Tag Archive: mental health

  1. Prioritizing Youth Mental Health Requires Intention and Investment

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    Whether you are a young person, a parent, a mental health professional, or an educator, you have likely heard about the youth mental health crisis in the United States—it is being discussed everywhere, from kitchen tables to news stations to the Governor’s office. And while there is finally urgency around addressing the mental health needs of Virginians, we continue to see a catch-all response for adult and children’s mental health needs in our current policies. It is undoubtedly easier to design mental and behavioral health systems and services for adults and retrofit young people into them, but this results in supports that inadequately meet the needs of children and youth. To truly invest in the mental health of young people, policymakers must do so with intention. It requires centering the needs and experiences of young people—especially those who are Black, Latino, and LGBTQ+—and developing mental health services that prioritize healing and well-being.

    The past few years have been particularly difficult for young people. The Joint Legislative Audit & Review Commission’s (JLARC) November 2022 report shared several alarming statistics that articulate the dire need to intervene and support young people right now: 

    • Self-harm-related emergency department visits among Virginia youth, ages 9 to 18, more than doubled from 2016 to 2021, with the largest increase in self-harm visits occurring in 2021, according to the Virginia Department of Health, and   
    • Youth deaths by suicide, ages 9 to 18, averaged 4.9 deaths per 100,000 youth from 2015–2019, and were 6.2 per 100,000 youth in 2020 and 5.6 per 100,000 in 2021.

    Graph showing youth emergency room visits for self-harm have risen over time; increasing substantially in 2021

    This constitutes a youth mental health crisis. In order to meet this moment for youth mental health, there must be major shifts in how children and youth are prioritized in our system. Historically, new initiatives and service expansions have delayed the implementation of child- and youth-focused plans until phase two—a step that often takes too long to achieve. Mental health resources that are not intentionally designed to reach children and youth will not reach them.

    Capacity to build up the infrastructure at local Community Services Boards, particularly for children and youth, is needed. The ideal system offers young people mental health support when and where they need it, but the reality is children and youth do not have access to a comprehensive array of crisis response services depending on where they live, who pays for their care, and who helps them identify resources.

    Currently, there are only three Residential Crisis Stabilization Units (RCSUs) specifically for young people across the Commonwealth. One goal of Governor Youngkin’s “Right Help. Right Now.” behavioral health transformation initiativeis to add more youth RCSUs and to develop 23-hour Crisis Receiving Centers (CRCs) to serve as a “behavioral health urgent care”, both of which are critical components of the crisis services continuum. However, if the locations and services are not developed with young people’s needs in mind, they will not be as effective of a resource. Having a cross-lifespan model for RCSUs and CRCs that only incorporate child-sized recliners does not make a space child- and youth-friendly. The design of RCSUs and CRCs must be fundamentally different from the design of a traditional hospital, which are often sterile and unwelcoming environments. Young people need culturally and developmentally appropriate resources in these locations, such as places for their family members to rest, blankets, sensory toys and comfort items, and a warm and inviting environment to encourage healing and create emotional and physical safety.

    Virginia lawmakers have a chance to reimagine what it means to put young people’s needs at the forefront of their decision-making during the 2023 General Assembly session. Between Governor Youngkin’s proposed budget and several budget amendments before the legislature, there are opportunities to ensure behavioral health services are available in every region and designed with the needs of children and youth in mind. This includes expanding crisis response services with components specific to children and youth and providing adequate resources to build the capacity of the system.

    TAKE ACTION: We urge lawmakers to prioritize young people’s healing and well-being. This can be done by making a targeted investment in youth mental health through the state budget.

    Build out crisis response and stabilization services that offer young people support when and where they need it.

    • Continue the expansion and modernization of the statewide crisis services system by investing in crisis receiving centers and crisis stabilization units. Hire a staff member to oversee Children’s Crisis Response Services.
      • Support the Governor’s proposed budget to increase funding for a comprehensive crisis services system | $58,345,204
    • Fund contracts with private providers to establish mobile crisis units in underserved areas.
      • Support the Governor’s proposed budget to provide one-time funds for mobile crisis units | $20 million

    Prioritize young people in the design and implementation of mental health services.

    • Build upon the base of $8.4 million the legislature has provided since SFY2017 to expand or enhance children’s behavioral health services in all five Department of Behavioral Health and Developmental Services (DBHDS) health planning regions and keep a dedicated focus on infrastructure specific to children and youth services within DBHDS’s Office of Child and Family Services.
      • Support budget amendments for Children’s Behavioral Health Services: Item 313 #1h (Price)/Item 313 #6h (Seibold); Item 313 #5h (Rasoul); Item 313 #3s (Favola)

  2. Improving Medicaid Reimbursement for Children’s Mental Health Services

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    Nearly half of Virginia’s children are enrolled in Medicaid for their health insurance coverage. To ensure that these young people have access to mental health providers, and for those providers to adequately compensate staff, reimbursement rates for behavioral health must be increased this year.

