Youth Summit on Mental Health Marks Monumental Moment

New School-Based Clinics a Potential ‘Game-Changer’

Let me start off with a not-so-little news nugget I learned last week.

Within the next two to three years, there might be as many as about 80 school-based mental health clinics (run by independent agencies) operating within Westchester schools, and hundreds more servicing students across New York State.

And yes, that would be a big, big deal.

But what’s fueling this effort to reinvent our mental health support system for the young?

Let’s start with a peek at the backdrop.

Last year, a group of researchers set out to confirm what we already instinctively know about the predacious engineering of social media platforms like TikTok.

The researchers posed as 13-year-olds, setting up new accounts across multiple countries, including the United States, and briefly engaged with content about body image and mental health.

What happened next?

In less than three minutes, TikTok’s algorithm, apparently prizing engagement over all other considerations, started pushing out suicide-related content to the “teen” users.

The nonprofit Center for Countering Digital Hate unveiled these research findings last December.

“The results are every parent’s nightmare; young people’s feeds are bombarded with harmful, harrowing content that can have a significant cumulative impact on their understanding of the world around them, and their physical and mental health,” Imran Ahmed, the nonprofit’s CEO, stated at the time.

It’s within this context that a summit on youth mental health was convened last Thursday in New York City at the Javits Center.

Hanging in the Balance

The summit featured more than 1,000 people, with mental health providers, advocacy groups, parents and caregivers, educators, policymakers and young people all gathering to tackle the immense problem.

I watched Gov. Kathy’s Hochul’s opening remarks last week, listening in on a live-stream. She cited the pandemic and social media as the pair of factors that turned an already severe problem into a next-level crisis.

Hochul identified TikTok specifically as a particularly bad actor in the space but called on all social media companies to acknowledge the problem and be part of the solution.

“They need to understand what they’re doing to our kids and that lives are hanging in the balance and stop putting profits over the health of our children,” Hochul said. “That is cruel, it’s irresponsible and it should no longer continue.”

She also said it’s important to remember how, from a mental health standpoint, many young people just can’t quickly turn the page on the trauma of COVID upending their lives.

“One day everything’s normal, then you start hearing about this virus floating around,” Hochul said. “One week you’re visiting grandma, and the next week grandma, perhaps the person who’s taking care of you, is on a ventilator and you can’t even say goodbye. That doesn’t go away just because we declared the pandemic over.”

Fundamental Change

The governor certainly didn’t hedge when framing the significance of the moment.

In fact, she framed last week’s summit as a historic event, a watershed in our reckoning with the scale of the problem, and the need for new answers.

“Every significant movement in our nation’s history began here in the state of New York,” Hochul asserted, before comparing the reform effort to the seeds of the civil rights and gay rights movements, both with roots in our state.

Whether last week’s summit proves to be a major historic marker or not, the significance of the crisis really can’t be overstated. It’s not quite like any societal issue we’ve ever grappled with before.

Hochul noted how about 42 percent of high school students in the United States feel persistently sad or hopeless, according to the Centers for Disease Control and Prevention (CDC), at what the governor described as what should be “one of the most spectacular times of their lives.”

And 22 percent of American high school students have actually considered suicide, Hochul said, emphasizing how teenage girls are particularly at risk while separately pointing to the fear of school gun violence as unnerving many young people.

“Teenagers are facing a crisis like never seen before in the history of this country,” said Hochul, who engaged in a youth listening tour this spring. “There was a time when it was always binge drinking, drunk driving, smoking were the greatest evils. Today, it’s so much deeper. It’s anxiety, it’s depression and it’s suicide. If you look at the statistics, they’re absolutely staggering. And it’s just a reminder that we’re failing our children.”

 Billion with a ‘B’

Early last month, Hochul unveiled a $1 billion initiative aimed at transforming the state’s mental healthcare system.

The plan, included in the fiscal year 2024 budget, aims to enhance accessibility, minimize wait times and ensure appropriate levels of care for people dealing with mental health challenges.

Key elements include funding for new residential units, expanded inpatient capacity and major growth in outpatient services.

Additionally, the blueprint features investment in peer-based outreach, school-based mental health services and addressing gaps in insurance coverage for behavioral health support.

Amid this effort, new CDC data was published last week that revealed suicide rates among young people ages 10 to 24 reaching a two-decade peak in 2021.

The Commish 

I connected last Friday for a phone interview with Michael Orth, commissioner of the Westchester County Department of Community Mental Health. As it turned out, Orth had attended Hochul’s summit, and appeared genuinely impressed with the program.

“You know, my expectations aren’t always the highest, but to be honest with you, it was very well done,” Orth said. “The governor clearly had a good understanding of the issues and backed it up with her state budget.”

But I wanted to drill down on what systemic change could actually look like here locally, beyond the governor’s rhetoric.

The most fascinating piece of the puzzle I learned about in that exploration with Orth involved school-based mental health clinics.

I didn’t realize before speaking with the commissioner last week that there are about 40 school-based mental health clinics already operating in Westchester, mostly in comparably lower-income local communities, such as Yonkers, White Plains and Peekskill.

