On May 3, 2022, the South Carolina Department of Health and Human Services (SCDHHS) announced the results of its comprehensive review of the South Carolina Department of Mental Health's (S.2, which was signed into law by Governor McMaster on April 28, 2025, established the South Department of Behavioral Health and Developmental Disabilities, which includes the renamed and restructured South Carolina Office of Mental Health [OMH]) school mental health services program and seven recommendations to improve access to mental health services in South Carolina schools. The review was conducted by SCDHHS' Bureau of Program Integrity and Internal Audits and included several key findings that prompted the agency to make recommendations it believed would remove barriers that previously existed to providing access to quality mental and behavioral health services in South Carolina's schools. Through implementing its recommendations, SCDHHS established a short-term goal of reducing mental health counselor-to-student ratio in South Carolina's schools from 1:1,300 to 1:650 (effectively the equivalent of providing access to a mental health counselor in each school in the state) by 2023. In January 2024, SCDHHS announced it had achieved that goal . The agency continues to work with providers, South Carolina schools and its partners at the South Carolina School Behavioral Health Academy to improve access to vital mental and behavioral services for South Carolina children. Updated school-based mental and behavioral health services data from a September 2025 survey of South Carolina school districts, along with a summary of the agency's 2022 review key findings and SCDHHS actions specific to its May 2022 recommendations are available below.

Summary of 2022 Key Findings

• The mental health counselor-to-student ratio was approximately 1:1,300.
• There were approximately 600 mental health counselors providing services in schools, of which approximately 60% were employed by DMH.
• Given the choice, 59% of school districts would prefer employing their own counselor rather than contract with DMH.
• SCDHHS had a differential rate schedule that paid DMH counselors, who are typically not licensed, more than double what district employed counselors were reimbursed for a 30-min. individual therapy session.

Summary of SCDHHS Actions

• Effective July 1, 2022, SCDHHS enacted policy changes to give school districts greater flexibility in hiring their own counselor or contracting with a private counselor. School districts are also able to continue to receive services through DMH and may use a combination of the three delivery methods listed above.
• Effective July 1, 2022, SCDHHS raised its counseling rates and placed an emphasis on paying licensed clinicians at a higher rate than unlicensed clinicians. The new rate is available for any licensed clinician, including those employed by a school district and private providers who are contracted with a school district. For a 30-min. individual therapy session, the rate for licensed clinicians who were not employed by DMH was increased from $37 to $71.31.
• On Sept. 28, 2022, SCDHHS announced a partnership with the University of South Carolina's Department of Psychology to help schools integrate mental health services into their operations.
• SCDHHS continues to partner with the South Carolina Department of Education to survey school districts to update school mental health services program data annually. Data updates from past surveys is available under "Communications".

September 2025 School Mental Health Services Data

• As of September 2025, the mental health counselor-to-student ratio is approximately 1:5671.
  • 2022 data showed a ratio of 1:1,300.
  • January 2023 data showed a ratio of 1:829.
  • September 2024 data showed a ratio of 1:593.
• The number of school-based mental health counselors rose from approximately 600 in the 2021-2022 school year to 1,391 at the start of the 2025-2026 school year.
• Survey data shows students at 318 more schools had access to school-based mental health counselors at the start of the 2025-2026 school year than during the 2021-2022 school year.
• The number of school-based behavioral health counselors by employment types (OMHemployed, school district-employed and private mental health counselors) is included below.
  • Employed by OMH: 297 (24.9% of the total number of mental health counselors)
  • Employed directly by the district: 799 (67%)
  • Employed by a private provider: 295 (24.7%)
    • The largest increase year-over-year in school-based mental health counselors has come from district-employed behavioral health counselors, with the number of district-employed behavioral health counselors increasing from 616 to 799.
  • In January 2022, 60% of the state's approx. 600 school-based counselors were employed by DMH.
• The number of districts where 100% of schools had access to mental health counseling increased from 35 in 2022 to 60 in September 2025.

Key Youth Behavioral Health Statistics

• According to a 2024 report from the Boston Consulting Group, 77% of youth in South Carolina with a major depressive episode do not receive any mental health treatment. This is well above the national average of 60%.
• According to the Centers for Disease Control and Prevention (CDC), most indicators of poor mental health and suicidal thoughts and behaviors worsened from 2013 to 2023 nationally. However, the same CDC data showed small improvement in most indicators from 2021 to 2023.
• In 2023, national data indicated four in 10 high school students experienced persistent feelings of sadness or hopelessness; and nearly one in 10 attempted suicide.
• High school students with depression are more than twice as likely to drop out than their peers.
• The number of suicides among South Carolinians ages 10-17 have dropped from an average of 25 per year from 2020-2022 to 21 in 2024.
• Suicide was the top reported cause of death for 10 to 14 year-olds and the third leading cause of death for South Carolinians between ages 15-17 in 2024.

1 The survey includes responses from 77 South Carolina school districts. One public school district, Jasper County, did not respond to the survey. 

Print Version