3 key steps for legislators to address the crisis of youth mental health

At my clinic this week, all but two of the patients I cared for needed mental health support or worked closely with a mental health professional to help with mood symptoms, such as feeling hopeless or trouble sleeping and appetite. Our provider’s inboxes are filled with letters from families (and patients) requesting resources after contacting several therapists and discovering that, at best, they can be added to the waiting list, but often there are no openings for new clients. The demand for professionals with experience in caring for the psychological needs of children and adolescents is increasing with very limited supply. Pediatric providers like me are desperate to help but have too few tools in our toolbox.

Last week, US Surgeon General Vivek Murthy released a report outlining the mental health crisis for young people in America saying “…the challenges that today’s generation of young people face are unprecedented….and the impact these challenges have had on their mental health has been devastating.”

This is an emergency, a crisis unlike any other in our professional lives as pediatricians. Our state ranked 43rd in the country in 2020 in terms of children’s access to behavioral health care. A March 2021 survey of Washington state students found that about 45% of middle school students and nearly 60% of high school students felt depressed or sad most days in the past year. A 2019 statewide study found that nearly half of children with a treatable mental health condition did not receive the care they needed. BIPOC (Black, Indigenous and Colored) children and youth have greater mental health needs if they are not addressed.

These statistics show the shocking prevalence of mental health issues among young people, but the stories of these young people are the most explosive.

  • A young man has been diagnosed with an eating disorder who is hospitalized due to the physical effects of malnutrition, but his state insurance is not acceptable in a private eating disorder facility.
  • A teen experiences growing panic and separation anxiety from moving to personal school, and his family summons seven therapists who don’t have slots.
  • A student with depression and non-suicidal self-harm (cutting) who has had three different therapists over the past six months because staff turnover is too high at the local behavioral health agency.

Children and teens were struggling with growing mental health concerns prior to COVID-19, but there is no doubt that this crisis has been exacerbated and accelerated by the pandemic. Families are frustrated, afraid and lose hope.

Kids and teens are often an afterthought that gets lost in systems built for adults. Our state and our institutions have taken steps to help, but they have not been enough. This is the time to take bold steps if we want to see big change. Our children cannot wait for the slow bureaucratic machinery to make incremental progress. We have a moral duty to do everything we can to address the mental health crisis of young people, and we urge the state legislature to use its upcoming session to make a strong statement that children matter.

The Legislature’s Child and Youth Behavioral Health Working Group has studied issues impeding access to care since its formation in 2019. It has presented a list of 12 solutions that the state can and should enact without delay when the hearing begins in January. Three critical recommendations include:

∙ Develop a vision and actionable plan to support children at all levels of need: from the first years of life to school-age children with mild or moderate needs to children in crises.

∙ Funding CHWs in primary care clinics to help families care for their children.

∙ Provide resources for primary care clinics to implement behavioral health care as part of their team, so that children can get the help they need right there in the clinic.

These simple solutions will help break down barriers, such as transfer and stigma, that often hinder our patients’ ability to start – and continue – mental health care. We hope that our nation’s policy makers will meet this challenge with the strength, courage, and creativity that the situation demands.

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