Children in America are in crisis–struggling with anxiety, depression, and other mental health issues at unprecedented levels. As a child and adolescent psychiatrist for the Behavioral Health Center at Children’s Hospital New Orleans, I have had a first-hand look at the increasing numbers of youth struggling with mental health.
From losses and disruptions caused by the pandemic to increases in gun violence and school shootings to social injustices, children are inundated with messaging across many platforms that negatively impacts their mental health.
In response to the influx of mental health cases, the American Academy of Pediatrics has declared a national emergency and the U.S. Surgeon General has issued a public health advisory. Over 60 percent of youth with major depression do not receive any mental health treatment. Even in states with the greatest access, nearly 1 in 3 are going without treatment.
Louisiana ranks 49th in child well-being and 62.5 percent of youth diagnosed with major depression did not receive mental health services.
To support a child’s mental health, we need to meet them where they are — at school.
Barriers to mental health care
Prior to COVID-19, The Centers for Disease Control and Prevention (CDC) reported that 1 in 5 children suffered from mental illness. Data from 2021 indicates that number jumped to 37.1 percent. Yet, only about 20 percent of these children received care from a mental health provider. Access to these mental health services is quite limited for various reasons.
Some families live in communities where they are unable to find mental health care due to the lack of providers in their area. Other families, particularly those in minority and low-income households, encounter financial and transportation barriers, making it more difficult for them to access mental health services. To tap into these services, they must travel far or be placed on long waitlists to receive care.
Alongside these barriers, stigma associated with mental health remains pervasive – and this is especially apparent in minority communities. According to the American Psychiatric Association, African Americans, Hispanic, and Latinx communities endorse significant depressive and anxiety related symptoms, and their suicide risk is gradually increasing over time. Studies show when students of color are treated in the medical system, they may experience discrimination, judgment, and implicit or explicit bias. As we work with minority communities, it is important for us to look back to where the distrust is coming from, and re-establish trust by remaining curious and collaborative, remove barriers, and ensure they have access to equitable care.
Creating a school culture of mental health awareness
When putting the pieces together to create the overall picture of a robust, school-based mental health program, another big component is the educational and training piece for school staff.
For our behavioral health team to provide mental health care and treatment for children, it is so important for schools to cultivate a safe, non-judgmental culture of mental health awareness where teachers and support staff are trained to identify the early signs of mental illness. Evidence shows that ethnic and racial minorities are often mislabeled as aggressive, violent, or combative when they are, instead, suffering from a chronic, underlying mental illness that was not identified early on. The presence of school based mental health services has been shown to reduce the number of students being misplaced in the school-to-prison pipeline or juvenile justice system.
Bringing mental health care programs to schools
Since children spend one-third of their lives in the classroom, schools provide a natural setting for students to receive support in a non-stigmatizing and barrier-free environment where they have seamless access to early intervention and treatment in one location.
School-based mental health care also presents a unique opportunity for us to eliminate barriers to accessing care. Other benefits include students missing less of their classes, parents not having to call out of work to bring their child to appointments, giving parents the ability to attend their child’s appointments virtually, and more opportunity for collaboration between school staff and mental health professionals.
It is important to provide mental health services from a systems of care approach. The adage “it takes a village” certainly reigns true as it applies to caring for children and their families. Children interact and engage with several different youth-serving entities: education system, primary health care system, mental health system, potentially religious/spiritual care system, child welfare system, substance abuse treatment services system, juvenile justice system, and developmental disabilities system. These systems, when functioning at their best, should be youth-guided and family-driven. Collaboration with the education system involves communicating with many diverse partners including teachers, staff, students, parents, and their families. With everybody coming together, we can address the individualized mental health care needs of children and adolescents within the naturalistic systems and communities in which they live, thus increasing the likelihood of the child growing into a successful, thriving adult.
Making a difference for our youth
Mental health issues do not get better on their own. The longer an illness persists, the more difficult it can be to treat and recover. Raising awareness of mental health and offering mental health services directly to students on campus is the focus of school based mental health care.
Whether you are directly involved in health care or not, we all have a role to play in supporting children by removing barriers to access, and creating communities where young people can grow and thrive.
U.S. Surgeon General Dr. Vivek Murthy expressed this collaborative notion so eloquently when he said:
“If we seize this moment, step up for our children and their families in their moment of need, and lead with inclusion, kindness and respect, we can lay a foundation for a healthier, more resilient and more fulfilled nation.”
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