Mental health support in German schools: a cross-sectional survey study of principals on demand vs. provision of support services

Introduction Student mental health concerns are rising globally and educational institutions constitute critical settings for the prevention and early intervention of these issues in youth. Yet, mental health support structures often vary between countries, regions, and schools and a systematic monitoring of provision and use of services is missing. Methods To fill this gap, we surveyed 486 principals across 13 German federal states in spring 2024 with a questionnaire developed through literature review, expert interviews and pilot testing by an interdisciplinary expert committee. The instrument assessed the availability and demand (as estimated by principals) for guidance counseling, school social work, and school psychology services during the previous and current school years, and examined variations by school type (primary school, lower track secondary and comprehensive school, higher track secondary school, and special-needs school). The data was analyzed using t -tests, chi-square-tests and analysis of variance (ANOVA). Results Findings revealed that demand increased compared to the previous school year, whereas provision remained unchanged. Although the majority of schools had access to school social workers and school psychology services, fewer than half employed guidance counselors. Where services were absent, demand was consistently high. Across all three domains, service provision failed to meet demand, which was up to twice as high as that offered by the services available. While resources varied across school types, no type consistently received more resources, though special-needs schools reported the highest level of both service provision and demand. Discussion These findings reveal a significant mismatch between students' mental health needs and institutional capacity in German schools, underscoring the necessity to expand school-based services and to implement systematic, comparative monitoring at the international level for the optimal governance of health-care infrastructures.