Utilization, awareness, and satisfaction with school counselors in Nagoya, Japan: repeated cross-sectional...

Mental health issues in childhood and adolescence have become a significant concern in Japan, underscoring the need for accessible school-based mental health care. School counselors (SCs) play a role in providing school-based mental health support; however, they are employed part-time, potentially limiting their presence and accessibility. In 2014, the City of Nagoya implemented a municipal policy assigning full-time SCs to public junior high schools. This study aimed to describe changes in students' utilization, awareness, and satisfaction with SCs within this policy context.

We conducted a repeated cross-sectional observational study using administrative survey data collected in 2014, 2015, 2016, 2019, and 2021 from public junior high school students in Nagoya. Teacher surveys were conducted in all survey years, and parent surveys were included in 2021. The surveys measured students' utilization of SCs, awareness of their presence, and subjective evaluations of consultation experiences. Analyses were descriptive and focused on comparisons across survey years; this study did not assess causal effects of the policy.

The proportion of students who reported consulting SCs about their worries or problems was higher in later survey years, with values of 2.6% in 2014 and 10.3% in 2021. During the same period, the proportion of students who reported knowing "absolutely nothing" about SCs was lower in later survey years, with values of 30.3% in 2014 and 16.1% in 2021. Among students who consulted SCs, subjective evaluations of the consultation experience tended to be more positive in later survey years. By 2021, approximately 95% reported they felt "glad to be listened to" or otherwise evaluated the encounter positively. Teacher surveys showed similar patterns, with higher reported use of SC services and more positive perceptions in later survey years.

This descriptive study, based on repeated cross-sectional surveys, examined changes in students' utilization, awareness, and satisfaction with SCs following the introduction of full-time SCs in Nagoya. Although causal inference is not possible, these findings provide contextual insights for future evaluation and planning of school-based mental health services. More rigorous study designs are needed to evaluate causal effects of full-time SCs on mental health outcomes and educational equity.