The U.S. surgeon general has issued an advisory on the current youth mental health crisis calling on everyone to help our children in these times of a dual crisis. This 40-page advisory outlines the pandemic’s impacts on the mental health of America’s youth and families, and the mental health challenges that existed long before the pandemic.
“Mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade,” said Surgeon General Vivek Murthy. “The COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating. The future wellbeing of our country depends on how we support and invest in the next generation."
In October 2021, a coalition of the nation’s leading experts in pediatric health declared a national emergency in child and adolescent mental health. As cited in that declaration rates of childhood mental health concerns and suicide rose steadily between 2010 and 2020, and by 2018 suicide was the second leading cause of death for youth ages 10-24.
The surgeon general's advisory calls for a quick and coordinated response. It provides recommendations that individuals, families, community organizations, technology companies, governments, and others can take to improve the mental health of children, adolescents and young adults.
Some of the top recommendations include:
Recognize that mental health is an essential part of overall health.
Empower youth and their families to recognize, manage, and learn from difficult emotions.
Ensure that every child has access to high-quality, affordable, and culturally competent mental health care.
Support the mental health of children and youth in educational, community, and childcare settings. And expand and support the early childhood and education workforce.
Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers.
Increase timely data collection and research to identify and respond to youth mental health needs more rapidly. This includes more research on the relationship between technology and youth mental health, and technology companies should be more transparent with data and algorithmic processes to enable this research.
AURORA, Colo. — On any given day at Children’s Hospital Colorado in October 2021, 40 to 50 kids were in need of emergency behavioral health care.
Across the Children’s Hospital Colorado pediatric system, emergency visits for a mental health crisis are up 73% over the same time period two years ago.
The leading cause of death for 10 to 24 year olds in Colorado is death by suicide.
Colorado’s youth mental health has reached a state of emergency and the state’s health leaders are calling on everyone to act.
In a virtual roundtable discussion Tuesday, November 16, Children’s Hospital Colorado, Healthier Colorado and a number of other people representing organizations or personal stake in the issue met to call on lawmakers. They’re asking for Governor Jared Polis and the state legislature to allocate $150 million in federal funding to youth mental health. The money would come from the American Rescue Plan Act (ARPA) and be a third of that funding Polis had previously designated towards mental health. The panel said that represents a third of the state’s population that are kids.
“This cannot continue to be our reality," said Jake Williams, the executive director of Healthier Colorado. “And we are here this morning to continue our collective efforts, to bring the relief that our children and youth deserve. The time to act is now. And we've come with solutions.”
The group also released the Children and Youth Mental Health Playbook detailing the exact steps that need to be taken to address this issue now. These action items aim to strengthen the workforce across multiple industries that help kids with mental health, expand the care continuum, and build a cohesive mental health care system in the state.
Pediatric Mental Health Media Roundtable
Emergency Response: Policy & Funding Solutions to Combat the Youth Mental Health Crisis
In May of this year, Children’s Hospital Colorado first sounded the alarm declaring a state of emergency with youth mental health in the state. The hospital said emergency providers across the state are not able to keep pace.
Following that announcement, Children’s Hospital Colorado worked with lawmakers and the governor’s office to pass Senate Bill 137. Dr. David Brumbaugh, the Chief Medical Officer at the hospital, described it as a broad effort to target mental health funds and a good start. But on Tuesday, November 16, he said more is definitely needed.
“And the challenge that countless providers are grappling with as demand far exceeds supply and story after story, some of which you'll hear today, there is this continued sense of being overwhelmed as a system,” said Dr. Brumbaugh.
A number of health care providers at different levels of the pediatric health care system provided those stories and stark realities they are seeing every day during the roundtable.
Rebecca Doughty is the program director for Four Corners Youth Clinics. That organization has two of the 70 school-based health clinics in the state and serves people up to 21 years old in Montezuma County.
“Two years ago one out of our five pediatric patients would report depression and anxiety. Today that has grown to four out of five of our pediatric patients reporting depression and anxiety due to the lack of behavioral health providers in our rural areas,” said Doughty.
She explained that the clinic is seeing more kids needing inpatient stays and schedules are full. Doughty said they had to hire a second behavioral health professional in the clinic and were very lucky to find one.
“I think that one of the main pressing issues is truly a lack of licensed medical and behavioral health providers, as well as additional community support,” said Doughty.
A pediatrician with Every Child Pediatrics in Aurora also noted the staggering need of mental health care. As a result, Dr. Sophia Meharena shared that she has witnessed a heightened number of patients that come into the clinic asking for help.
“This really hit home for me recently on a Friday, when four of 16 patients I saw confided in me that they were having suicidal thoughts,” said Dr. Meharena. “This is a health emergency, the mental health of our youth; they're suffering.”
Another group of people who are seeing the mental health struggles of our children first-hand are teachers. But the workforce of about 60,000 educators are suffering from the Great Resignation as many are burning out from the stresses of the last couple of years.