    Medicaid-funded services for children’s behavioral health has declined by $100 million since the beginning of the pandemic, largely due to the phase-out of Therapeutic Day Treatment Services in schools. While the dollar amount of funding has decreased, more children and youth have sought mental health services since the pandemic, meaning that services have not adequately kept pace with needs. Furthermore, only 14% of children on Medicaid are receiving behavioral health services, a significant gap below the need expressed in the general population of children and youth where 30% or more of young people express mental health concerns. Black and Latino children are disproportionately enrolled in Medicaid and report more barriers to accessing mental health care.

    Medicaid reimbursement for children’s mental health services has declined by $100 million since the pandemic, despite an increase in children seeking services. (Bar on the far right does not represent a full year.)

    The members of the General Assembly will consider several proposals to improve Medicaid reimbursement for behavioral health services. The options below can put Virginia on a path forward to bringing more behavioral health resources into schools and reaching more students who need mental health support.

    The Solutions:

    Medicaid rates must keep pace with inflation and ensure adequate staff compensation.

    Short-term solution: increase community behavioral health services rates in FY24

    • Support 304 #9s (Deeds)/304 #23h (Farriss): Medicaid Reimbursement Rates for Community-Based Behavioral Health Services

    This proposal would provide:

    • 25% rate increase for:
      • Intensive In-Home, Mental Health Skill Building, Psychosocial Rehabilitation, Therapeutic Day Treatment, Outpatient Psychotherapy, Peer Recovery Support Services — Mental Health.
    • 10% rate increase for BRAVO services:
      • Comprehensive Crisis Services (which include 23-hour Crisis Stabilization, Community Stabilization, Crisis Intervention, Mobile Crisis Response, and Residential Crisis Stabilization), Assertive Community Treatment, Mental Health – Intensive Outpatient, Mental Health – Partial Hospitalization, Family Functional Therapy and Multisystemic Therapy.

    And a long-term solution: conduct a rate study to determine inputs to delivering care and suggest a process for annual rate increases based on inflation.

    Modernize reimbursement rates for school-based mental health.

    Long-term solution: conduct a rate study on school-based mental health services to replace the currently offered service—therapeutic day treatment “TDT”. The future of behavioral health redesign planned to look at this service and develop new school-based services connected to multi-tiered systems of support in school. 

    • Support Medicaid Rate Studies for Behavioral Health 308#7s (McClellan)/ 308#11s (Brewer)

    This proposal provides a long-term solution to modernizing school-based mental health services and empowers young people to help design those services.

    • Youth voice/choice: this amendment specifies that students and school-based stakeholders must be involved in the design of school-based services.

    Provide TA to School Divisions to Implement Medicaid Reimbursement

    In a follow-up to the 2021 legislation proposed by Sen. Dunnavant to implement the “Free Care Rule” in Virginia, our state Medicaid agency has an application pending approval at the federal level to allow school divisions to bill Medicaid directly for school-based health and mental health services outside of a students’ IEP. This would enable school divisions to pull down a dollar-for-dollar match for the health services provided or initiated by schools. There is a catch though. School divisions will have to take on extra administrative tasks in order to seek reimbursement. This proposal allows DMAS to provide resources to DOE and school divisions to provide technical assistance and professional development to seek reimbursement.

    • Support Technical Assistance to School Divisions to Implement Medicaid Reimbursement Item 308#13s (McClellan)

  3. Recap: Racial Truth & Reconciliation Week (August 2022)

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    This blog post was written by Voices intern Cat Atkinson.

    “If you have come here to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together.” – Lilla Watson, Indigenous Australian artist, scholar, and activist.

    This year marked Virginia’s 3rd Racial Truth & Reconciliation Week (RTRW); a virtual week-long conference hosted by Voices for Virginia’s Children. This year’s RTRW took place August 22-27, 2022. The mission of RTRW is to empower the voices and experiences of marginalized communities in acknowledgment of truth to promote healing, reconciliation, and justice for children and families. This week promotes the reckoning of our past to reconcile our present and future. In this blog post, we’re taking a look back at this year’s themes and workshops.

    RTRW seeks to advance policies that dismantle systems that perpetuate racial trauma, oppression, and inequity by educating Virginians, encouraging advocacy and activism, promoting equity, inclusion, and justice, and uplifting the voices, truths, and experiences of communities of color.

    As we continue to navigate divisive political landscapes and strive to promote trauma-informed healing, compassion, and justice, we intentionally selected RTRW themes to reflect the intersections of current events, history, culture, time, and policy that we find ourselves in. RTRW 2022 highlighted the themes of “Good Troublemaking: Necessary Trouble to Enact Change”, “Voices of Virginia’s Future: Highlighting Young Advocates”, and “Activists and Organizational Change: Reckoning and Reconciling Our Truth”, centering the voices and stories of youth and community members as the experts on their lived experiences in these topics.

