DENVER — Being a teenager is tough. There is a pressure to do well in school or sports, a pressure to fit in with your peers, a pressure to figure out your future all while experiencing puberty.
In normal years, teens stress over things like who to ask to the homecoming dance and how to best cram for a big test. The COVID pandemic added its own set of unique challenges and stressors.
Seemingly overnight, students lost their ability to hang out with their friends, get face-to-face help with a teacher, get some space from their families, play sports or just be a kid. With that loss came fear, anxiety, stress and depression.
With the state starting to slowly return to normal, Colorado lawmakers are looking for ways to help youth cope with a traumatic past year.
House Bill 1258 would establish a temporary youth mental health services program to help kids learn to cope with the stress.
The bill calls for everyone under the age of 18 to be offered a free mental health assessment as well as three mental health sessions with a licensed professional, which the state would pay for. These services would also be offered to people 21 and younger who are enrolled in special education classes.
Lawmakers would allocate roughly $9 million of state stimulus money to cover the program’s costs.
Coping with COVID
If there’s one person who knows how serious youth stress and depression can be, it’s Rep. Dafna Michaelson Jenet. Her son attempted to commit suicide several years ago at the age of 9.
Suicide is the leading cause of death among Colorado’s youth. The state has the seventh highest rates in the nation.
Over the past year, Children’s Hospital Colorado reports it has seen a notable increase in the number of kids who visit the psychiatric ER due to thoughts of suicide.
Meanwhile, the Colorado crisis system has experienced a 30% increase in calls to its system from people of all ages over the course of the pandemic.
Since her son’s attempt, Michaelson Jenet has been fighting for more behavioral health treatment among the state’s youth. This past year, she’s seen a lot of need.
“I came into session and I have been racking my brain about what do we do to protect our kids when they have to go back to what’s perceived as normal,” she said.
Her big idea was to propose a bill that would offer every school-aged kid in the state a free mental health screening. Michaelson Jenet, who was a chair of the interim school safety committee that was created in the wake of the STEM Highlands Ranch school shooting, thought the idea was forward-leaning and bold so she presented it to the governor’s office.
“The governor’s office came back and said, ‘I’ll do you one better: How about we not only do screenings, but we get three free mental health exams?’ And this is a game changer,” Michaelson Jenet said.
House Bill 1258 already has bipartisan support and Republican cosponsors.
If passed, the bill would be the most audacious attempt at addressing student mental health needs in state history. Even discussions of the bill are already making national headlines.
The bill pushes for therapy sessions so that kids can talk through their problems and learn some coping mechanisms; it’s not a meeting with a psychiatrist and no medications would be prescribed.
“Having an intervention with a mental health professional (will) help them figure out how are you going to deal with that stress and what are some of your plans that you can make in the classroom if you become overwhelmed and how do you reach out to someone you trust,” Michaelson Jenet explained.
However, it would be completely voluntary for youth and families would be encouraged to participate.
The help would begin in the form of a free online assessment for youths to either take on their own or with the help of a parent. No personally identifiable information would be collected from that assessment.
The data would help determine whether the youth need to see a mental health professional.
The mental health sessions would focus on providing the kids with coping skills and well as mental wellbeing components.
While some students might only need three therapy sessions to work on coping mechanisms, Michaeleson Jenet said others might need ongoing care and says if there is money left over, the bill does offer some flexibility to cover additional therapy sessions.
The program would attempt to connect youth with someone within their insurance network so that if they do require ongoing treatment they won’t have to start over from scratch or pay exorbitant prices.
“How many of those kids are we going to catch before they get too stressed, too anxious and too depressed?” she said.
A surge and a shortage
Colorado youth are not the only ones experiencing increased stress and anxiety. Vincent Atchity, the president and CEO of Mental Health Colorado, says the state has seen a significant increase in adults reaching out for mental health help as well.
However, there are not enough mental health providers in the state to go around.
“There’s a shortage of mental health providers nationally. Colorado is definitely up there. We are ranked 47th out of 50 in the country when it comes to need for care versus access to care,” Atchity said.
Along with an increased demand, patients are staying in treatment for longer due to ongoing stressors, according to Dr. Carl Clark, the president and CEO of the Mental Health Center of Denver.
“If you take all of the therapists in Colorado, there frankly are not enough therapists to provide the needs of people who need help,” Dr. Clark said. “My experience as a psychiatrist is we have breached capacity for behavioral health my entire career.”
As a result, some patients are already experiencing up to a three-month waiting list to be able to see a therapist. In rural communities the problem is even worse.
Part of the reason there are fewer therapists in the state is the fact that they receive lower reimbursement rates than other medical professions.
The office of behavioral health estimates House Bill 1258 would result in roughly 15,000 youth in the state seeking mental health help within a short window of time.
If the bill passes, a surge in Colorado youth seeking mental health help could further strain the availability of therapists in the state.
That’s where Robert Werthwein comes in. He’s the director of the office of behavioral health in the Colorado Department of Human Services.
“This is going to be an undertaking. It’s not a simple task, but it is achievable,” Werthwein said.
