Privatization and school mental health Mark Weist, Kathleen Blackburn Franke, Rob Lucio, Jefferson Bass, Terry Doan and Deborah Blalock Abstract Purpose – The purpose of this paper is to describe the relationship between privatization and school mental health (SMH) in the USA, as well as to present a case study of the SMH system in South Carolina. Design/methodology/approach – The authors reviewed data regarding states’ mental health systems (e.g. public, private and hybrid of public and private), mental health budgets and percentages of schools with mental health clinicians. Findings – The results demonstrate that the majority of states have public mental health systems. There is variability between states regarding general funding, as well as funding for SMH. Further, there was variability in the percentage of schools with SMH clinicians, with South Carolina reporting the greatest percentage. South Carolina’s mental health system, which is a public–private hybrid is reviewed, along with relevant history on the development of SMH programs in the state. Originality/value – This paper contributes to the general knowledge by describing the provision and funding sources for SMH services within the USA. It yields important implications for integrating public mental health services within schools. Keywords School mental health, Privatization, Public funding Paper type Literature review P rivatization has been broadly defined as the delegation of publicly funded services to private organizations (Brent, 2008; Donohue and Frank, 2000). In mental health, privatization has been described as taking place along the arenas of production/ marketization, financing and management (Donohue and Frank, 2000). The production/ marketization domain refers to the delivery of services by private organizations. This can be through community-based contracts or privately owned organizations at the for-profit level. The distinguishing factor is whether the providers of the mental health services are employed by the public entity or a private organization. Privatization of financing is when mental health services are financed through private mechanisms rather than public funding. The notion of applying business principles occurs when insurance funding is used to replace public funding to support social services and mental health. Finally, privatization of management suggests that public agencies transfer the oversite, monitoring and administration of mental health services or systems to private organizations. These distinctions become important because privatization can happen across all domains or a single one. In addition, the scope of privatization might be small, such as contracting for specific services, to transferring the entire mental health system to private organizations. The level and extent of privatization could have a different impact on the system’s operation and success. History of privatization in child and adolescent mental health The early 1900s saw an emphasis of children’s mental health services toward counseling school children and reducing absenteeism, which coincided with the rise of school-based health centers (Keeton et al., 2012). Around this time, the first mental health clinic for Mark Weist is based at the Department of Psychology, University of South Carolina, Columbia, South Carolina, USA. Kathleen Blackburn Franke is based at the Department of Psychology, University of South Carolina, Columbia, South Carolina, USA. Rob Lucio is based at the Department of Social Work, Saint Leo University, Saint Leo, Florida, USA. Jefferson Bass and Terry Doan are both based at the Department of Psychology, University of South Carolina, Columbia, South Carolina, USA. Deborah Blalock is based at the South Carolina Department of Mental Health, Columbia, South Carolina, USA. Received 9 August 2019 Revised 6 October 2019 28 October 2019 3 December 2019 Accepted 7 December 2019 DOI 10.1108/JPMH-06-2019-0065 VOL. 19 NO. 2 2020, pp. 99-107, © Emerald Publishing Limited, ISSN 1746-5729 j JOURNAL OF PUBLIC MENTAL HEALTH j PAGE 99