    “Our kids were born for this time.” – Ann Zweckbronner, Parenting an Activist

    Over the course of the week, we had 19 workshops, 31 presenters, and 586 registrants from 29 states and Canada! RTRW went international! We had attendees from state agencies, non-profit organizations, community-based organizations, students, youth, parents, and more. 95% of those polled were satisfied with the programs and 98% of those polled thought the content was relevant to their work. We have been celebrating the community that RTRW has created by continuing to engage with repeat attendees over the years.

    Graphic featuring the words Racial Truth and Reconciliation Week 2022 followed by four purple circles each containing text. The first says 19 workshops. The second says 2,171 registrations. The third says 31 presenters. and the last one says 586 registrants. Followed by a grey bar containing the racial truth and reconciliation logo at the bottom.A graphic that says Racial Truth and Reconciliation Week 2022 at the top followed by the words 29 u.s. states participated and Canada and an icon of the globe. At the bottom there is a grey bar with the RTR logo in the center.
    The workshops this year highlighted the importance of community partnership and the collective liberation of the communities we uplift through advocacy. We engaged in conversation about DEIJ (diversity, equity, inclusion and justice) within organizations and communities, we discussed the importance of understanding intersectionality, how to support and encourage social justice advocacy within youth and cause “good trouble” within our social system to bring about radical change. There was collective storytelling, intentional self-reflection, engagement with new lenses of focus, and a buzz of energy from attendees and organizers to take this work back to their own spaces. In one week, we got to see the power of community engagement in mobilization for radical change.

    Let us continue to work together:

    Upcoming Coalition & Committee Meetings:

    Learn More About Advocacy:

    • Legislative Advocacy Guide: This comprehensive guide describes advocacy through the Virginia legislative process and gives specific instructions on how to communicate with elected officials.
    • Watch livestream or view recordings of House and Senate committee meetings.
    • Who’s My Legislator? Click here, then type in your address to find your Virginia representatives.

    Support Voices’ Work:

    • Voices is able to convene events like RTRW that ignite change in pursuit of healing, reconciliation, and justice thanks to your generous contributions. Please consider giving a gift to support the dedicated work of Voices staff in putting together RTRW and other events focused on improving the lives of Virginia’s children.
    • Make your one-time or recurring gift online by clicking here.

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  4. 9-8-8 is Just One Step Towards a Comprehensive Crisis Services System

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    This blog is the second post in a two-part series that takes a deeper look into Virginia’s efforts to integrate the 9-8-8 hotline with the behavioral health crisis services continuum. Read the first blog post in the series here.

    For years, communities have advocated for diverting mental and behavioral health calls away from law enforcement and for states to adopt a comprehensive crisis response system. Now, that dream is beginning to come to fruition. On July 16, the National Suicide Prevention Lifeline transitioned to the three-digit number 9-8-8. While this transition was initiated by legislation at the federal level, states are responsible for the rollout and linkages to their crisis response systems when the caller’s needs cannot be resolved over the phone. Virginia has been working on a rollout behind the scenes to link the lifeline to crisis response services that are currently being designed and implemented by state agencies and stakeholders.

    The commonwealth’s plan for minimizing emergency room visits for mental health crises and providing an alternative to calling 9-1-1 is to link the crisis call centers with regionally focused resources by integrating mobile crisis response alongside the Marcus Alert protocols. However, at this moment, this is simply the goal and not the reality. The development and implementation of Virginia’s behavioral health crisis system has been a piecemeal approach, and is not yet fully prepared to deliver comprehensive, trauma-informed, and culturally responsive services to meet individuals’ mental health needs—specifically the needs of young people

    The Surgeon General sounded the alarm in December 2021 by issuing an advisory on the youth mental health crisis. Despite widespread awareness, young people’s mental and behavioral health needs are often an afterthought or part of “phase two” when developing programs and services. Current resources dedicated to young people’s behavioral health make up less than 10% of Virginia’s overall behavioral health agency budget. The lack of sufficient funding and resources further the disparities that historically marginalized communities face in accessing support and services.

    Due to the inconsistent mental health crisis services across regions, law enforcement is often the first point of “care” for mental health emergencies, especially for Black, Latinx, Indigenous, and LGBTQIA+ youth. While most calls to 9-8-8 can be resolved during the call, some crises will require an in-person response based on a four-level call matrix.

    four level call matrix

    This new entry point for mental health support is supposed to be an alternative to law enforcement response, but a new law allows 89 of Virginia’s 133 localities with 40,000 or less residents to opt out of two protocols under the Marcus Alert System. This means that for those living in one of the 89 localities that are not required to implement all Marcus Alert protocols, an attempt to get in-person crisis support may still result in law enforcement, with or without Crisis Intervention Training, responding to your call. The criminalization of youth crises often results in further traumatization. This experience can intensify their crisis, compromise their treatment, and make them and their families less willing to call for help if another crisis occurs. Far too often children and families are met with a response that is not suited to meet their immediate or long-term needs.

