A CDC report published this week asks a question that prevalence numbers alone cannot answer: of the high school students who say they are struggling, how many needed counseling and did not get it? Among students reporting persistent feelings of sadness or hopelessness in 2025, the answer was 28.8%, a little more than one in four. For district and school leaders, that figure measures the distance between identifying need and having somewhere for a student to go.
What the CDC report measured
The analysis, published in MMWR Supplements by CDC researchers, uses the 2025 Youth Risk Behavior Survey, the nationally representative survey of U.S. high school students. The analytic sample was 10,710 students.
The survey asked students whether they had needed counseling or therapy from a health professional for their emotions, concentration, behavior, or mental health. Students who said they needed it but did not get it were counted as having an unmet need.
Two findings anchor the report:
- 15.4% of all high school students reported an unmet need for counseling or therapy.
- 28.8% of students reporting persistent sadness or hopelessness reported an unmet need.
After adjusting for sex, grade, and race and ethnicity, students with persistent sadness or hopelessness were about three times as likely as their peers to report an unmet need (adjusted prevalence ratio 3.05).
This is a different measure from the headline YRBS results covered in this review on September 30, when CDC reported that persistent sadness or hopelessness fell from 40% in 2023 to 33% in 2025. That figure describes how many students are struggling. This one describes whether they reached care.
Where the gap is widest
The gap is not evenly distributed. Among all students, 21.1% of female students reported an unmet need, compared with 9.9% of male students. Grade 11 was the highest of the four grades, at 17.2%.
Among students reporting persistent sadness or hopelessness, the differences by grade mostly disappear: every grade fell between 27.3% and 29.6%. The differences by sex and by race and ethnicity remain:
- Female students: 31.7%; male students: 23.8%
- Asian students: 38.4%
- Black or African American students: 33.9%
- Hispanic or Latino students: 29.0%
- White students: 27.1%
These are descriptive survey estimates. They show where unmet need was reported more often, not why. The report is explicit that the survey did not collect the specific reason a student did not get help.
What the survey does not tell you
The authors list limitations that matter for anyone using these numbers to plan.
The counseling question does not capture the type, frequency, or quality of care, so the survey cannot say whether students who did receive counseling received enough of it. Because specific reasons were not recorded, the data cannot distinguish among the barriers students faced. And some students were not asked the counseling question because of how the survey was administered in certain schools, although the authors found those students did not differ significantly by sex, race and ethnicity, or grade.
The practical reading: the national figure establishes that a gap exists and roughly how large it is. It does not diagnose the cause in any particular district. That work has to happen locally.
The school-side picture
The CDC authors point to school-based mental health as one way to improve access, noting that services located in schools can reduce barriers such as transportation for families. Federal data on school capacity shows why that is not a simple fix.
In the National Center for Education Statistics School Pulse Panel, collected in March 2024:
- 97% of public schools reported providing some mental health services.
- On average, schools reported that 19% of their students used those services.
- Only 48% of public schools agreed that they were able to effectively provide mental health services to all students in need, down from 56% in 2021–22.
- 55% cited too few mental health staff to manage the caseload, and 49% cited inadequate access to mental health professionals as limitations.
Read together, the two data sets describe the same problem from opposite ends. Students report needing help they did not receive; fewer than half of schools say they can reach every student who needs it, and more than half point to staffing.
What this means for district and school leaders
Ask your own version of the question. Many district climate surveys and screening tools measure how students feel. Fewer ask whether a student who wanted help got it. Adding a single item, modeled on the YRBS wording about needing counseling or therapy and not receiving it, gives a leadership team a local measure of the gap rather than a national estimate.
Map the pathway before you expand identification. Universal screening, staff training, and peer awareness efforts all increase the number of students identified as needing support. If the receiving end is already at capacity, identification adds to a waiting list. Before expanding any identification effort, document what happens on the day a student or parent asks for help: who receives the request, how long until a first conversation, and what happens when the on-campus team is full.
Look at the groups the data flags. The CDC estimates show higher unmet need among female students and among Asian and Black students reporting persistent sadness. A district can check whether its own referral and engagement patterns show similar gaps, and whether outreach materials, family communication, and staff composition reflect the students least likely to be reached.
Use the tools already built for this. CDC's action guide, Promoting Mental Health and Well-Being in Schools, sets out six strategies for school and district leaders, including increasing students' mental health literacy, enhancing connectedness among students, staff, and families, and supporting staff well-being, all aligned to an existing Multi-Tiered System of Supports. The National Center for School Mental Health's School Mental Health Quality Assessment, publicly available through the SHAPE System, scores a district's system across seven quality domains and is a practical way to locate where the pathway breaks down.
Keep Tier 1 and Tier 3 in the same conversation. Mental health literacy and connectedness work at Tier 1 helps students recognize when they need support and feel able to ask. Its value depends on Tier 2 and Tier 3 capacity being there when they do.
Looking ahead
The 2025 YRBS gave schools two numbers worth tracking side by side: how many students are struggling, and how many of them reach care. The first improved between 2023 and 2025. The second gives districts a national baseline to compare their own data against. School-Based Healthcare Solutions Network, Inc. (SBHSN), a private grant-making organization focused on access to mental health care on school campuses, publishes this weekly review to help school leaders turn national and state developments into local decisions. Schools and districts weighing campus-based mental health capacity can review the grant solicitation and its published criteria at sbhsnetwork.com/grants. Application deadlines fall on the first Monday of July, September, November, and February; questions can be sent to grants@sbhsnetwork.com.
Sources
- Unmet Need for Mental Health Services Among High School Students Experiencing Persistent Feelings of Sadness or Hopelessness — Youth Risk Behavior Survey, United States, 2025 — CDC, MMWR Supplements, accessed 2026-10-15
- Youth Health in Focus: Mental health indicators, 2025 — Centers for Disease Control and Prevention, accessed 2026-10-15
- School Pulse Panel release on mental health services in public schools, May 2024 — National Center for Education Statistics, Institute of Education Sciences, accessed 2026-10-15
- Promoting Mental Health and Well-Being in Schools: An Action Guide for School and District Leaders — Centers for Disease Control and Prevention, accessed 2026-10-15
- School Mental Health Quality Assessment (SHAPE System) — National Center for School Mental Health, accessed 2026-10-15
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