‘Game-Changer’ 

While I couldn’t get Orth to spill the beans, or at least the details, it turns out several northern Westchester districts might see similar agencies enter their buildings over the next few years, perhaps as soon as this fall in some cases.

Due to Hochul’s mental health initiative, Orth said within two to three years that figure of 40 school-based mental health clinics in Westchester might expand to as many as about 80, with $30 million earmarked in the statewide budget for the initiative.

Establishing professional mental health service clinics within school buildings across New York sounded pretty revolutionary to me, and I asked Orth if I was overemphasizing the potential significance.

In short, he said I wasn’t.

Spanning his three decades with the county, Orth cited this development as one of the most, if not the most, “major” breakthroughs in the mental healthcare system. He characterized the planned expansion of access to treatment as a “significant service for adolescents and families.”

“With all the waiting lists for outpatient treatment and obviously since the pandemic, the great need for mental health services, this is sort of a game-changer,” Orth also told me. “This really opens up access for young people. It’s less stigmatizing, it’s easier to access. So this is very big in terms of just having those services available.”

‘Really Excited’

As you might expect, widening access requires policy change when it comes to funding mechanisms. There’s a reason the current school-based clinics reside within lower-income communities where there’s a far greater opportunity for agencies to bill Medicaid for their services.

“That part of the governor’s plan is to make commercial insurance pay for school-based mental health services because they often deny the service or pay at a lower rate,” Orth explained. “So her goal was really to build access and make commercial insurance, just like Medicaid managed care, responsible for paying for that service. So we had many superintendents at the conference who are really excited to get that support to build access to mental health services.”

Put another way, children in generally wealthier districts – students who have parents with private insurance – also need help.

“So in many of our more affluent parts of the county where there’s primary commercial insurance, they couldn’t bill,” Orth explained. “That’s why it’s hard to sustain a program. But with the governor not only offering $30 million, but also a commercial insurance requirement, that’ll help build capacity.”

I asked how delivering mental health services inside of schools might address the stigma issues, even while acknowledging how seeking mental health support is far less stigmatized than in the past.

“Most parents don’t want to pull their kid during the day to go to treatment,” Orth observed. “It breaks up their educational time. It’s disruptive, it’s stigmatizing. Where is Johnny going? By having it in a school building, many kids do sort of pull-out sessions or after school. They go to certain activities or events. So it’s right there.”

Access, Access, Access

But beyond the stigma issue, it’s also about access, for inpatient and outpatient services, given the outrageous waiting lists that currently plague our system.

As incredibly important as psychologists and social workers are to school communities, they can’t deliver comprehensive psychiatric treatment. That’s not their charge.

Offering these resources, through outside agencies, within school buildings, would deliver young people a revolutionary new level of access.

“So if a young person really has ongoing mental health needs, they’d have a therapist in the school, they would have a psychiatrist to monitor medication,” Orth said. “They would be able to do family therapy, whether it’s time in the school or using it virtually. So it’s all those services you would get in a normal outpatient mental health clinic, which the schools just don’t have the ability, resources, nor is it really their job description to do that.”

As for inpatient waiting lists, it’s not hard to understand just how dangerous delays can be for teens in distress.

“There’s like six-, seven-month waiting lists,” Orth said. “And as you know, if you’re struggling with a toothache or a broken ankle, you can’t wait five, six months for treatment. So it’s the same thing with mental health.”

What can that look like for emergency situations here locally?

“There are times we don’t have a single hospital bed for kids in Westchester County,” Orth replied. “So kids are waiting in the emergency room for days until they can access the bed. So it’s statewide now. It’s a major crisis in terms of just accessing services.”

‘General’ Speaking 

When it comes to social media, Orth pointed to the dramatic advisory the U.S. surgeon general issued just last month, when Dr. Vivek Murthy concluded how the platforms “pose a risk of harm to the mental health and well-being of children and adolescents.”

Just take a moment to consider the world we live in today compared to the one where kids grew up only two decades ago.

Imagine even your early 2000s self (if you’re old enough) envisioning an adolescence where kids spend about three-and-a-half hours a day (or far more) absorbed in online social networks. All this remains very new, in the grand scheme of things.

An astounding 95 percent of young people ages 13-17 report using a social media platform and more than a third say they use social media “almost constantly.”

I asked Orth what parents can or should do.

“We’re telling young people to limit the time, but when you look at our society, some of the adults are not doing a great job of modeling that either,” he replied in part. “So how, as adults, can we sort of model some healthy use of social media and devices?”

Orth acknowledged “good aspects” of social media, in that it can help some young people feel connected, although he qualified his acknowledgment by also noting how there’s “not a lot of research on the positive impacts.”

At the youth summit, experts addressed the issue from a scientific standpoint.