    At a time when young people need support the most—while their worlds have been turned upside down by COVID-19—we must ensure there are providers and services in place to provide access to timely, culturally responsive services, and address social determinants of health to support children and families’ overall wellbeing. This requires investments from lawmakers and interagency collaboration.

    For 9-8-8 to be truly transformative, investments are needed now.

    While all these recommendations are not immediate and some are considerations for future policy, Voices for Virginia’s Children suggests the following key recommendations:

    • Mobile Crisis services need to be fully funded across all regions, with an emphasis on providing services in underserved and rural communities. Voices also suggests separate mobile crisis protocols designed specifically for youth, as the intervention points at which young people receive support may include schools, parental consent, developmental appropriateness, or specifically trained professionals;
    • Mobile Crisis and Community Care teams should include a peer specialist, interpreter, community advocate, and child-serving mental health professional;
    • More small-scale children’s Crisis Stabilization Units should be placed in communities across the state;
    • Establish an infrastructure for language access and a culturally diverse and appropriate workforce;
    • Mandatory trainings should include equity-centered concepts, including implicit bias training, trauma-informed care, child and adolescent development, and training specific to special populations (i.e., LGBTQIA+ youth and youth with intellectual and/or developmental disabilities);
    • Stakeholders involved in implementation should include those most impacted, such as youth with lived experience and communities of color;
    • Ensure that crisis response protocols and services are equipped to support systems-involved youth and their family members. Protocols should be designed to avoid future involvement in the child welfare system or juvenile justice system.

    Voices will continue to advocate for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services. The future wellbeing of our state depends on how we support and invest in the next generation.

    To learn more about Virginia’s plan for crisis system transformation, visit these resources: Virginia’s Crisis System Transformation and Marcus Alert and STEP-VA.

  5. Impact of Burnout on Transitional Aged Youth

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    This post was written by former Voices intern Abby Aquije.

    Between a rigorous academic schedule, part-time job, and extracurriculars, my high-school self often had 12+ hour days. Just thinking about it makes me overwhelmed and exhausted. This, unfortunately, is the norm for young people, especially those that are looking to go to college or who have families they help to support. It is a lot of pressure to put onto young people and having graduated the year before COVID-19 started its impact, I can only imagine how much worse it has gotten.

     

    Youth Experience Burnout Too

    Burnout, which is on the World Health Organization’s (WHO) International Classifications of Diseases list, is when chronic stress is not successfully managed. It is characterized by feelings of exhaustion, depersonalization or cynicism, and reduced efficacy. Workplace burnout has been a hot topic for years and is especially talked about as we continue to face widespread labor shortages that are impacting healthcare workers, behavioral health providers, and educators. Though the WHO cautions not to apply burnout to other areas of life, as it is an occupational phenomenon, they fail to realize that youth can experience unofficial occupational roles.

    These roles have aspects of, at minimum, part-time occupation. The average American student spends about seven hours in school, which is just shy of a full-time workday. Only an extra hour spent traveling, doing homework, or studying makes being a student a full-time job, and it is often more than that. Extracurriculars alone can add eight hours to a student’s week, and socializing and family demands add even more. Students have long days, lots of stress, loads of pressure, and few breaks. It’s no wonder that these students are affected by burnout. Those that learn and think differently are even more susceptible to burnout and burnout in young athletes is also a risk factor.

     

    Current Events and Societal Stressors are Worsening the Impact

    With all the uncertainty throughout the first years of the COVID-19 pandemic, motivation was low. I remember in the fall of 2022 I barely got ready for my second year of college. I did not want to fully commit myself to something that could be taken away from me as it was the semester before. Beyond the fear of having to go back into a full lockdown, I also knew the year was not going to be anything like the college experience everyone talks about. Online schooling, frequent testing, and following the ever-changing safety guidelines all contributed to my burnout. Yet, I know I did not have it bad.

    A survey of online learning experiences found that nearly 3 in 4 college students felt their learning was impacted due to low engagement. I would agree that engaging in virtual classes was a challenge, however, for many, it was not just the style of learning that caused academic disengagement. Changes in life circumstances were said to be one of the greatest reasons for students not engaging in distance learning. Students were dealing with grief, illness, or economic hardships, including having to work during the virtual school day, among other stressors.

     

    When Burnout Persists, Other Concerns Arise

    Many students faced serious signs of burnout. As a result, we saw students wanting to stop school and get a GED and showing concerning signs of depression. In the following semester (Fall 2020) nationwide rates of college enrollment dropped. Although Virginia’s overall higher education enrollment was stable, new student enrollment decreased. Unsurprisingly, the impact was worse for community colleges and Virginia’s historically black colleges and universities (HBCUs) considering lockdowns disproportionally affected low-income students and Black children were more likely to have lost a caregiver to the pandemic.