Part of the strategy includes using telehealth to meet the state’s therapy needs. He’s also planning on opening the sessions to a broad range of licensed specialists and actively recruit providers, first with an email blast asking them to help a student out.
Some of those providers might even be coming from or working out of another state and remotely meeting with the patients in order to meet all of the needs.
Werthwein is hoping providers will be able to pick up a session or two in the evenings, when kids are out of class and after most adults would be seeking a session.
Beyond that, he’s also planning on paying a quality rate for the sessions to encourage more providers to take up these youth sessions.
In the long-term, though, Werthwein knows the state needs to do more to fix the shortage of mental health therapists.
“We still need providers, but we’d rather know who those youth are that need those services then not know it all,” said Werthwein.
He said he believes that if the bill passes, it could serve as a litmus test for how offering mental health services to youth could work in the future.
Equity in access
While Werthwein and others are looking forward to the possibility of the bill passing, others are worried about how it would be implemented equitably.
Mohamed Ibrahim is a junior at Wiggins High School, a school located in a community of about 1,100 people in rural Colorado.
There’s only one counselor to serve 208 students in the high school, dealing with mental health but also college admissions, scholarships and more.
In neighboring schools and districts, there have been several suicides among teens.
Ibrahim welcomes the mental health help for himself and fellow students, however he worries about how the program will be implemented.
“The only concern I have is that it is carried out in an equitable manner, especially coming from a rural district, you know. We are kind of always left in the shadows,” he said.
The Office of Behavioral Health says it is planning on increasing its outreach to talk to diverse populations across the state if the bill passes, including translating the material into Spanish. It will also connect with community organizations that are already serving diverse populations.
For Ibrahim, equity means reaching out to minority youths to make sure that they are getting access to care, but it also means overcoming economic and transportation gaps for students away from metropolitan areas.
In some rural communities in Colorado, there are no mental health providers at all. While telehealth may be a viable option for some, others don’t have access to broadband in their homes.
“If we just had access to telehealth, I really don’t think it would benefit us,” he said. “There’s so much value to be gained out of really talking to a person and really sharing those issues and being able to have that personal connection to that person then it is to talk to someone over the phone.”
As someone of Muslim faith, Ibrahim says another area of equity would mean making sure that the professionals themselves come from a diverse set of backgrounds.
“If I’m talking to someone that’s unaware of my culture or unaware of how I was raised and those values that were instilled in me from when I was very young, then I don’t feel that person can help me at all. If anything, they could possibly contribute to the issue,” he said. “So definitely having someone that you can talk to you, someone that looks like you and someone that understands where you’re really coming from.”
Werthwein agrees that diversity would be preferred among the mental health professionals as well, and he plans to ask them some basic demographic information about themselves so that kids can choose someone who might be more like them.
However, he says sometimes any help is better than no help.
“That’s one of the difficult parts — is really having this grand ideas but I think implementing them is a difficult part and I really think that’s where youth perspective and youth input really comes in play,” Ibrahim said.
Not waiting on lawmakers
While House Bill 1258 makes its way through the legislative process, some school districts aren’t waiting for the state legislature to try to help their students.
Cañon City School District has already begun providing resources to students to help them coping with the pandemic and the normal challenges kids face.
Each school in the district has a counselor who has been going into classrooms to provide tier 1 social-emotional skills to kids.
“We’re also doing one-to-one check-ins with students, small group interventions,” said Jamie Murray, the behavioral health coordinator for the district.
Since the pandemic began, Murray said she noticed a decrease in suicide ideations but an increase in anxiety and stress for students.
The district also had quite a few kids drop out of their therapy services when COVID hit, so the district has been working hard to bring the kids who were getting ongoing treatment back in.
Currently, the district has roughly 300 students who are receiving some sort of mental health support. They’ve worked on suicide prevention, bring licensed clinicians into schools to work with kids and offer behavioral health screenings to kids twice a year. Much of this work began before the pandemic but was amplified as a result of it.
“It’s important for kids to know they’re not alone, that these are normal reactions, and this was a very challenging situation” Murray said.
When quarantining began, the counselors also virtually checked in on students, sent surveys out asking them about their virtual learning experience and ran virtual group therapy sessions.
Cañon City Schools also offered teen wellness vouchers this year that allowed any student 12 or up to receive two free mental health sessions with a licensed clinician.
“Has it been challenging? Absolutely, between virtual and quarantining and learning a whole different platform,” Murray said.
However, overall, she said she believes the kids have adjusted to all of the changes well. Even without a bill, Murray says schools are committed to trying to help students work through all of the stressors of an unprecedented year.
If approved, House Bill 1258 would bring the biggest step to addressing youth mental health the state has seen. The bill is already making national headlines.
The program would be short-lived; it would be available to students from May 31, 2021 until June 30, 2022 as an immediate response to the COVID-19 pandemic.
However, if the program goes well it could serve as an example for future legislation both in Colorado and in other states.
With bipartisan support, passing the bill might be the easy part. Implementing it and equitably might be the real challenge.
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