Why Schools Need a Public Health Approach to Student Mental Health

In this episode of the TomoClub Podcast, host Manik Mehta sits down with Dr. Armand Pires and Dr. Ryan Sherman, co-authors of The Fourth Tier: Modernizing MTSS for Student Mental Health, to confront a hard truth: the traditional three-tier MTSS model was never designed to meet today’s student mental health crisis.

Drawing from a decade of real district-level work, Armand and Ryan explain why schools are overwhelmed, where MTSS breaks down, and how a fourth tier—focused on treatment, access, and care coordination—can transform how districts support students. From screening and in-school clinical services to telehealth, wraparound supports, and realistic budgeting strategies, this conversation offers a practical roadmap for school and district leaders navigating rising mental health needs.
If you’re a superintendent, principal, counselor, or policymaker asking how schools can move beyond crisis response toward sustainable mental health systems, this episode delivers grounded, actionable insight.

Key Points Discussed

The Mental Health Bottleneck in Schools – Counselors are overwhelmed by high-need students, leaving foundational MTSS tiers under-resourced and ineffective.


From Education to Public Health Thinking – Reframing student support through a public health lens unlocks new, more effective mental health systems in schools.


The Real Access Problem – Long wait times for outside care create dangerous gaps where student mental health declines before treatment begins.


Why Adding More Counselors Isn’t the Fix – Hiring more staff without changing the system only shifts the burden—it doesn’t solve the root problem.


How Tier 4 Reimagines Responsibility – School and district leaders must take ownership of treatment coordination, not just classroom readiness.


Tier 4 as a Bridge, Not a Replacement – The fourth tier connects schools, families, healthcare, and community services into one coordinated system.


The Role of Proactive Screening – Schools must move beyond “wait and see” models to identify internalizing mental health needs early.


In-School Mental Health Services – Bringing outpatient clinicians into schools dramatically improves access at little to no cost.


Care Coordination as a Force Multiplier – Centralizing care navigation frees counselors to focus on Tier 1–3 supports where they matter most.


Telehealth Expands Equity – Virtual mental health services remove barriers like transportation, scheduling, and provider shortages.


Wraparound Services Explained – Therapeutic mentors, social workers, and parent coaches support students across school, home, and community.


Family Support Is Non-Negotiable – Student progress accelerates when parents receive guidance, coaching, and emotional support.


Budget Reality for Districts – Tier 4 isn’t about spending more—it’s about spending smarter with long-term returns.


Low-Cost Entry Points for Schools – In-school outpatient care and care coordination are the fastest, most affordable starting points.


Concerns About AI as Therapy – Rising student reliance on AI chatbots raises serious ethical and safety concerns.


The Need for Guardrails, Not Fear – Schools must proactively educate families and students on safe AI use before harm occurs.


Time Stamps / Chapters
00:00 Introduction: Why MTSS is failing student mental health
00:32 Meet Dr. Armand Pires & Dr. Ryan Sherman
01:23 Why write The Fourth Tier?
01:52 A superintendent’s perspective: systems that stopped working
03:35 A public health lens on student mental health
04:52 The youth mental health crisis and post-pandemic realities
06:00 Gaps between school supports and outpatient care
07:13 Why adding more counselors didn’t fix the problem
08:13 The MTSS bottleneck and breakdown of Tier 1–3
09:50 Defining traditional MTSS: Tier 1, 2, and 3
10:49 Why MTSS was never designed for today’s world
12:39 Where the system truly breaks down
13:18 Introducing Tier 4: a new responsibility for districts
14:16 Rethinking the role of schools in treatment models
15:04 The five core components of Tier 4
15:11 Universal screening for mental health needs
16:27 In-school mental health services
16:44 Care coordination for families
17:06 Telehealth as an access solution
17:23 Wraparound services: students, families, and community
18:52 Budget constraints and hard district decisions
20:00 Why mental health investment improves school culture
21:34 Long-term financial impact and preventing out-of-district placements
23:52 What can districts do with little or no budget?
24:36 Zero-cost solutions: community partnerships
25:43 Low-cost care coordination and counselor capacity
27:25 Hidden costs and reclaiming staff time
29:16 Students using AI as therapy: emerging concerns
35:52 Risks of AI chatbots and student mental health
42:21 Communicating guardrails to families and students