     

    Tackling Burnout Can Help Prevent Other Mental Health Crises

    Burnout is certainly not at the top of the list for reasons young people struggle with depression or stop pursuing higher education, however, tackling it can help prevent those outcomes. Catching signs of youth burnout early can allow adults to help these individuals engage in routines and other preventative measures.  In addition, there are many stressors that adults can work on limiting or managing better. This is especially so for students that have additional hardships and stressors. Students with learning disabilities, students from low-income families, and students of color are all at higher risk for burnout. Policies aimed at alleviating these stressors can tackle symptoms of burnout early on. If burnout is inevitable, it is necessary to integrate peer support and other forms of behavioral health resources to assist youth through the symptoms.

     

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  6. Youth Mental Health Crisis

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    Written by Voices’ intern Abby Aquije

    Increasing mental health resources and access to behavioral health services is a necessary step to mend our youth mental health crisis. If we are truly committed to ending this crisis, we must also consider what factors lead to the situation getting this bad. What is different about our youth today? What has gotten us to this crisis point?

    Youth are feeling alone and disconnected

    Our youth are facing an unprecedented number of stressors that can explain rising rates of depression and anxiety among children and adolescents. Gen Z youth are experiencing stress from sources ranging from school demands to family issues, and even “eco anxiety.” Though these statistics tell us that most youth are struggling with similar hardships, those that work closest to them assure us that this is not how they see it. Recent conversations with Virginia youth directors have made it clear that a key element in this crisis is that youth are feeling alone and disconnected from those around them.

    Most of us have been there, feeling as if we are the only ones stressing about school, social image, or family issues, when in reality the majority of us go through similar issues. As a society, we are becoming more open about mental health issues, yet, there is more to be done. If youth do not feel comfortable talking about their struggles, they will continue to feel alone. Think of a student falling behind in a class. On top of feeling the academic stress, they may also feel shame, which could lead to feelings of isolation and then more serious mental health issues. Even in the Netherlands – whose COVID-19 response included short lockdowns, equitable funding, and high rates of broadband access – student test results revealed a learning loss. How can a student blame themselves for something that is happening globally, even in “best case” scenarios? Why is it that they feel shame rather than solidarity?

    The COVID-19 pandemic has worsened the already concerning rates of loneliness

    Loneliness is being described as an epidemic, with over 60% of young adults feeling it. They are unable to connect with those around them and have to tackle their challenges alone. This all makes the perfect recipe for deteriorating physical and mental health issues that must be addressed.

    High rates of youth loneliness can easily be attributed to the COVID-19 pandemic: the nationwide lockdowns, social distancing, and virtual schooling all caused disconnection. Efforts to boost human connection were admirable, but the damage is done. No amount of virtual connection can make up for the formative middle school years, high school celebrations, and other important in-person experiences youth missed. While it is easy to point fingers at the pandemic, we cannot forget that these rates were rising prior to it. Social media and changing family structures also play a role in limiting the connections youth build with one another.

    Program Response: Employ connectedness strategies

    As we move forward, we have to be more intentional about forming and maintaining connections. Those that work with youth should prioritize creating spaces for youth to meet and truly connect with one another. Youth thrive when they feel they belong, they need to know that people hear and care about them.

    Most parents and caregivers know the importance of forming secure attachment in early childhood and actively work toward developing it. Attachment building paves the way for healthy and independent children, however, as they grow up there is less of an emphasis on developing and maintaining these sorts of connections. It is important for kids to learn independence, but no one can survive on their own, not physically or mentally. It is no surprise that youth connectedness is a protective factor for negative mental health outcomes and that the CDC supports the implementation of connectedness strategies, policies, and activities. As we move forward, we must value building youth connections just as much as we do infant attachment building.

    Policymakers should push for Peer Support Services before crises arise

    Peer support is an evidence-based practice used to help individuals cope with mental health challenges and improve quality of life. In addition to being cost-saving, it has been shown to be more effective than usual care for treating depression, and is especially engaging for “difficult to reach” individuals. Virginia already has qualified peer support providers that use their lived experience with mental health and substance use disorders to help others with their recovery. These providers are important for recovery once mental health challenges arise; however, their experience can also be beneficial for preventative measures before the issues arise. Programs like Hoos Connected, at the University of Virginia, use a form of peer support by having upperclassmen facilitators bring students together to develop meaningful connections with one another.  Students that participate in these programs report feeling significantly less depressed and as a former facilitator, I can attest to the difference the 9-week program makes. Despite its limitations – mainly the challenge of enrolling youth into a “feelings” class – there is a lot of promise to programs like these.

    Combating the loneliness epidemic will take time as it requires youth buy-in and societal shifting. Working alongside young people as we continue to research and develop solutions will be essential as we move forward in an effort to improve the overall mental health of our youth.

  7. How the 988 Hotline Can Break Down Systemic Barriers to Health Care

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    This blog is the first of two posts that will take a deeper look into Virginia’s efforts to integrate the 988 hotline with the behavioral health crisis services continuum.

