by Larke Nahme Huang, Ph.D.
Annapolis Coalition Board Member
Former, Senior Policy Advisor, Substance Abuse and Mental Health Services Administration
The mental health crisis for children and adolescents in the U.S. has reached a critical point, presenting challenges not only to families, communities and the mental health care system, but across all child-serving systems, including schools, primary care, child welfare and juvenile justice. From 2009 to 2019, the proportion of high school students reporting persistent feelings of sadness or hopelessness increased by 40%; those seriously considering suicide increased by 36%; and those creating a suicide plan increased by 44%. Between 2011 and 2015, youth psychiatric visits to emergency departments for depression, anxiety, and behavioral problems increased by 28%. Between 2007 and 2018, suicide rates among youth ages 10-24 in the US increased by 57%. Suicide rates among Black children (below age 13) have been increasing rapidly, with Black children nearly twice as likely to die by suicide than White children. Children growing up in lower-resourced families and communities are two to three times more likely to experience mental health conditions than those with a higher socioeconomic status.
The COVID-19 pandemic exacerbated these alarming trends in children’s mental health. Globally, depressive and anxiety symptoms doubled during the pandemic with 25% of youth experiencing depressive symptoms and 20% experiencing anxiety symptoms. In early 2021, emergency department visits in the U.S. for suspected suicide attempts were 51% higher for adolescent girls and 4% high for adolescent boys compared to the same time period in early 2019. Black and brown youth remain underserved even as the burden of mental health problems increases. While the overall rate of drug use among adolescents remained relatively stable through the first six months of the pandemic, adolescents who experienced pandemic-related severe stress, depression and anxiety or whose families struggled with material hardship, were most likely to use substances.
During the pandemic, youth have been seriously impacted by loss and disruptions in routines, relationships and resources (e.g., food insecurity, family job loss, etc.) that have increased social isolation, anxiety, sleep disruptions, and learning loss. The pandemic also created approximately 200,000 pandemic orphans – those children who lost one or both parents or primary caregivers to COVID. Prior to the pandemic, many children with mental health needs received services and supports through their schools. With the closure of schools, these supports were inaccessible to youth.
However, the pandemic did not cause this crisis in children’s mental health. For decades we have struggled with an inadequate and fragmented system of services with poor access to care, limited services and poor outcomes. Prior to the pandemic, the mental health system lacked sufficient resources and a workforce to meet the needs of children with mental health problems. Less than half of the children needing treatment were able to access appropriate services. Children and families from under-resourced communities were even less likely to get access to care. Extreme workforce shortages have been a perennial problem.
The current tsunami of children’s mental health problems exacerbated by the pandemic has made it impossible to ignore this crisis. Essentially, the pandemic has precipitated the “big reveal” – there is no coordinated, systematic continuum of care for children and youth with mental health challenges. Children and their families struggle to access mental health services – because they are not available. When will children finally begin to get the critical services and supports needed to ensure healthy, future development? When will there be a sustained effort to invest in an adequate, well-trained, quality workforce in children’s mental health?
The Biden Administration has responded to this mental health crisis, including a focus on children and adolescents. Protecting Youth Mental Health- The Surgeon General’s Advisory (2021) is a call to action that details specific recommendations for key stakeholder groups. The Advisory includes a recommendation to “expand and support the mental health workforce” and suggests investing in training and hiring from a broader set of disciplines, including peer supports, care coordinators and community health workers; recruiting a diverse workforce that reflects local communities; and building a pipeline of school-based mental health providers.
The President’s “Unity Agenda” presented in the State of the Union Speech (March, 2022), similarly had a focus on child/adolescent mental health and noted workforce-related items in the President’s 2022 budget, such as one billion dollars for a new School-based Health Professionals program to build the pipeline and support the hiring of school counselors, nurses, social workers and psychologists.
The U.S. Department of Education issued Supporting Child and Student Social, Emotional, Behavioral, and Mental Health Needs, (2021) which highlighted the challenges of addressing mental health issues in pre-K, K-12 and higher education and provided seven specific recommendations. The report details gaps in professional development, includes a specific recommendation to “Enhance Workforce Capacity” and directs states to use the American Rescue Plan’s Elementary and Secondary School Emergency Relief funds for blended professional training, coaching models, and connections with local community and 4-year colleges.
These policy reports clearly underscore the overwhelming mental health problems for youth and the lack of a well-organized system to address prevention and treatment. They also hint at a critical, often overlooked element: the need to invest in a well-trained, multi-disciplinary, culturally-relevant and expanded workforce. Now the question is: Is it too little too late? Or is there finally substantial political will to invest in the necessary workforce to meet the mental health needs of our children?