)00068-3 131 CHALLENGES AND OPPORTUNITIES IN EXPANDED SCHOOL MENTAL HEALTH Mark D. Weist University of Maryland School of Medicine IN MANY COMMUNITIES, mental health services in schools have been limited to youth referred for or already in special education, along with academic advisement and minimal counseling services for other youth (Duchnowski, 1994; Short & Talley, 1997). However, in more and more schools throughout the country, comprehensive mental health programs are being developed. These expanded school mental health (ESMH) programs augment services traditionally offered in schools to provide a broad array of services, including evaluation, treatment, consultation, and prevention, available to all youth, in special and regular education (Weist, 1997). As a testament to the rapid growth of ESMH programs, in October of 1995 the Office of Adolescent Health of the Maternal and Child Health Bureau (MCHB), Health Resources and Ser- vices Administration funded two national centers to provide support and technical as- sistance to this national movement. The Center for School Mental Health Assistance (CSMHA) operates out of our Department of Psychiatry at the University of Maryland, and the Center for Mental Health in Schools operates out of the University of Califor- nia, Los Angeles (UCLA). The Office of Adolescent Health of MCHB is also funding projects in five states (Kentucky, Maine, Minnesota, New Mexico, and South Carolina) to enhance infrastructure for comprehensive mental health services in schools. Why are ESMH programs beginning to proliferate throughout the United States? There are a number of answers to this question. First, in spite of improvements in the children’s mental health service delivery system (e.g., those related to the Child and Adolescent Service System Program [CASSP]), the gap between children who need, and those who receive appropriate mental health services is still very large (Day & Roberts, 1991). At a gross level, approximately one in four youth will present needs for mental health services at some point in their lives, but less than one third of these youth will receive appropriate services (Dryfoos, 1997; Institute of Medicine, 1995; Zahner, Pawelkiewicz, DiFrancesco, & Adnopoz, 1992). Correspondence should be addressed to Mark D. Weist, Center for School Mental Health Assis- tance (CSMHA), Department of Psychiatry, University of Maryland, 680 West Lexington Street, 10th Floor, Baltimore, MD 21201. E-mail: mweist@umpsy.ab.umd.edu