NYAPRS Note: The current mental health crisis among our youth has become a major area of concern for states across the nation. Tackling this major challenge will require robust collaboration between government, providers, and youth who use or need services. Last month, NYAPRS attended New York Governor Kathy Hochul’s Youth Mental Health Summit in which stakeholders discussed ways we in New York can add more support for our youth. The National Governors Association is looking to help states improve their systems and services by releasing a list of policy recommendations based on programs which are working throughout the nation. While it is just a first step, sharing what has worked in other states will go a long way to improving our own systems. We must learn from the successes of other states to help our youth and others living with mental health challenges. See below for more information, including some of the target areas the National Governors Association has identified.
Opinion: A Governor’s Playbook for Improving Youth Mental Health Should Catch On
Editorial Board | The Washington Post | July 4, 2023
As we have noted here before, governors across the country are putting the youth mental health crisis at the top of their agendas. Now, one of them has pulled together ideas for what they can do about it. As chairman of the National Governors Association, New Jersey Gov. Phil Murphy (D) convened listening sessions in Salt Lake City, Detroit, Philadelphia and Los Angeles to hear from hundreds of experts and state officials about programs showing promise. His team, collaborating with the Boston Consulting Group, prepared a playbook with 35 nonpartisan policy recommendations, which he plans to share with fellow governors at their summer meeting next week in Atlantic City.
Mr. Murphy gave us a first look at the report. It contains good ideas that some states are trying and that we hope will catch on further:
Prioritize Early Screening and Interventions
Many mental health challenges can be traced to a child’s formative years, from infancy to adolescence. The Centers for Disease Control and Prevention says 16 percent of children ages 2 through 8 have been diagnosed with a mental, behavioral or developmental disorder. About half of all mental health conditions begin before age 14, according to the Substance Abuse and Mental Health Services Administration.
Most of it goes untreated until adulthood. This is why the U.S. Preventive Services Task Force recommends screening for anxiety from age 8 and for depressive disorders or suicide risk from age 12.
For many children, this is part of standard wellness checkups. But poorer kids, who are more likely to suffer trauma, often don’t receive these services from medical providers. At least 43 states now use Medicaid to cover social-emotional screening of young children, but only 27 allow these to take place in a nonmedical setting, such as the home.
Only one-third of schools offer mental health screenings for all students, per Kaiser Family Foundation. Iowa, Utah, Colorado and New Jersey have enacted laws allowing schools to screen students. Illinois requires it. Montana provides grants for free, and optional, mental health and substance abuse screenings at all schools. Of students identified as being at high risk for future suicide, the state says 99.5 percent received same-day follow-up care by a licensed clinician.
By some estimates, meanwhile, up to 70 percent of youths in the juvenile justice system and 80 percent in foster care suffer from diagnosable mental health issues. To reach them, Minnesota funds mental health screenings for children ages 3 months to 17 years in the custody of Child Protective Services and ages 10 to 17 in the juvenile justice system.
Invest in Mobile Response Teams
The governor’s report highlights four successful statewide efforts to quickly reach minors in crisis.
Oklahoma says its program has diverted 78 percent of youths from inpatient care, leading to fewer police calls and reduced Medicaid costs. Nevada claims 92 percent of those who engaged with its Youth Mobile Crisis Program had avoided emergency room stays. Connecticut contracts with clinics to provide no-cost statewide mobile response teams, whether at home or in school. It has seen a 22 percent reduction in emergency room visits and a 40 percent drop in student arrests. New Jersey’s Mobile Response and Stabilization Services effort, which provides 24/7 access to behavioral health workers, has kept 94 percent of children experiencing a crisis in their existing living situation, as opposed to hospitalization or institutionalization. These are all heartening numbers that underscore the importance of rapid response.
But it’s not enough to stabilize kids when they’re already in crisis. Rapid response will have the most success when combined with lasting individual, familial and community support.
Expand Mental Health Education in School Curriculums
More than 40 percent of students reported feeling persistently sad or hopeless in 2021, according to the CDC. The figure includes nearly 60 percent of teenage girls. One in 5 students and half of LGBTQ students said they’ve seriously considered attempting suicide. Dire numbers such as these pushed Virginia and New York to become the first two states, in 2018, to require mental health education in schools. Maine followed in 2019 with a law requiring instruction on the relationship between physical and mental health.
States are also investing in anti-stigma campaigns — messages aimed at showing kids that they’re not alone and that there is no shame in mental illness. Georgia encouraged youths to share their real feelings online in a 2022 campaign called #FreeYourFeels. Ohio has sought to reduce the high suicide rate among African American youths with a “Life Is Better With You Here” campaign, accompanied by events at colleges.
Teach Children Life Skills that Build Resiliency
Learning how to cope with and bounce back from setbacks prepares youths to respond to the stressors and challenges that life throws at everyone. Just 15 states mandate life skills be taught, and education publisher McGraw-Hill found in a survey that only 22 percent of educators feel very prepared to teach them.
States are moving to fill what might be called a resiliency void: Educators in Arkansas developed a Guide for Life curriculum around the principles of growth, understanding, interactions, decisions and empathy. Florida this year adopted standards focused on building character. Michigan has a program called Trails, short for Transforming Research into Action to Improve the Lives of Students, that develops resilience-focused lesson plans. Oklahoma first lady Sarah Stitt launched a program called Hope Rising to offer coaching and training for community-based organizations. New Hampshire rolled out a Choose Love curriculum in 2020 that was designed by a nonprofit. California partnered with the Child Mind Institute to create a curriculum called Healthy Minds, Thriving Kids.
Expand the Mental Health Workforce
It takes an average of 11 years from the onset of symptoms for individuals to receive treatment for mental illness, according to the National Alliance on Mental Illness. Part of the problem is a shortage of mental health professionals. The University of Michigan School of Public Health estimates that by 2030, America will need more than 28,000 additional child and adolescent psychologists — which means expanding today’s workforce by more than a quarter. The shortage is most acute in poor rural and urban areas.
New Jersey, Texas and North Dakota have used loan repayment to incentivize providers to practice in areas most in need. Michigan has a student mental health apprenticeship retention and training program that provides a $25 per hour stipend for psychologists-in-training who are doing field education in public schools. Georgia’s Transformative Experiential Training grant program sends specialists to high-need areas.
The report also urges states to review licensing regulations and requirements to make it easier for professionals to easily move where they’re most needed. Boosting telehealth is an obvious way to get kids access to help in rural areas that otherwise lack counselors. Twenty-five states have joined a counseling compact that lets professional counselors practice in other member states. The other 25 should follow.
Another idea to expand supply is peer support. More than 200 schools in Wisconsin have student-led wellness programs. California and New York allow certified youth peer-support services to be reimbursed through Medicaid. North Carolina has a program to provide training and technical assistance for them.
Given the workforce shortage, it’s worth training educators to recognize warning signs of mental health challenges in their classrooms. When teachers are expected to be on the lookout for kids in distress, they should also have access to care for their own mental health needs.
As pandemic relief funds dry up, Mr. Murphy expresses optimism that funding will materialize from legislatures because there’s widespread bipartisan recognition the next generation needs help. He says it’s also vital to push insurers to reimburse at the same rates for behavioral health as physical health. An estimated 1.2 million youths covered under private insurance do not have coverage for mental health care, according to Mental Health America.
“I don’t want to lie to you: Most of this stuff doesn’t come free or cheap,” he said in an interview. “But the solutions exist. They’re within our reach.”
Opinion | Gov. Phil Murphy has a plan for improving youth mental health – The Washington Post