Our YouthCharge boards have been interviewing experts on the biggest issues facing children and youth. Here are some of the biggest takeaways from the Mental Health panel.
- Megan Lee – Office of Behavioral Health, Colorado Crisis Services
- Sam Moccia – Office of Behavioral Health, Colorado Crisis Services
- Bre Donnelly – Joy as Resistance
What are the biggest needs in the issue area of mental health for teens?
Megan: What we see in crisis services in terms of need is more awareness of what the available services are and for those services to be trustworthy. Because of confusion around what services exist, I think there’s hesitation in reaching out and getting involved in them. What we’ve found is we need to make people more aware, but also make sure the services we’re presenting are relevant and important to young people. In some ways I think we’ve built a system for adults that we’ve tried to make fit with kids and it doesn’t work very well.
Sam: From both a systems side of things and from individual experience, there’s this dual issue in youth behavioral health. Youth are often expected to advocate for themselves at the same level as adults when we go into these conversations around mental health. But also, the systems are built around this age issue – the moment a youth turns 18, oftentimes that’s the line where support stops, and that’s a huge issue.
Bre: I work a lot on the ground with young people doing direct services, and I think one thing that is consistently there is the stigma around mental health. There’s this idea that it has to look a certain way for it to be useful, honest, or billed through insurance. Transportation is also a huge barrier. Another thing I see a lot is the lack of group services or group efforts. It’s either very individualized or taking place at a very high level. The in between space is a lot harder to find, but honestly youth learning from youth is an incredibly powerful thing. I think that’s missing a lot in mental health work.
Have you seen any trends in a specific age, gender, or economic group? Specifically around suicide, depression, and anxiety.
Megan: Something we’ve been seeing on a statewide scale is that more young people had started reaching out at the beginning of COVID and shelter in place orders. Before that we had been seeing an upward trend in people reaching out by text message to the crisis line. Themes or trends that they talk about are relationship issues, anxiety in general, uncertainty about the future (even prior to COVID).
More kids than ever are dying by suicide we know that for sure. Unfortunately it’s hard to measure trends and see if something is working because we can’t say what would or wouldn’t have happened if an intervention hadn’t been in place. I don’t know if more kids are dying by suicide and more kids are reaching out OR if more kids reaching out is reflective of more kids thinking about suicide. We can’t place those things together necessarily. But we do know all of those things are true at the same time.
Bre: LGBTQ+ young people are always at a significantly higher risk when looking at data and statistics, which is a very important issue for me. There’s also trends in depression and anxiety that I’ve seen in that people are calling things depression and anxiety and what I’m noticing is a lot of grief. Working with a lot of people across the front range, there’s so much grief around everything that’s going on, especially in light of COVID-19, in light of racial injustice. The fact that people are having these conversations more publicly now than they maybe had been before is bringing up a lot of mixed feelings. Everyone feels like there’s so many issues happening right at the surface, so there’s a lot of grief and confusion around that. With that comes a lot of anxiety and depression about not knowing how to have a clear path forward, with young people and adults.
Do you believe that there is a lack of services for any particular demographic(s)?
Sam: I would argue that there’s no facet of behavioral health that isn’t understaffed, underpaid, underfunded in any sense. With COVID, we’re getting a better understanding of the problems in our health infrastructure, and I would argue that that is a really great example of what we’ve been dealing with in behavioral health for years now. It’s a continuous lack of services. It’s a lack of relevant services for folks of various identities. It’s a lack of services for anyone who is remotely in any lower economic status. It’s a lack of services for a lot of people who aren’t in an urban area. In Colorado a lot of what I’ve seen is that folks in rural areas have this triple threat of tight knit communities that respond very differently to behavioral health, a lack of services altogether, and on top of it oftentimes services are for one specific group of people.
Bre: I think there’s a significant lack of services across Colorado in terms of individual and group mental health providers, especially those that align with various identities. Having more organizations available would be helpful. The other piece is, as someone who just started an organizations doing direct services, it’s really hard to get through all of the legal pieces of youth mental health specifically. I think that’s something a lot of people don’t realize, that it’s not just starting something or having people available, it’s also about having people willing to put in that level of work to provide those services in a really authentic way.
Megan: Therapists, especially in public organizations like schools or community mental health centers, get paid poorly. Bre mentioned that there’s a lot of work involved in doing responsive quality care, and these therapists make a lot less than they could in other careers, often with advanced degrees that were really expensive to attain. There’s a lack of resources, certainly. There’s a lack of workforce, definitely, all throughout the state, especially in rural areas. But there’s also a lack of respect for the field, when individuals doing life saving work are getting paid $16/hour. It’s really hard for therapists to get motivated to want to do that sort of work. So it’s not just the therapists and it’s not just the lack of therapists, it’s also what the system has in place to get in the way of providing quality care.
In your two organizations, what is the most prevalent issue you see in your day to day work?
Bre: I think the most prevalent issues are stigma around mental health and transportation. The stigma of do I seek mental health services? Is it even to that level? Are my parents going to be okay with it? Do I feel okay with it? What are my friends going to think? And the problem with transportation is that people just can’t get to the places they need to get. Our public transportation system is not great, and the further you get outside of Denver, the less resources there are and the harder they are to access.
Sam: From a systems side of things, there are many barriers that really need to be checked out. But again, there’s a lack of resources and a lack of prioritization about this issue. I think the biggest thing I’ve seen continuously is this lack of consultation with groups who are affected. This is something we see in all governmental work, but especially in youth mental health. There’s no youth in the room to say this is what I’m truly feeling, this is what isn’t working, this is where we’re hitting walls. And that’s probably one of the biggest things I’ve seen that I truly believe is stoppable. When there’s programs being developed or changes in systems, there’s not consultation for the people it’s going to affect. But oftentimes that one call entirely changes what should be planned and what should be happening.
Megan: That’s a really interesting perspective, Sam, and I wonder if that were actually being practiced if we could overcome a lot of the other barriers in the system. I also think culturally responsive care in a way that’s willing to shed how things have always been done and move toward something that looks completely different or something that people in the community are asking for. I think that it’s not about how we entice more people to use services, but how can we make sure the services are more relevant to the people that need them?
Sam: One more thing I don’t want to gloss over. There’s a real issue around lack of respect for the fact that mental health and behavioral health are evolving to something beyond talk therapy. This is a huge thing for our generation – a lot of us don’t respond well to talking to people. That is a hard thing when we grew up isolated, on our phones, dealing with the things we’re dealing with. There’s an evolving effort around these alternative therapies, and although there’s a lot of varying perceptions about it, I think that’s another thing that needs to be thought about. What people think of as therapy to being with is really starting to shift, and it needs to.
Answers have been edited for clarity or length.