One in five teens in the U.S. will experience a mental health challenge before they turn 18, but 64% of them won't seek help.
A new training program is turning to teens to get their peers connected to the resources they need to turn things around.
Betsy Molgano, program director for Mental Health First Aid Colorado, said young people are in a unique position to identify warning signs. Maybe someone they know has been withdrawing from friends, or they used to enjoy soccer and now they aren't showing up for practice.
"You're not diagnosing this person, you're just kind of noticing a change in behavior or appearance," Molgano explained. "The training is supposed to help kids feel more comfortable to approach someone and to be like 'I've noticed that there is a change in your typical behavior. Do you want to talk about it? Is everything OK?'"
According to the 2021 Healthy Kids Colorado Survey, nearly 40% of high school students said they experienced symptoms of depression in the last year, and 17% said they had seriously considered suicide. Suicide is the third leading cause of death for kids aged 15 to 19.
Maranda Miller, mental health first aid coordinator at Centennial Mental Health Center, said Colorado has taken steps to help young people, including offering free mental health therapy for all youth through a legislatively funded program called I Matter. She encouraged all school districts, even those with tight training budgets, to explore local training opportunities at mentalhealthfirstaid.org.
"We know that there's a huge return on investment if our youth know that they can help each other, that they can help themselves, and that there are highly vetted, highly trained resources available to them," Miller outlined.
Molgano noted the Teen Mental Health First Aid training helps young people learn how to get their peers to address mental health and substance use challenges, how school violence and bullying impacts mental well-being, and how to get help from trusted adults and mental health professionals.
"It helps arm kids with the tools that they need to not only help themselves understand what's going on in their own lives -- and what they might be dealing with -- but also to be on the lookout for what might be going on with their friends, and help build a stronger community," Molgano emphasized.
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Some 125,000 children in Michigan struggle with major depression, which can hinder learning, behavior and relationships, according to a recent survey. Research shows the benefits of school-based services to connect them with the care they need.
Together with parents, school mental health resources can help keep kids safe.
Scott Hutchins, who manages the behavioral health unit for the Michigan Department of Education, stresses the importance of these services, especially in light of the pandemic and school shootings.
"Those needs have only been exacerbated since COVID and those other violent tragedies," he said. "So, what mental-health services do is, they allow us to break down the barriers that students need to get the care that they need."
However, the state needs more of these professionals. Michigan has one school psychologist per almost 2,200 students. The recommended ratio is one for every 500 students. The state also requires school districts to include suicide-prevention hotline contact information on IDs for students in grades 7 through 12.
Statistics show youths receiving school-based mental-health services are six times more likely to complete treatment than those receiving community-based services.
Angela Kimball, chief advocacy officer for the nonprofit mental health advocacy group Inseparable, noted that funding is one key challenge in expanding the school mental-health workforce.
"In order to become a licensed professional," she said, "you not only have to pay for schooling, but there's also periods of supervision - where people are essentially working for free and having to pay for supervision as they work towards their credentials."
Kimball said groups like hers are pushing for policies to improve staff ratios and encourage people to consider mental-health careers. In the meantime, if you or someone you know is in crisis, call 988 to be connected with a trained counselor, available 24/7.
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About half of youths experiencing depression in Illinois are not receiving treatment. While the state ranks fairly well nationwide when it comes to youth mental health, officials say there is room for improvement.
Andrea Durbin, CEO, Illinois Collaboration on Youth, said anxiety and depression are at an all-time high, especially with LGBTQ youths and those in immigrant families.
"This is a time for us to be compassionate and empathetic and to embrace folks who are feeling this way and to be supportive, and understand where this is coming from and what our responsibility as adults is to protect them," she said.
The state's Children's Behavioral Healthcare Transformation Initiative passed in 2022. It emphasizes the importance of proactive mental-health screening in schools, similar to vision and hearing tests. Now, a new state law requires yearly mental-health screenings for seventh through 12th grade students.
Despite this progress, barriers to community-based mental-health services for youths still exist and include cost, transportation, insurance issues and stigma.
Angela Kimball, chief advocacy officer with Inseparable, said school-based services that provide different levels of support are one of the most effective tools for supporting student mental health and improving access to care.
"We are starting to see some improvements in student mental health, and that's very encouraging, but the need is still very, very high," she explained. "So we can't let our foot off the pedal now. We really need to do everything we can to build the workforce and to make sure students are supported."
She said youth who get school-based services are six times more likely to complete treatment and have improved long-term education and work outcomes. Yet currently, most state schools don't have the recommended ratio of mental-health staff to students. State-funded programs such as the Behavioral Health Workforce Center are working to address the provider shortage. Kimball added that state policies and initiatives that continue to provide solutions to any roadblocks to mental-health services are crucial to providing youths the care they need.
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More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.
The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.
Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."
"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."
A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.
As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.
David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.
"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.
The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.
Disclosure: Inseparable contributes to our fund for reporting on Criminal Justice, Health Issues, Mental Health, and Social Justice. If you would like to help support news in the public interest,
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