As the school year winds down, mental-health providers say they recognize many students still feel the weight of the pandemic, and in North Dakota, it has prompted a more dedicated response to help kids dealing with higher levels of stress and anxiety.

The Centers for Disease Control and Prevention (CDC) recently issued findings which showed more than a third of high school students reported having poor mental health during the crisis. Another 44% said they persistently felt sad or hopeless in the past year.

Christy Wilkie, a therapist with Dakota Family Services, said they have seen a big increase in referrals.

"When they do come into the office, we're seeing more anxiety, more depression," Wilkie reported. "And I would say it's more intense anxiety."

She said some of it might be greater awareness from parents after spending more time together during the crisis. Any family financial stress or disruptions in connections with peers are other factors. Wilkie pointed out they are doing more outreach with local schools to help identify concerning situations and to navigate the referral process.

Wilkie emphasized they are also trying to help fill gaps in areas where services are scarce, including having one of their staff routinely visiting a rural high school in Barnes County to provide therapy. She added telehealth has helped during a time of greater need.

"The schools will provide spaces for kids to do therapy in school," Wilkie noted. "It's one less barrier to getting help for kids when the parent doesn't have to take time off and drive them to the clinic and then wait for that hour and then drive them back."

Despite the extra efforts, Wilkie stressed waiting lists are long, and recruiting is ramping up in hopes of adding providers. The CDC report revealed more than half of high school students reported experiencing emotional abuse by a parent or other adult in their home during the pandemic.

A new book by a University of Washington professor on the death penalty finds support for executions may be motivated by people's own fear of death.

Philip Hansten, professor emeritus of pharmacology at the University of Washington and author of "Death Penalty Bulls---," argues against the practice.

Hansten draws on work by Ernest Becker, an anthropologist who said reminding people of their own mortality made them cling tighter to their cultural views and even increases people's punitive urges in order to defend their culture.

Hansten suggested hearing about a murder could cause somebody to think more about death, especially if it happens in their community.

"The murderers are an out group in general; I mean most of us aren't murderers," Hansten pointed out. "So the murderer is automatically an out group, somebody who we would tend to protect our culture from anyway."

Hansten argued it could make people more likely to support the death penalty. He also noted the fear of death can inspire xenophobia and racism in people who feel they need to protect their culture.

Becker's Pulitzer Prize-winning book The Denial of Death led to the creation of a study known as Terror Management Theory.

Hansten contended Becker's theory puts death row in a new light.

"If the terror of death has such a huge influence on all of us, putting people on death row for decades, it would be hard for me to imagine something more cruel than that," Hansten stated.

Hansten added Terror Management Theory also makes it clear people do not necessarily create their views on issues like the death penalty with their rational minds.

"You give them all this data and all the rational arguments and show how it's totally arbitrary, etc., etc., and it just falls on deaf ears because this death terror is preventing them from hearing it," Hansten emphasized.

Seventy percent of the royalties for Hansten's book go to the group Death Penalty Focus.

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.