December 2025"The Accessibility of Online Mental Health Crisis Resources in Texas Public School Districts"

The Accessibility of Online Mental Health Crisis Resources in Texas Public School DistrictsHolly Ainsworth¹

and Karen Johnson¹

The Journal of School Nursing
2025, Vol. 41(6) 769–774
© The Author(s) 2024
Article reuse guidelines:
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DOI: 10.1177/10598405241257925
journals.sagepub.com/home/jsnAbstractYouth mental health and access to mental health resources are ongoing concerns for many students, families, and school personnel. Schools are trusted entities with the potential to disseminate accurate information. However, little is known about how school districts utilize the opportunity to connect students to trustworthy online mental health crisis resources. The objective of this study was to determine whether school districts are using technology to connect students to mental health resources. Using a stratified random sample of Texas public school districts, we assessed the presence and accessibility of mental health resources through district websites. Only 20.3% of district websites had mental health crisis resources present. Further evaluation revealed that districts are not fully utilizing technology to promote online mental health crisis resources. School nurses can play a key role in expanding access to mental health crisis resources by developing and promoting such websites.Keywordswebsite, nursing, mental health, crisis, public schools, and help-seekingBackgroundAbout 10–20% of school-aged children and adolescents experience mental health problems, and of those individuals, 50% of these mental health concerns begin before 14 years of age (World Health Organization [WHO], 2017). Within Texas, approximately 31% of Texas youth reported that their mental health was not good most or all the time (Texas Health and Human Services, 2024). On average, 55% of public schools in the United States provide mental health screening services, and only 42% of public schools actually provide mental health treatment services to their students (National Center for Education Statistics, 2022). Many youth are unable to get access to mental health resources due to inequities such as financial concerns, lack of transportation, and unstable housing (Centers for Disease Control and Prevention [CDC], 2023). Connecting students to information about mental health through the public school system may allow youth who face multiple inequities to gain access to mental health resources (CDC, 1991–2021; Stempel et al., 2019). Therefore, addressing mental health needs through the framework of public schools may help close the gap in access to care and information (Baker et al., 2022; Pestaner et al., 2019).The Internet continues to be an important source of mental health information for young people and their caregivers, offering instant access to information and anonymity for those concerned about stigma from others in their community (Pretorius et al., 2019). Given the shortage of mental health care providers and barriers to accessing care, this is particularly true in rural areas (Summers-Gabr, 2020). Internet resources can be important in helping those in need access information and virtual support (Marrapese et al., 2021). Students consistently report using the internet for helpseeking related to mental health, commonly through textbased queries using search engines but also directly through a variety of websites (Pretorius et al., 2019). There are potential drawbacks to websites, however, including inaccurate information from unreliable websites, breaches of confidentiality, and lack of health literacy (Galemore et al., 2022). Nonetheless, school websites can serve as important gatekeepers of trustworthy information and outside resources (e.g., community-based care, national hotlines) related to mental health (Marrapese et al., 2021; Navi & Atwell, 2020).With the large amount of mental health information and resources available online, it is more important than ever for school districts to share reputable and well-trusted resources with students to prevent misinformation and promote safety (Moss et al., 2019; Pestaner et al., 2019). Yet very little is known about the mental health information available on school and school district websites. As such, the purpose of this study was to: (1) investigate the availability and accessibility of online mental health crisis resources on Texas school district websites, (2) determine if availability differed by type of geographic region, and (3) describe where within district websites such information was housed. By sharing information about mental illness and connecting students to available mental health crisis resources, students may have a more positive attitude surrounding help-seeking behaviors for mental health treatment and services (Chao et al., 2020). Very few school nurses currently maximize the use of school district web pages to disseminate health promotion materials, let alone mental health crisis resources (Moss et al., 2019; Navin & Atwell, 2022). Therefore, school websites may be an untapped resource for sharing reliable mental health services and information with students, guardians, teachers, and administrators (McIntosh et al., 2021; Kahan & McKenzie, 2020).MethodsStudy Design and SampleUsing stratified random sampling, we selected websites from 123 school districts in Texas to evaluate the presence of mental health crisis resources. This study was determined to be exempt by the University of Texas Institutional Review Board.We defined crisis resources as a tool that students, family members, teachers, or peers could use to receive immediate, actionable help in a mental health crisis through services such as counseling, crisis intervention, and medical attention, or information about mental health. Most often, the crisis resource listed was the National Suicide Prevention Lifeline phone number or the area’s local crisis hotline, crisis text lines, and nearby hospitals and clinics. If the resource provided was simply a link to an outside organization without any additional information provided on the school district page (e.g., phone number), we did not count that district’s web page as having a crisis resource because the user would have to expend additional effort to navigate to an external website for the resource. Additionally, it was outside the purpose and scope of our study to assess the presence, accessibility, or quality of resources external to the school district.Districts in Texas are classified by the Texas Education Agency (TEA) in two ways: first, by nine strata defined by TEA which are based on geographical and population standards: major urban, major suburban, other central city, other central city suburban, independent town, nonmetropolitan fast growing, non-metropolitan stable, charter, and rural (Texas Education Agency, 2021). Second, by four geographic regions are defined by the National Center for Education Statistics (NCES): city, suburban, town, and rural (National Center for Education Statistics, 2022, February 25). TEA predetermined which NCES category each of their nine categories fit into, ensuring fluidity between the two classification systems. An initial power analysis using TEA’s nine categories suggested that 14 school districts be randomly selected from each of the nine strata. The only exception was the major urban category because there were only 11 school districts that qualified; therefore, all 11 school districts’ websites in the major urban category were evaluated.After the initial selection of schools within each of the nine TEA strata, we opted to further collapse the selected districts into the four NCES categories because the sample size was not large enough to appropriately analyze the accessibility of the resources. Of the 123 school districts originally selected, 31 were considered to be in a city, 26 in towns, 24 suburban, and 42 rural.ProceduresAll selected school district websites were explored during the timeframe of May 2019 to August 2019 to check for the presence of mental health crisis resources and, if available, how many clicks from the district’s homepage it took to reach the resource. We developed a structured guide for how to navigate the school district websites. One researcher completed the evaluation for all of the websites. The first step was to check whether a mental health crisis resource was present or not. To do this, all potential pages that could be generated by clicking through the school district website were opened by using the “sitemap function” found on each website. Then, each page opened through the site map of the school district website was checked for mental health crisis resources. After it was established if a crisis resource was present, we navigated to the page that contained the crisis resources starting from the home page of the school district website. From there, we tracked how many clicks it took to reach the resource from the home page of the website. Additionally, the search bar function was not utilized in surveying websites due to the lack of standardization between schools and the inability to quantify accessibility.Once the crisis resource was reached, the title of the specific subpage (i.e., Suicide Prevention, School Counselor, etc.) of the school district website was recorded