“What I see every day is that my students and my colleagues are walking around with open wounds, things that haven't really been addressed,” described Gerardo Munoz, the 2021 Colorado Teacher of the Year.
He pointed out how incredibly difficult and challenging it has been for teachers and students around the state because of the pandemic. From teaching remotely to getting reliable and consistent internet connectivity, Munoz said on the surface it looks like schools have recovered.
“What I need to really drive everybody's attention to is that it’s coming at a very heavy cost. People are stretching themselves beyond what is funded beyond what we have the capacity for, and it's getting worse daily,” said Munoz.
As a recent high school graduate, Ashley O'Day understands the stress, the anxiety and untreated trauma many of her peers are experiencing. As she attended online school, she also understood the impacts of this pandemic.
“When you're not in a traditional brick and mortar school, the isolation is just so much deeper. It's more vast, it's terrifying,” said O'Day.
In high school, she was able to create a peer-to-peer mental health support group for struggling teens. She emphasized the importance and need for in-person interaction and how social media made her feel more lonely.
“When it feels like you're just yelling into a cave and only hearing an echo on social media, you don't feel like you can turn to anyone else,” explained O'Day. “You think, ‘Oh, I have 5,000 followers, I posted a cry for help and nobody said anything. Why is the doctor going to care? My family, my friends... they saw that too. And nobody reached out.’”
She described having to adjust her organization to get her fellow teenagers the connections they needed during a time when we were asked to stay apart. That involved reaching out to the community and partner up with other facilities like long-term care facilities.
The pandemic isn’t the only thing to blame for the crisis Colorado has found itself in. Several speakers in the roundtable talked about a broken and uncoordinated system of care for youth mental health.
Jim Wiegand, a parent of to seven children, saw first-hand how difficult it was to get his daughter the proper care.
“We keep hearing about gaps in mental health services in the state. I don't see them as gaps. I see them as black holes. Systems are just failing the families and kiddos over and over again,” said Wiegand. “It's complicated. It's a system that does not allow for a parent to be able to navigate.”
His family’s story exemplifies the problems all too well. He and his wife adopted their daughter, Lucy, when she was young, but unfortunately she had already experienced tough times. Wiegand said when she hit puberty that trauma resurfaced and she was in need of mental health help.
To get her residential treatment, Wiegand said they had to give the county partial custody. Despite that, she still went through multiple residential treatment programs for two and a half years. The place they were finally able to find her successful treatment was in Georgia, hundreds of miles away. She is now doing much better and hopes to become a mentor to help others who are in similar situations.
“We were lucky that we have the means and the ability to engage with our child and, and really advocate for her,” said Wiegand. “But through this process, we have created lots of friends and we have lots of people that we know that have similar struggles and they're totally silenced by the frustration that they have with the current system, because they don't know what to do. We have friends that have their child was in the hospital for six months because there was no placement for them.”
While this group of advocates shared sadness and startling stories and statistics, the purpose was also to make a positive step forward.
“We're also pushing the state to prioritize children and youth, as it considers the development of policies and funding levers to rebuild a system,” said Dr. Jenna Glover, a child clinical psychologist with Children’s Hospital Colorado.
Dr. Glover explained that this is a once-in-a-generational opportunity to rebuild the system by strengthening the mental health workforce, building off the success of tele-health experienced in this pandemic, and enhancing the mental health insurance parody to increase access to care.
The insurance parody is the way the current system is set up and has been for decades. In this system, healthcare in the United States treats medical and mental health as two separate problems to address and behavioral health plans are often restricted in this model. That means most primary care providers can’t afford to staff a behavioral health provider because they can’t get reimbursed for it.
“We need to invest in the inextricable link between behavioral health and medical health, which we know exists on a biologic neurologic level and is playing out at a systems level now,” said Dr. Brumbaugh.
Rebuilding the system also means shifting the focus to reactive care to preventative care, therefore reaching children before they get to that emergency level.
“I do think one of the other problems with the system was that we really did not have a coordinated, systematic way that we screen children. And so there are ways to catch these things much, much earlier. So we don't get at this bottle neck where kids need very, very high acuity services that we have not a lot of,” said Dr. Glover.
A big part of the discussion about solutions also became a talk about the stigma around mental health and how that has ultimately led to so many of these problems.
“The system has always been broken and it's been broken because of stigma and a lack of understanding, which has led to a lack of integration and the lack of resources,” said Williams.
Around the virtual roundtable the general consensus to break down that stigma was to speak up about what you or your family is going through. And many agreed it’s the only way individuals can take immediate action.
“If you or your child needs help, parents should be going to their doctor. Even without an integrated model. Your primary care should have resources in your community for help...or to a school counselor, if that's where you feel most comfortable, because schools have some mental health resources also, but you have to ask for help wherever you feel comfortable, ask for help, said Dr. Meharena. “So yes, speak up, bring down the stigma, have a voice, talk to your elected officials, talk in your community, but also get the help you need.”
If you have to listen to the full roundtable discussion, you can find that here.