“They talked about some of the concerns regarding brain development between ages of 10 and 19, your brain is forming,” Orth said. “They talked about how frequent social media use may be associated with distinct changes of the developing brain – the brain, the amygdala, which is important for emotional learning and behavior. The prefrontal cortex, which is important for impulse control, emotional regulation. So just the impact of that and obviously sleep deprivation and then some of the more social aspects of cyberbullying body imaging has led to an increase in eating disorders, anxiety and low self-esteem.”

Investing in the Future 

Orth also highlighted issues such as insurance disparities and low reimbursement rates, which contribute to a shortage of mental health professionals. Young people often face extended stays in hospitals while awaiting treatment options.

He said collaborative efforts are underway between his department, local hospitals and the outpatient system to try to address the problem.

Westchester has four hospitals offering 243 beds for child and adolescent care, but these beds frequently reach full capacity, resulting in emergency department stays.

The department has also received widening support via the New York State Office of Mental Health to improve services.

Orth referenced a plan to establish short-term crisis/respite services as an alternative to hospitalization as soon as later this year through the JCCA, a child care organization.

He also pointed to plans to enhance Youth Assertive Community Treatment, a program through the Mental Health Association of Westchester, designed to provide young people with intensive, highly-coordinated, individualized support.

Separately, the department recently gained a five-year federal grant – $545,000 annually for five years – secured by U.S. Sen. Kirsten Gillibrand. The money aims to support the Westchester Co-Occurring System of Care project, which seeks to expand comprehensive treatment and recovery support services for adolescents and transitional-aged youth with substance use and mental health disorders, along with their families.

Speaking of co-occurring disorders, (a term to describe when a person has a substance use disorder and a mental health disorder, either simultaneously or one following the other) let’s not forget the millions pouring into states across the country as a result of the opioid settlements.

“We’re just about to release the award amounts,” Orth told me. “A good percentage of the $5.8 million are going into youth adolescent co-occurring mental health, substance use, treatment, prevention.”

But despite all of the investment, Orth stressed how there’s lots more work to do.

“Westchester is not immune to the impact of the pandemic on our young people and we see it through the need for more access, the need for more services,” he said.

Belly of the Beast 

I also wanted to hear the perspective of someone inside the belly of the beast.

A friend of mine, Annemarie MacSweeney, works at John Jay Middle School as a guidance counselor. I wondered how the playing field had changed not just since 2002, when she started working in Westchester, but also since 2020, post-pandemic.

“Now a lot of students come into sixth grade already being familiar with it, already having a phone, where it used to be that a kid would get a phone possibly in eighth grade,” she said in a phone conversation over the weekend. “And now a lot of kids come into the middle school with phones and having had them already for a year or two.”

MacSweeney said Snapchat in particular has become especially problematic.

“Snapchat is tough for us because unless someone takes a screenshot of what was said, a lot of these messages disappear on Snapchat, which I think why kids feel more emboldened to use Snapchat,” MacSweeney commented.

She continued: “So a lot of these kids, they don’t think before they type something in, and next thing you know, they said something pretty inflammatory and there can be a lot of backlash from it.”

I wondered what MacSweeney has seen as effective ways to engage with young people. She cited a survey she offered, providing students a comfortable space to articulate what was on their minds.

“It’s amazing how if you call kids into your office, they might not be as open to share,” she explained. “But kids, they love surveys and they were happy to report and share what I don’t think they would have otherwise shared. But then I had like a jumping point, a jumping off to discuss what else in their lives they might feel was negatively impacting them.”

MacSweeney stressed how helpful it is to work at a school district such as Katonah-Lewisboro where a “concerted effort” is made to ensure students gain meaningful connections. Between a therapy dog, a wellness week and much else, she said the district has displayed an eagerness to invest time and resources in addressing mental health concerns.

But even with all that, and even in a wealthy school district, families face significant financial barriers to treatment.

“Obviously, I work in a community where a lot of parents have resources, but even there, a lot of these therapists will charge $150 to $200 an hour,” she said. “And that’s kind of prohibitive for most families.”

One positive change she’s seen over the past dozen or so years has been an increased openness among parents, even well before the pandemic, to mental health support for their children.

“When I first started, it was kind of like, ‘Wow, a therapist,’” she recalled. “They’d be like, ‘I’m going to go get my kid a therapist?’ And now I feel like it’s just very commonplace.”

When and why?

“I would say maybe around 2010 it felt like things started to change; I guess the new generation of parents who maybe they had had support when they were in school,” MacSweeney replied. “So I’ve definitely seen that evolve.”

Last Word

At the end of her remarks last week, the governor called on summit attendees to bring her new ideas, specifically requesting “concrete action items,” that would form the basis of a preliminary report and a template for change.

She wanted to figure out how “we get kids off their phones, off their devices, into healthier activities and relationships? So now it’s up to you.”

“So don’t be timid,” Hochul also remarked. “Don’t think that something’s too radical or unconventional or controversial. Those are actually the ones I like the best.”

Whether last week’s summit proves to be a historic moment or a fleeting one, the bottom line is that our youth mental health emergency must be addressed with urgency and bold, prompt action.

Our future is largely intertwined with how we handle this monumental crisis. Here in New York, it appears we’re starting to head in the right direction.