After eight students and two teachers were murdered in 2018 at Santa Fe High School in Santa Fe, Texas, Governor Greg Abbott vowed to find solutions for the lack of mental health resources in schools.
"We need to do more than just pray for the victims and their families," said the Texas governor.
Four years later and on the heels of another deadly Texas school shooting, a CBS News analysis found most of the state's public schools still offer little to no direct access to mental health services for their students.
"No one listened to us, students," said Zach Muehe, who four years ago ran out of his sophomore art class at Santa Fe High School when a gunman opened fire. "The mental health problem, I believe, is the root of it all. It is just never talked about and I don't know why."
Survivors of school shootings said they've tried sounding the alarm about the lack of student mental health services for years, but often felt their concerns were ignored.
In Texas, 593 school districts have no school psychologist on staff and do not offer a telehealth option, according to CBS News' analysis of data from the Texas Education Agency (TEA). This leaves more than half a million Texas kids without any mental health services in school.
Uvalde Consolidated Independent School District (CISD) currently has two school psychologists. With about 4,000 students enrolled in Uvalde CISD, the district would need six psychologists to meet the minimum recommended ratio from the National Association of School Psychologists. Thewas not enrolled in the statewide telehealth mental health program that was set up in response to the Santa Fe High School shooting.
The suspect in the Santa Fe shooting, a 17-year-old student, wasand was found unfit to stand trial.
After Santa Fe, Texas officials approved nearly $100 million to increase child mental health services across the state. Among the initiatives was a telehealth program called Texas Child Health Access Through Telemedicine (TCHATT).
TCHATT, which is now set up in nearly 400 school districts statewide, connects troubled students with licensed school psychologists through live video conversations.
Dr. David Lakey, the Chief Medical Officer for the University of Texas System, said TCHATT has already helped more than 12,000 students who've received counseling through the program.
"The other reason I think it's working is because we asked the parents: 'Is it working?'" Lakey said. "And when we do that kind of analysis, we get overwhelming feedback that the parents and the kids are satisfied and believe they are significantly better or better because of that TCHATT service."
But Lakey acknowledged the telehealth program has a long way to go.
This school year, TCHATT will be in as many as 417 school districts in Texas, covering about 59% of the student population, according to a CBS News analysis of data from TCHATT and the Texas Education Agency.
But that still leaves more than 800 districts without TCHATT access — including the Uvalde CISD.
When asked if having the TCHATT program could have flagged the Uvalde gunman, Lakey said, "If five years ago we could have had that program there, when he was in 7th grade or so, and figured out that things weren't going well, and then linked him to the services he needed, I think that's a situation where it would have been much less likely that that individual would have done what he did."
The challenge with getting the TCHATT program in all Texas schools hasn't been due to a lack of funding. Millions of dollars budgeted for the program went unspent in its first two years.
Lakey said one challenge has been getting schools on board; some have been hesitant about a new program. The other challenge is finding enough mental health professionals to do the job.
"We have a major challenge related to the mental health workforce in the state of Texas, so one of our barriers that our institutions have is just hiring the people we need to provide the service to all the schools across the state of Texas," Lakey explained.
To work as a school psychologist in Texas, a person must have a special license certifying that they've received training related to school psychology. School psychologists are different from guidance counselors, who don't need to have any formal psychology training.
The National Association of School Psychologists recommends at least one such psychologist for every 500-700 students, but most students in Texas go to school districts with ratios far above that: one psychologist to more than 1,200 students on average, according to CBS News' analysis.
Almost no schools in Texas employ enough psychologists, CBS News found. Of the more than 1,200 districts across the state, just 39 meet that recommended ratio. Those districts serve less than 1% of all Texas students.
For the rest of Texas schools to meet that minimum standard, they'd have to hire about 5,600 more psychologists. Texas has incentive programs to lure people into mental health professions, but they still haven't managed to fill the gap.
Texas isn't alone. A May report by the National Center for Education Statistics found only about half of public schools nationwide said they could effectively provide mental health services to students.
That data showed only about 50% of all public schools provided mental health assessment services, and just over 40% provided mental health treatment. For rural districts, those rates were even lower.
According to Lakey, it's particularly difficult to find enough mental health professionals to work in rural districts like Uvalde, where the need is often greatest.
"I've told the Legislature just that point," Lakey said. "They can give me a bucketful of money but if I can't hire enough people to provide these services, I can't spend those dollars."
Sanger ISD, about 60 miles north of Dallas, is one of the 39 districts that meets the recommended ratio for mental health professionals.
Faced with similar funding challenges as most Texas schools, the small rural district has used community partnerships and creativity to tackle the mental health needs of its students.
"Mental health is a priority for this community and this school district," said Ann Hughes, Sanger ISD's director of student emotional behavior and student intervention. "We teach behavior the way other individuals teach math. We don't give up when someone is having behavior problems. We get to the bottom of it."
To get around the lack of state funding, Sanger ISD partners with churches, charities and the city to bridge gaps in student services. Hughes has also applied for and received grants to help with mental health funding.
However, it's what the district has done with the money that sets it apart.
In three of Sanger ISD's schools, there are dedicated "movement rooms" and "chill rooms" where students learn to manage their emotions.
Inside Linda Tutt High School, where kids who struggle the most are sent, there's a free grocery store.
The store not only meets a need for many of these students but, since it's also run by students, it gives them a sense of purpose.
"It's about contributing," Hughes explained. "It's seeing maybe somebody has a need like your own or somebody has a bigger need, so it builds connection."
For every behavioral program, Sanger ISD collects data, so the district knows what's working and what's not.
But success isn't just measured by numbers.
"I probably wouldn't be here without Ann," said former Linda Tutt High School student Preston Westbrook, 18.
By the time Westbrook started high school, he said he had bounced between 26 different foster homes. At a dozen homes, Westbrook said he was abused both mentally and physically.
Westbrook had a severe anger issue when he got to Linda Tutt High School. He often ran onto the roof of the school to escape.
"That's how I would get away from people when I was mad," he said. "I've ripped off door hinges when I was 9. I've punched holes through doors. … Without Ann, I wouldn't be here. I think there should be more schools like this."
"He is one of our true success stories," Hughes said.
Hughes said she too gets frustrated with the lack of dedicated funding from the state for mental health but said schools should not allow that to keep them from trying.
"The energy that I put to throw my hands into the air and carry it on, let's use that and take a little step. And then little steps become big steps and before you know it, you are on a journey, and you are impacting lives."
Correction: After the initial publication of this report, CBS News learned that the Uvalde Consolidated Independent School District employed two school psychologists during the 2021-2022 school year. This information was not reflected in the data analyzed by CBS News. This article has now been corrected to include that data.