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.

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.

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