CONCORD, N.H. – Stigma around substance abuse, mental-health issues and suicide can make those between the ages of 18 and 25 reluctant to share their stories – but experts in New Hampshire say the state's peer-to-peer counseling program is effective.

Studies show many young adults are aware of the relationship between substance use and a sense of hopelessness. And for some, that combination can create mental-health symptoms and even increase their suicide risk, according the state's Bureau of Drug and Alcohol Services.

The Chief of Prevention and Education Services for the agency, Jill Burke, says when a counselor is a peer, they can create a "safe space" because life's transitions and stressors are similar.

"What we have found about this particular population is that they don't speak in terms of stigma and shame,” says Burke. “They are very open and very genuine with one another, and they want to talk about these issues."

Burke says the Young Adult Connect Initiative through the state's National Alliance on Mental Illness trains those ages 18 to 25 how to talk to others and identify risk.

In the past few days, two students and a parent traumatized by school shooting deaths took their own lives, which mental-health experts say demonstrates the lasting grief that can accompany suicide.

America's rate of suicide has increased dramatically in recent years, making it the 10th-leading cause of death.

Ann Duckless, community education and prevention specialist with NAMI New Hampshire, says young people who join the organization's Connect program to learn peer-to-peer counseling often recognize the problem in their school or workplace and want to be part of the solution.

She adds that "trust" makes a huge difference.

"I think there's a very big disconnect with adults in terms of adults not being there to mentor them in the workplace, or not giving them their fair share of credit and their value added to the workplace," says Duckless.

More than two dozen young adults have participated in the three-hour training to become peer-to-peer counselors, funded through a Partnership for Success Grant, that includes participants from 13 state public health networks.


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Most South Dakotans live in federally designated mental-health professional shortage areas, and a new report recommended steps Congress and other decision-makers can take to help states close gaps within the behavioral health workforce, amid a growing demand for mental-health services and a shortage of licensed providers.

Kendall Strong, senior policy analyst for the health project at the Bipartisan Policy Center, said one solution is to enhance the role of those with mental-health training who do not have the full credentials. She argued behavioral-health support specialists are certainly up to the task.

"These people are underutilized," Strong contended. "They have a lot to offer because part of the folks that we're talking about are folks like peer-support specialists, who have lived experiences and can really connect with folks who are struggling."

Others in the group are community health workers and paraprofessionals. The report recommends reducing barriers for them to take on bigger roles in behavioral health, including adopting a certification framework to promote flexibility but still protect patients.

Strong acknowledged a divided Congress might provide obstacles but added there is optimism with both parties recognizing the provider shortage.

The report advised pulling in more help can free up licensed providers who are dealing with patient backlogs. Strong added behavioral health support specialists are embedded in the community and can meet in a nonclinical setting. She suggested it can be especially helpful in rural areas where mental-health stigma still might exist.

"In areas where there is just less infrastructure visibility as compared to urban areas, it's really clear if you're going into a health care facility," Strong noted.

The report also called on federal officials to explore expanding Medicaid and Medicare coverage of services provided by behavioral-health support specialists.

The Kaiser Family Foundation said South Dakota has nearly 60 areas with provider shortage designations, which affects nearly 800,000 residents.

A recently proposed plan has been devised to better fund Virginia's mental-health programs.

The new Right Help, Right Now plan calls for $230 million in funding for upgrades to the state's mental-health system.

Some elements of the plan include expanding mental-health programs in schools, growing tele-behavioral health operations in high schools and college campuses, and creating more than 30 mobile crisis centers.

However, some feel the plan is a good start with more to be done.

Bruce Cruser - executive director of Mental Health America in Virginia - said in the past, more money has been put toward hospital care than community care. Although this plan changes that dynamic, he outlined what else needs to be addressed in the state's mental-health landscape.

"What we don't see there is funding for the Community Services Board's employees," said Cruser, "and they're really the front line of care in the community to help prevent people from having to go into the hospital. And so, what we'd really like to see is some additional funding to make up the ground for the Community Services Board, the direct care staff."

The plan finds 106 of Virginia's 133 counties are classified as having a mental-health professional shortage.

Cruser said the COVID-19 pandemic only exacerbated existing flaws in Virginia's mental-health system. This resulted in less people being able to get the help they needed.

While he said it's fortunate to see the attention this plan is creating, he noted that it's a shame it took years of crisis to reach this turning point.

Although the plan has great support, Cruser also noted that there will be challenges to implementing this plan. Specifically, he noted that the pay rate from insurance or Medicaid needs to be increased.

But, Cruser said he feels there are two elements of this plan which ensure people won't always end up in hospitals for behavioral-health issues.

"The mobile crisis and the crisis receiving centers would help build up that continuum of care in the community so that people don't have to end up going to the hospital," said Cruser, "They can get the care they need, they can get the crisis resolved, they can find the services that they need in the community with much better outcomes."

He added that this would boost the state's mental-health system a lot.

Over the Virginia General Assembly's next legislative session, Cruser said he is eager to see this proposed plan become a package of legislation that'll advance the state's mental-health system.

One in 11 Missouri children, and one in 13 nationally, will lose a parent or sibling by age 18.

Childhood grief that is not dealt with can have short and long-term negative effects, including school problems, mental health issues and even a shortened life span.

Becky Byrne, founder and executive director of Annie's Hope, The Center for Grieving Kids in Glendale, explained kids grieve differently than adults, so it is not always obvious when they are struggling. She emphasized anyone can help a grieving child if they can overcome their fear and discomfort.

"And if you can't figure out what to say, just simply say, 'I want to be able to help you, I do not know what to say.' You don't have to be a trained professional," Byrne explained. "All you have to be is human, and willing to open up yourself to hear somebody else's pain."

During eight-session family support groups, she noted Annie's Hope pairs children with their peers and adults with adults. Byrne pointed out death affects the whole family system, and adults can learn about ways to best help their children at home.

Cindy Izzo, school support and education coordinator for the organization who facilitates the six-week school-based program, said it is especially important for kids who are not attending a grief support group outside of school, and it provides additional training for school professionals.

"We are showing the kids in the school that they are not the only one who is grieving," Izzo stressed. "Really, our group of participants is just the tip of the iceberg. So then, we're also connecting the students to the adults in the school who will provide that ongoing support for them."

Byrne added peers who are experiencing the death of a loved one can be immensely helpful to each other.

"When you find somebody who's your contemporary -- who this makes total sense to, and they can validate you -- that makes it like, 'Oh well, if that person can do it, maybe I can do it.' You immediately get this head start if it's a peer," Byrne stated.

For grieving families unable to attend an in-person support group, Byrne suggested virtual groups can also be helpful.