Promoting mental health is on the checklist as the new school year nears for Washington state students.

Mental-health professionals on school campuses are critical. The suggested ratio is 250 students per counselor, but a recent report found most states aren't achieving that.

In Washington state, the ratio is 373 students per counselor. State Rep. Lisa Callan - D-Issaquah - said the state is working on a Prenatal Through 25 Behavioral Health Strategic Plan.

She said kids need mental health services to get the most out of school.

"We have to take care of those needs - so you're ready and able to learn, and then you can meet the K-12 objective," said Callan. "So that's K-12's charge, but outside of that, Washington state has a charge to make sure that we can deliver behavioral health access and meet the needs and the care of our children wherever they need it."

Callan said the state is looking to find ways to bring in more supports for kids in school.

For instance, some lawmakers want to increase Medicaid dollars for school-based mental-health services, as well as streamlining the delivery of funds to schools.

Caitlin Hochul is the vice president for public policy with Inseparable, a mental-health advocacy organization.

She said long-term funding and policy changes are needed to address the complex issue of mental health in schools, but it's critical because that's where kids spend much of their time.

"There has been a recent Centers for Disease Control and Prevention survey that was published that offers a glimmer of hope when it comes towards kids' mental health," said Hochul, "showing that the big investments that we've made in the last several years are starting to work, but there is just so much more that needs to be done."

Hochul added that her organization created a checklist for promoting mental health in schools.

It includes ensuring regular staff training - in mental health, substance use & suicide prevention - annual well checks for every student, and school engagement with families and community partners.

Sen. Richard Blumenthal, D-Conn., is introducing federal legislation to boost mental health equity.

The Pursuing Equity in Mental Health Act allocates $995 million in grant funding over five years for states to use to reduce disparities in mental health care, which comes as a new report showed Connecticut teen suicides doubled from this time last year.

Janelle Posey-Green, founder of the Connecticut BIPOC Mental Health and Wellness Initiative, said teens need more education on the language of mental health.

"I really think we need is more education on what to look for so that way friends can check in on friends and they know the warning signs and even have, maybe, a script or a narrative that they can go to," Posey-Green suggested. "Let's normalize that at some point you may feel depressed."

She recommended it should be done through a community initiative involving schools and parents. Aside from the bill's funding, Connecticut is receiving more than $4 million from the Health Resources and Services Administration to expand mental and behavioral health, and substance use disorder services.

However, disparities in care are not the only thing preventing people from accessing mental health care. Studies show women of color are at higher risk for mental health issues but are less likely to seek treatment.

Posey-Green observed as much as the Black community can lift people up, things such as "strong Black woman syndrome" can hold women of color back from talking about their mental health.

"Where does this woman who is expected to be so strong get the opportunity to talk about how hard it is that from childhood to adulthood she's faced with many microaggressions and major aggressions over her life period that impact her mental health?" Posey-Green asked.

Other issues such as cultural differences can pose a challenge. Posey-Green works with a collective of providers for patients to access mental health professionals with similar backgrounds. She argued providers should be trained in cultural humility rather than cultural competency.

"Why it's important for providers to lean towards cultural humility and be trained well with understanding how cultural humility can help with providing better service is because it also teaches you to check your unconscious biases," Posey-Green stressed.

A 2024 study showed almost 26% of Nebraskans reported having a mental-health illness in the past year -- nearly 3% higher than the national average.

Providers and stakeholders of Nebraska's behavioral health care system face uncertainty as more budget cuts loom. In the last legislative session, $15 million was cut from the state's behavioral health services budget and the heads of state government divisions are now being asked to find more cuts.

Tiffany Gressley, regional administrator for Region 3 Behavioral Health Services, questioned how cuts to behavioral health align with Nebraska's conservative values.

"We're being fiscally conservative by serving these people early; as early as we can," Gressley pointed out. "We're saving money and we're saving, on top of that, the human cost that goes along with untreated mental health conditions. "

Gressley explained last year's cut brought the total budget reductions to Nebraska's behavioral health system to nearly $50 million over the past six years, much of it from unfunded provider rate increases. She stressed budget cuts mean fewer Nebraskans receive services.

Among Nebraska counties, 88 of 93 had a shortage of behavioral health providers in 2023, and 29 had none at all. Many rural Nebraskans face considerable challenges accessing behavioral health care, which advocates said further budget cuts will only exacerbate.

Sadie Thompson, chief innovation officer for the Lincoln-based Wellbeing Initiative, an organization providing services for mental health, substance use and chronic physical health conditions, said after a nearly 12% cut to its budget this fiscal year, the organization had to close satellite locations in Fairbury and Geneva and was unable to open one planned for Seward.

"All of these rural communities that we were really starting to see lots of engagement with and impact basically got the rug pulled out and weren't able to continue to have these services," Thompson noted. "These communities don't have services anyway."

Bob Shueey, CEO of South Central Behavioral Services in Hastings and Kearney, said they are constantly looking for qualified therapists and frequently have to turn patients away as a result. Shueey added the state's low provider rate combined with retirements has depleted the state's behavioral health workforce. He argued without attention, the situation will only worsen.

"Even if we raise the rates to a sustainable rate today, it's a multiyear pipeline before someone's even able to start working," Shueey emphasized. "Then that information has to be out there to new students and to young people. 'I'll be able to make my house payment and pay my student loans if I do this; I'm not going to be poor my whole life.'"


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One in four Californians is an immigrant and a new report showed many are refugees who may need mental health services but have trouble finding treatment.

Researchers from the California Pan-Ethnic Health Network found a pressing need for culturally-responsive behavioral health services.

Vincent Chou, community advocacy manager for the group, said many barriers can hinder access.

"These communities face distinct challenges such as trauma from displacement, stress, language barriers, and systemic discrimination," Chou outlined. "All of which contribute to why they're not really utilizing the mental health services that are available to them."

Community groups said they have seen a huge increase in demand for mental health services since the pandemic. The report also called for training on trauma-informed care for providers and county workers who assist immigrants.

Mary Anne Foo, executive director of the Orange County Asian and Pacific Islander Community Alliance, said California faces a dire shortage of bilingual, bicultural mental health providers; people who can better connect with patients.

"When they see a counselor who can speak their language, they're more apt to be able to describe what's going on with them," Foo pointed out. "Or to be able to participate fully in their care."

Ruqayya Ahmad, policy manager for the network, said the state needs to better fund community-based organizations so they can recruit mental health professionals from the populations they serve and offer competitive pay to retain them.

"They're the ones who have these trusted relationships," Ahmad emphasized. "They're helping to normalize mental health conversations and reducing that stigma that exists in some communities."

Vattana Peong, executive director of The Cambodian Family Community Center in Santa Ana, said the state also needs to make it easier for groups like his to get credentialed to accept Medi-Cal insurance.

"There are a lot of barriers for community-based organizations who want to become Medi-Cal mental health providers," Peong stressed. "That is something we need to fix."

He added community groups often offer wraparound services, like child care and transportation, making it easier for low-income families to access health services.