A version of this commentary appears in Bridge Magazine.
Last month, the Citizens Research Council released a report on child and adolescent behavioral health in Michigan, finding increasing needs and a lack of services and programs to address them. Shortly thereafter, Bridge released a series of articles capturing the human toll of this growing youth mental health epidemic. Together, these reports paint a solemn picture of declines in our youths’ wellbeing.
While new data has begun to quantify the increase in behavioral health issues caused by (or at least coinciding with) the coronavirus pandemic, youth mental health troubles have been increasing for more than a decade. Due in no small part to the risks posed by mood, anxiety, and substance use disorders, the rate of suicide among children, adolescents, and young adults has also increased at an alarming pace.
And yet, despite this serious and growing problem, many children and adolescents are not able to access needed treatment. Access to treatment is a complex issue, due in no small part to both provider shortages and a maldistribution of services. Stigma and other social factors coupled with uncertainties about care seeking, transportation, and insurance coverage also create barriers for youth.
While providing equitable access to treatment for all who need it is imperative, it is also important to reduce the demand for treatment through a public health approach that prioritizes multiple levels of prevention, providing supports and fostering resilience, screening for early detection of problems, and looking upstream to address root causes and harmful exposures that affect youths’ wellbeing.
Addressing both treatment and prevention will require Michigan to examine a wide range of economic, social, and legal structures at the state level and in each community; treatment and prevention depend on society as much as, if not more than, the individual.
While there are multiple strategies and approaches to addressing this growing problem, our report finds that schools are uniquely suited to assist youth with mental health concerns. Youth spend a substantial amount of time within school buildings, making schools optimal locations for building stronger systems of support and mounting preventative interventions, as well as providing opportunities for the identification of behavioral health conditions and referrals to treatment.
As places centered around learning, schools are also an ideal setting to deliver information about mental health and teach social and emotional skills that foster resilience and emotional maturation. Because schools are also venues of socialization and psychological development, they are important venues for dismantling stigma and normalizing treatment-seeking behaviors, as well as encouraging positive behaviors while reducing bullying and discrimination. To be successful, these efforts require both active and engaged school-based health professionals and teachers equipped with knowledge of social-emotional learning and trauma-informed practices, as well as generalized knowledge in the various domains of behavioral health.
To be clear: a teacher’s primary role is without question to provide instruction, and teachers will never replace trained mental health professionals. Nonetheless, providing teachers skills and strategies to help their students overcome mental health obstacles to educational success may be an important means for improving educational outcomes. Moreover, children once dismissed as problem students might be regarded differently when educators have deeper awareness of the impact trauma and various health disorders can have on a child’s development, personality, and behavior.
Despite the growing mental health needs of students, Michigan has a dearth of health professionals working in schools. Our state falls short of the recommended number of health professionals employed in schools, and, in most cases, falls far behind the national average as well. To address existing student needs, and to provide multi-tiered approaches to prevention and student support, it is essential that schools increase the number of nurses, social workers, psychologists, and counselors.
In tandem with school health professionals, school-based (and school-linked) health centers offer further opportunity to bolster student health and address youth behavioral health needs. School-based health centers are clinics located within or adjacent to schools that provide a wide array of medical and behavioral health services. These centers may be operated by hospital systems, federally qualified health centers, or by governmental entities (i.e., local public health departments). School-based health centers can provide economical and easy access to behavioral health services and can facilitate destigmatization and foster treatment-seeking behaviors throughout the formative years for children and adolescents.
Aspirational solutions to Michigan’s youth mental health crisis would consider collaborative efforts to center school environments on individual/community well-being as a prerequisite for academic and student success. This means increased opportunities for quality nutrition and physical activity, as well as investment in music and the arts as vehicles of community-building and social/emotional enrichment, expression, and healing.
In contrast, providing students with base levels of access to school health professionals and behavioral health treatment is the fundamental, bare-bones starting point for addressing the growing youth mental health crisis.
Coordination of health care, public policy, and community-based interventions in schools has the best chance of success for enhancing treatment and prevention of youth behavioral health in Michigan. If we want to have successful students who graduate into healthy and productive workers and community members, Michigan must invest in long-term strategies to bolster health and prevent disease within schools and communities. Moreover, for these investments to be meaningful, we must all work to dismantle the stigma associated with mental health conditions, as well as addiction and obesity, and regard the health of others not with judgement and blame, but rather with empathy and support.