for further analysis using descriptive statistics. The titles of the webpages were generally consistent across the surveyed school districts, and as a result, were the categories utilized during analysis.AnalysisWe calculated descriptive statistics (e.g., counts, percent) to determine how many school district websites had crisis resources. We then performed chi-square tests to determine whether the availability of resources differed by the geographical categories as defined by NCES (i.e., city, town, suburb, rural), and an ANOVA to compare the mean clicks taken to reach crisis resources between the district geographic locations. Finally, the categories of the resource webpage titles were explored descriptively by recording the location of the information on the school district website.ResultsWe discovered that 20.3% of the sample (n = 123) had crisis resources on their website. There was a significant difference between the geographical groups on the Chi-square analysis (df = 3, p = 0.013). Districts in the city category (38.7%) were most likely to provide mental health crisis resources as compared to town (19.2%), suburban (4.2%), and rural districts (16.7%). See Table 1.Across the total sample, it took an average of 3.6 clicks (SD = 1.34) to navigate to the mental health resource from the home page of the school district website. In the ANOVA, there was not a significant difference by geography in the amount of clicks taken to reach the crisis resource from the home page of the school district website (F(3.22) = 0.030, p = 0.993). This is in part due to the lack of school districts with mental health crisis resources available, so there was not enough data to adequately compare the amount number of clicks taken to reach the mental health crisis resources of the school districts. See Table 2.For the 25 school districts with mental health crisis resources present, the resources were found in a variety of locations. We then broke these location down into three categories: mental health/suicide prevention/bullying prevention (n = 11), counseling/student advising (n = 12), and parent resources/community resources (n = 2) as displayed below in Figure 1.Table 1. Crisis Resource Presence in Texas School Districts.Table 2. Number of Clicks Taken to Reach Crisis Resource by Geographic Category (n = 123).DiscussionDespite school districts having the opportunity to disseminate information via their websites, very few school districts in Texas used this opportunity to highlight mental health and provide respective resources. Only 20.3% of the 123 school districts surveyed presented any information regarding mental health. Of those with resources present, it took on average 3.6 clicks to reach the resource or information from the home page of the school district website, thus potentially detracting from the accessibility of the resource. A lack of user friendliness an increased amount number of pages to navigate through may serve as barriers to finding help during a crisis situation. Therefore, students with mental health struggles, peers concerned about a friend, parents, teachers, and school nurses might find excessive clicks to mental health crisis resources as a barrier. In the future, it would be beneficial to explore accessibility through the users’ perspective to further assess the barriers to accessing crisis resources. Additionally, no mental health crisis resources were located on the school nurses’ web pages within the school district websites which may be a logical place where students and families would go to seek help. Therefore, school nurses may provide more comprehensive care by using their web page for the promotion of student mental health crisis resources.Looking at the geographic regions of city, town, suburban, and rural, there was a significant difference in the presence of resources, thus illustrating that there is a gap in accessibility of resources between the regions. Further research should explore whether this gap is due to a lack of mental health crisis resources within certain geographic categories or if available resources are not listed by school districts due to various barriers (e.g., lack of technology support in the school district, stigma surrounding mental illness, decreased level of need for mental health crisis resources).The TEA has a state mandated list of resources and information that must be included on Texas school district websites, which is referred to as “Required Postings”. Education agencies in Texas and elsewhere should include mental health crisis resources in the required postings of all school districts’ webpages, and districts across the country should assess whether their webpages provide adequate, accurate, user-friendly information. Education agencies in Texas and elsewhere should include mental health crisis resources in the required postings of all school districts webpages , and districts across the country should assess whether their webpages provide adequate, accurate, userfriendly information. Mental health conditions exist across geographic regions; therefore, all students should be given the resources they need to receive help and identify illness early on. There is more research needed to determine what types of resources are needed and the best location to place these resources on school district websites to best meet student needs. For example, do users prefer sites with more passive information (e.g., phone numbers, facts about mental health), or interactive sites where they could communicate confidentially or anonymously with a school nurse, therapist, or other students? Additionally, it would be beneficial to further explore whether the resources provided on school district websites were evidence-based and what type of resource they provide.Figure 1. Mental health crisis resource presence and information location.LimitationsThe limitations that exist include the cross-sectional nature of the study and the possibility that available resources vary over time and in response to need (e.g., COVID) as well as limiting our sample to the state of Texas. However, in this descriptive study, we were not aiming to determine causality, making our study design more appropriate for our study aims. The school district webpage accessibility data were collected during the summer of 2019. Therefore, some administrative roles and responsibilities may have shifted during this time period, leaving mental health crisis resources temporarily unaccounted for on the school district webpages. Additionally, the use of the search bar function was not included in this study even though its inclusion on a limited amount of school webpages could streamline mental health resource access with search terms such as “crisis resources” and “suicide prevention.” Future studies should qualitatively explore the functionality of using search terms to determine the availability of resources.School Nurse ImplicationsWith an increasing ability to disseminate information through web-based platforms, school nurses are in a unique position to present health promoting ideas through their school website (Kahan & McKenzie, 2020; Navin & Attwell, 2022). This information would be publicly available to not only students but their families as well even when school is not in session. Considering the stigma behind mental illness, providing accurate and reliable information about resources and conditions could lead to early identification and intervention (Shattuck et al., 2024; Williams et al., 2021). Additionally, school nurses have the opportunity to advocate for policy changes to create required listings for district websites. School nurses hold an obligation to not only the physical health of their students but also their mental health through screenings and risk reduction (Bourgault & Etcher, 2022; National Association of School Nurses [NASN], 2016; Pestaner et al., 2019). Creating a healthy environment for students can be a collaborative effort between school counselors, administrators, school nurses, social workers, and technology staff to increase access to mental health resources on school district websites (Hardiman & Sonnenberg, 2022; McIntosh et al. 2021).ConclusionWe found a significant difference between the geographical location groups in whether mental health crisis resources were present. Since 79.7% of the school district websites sampled did not have a resource present, we recommend that nurses partner with school technology departments, school counselors, school social workers, community mental health providers, and student advocates to collect resources and design an easily accessible web platform for mental health crisis resources. School nurses are often a first point of contact for the health of students and can promote wellness by posting information about mental health resources on their individual webpage, utilizing electronic newsletters to parents, and raising awareness among staff regarding the promotion of health information via school websites. Further research is needed to determine the impact of online crisis resource accessibility on the mental health of students and the types of resources that would be most useful to those in crisis.Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.FundingThe author(s) received no financial support for the research, authorship, and/or publication of this article.ORCID iDsHolly Ainsworth