    **This blog contains information and statistics on suicide and mental health. If you or a loved one are experiencing a crisis or need mental health resources, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (en Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741-741.

    On July 16, a new three-digit national hotline–988–will launch to connect callers with trained counselors through the National Suicide Prevention Lifeline to provide 24/7 call or text support for anyone experiencing a mental health crisis or in need of suicide prevention services. Though the hotline is administered through the national Lifeline, calls to 988 will be routed based on area code to regional crisis call centers that can connect individuals with crisis and emergency services that are available in their local communities.

    Virginia is utilizing the national 988 hotline implementation as an opportunity to link the three-digit dialing to the broader behavioral health crisis services continuum that is being developed across the state. Eventually, this will mean that more young people and their families will have access to mental health professionals responding to a crisis instead of law enforcement. This is especially important given the compounding traumatic effects of the COVID-19 pandemic, systemic racism, LGBTQIA+ discrimination, and gun violence in this country.

    The Need for a Lifesaving Hotline

    Suicide is the second-leading cause of death among young people aged 10 to 24. However, deaths from suicide are only part of the problem. Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at emergency departments across the U.S.

    The Centers for Disease Control reported that during 2020, mental health–related emergency department visits among youth aged 12 to 17 increased 31% compared to 2019. Specifically, emergency department visits for suspected suicide attempts among 12 to 17-year-old girls were 50.6% higher in February to March 2021 than during the same period in 2019; among boys aged 12 to 17, such emergency department visits increased 3.7%.

    In Virginia, the percentage of students who experienced feeling sad for two weeks or more increased significantly from 2011 (25.5%) through 2019 (32.4%). And among those who reported feeling sad for two weeks or more, 39.1% reported that they considered attempting suicide, 29.5% made a suicide plan, 18.0% attempted suicide and 4.9% made an injurious suicide attempt.

    The pandemic is deteriorating children’s mental health to new lows, with more than 25% of high school students nationally having reported worsened emotional and cognitive health.

    Figure 1: Percentage of Students who felt sad or hopeless almost every day for 2 weeks or more, VYS, 2011-2019

     

    Figure 1. ED visits related to suicidal thoughts, self-harm, and suicide attempts among Virginia youth aged 9-18 years, 2016-2021

     

    Figure 2: ED visits rates for suicidal thoughts, self-harm, or suicide attempts among Virginia youth aged 9-18 years, by sex, 2016-2021

    Barriers to Accessing Mental Health Services

    Although rates of mental health problems are not statistically different by race, the rate at which children of color receive mental health care is much different than white children. A National Center for Health Statistics data brief reported that non-Hispanic white children (17.7%) were more likely than Hispanic (9.2%) or non-Hispanic Black (8.7%) children to have received any mental health treatment in the past 12 months.

    As noted in Voices’ Children’s Mental Health Discussion Paper, “systemic barriers such as eligibility criteria for health insurance and accessibility of services contribute to lower participation among Black and Latinx children. A history of racism and disinvestment in communities of color have made mental health services less accessible for children of color by geography, cultural fit, and language.”

    LGBTQIA+ youth also often lack access to affirming spaces, which include health care and mental health care services. The Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health reported that 60% of LGBTQIA+ youth who wanted mental health care in the past year were not able to get it. Some of the reasons youth cited for wanting care but not having access include fear of discussing mental health concerns (48%), concerns with obtaining parent/caregiver permission (45%), fear of not being taken seriously (43%), and lack of affordability (41%).

    LGBTQ youth who wanted mental health care but where unable to get it cited the following top ten reasons.

    Of the LGBTQIA+ youth aged 13 to 17 that were surveyed, 73% reported symptoms of anxiety and 67% reported symptoms of depressive disorder in 2020. Almost half of those youth surveyed seriously considered attempting suicide in the past year.

    These statistics demonstrate the clear need for appropriate and effective mental health services for young people. Lack of access can lead to serious and lasting impacts across all areas of a child’s life. Ensuring that emergency services are accessible, unintimidating, and culturally competent will take creating programs like the 988 hotline and implementing them with full funding and public support.

    As lawmakers work to streamline Virginia’s mental health and behavioral health system, Voices is focused on opening these services to all our communities and addressing past harms in the way of healing.

    Stay tuned for more on the 988 hotline and children’s mental health.

  8. General Assembly 2022: Mental Health Wrap-Up

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    The momentum was in place for children’s mental health in Virginia. The US Surgeon General and key advocates declared a national emergency to confront a decade-long decline in children’s mental health. Despite widespread concern, Governor Northam’s original budget proposal did not fund new programs in schools for children’s mental health. To meet the moment, a bipartisan group of legislators and advocates from various communities lobbied for investments in psychological services and counseling. Additional resources of $1.4 million per year will expand the Virginia Mental Health Access Program to integrate services in health care settings. Noted below are other new investments integrating mental health in school settings, increasing reimbursement rates, and supporting the workforce.

