As lawmakers prepare for the new year and wrestle with budget decisions that tap into their surplus or face shortfalls, there are significant opportunities for states to make big strides in youth mental health. The time is now.
Across the nation, young people are actively seeking help through Mental Health America screening program, which records more than 10,000 visitors a day – over a third of reviewers are under 18. Youth commonly express how trauma, relationship problems and isolation are the top three contributors to their mental health concerns at the time of screening and data Show LGBTQ+ and Black, Indigenous and People of Color (BIPOC) as those who will benefit most from swift action. Research by Common sense media suggests that teens want help managing their internet and smartphone use, but feel powerless to make changes on their own (notably, over a dozen states are suing Meta over its harmful practices).
The Association of National Governors Youth Mental Health Book, released earlier this year, is a tool that states can draw from to create policies and initiatives and offers examples of administrative and legislative actions that states have already taken. It is informed by a year of work by New Jersey Governor Phil Murphy, in his role as president of the National Governors Association (NGA), and NGA staff working with national mental health advocacy organizations, including Mental Health America, and advocates for youth. The playbook uses four pillars to show how systems can be overhauled to address today’s critical needs of children and young people and how to build capacity to reduce tomorrow’s needs.
As communities face decisions about whether or not to end programs and policies funded by one-time supplemental funding for COVID-19, it’s important not to return to “business as usual” by putting mental health on the back burner. Before the pandemic, families looking for mental health care for children couldn’t find it 69% of the time, according to NORC research nearly 3,000 people in 2019-2020. In comparison, 17% of people looking for physical child health care were unable to find it. State leaders must ensure that their budgets and policies reflect the will of the many voices of young people seeking mental health help for themselves and their peers.
Key opportunities
Pillar 1: Addressing prevention and building resilience
Key opportunity to Pillar 1 points to Massachusetts (page 14) for developing healthier school climates. To address the root causes of student behaviors, rather than responding with harsh punitive measures, Massachusetts requires schools to first use alternative forms of discipline, including mental health intervention. Although black children make up 15% of the K-12 school population, they make up more than 40% of referrals to law enforcement.
Pillar 1 it also emphasizes data collection and analysis as critical steps in the process. It is important that such data and analyzes come from a representative sample of the affected population: students. States should review how schools consider student experiences and reassess student engagement and accessibility frameworks when implementing mental health initiatives. Establishing a strong youth mental health system involves listening carefully to the concerns and struggles of young people and judiciously using this data to take proactive steps to promote a healthier school climate. In this way, schools will provide their students with a transformative experience that goes beyond academic metrics to one that is also concerned with guiding students to become emotionally competent individuals.
Pillar 1 shows the importance of building resilience, which includes teaching life skills in schools and community programs. Building resilience on school campuses should be a top priority for school officials, as research has shown the benefits of such practices. ONE Yale Study 2020 found that “to improve students’ mental health, schools should teach them to breathe.” A specific resilience program, SKY Campus Happiness, which relies on a breathing technique, yoga postures, social connection and service activities, was most beneficial to students’ mental health, with students reporting improvements in six areas of well-being: depression , stress. , mental health, awareness, positive affect and social connectedness. A recent law in Florida and a new policy in New York highlight the growing recognition of the power of resilience and its incorporation into education. By incorporating meditation and breathing practices into daily routines, states will not only address youth mental health concerns but also to cultivate a new generation of emotionally competent leaders that have high performance.
Pillar 2: Raising awareness and reducing stigma
Pillar 2 points out that all activities must be conceptualized, implemented and implemented with young people. By giving young people a place at the decision-making table, we make them key players in ensuring that systems are user-friendly and continuously improved using feedback. User feedback is highly valued by many private companies, yet public systems are slower to adapt and transform based on real-time data than they serve. New Mexico (page 23) created the Indigenous Youth Council, which provides youth-specific referrals to the state Department of Indian Affairs for behavioral and mental health needs in tribal communities. Several other states, including Vermont, Maryland, and Arizona, also allow youth councils to directly inform state policy.
Pillar 3: Ensuring access and affordability to quality treatment and care
An exciting opportunity to Pillar 3 funds peer support models. Peer support services are known to reduce isolation and help build support systems, increase self-help skills and service engagement, and empower young people to lead self-directed lives. In addition, peer support can prevent behavioral crises by helping individuals better manage physical and mental health conditions. Although formal peer support is evidence-based, it is also commonly practiced among friends, colleagues, trusted colleagues, and has a long history outside of evidence-based practice. Informal peer support is commonly used among young people because of the ethos of reciprocity, accessibility and trust embedded between peers. There are quite a few youth peer support modelsincluding peer counseling programs and programs using formal certified peer specialists.
In Wisconsin (page 30), more than 300 schools offer student-led peer wellness programs. Currently, 18 states bill Medicaid for youth peer support, which can be offered as part of mobile crisis programs, in schools, or as part of other community-based services—but no schools use Medicaid as a funding source. Young people are very interested in learning skills to support their own well-being and to support the well-being of their friends and peers. In a survey of almost 2,000 young people seeking help through the MHA’s online screening programme, 44% of 14-18 year olds said they have access to support from other young people is one of the most important resources for their mental health. Peer support is intuitive because young people turn to each other first long before they’re ready to talk to an adult about what they’re experiencing, and schools should bill Medicaid for that.
Pillar 4: Education and support of carers and teachers
Key opportunity to Pillar 4 emphasizes the importance of training and education of adults and caregivers serving youth. The North Dakota Department of Health and Human Services Division of Health Behavior (page 35) has made online role-play simulation technology available to help school personnel recognize signs of distress. The program models conversations to reach out to students discussing concerns and makes referrals to appropriate resources.
Not specifically addressed in the playbook, it should be noted that there is often an additional layer of stigma attached to student-athletes experiencing mental health issues due to the culture and attitudes around help-seeking. Student athletes support change in athletic programs where students spend a significant portion of their time. Therefore, athletic trainers should be trained in mental health as they are required to be trained in CPR and heat illness prevention as both mental and physical health can be a life or death situation. This year, Ohio passed HB33, which mandated mental health training for all 80,000 high school coaches. In Maryland, the youth-led Alston for Athletes supports HB375, which would require all coaches at public institutions to undergo mental health training. However, training should not be exclusive to coaches, and the long-term goal is to ensure that other school staff receive it, including teachers, bus drivers and all adults who serve young people.
What’s next?
We’re excited about the opportunities this playbook brings to the states and appreciate the incredible work that went into putting this comprehensive guide together. MHA and its partners look forward to working with stakeholders to implement playbook policies, including the few highlighted here, because there is no health without mental health.
Advocates, tell state officials to make sure youth mental health is a top issue in the next session. Let your governor know they need to prioritize youth mental health. Inseparable action alert will automate a letter based on your residence.
Caren Howard is the senior director of policy and advocacy for Mental Health America. Jose Caballero is a national award-winning mental health activist, a member of the MHA Young Leaders Council, and a student at Columbia University. Marcus Alston is an award-winning mental health advocate, founder of Alston for Athletes, and alumnus of the MHA Young Leaders Council.