https://orcid.org/0000-0001-7477-6969Karen Johnson

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Texas Youth Risk Behavior Surveillance System. https://www.dshs.texas.gov/texas-youth-risk-behavior-surveillance-systemWilliams, M. L., Morse, B. L., DeGraffenried, W., & McAuliffe, D. L. (2021). Addressing stress in high school students during the COVID-19 pandemic. NASN School Nurse, 36(4), 226–232. https://doi.org/10.1177/1942602X21993053World Health Organization (2017). Global accelerated action for the health of adolescents (AAHA!): Guidance to support country implementation. World Health Organization.Author BiographiesHolly Ainsworth is a registered nurse practicing in the field of mental health and received her bachelor’s in science of nursing from the University of Texas at Austin. She is interested in quality improvement, the role of schools in student health, and early detection and screening for mental health conditions.Karen Johnson PhD, RN, FSAHM, FAAN is an associate professor at the University of Texas at Austin within the School of Nursing. She completed her PhD in Nursing at the University of Minnesota, her bachelor’s in science of nursing at the University of Colorado, and her BA in Sociology at Colorado State University. She is interested in adolescent health experienced by youth, health in alternative high schools, and addressing healthrisk behaviors.¹ School of Nursing, The University of Texas at Austin, Austin, TX, USACorresponding Author:
Holly Ainsworth BSN, RN, School of Nursing, The University of Texas at Austin, Austin, TX, USA.
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