    A First Step for School-Based Mental Health Integration 

    Over the last three years, the General Assembly has focused on improving school-based mental health by funding specialized student support positions—counselors, social workers, and psychologists. While students have benefited from better relationships with faculty, COVID presented unanticipated disruptions, rapidly increasing needs, and barriers to vital care. School divisions have responded by allocating federal recovery funds into training, coaching, and even bringing community-based mental health professionals into schools.

    However, federal support during this emergency is impermanent and mental health threats are ongoing. School divisions need resources to continue to support these efforts. Voices led advocacy for additional state general fund resources supporting school-based mental health in flexible ways to assist school divisions in identifying key partnerships and resources. The General Assembly allocated $2.5 million in FY23 to begin supporting school-based mental health services and included language asking the newly established Behavioral Health Commission to study how schools can better integrate mental health services with sustainable funding streams such as Medicaid.

    The General Assembly also approved funding to establish a regional Recovery High School based in Chesterfield where substance abuse recovery is incorporated into the school day. The proposal by Delegate Carrie Coyner was finally approved after the 2020 COVID response cut funding. Other high schools will be able to look toward this model to support health needs in the classroom.

    Senator Jennifer McClellan has been a significant leader on school based mental health and increasing resources for school-based professionals. Read more in her Op/Ed in the Fredericksburg FreeLance Star.

    Addressing Workforce Shortages

    The lynchpin to support the social and emotional well-being of students is having an appropriate workforce. We are excited about two changes that will help address pressing workforce challenges.

    The House and Senate approved HB829, proposed by Del. Tony Wilt, that will provide flexibility on a provisional basis for licensed mental health professionals without certification to work in school-settings. This flexibility will ensure that school divisions can hire more mental health staff.

    The budget adopted by the General Assembly includes funding for a new initiative to help mental health professionals seeking licensure when they must pay for their supervision time out-of-pocket. The new initiative, Boost200, will provide resources to cover out-of-pocket expenses for licensure and match them with approved supervisors. This initiative is poised to make a significant impact on removing barriers towards licensure and diversifying the mental health field. Learn more about participating to address licensure costs or to work as a supervisor.

    Improving Medicaid Reimbursement Rates

    The third area that the legislature improved on mental health services was improving Medicaid reimbursement rates for several mental health services. Federal funds from the current “public health emergency” have increased payment rates for community-based services by 12.5%. The General Assembly approved resources to continue financing those services. The General Assembly also improved rates for psychiatric residential treatment facilities. Many facilities served children from other states and lacked placements for children in Virginia, leading to greater instability for the hardest to place children, who are the focus of the Safe and Sound Task Force. The increased rates should help caregivers meet immediate needs, but challenges remain to ensure that children are not placed in inappropriate and lengthy stays in congregate settings. While increasing Medicaid rates is a positive step, adequate reimbursement is essential to looking after the mental health of economically disadvantaged children and vulnerable children in the foster care system.

  9. A National State of Emergency in Children’s Mental Health

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    Advocates, school personnel, mental health clinicians, and families have been saying for years – even before the pandemic –  that children’s mental health access is in a state of emergency. Over the summer, we heard from outpatient treatment clinicians who had months-long waiting lists and emergency departments that were filling up with children in mental health crisis without other options. As school returned, more reports of mental health and behavioral disruptions resonated across the Commonwealth. Now, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association are declaring a “National Emergency” in children’s mental health.

    Virginia lawmakers are paying attention too. During a discussion about education funding in a Senate Finance Committee meeting, Senator Jennifer McClellan stated, “the kids are not okay.” The compounded effect of the pandemic, racial trauma, and individual traumatic experiences are causing anxiety, depression, and more severe mental health issues in students. It was evident to Senator McClellan as a parent that mental health is causing major distress and barriers to learning.

    Young people are ready for policymakers and leaders to address this emergency.

    Justice, a young adult in Richmond told us this week, “I believe that if we can put more free mental health services out there for young people to turn to if they don’t have somebody to talk to they won’t just keep things in and one day just explode… It’s okay to not be okay.”

    Children’s Mental Health Discussion Paper: October 2021

    Children’s mental health needs touch all systems and all aspects of life. To fully address children’s mental health issues, we need an “all-hands-on-deck” approach.  There are no easy solutions to address a “state of emergency” but there are many points to begin trying.

    Voices has released a discussion paper for lawmakers to tackle children’s mental health issues from the perspective of the child-student and outside any one silo. This paper is relevant for lawmakers serving on the education funding committee, health and human resources funding committees, and the newly formed Behavioral Health Commission. It also creates a framework for the incoming governor to tackle a pressing issue and create some opportunities to continue collaborative efforts such as the Children’s Cabinet.

