Opinion | Teen mental health crisis requires more access to care in schools

Opinion | Teen mental health crisis requires more access to care in schools

(Washington Post staff illustration; iStock)


Responding to clamoring from parents, and dreadful stories of youth suicide and hospitalizations, leaders in both parties convey an increasing sense of urgency to address epidemic levels of teenage anxiety, depression, loneliness and lashing out. About two dozen governors described teenage mental health as a crisis during their state of the state addresses this year and proposed budgets that would expand treatment options. The need is glaring; the pandemic supercharged trend lines that have grown worse as America’s social fabric has been pulled at the seams and social media has grown ubiquitous.

Leaders across the ideological spectrum are surging resources into expanding access to mental health care for kids, especially those who lack strong family support systems. It’s essential to create sturdy lifelines that students know about and can grab hold of when a crisis develops. Many places are scaling up or replicating programs that show promise. But the nation’s leaders are behind; even as they acknowledge the problem, there is a vast number of difficult-to-solve issues — such as onboarding enough mental health professionals and responding to the nation’s deepening cultural decay — after they have already become major problems. The country’s leaders should make this a long-term commitment, even as federal relief dollars dry up.

The Centers for Disease Control and Prevention’s Youth Risk Behavior Survey shows 42 percent of high school students report persistent feelings of sadness or hopelessness and 22 percent say they seriously considered attempting suicide in 2021. It’s much worse among girls. “It’s an issue that transcends both state and party lines,” said New Jersey Gov. Phil Murphy (D), who has made teen mental health his top priority as chair of the National Governors Association.

IMatterColorado.org offers six free mental health consultations for every student in the state, with the promise of confidentiality. The SafeUT app allows any Utah student to immediately, and anonymously, contact a mental health professional. Children can also report friends struggling with suicidal thoughts or who might bring guns to school. “We know we have saved lives,” said Utah Gov. Spencer Cox (R), who speaks openly about his own struggles with suicidal thoughts in middle school after his parents got divorced. Several other states are looking into requiring student identification cards to include a phone number for children and teenagers to call if they’re in crisis.

Pennsylvania Gov. Josh Shapiro (D) campaigned on putting a mental health counselor in every school, and his new budget calls for $500 million to do it. As attorney general, he launched Safe2Say, an anonymous system for students to report threats of violence. More than 100,000 tips were submitted in its first five years, but 75 percent were from kids reaching out about mental health issues. “Students want someone who can help them,” he said. “They want people to talk to.”

Ohio Gov. Mike DeWine (R) launched a Medicaid managed care program last summer that’s already providing 16,000 children specialized behavioral health care. And Virginia Gov. Glenn Youngkin (R) proposed $230 million to build “a strong and stable behavioral health safety net,” including “greater pre-crisis service capacity in schools.”

Federal funding has made much of this investment possible, including the continuing build-out of the 988 suicide prevention hotline. State and local officials used pandemic relief funds and grants under the American Rescue Plan specifically for teen mental health. The bipartisan gun control bill that passed after last year’s elementary school shooting in Uvalde, Tex., includes $1 billion in grants for K-12 schools to combat mental illness. President Biden’s recent budget proposal calls for $428 million in additional grants.

Even if Congress approves that request, which it should, the federal spigots are starting to slow. Many states are now trying to make more permanent investments with their general funds. Wisconsin Gov. Tony Evers (D) declared 2023 “the year of mental health.” Last year, his state spent $30 million of federal pandemic relief funds to expand school-based mental health services through an initiative he called “Get Kids Ahead.” This year he’s proposing to make that a permanent state program and invest $270 million to ensure every student has access to mental health care. “The state of mental health in Wisconsin is a quiet, burgeoning crisis that I believe will have catastrophic consequences for generations if we don’t treat it with the urgency is requires,” said Mr. Evers.

Combating the teen mental health crisis requires more than money. In neighboring Minnesota, Gov. Tim Walz (D) pushed a ban on conversion therapy as part of putting mental health “front and center.” He said it was vital “to ensure that every LGBTQ student knows they are perfect just the way they are.”

Another problem is that, amid growing demand for their services, mental health professionals are in short supply because of low pay and high burnout. No appointments are available in many places and sometimes insurance won’t cover care. Many kids suffer in silence, and their illness gets worse when it goes untreated.

California, Arizona and South Carolina have increased Medicaid reimbursement rates to incentivize psychologists and others to provide mental health services in schools. Nevada Gov. Joe Lombardo (R) proposes increasing reimbursement rates for anyone providing mental health services in areas of acute need. Governors in states such as Montana and Idaho are talking about generational investments to get more doctors to rural areas. In some cases, telemedicine authorizations will need to be expanded so that psychologists can treat people in places without enough therapists. New Jersey launched a student loan redemption program as an incentive for certified professionals to serve communities that have shortages.

California Gov. Gavin Newsom (D) calls for hiring, training and engaging 40,000 new mental health workers in his state. New York Gov. Kathy Hochul (D) aims to reduce unmet mental health needs among children by half in the next five years. “Our children need preventive services now to stop them from needing intensive services in the future,” she said. New Mexico Gov. Michelle Lujan Grisham (D) speaks in moral terms and calls access to mental health treatment a fundamental right.

Maryland, Iowa and Illinois started programs last year that offer mental health training for staff in schools. North Carolina Gov. Roy Cooper (D) is using state money to expand the availability of a national training program called Youth Mental Health First Aid so adults who work with 12-to-18-year-olds, whether teachers or coaches, can learn how to identify and respond to signs of mental distress and substance abuse. This is a welcome stopgap in rural areas with shortages of psychologists.

Making more counselors available to children is an important step, as are many of the varied ways in which state leaders have responded to the teen mental health crisis. But these will not address all the root causes. It’s fair to expect the severity of this crisis to recede as more time passes post-pandemic. But the nation also needs to look upstream to counter the poisons making youngsters feel so sad, hopeless and inclined to self-harm.

Do TikTok, fentanyl and other opioids deserve a share of the blame? Certainly. But there’s also a toxic sludge of selfishness and entitlement that’s corrosive to the culture. Intolerance, polarization and the demonization of the other fuel disunity in civic life. A study this week showed Americans, driven by young adults under 30, place declining value on patriotism, child-rearing and community involvement. The kids are not alright.

If you or someone you know needs help, visit 988lifeline.org or call or text the Suicide & Crisis Lifeline at 988.

The Post’s View | About the Editorial Board

Editorials represent the views of The Post as an institution, as determined through debate among members of the Editorial Board, based in the Opinions section and separate from the newsroom.

Members of the Editorial Board and areas of focus: Opinion Editor David Shipley; Deputy Opinion Editor Karen Tumulty; Associate Opinion Editor Stephen Stromberg (national politics and policy, legal affairs, energy, the environment, health care); Lee Hockstader (European affairs, based in Paris); David E. Hoffman (global public health); James Hohmann (domestic policy and electoral politics, including the White House, Congress and governors); Charles Lane (foreign affairs, national security, international economics); Heather Long (economics); Associate Editor Ruth Marcus; and Molly Roberts (technology and society).