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    The most important steps lawmakers must take to address the current emergency include:

    • Addressing workforce shortages. Children’s clinical workforce shortages existed even before the pandemic, but overall workforce shortages are contributing to even longer waits for care. We need to retain the current workforce, attract a future workforce, and align the current workforce to opportunities for licensure and appropriate reimbursement. We support a proposal in front of the Behavioral Health Committee and consideration for the governor’s budget to assist clinicians in paying for supervision towards licensure to help meet immediate needs. Additionally, retention bonuses proposed for providers in the public mental health system and loan repayment programs are critical. In the longer term, stakeholders and leaders should spend time defining the best fit for certain roles, particularly the roles that can be filled by Qualified Mental Health Professionals (QMHPs) in schools and community settings.
    • Building out the capacity of health providers to address mental health issues. Continuing efforts to expand the Virginia Mental Health Access Program to reach more health providers, such as emergency department staff, and enhancing awareness of early childhood mental health issues are necessary. Additional recruitment and professional development for the health care workforce to identify and address mental health needs can help children who might not have robust school-based services.
    • Facilitating connections between schools and community providers. School have gotten very creative at finding ways to meet mental health needs during the pandemic. And thanks to investments from state lawmakers, many have been able to add additional school counselors and specialized support staff. For these new initiatives to meet increased demand and increased severity of need, the schools will need support to implement trauma-informed and multi-tier support from the state Department of Education and from their school divisions.

    Additional federal resources and Medicaid reimbursement will be critical to supporting school-initiated services in the long-term. There are several opportunities to create strong support systems for student mental health with American Recovery Act funds, the recalibration of Medicaid-funded mental health services through Project BRAVO and the ability for schools to bill for health and mental health needs outside a students’ IEP through the “free care” rule. Stakeholders, students, providers and schools should come together on some ideal plans and programs to implement at the school and child care level to meet student needs.

    Read the paper in its entirety and continue to follow Voices on social media for updates.

  10. Talking to Youth After Violence

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    It is an unfortunate truth in this country that we must have difficult and scary conversations that follow acts of violence, including school shootings. These events stir up confusion, fear, and unease for ourselves as caregivers or parents who are witnessing our worst nightmare, and also alarm the young people in our lives. It is during these difficult moments that children and youth look to trusted adults to understand how to react, cope and how to trust the world around them again. As you embark on these challenging conversations, consider the guidance below:

    • Name emotions together. Anxiety. Hypervigilance. Name the things that are coming up and be open about what comes up for you as a parent/caregiver. Sharing like this demonstrates that a) emotions are acceptable and b) gives them an opportunity to model their coping styles after you. Reserve processing more intense emotions with other supportive adults. While it is good to be open about emotions, you do not want children to think they must care for you too, or that they are somehow at fault. Phrases like, “I’m upset about what I saw, it’s not you,” can also help ease heightened and worried young minds.
    • Consider what is developmentally appropriate. You are the expert in your child. For any child or youth, approaching the conversation with curiosity and playfulness will be most helpful, but there are some things to keep in mind depending on age.
      • Remember that younger children (up to Elementary School age) tend to think in more linear, concrete terms, so keeping things simple, clear and concise will be important in addressing their anxious behaviors. Accept and hold the full range of their emotions. Phrases like, “A scary thing happened here, and grown-ups are working hard to try to fix it and keep everyone safe.”
      • Older children (Middle to High school) are keenly aware of when they are being condescended to and already have access to so much information on their own. Begin by being curious about what they already know. Anchor your conversation in facts. Invite a check-in later, if needed. “This scary thing happened and it’s making me think about safety. We can talk whenever you’re ready.”
    • Reassure safety. School is supposed to be a safe place. Help the young people you are connecting with understand that school is still a safe place to learn and connect with friends and trusted adults. You can approach this practically by helping to identify the things that keep them safe day-to-day, like talking to trusted adults when they are feeling afraid or unsure. Reiterate their safety by reminding them that you are always there for them and that authorities are investigating. “It’s okay to feel scared, but know that your teacher(s) works with me and other helpers to keep you safe.”
    • Keep the news and any violent or potentially triggering media away. If you as an adult are eager for the information, practice discretion, or try distracting your child to shift their focus. For older youth, filter the news for optimal times of day (avoiding close to bedtime) and/or watch together. Consider youth-centered news resources as well, such as Xzya: News for Kids.
    • Maintain routines. Keep it as “normal” a day as possible. Regular schedules are reassuring and can reduce anxiety. Ensure plenty of sleep, regular meals, and movement. Encourage academics and extracurriculars, but if your child is overwhelmed, take those cues and suggest a more emotionally accessible activity to do.

    Navigating these conversations is not an exact science. You and the child you are supporting may have different needs depending on aspects like age, race and ethnicity, where you live, and the resources available to you for support. Let these talking points and recommendations guide you, but recognize when to ask for help.

    Sign up to receive emails from Voices. We’ll be sending out resources to support these conversations, and youth, via email and social media in the coming weeks.