Children’s Mental Health is a National Emergency

By Marisa A. Parrella, LICSW, LCSW-C, MSW, Director of School-Based Mental Health at Mary's Center, a health center serving the DC metro area.

Children's mental health has been a hidden pandemic for years; COVID-19 has simply ignited a simmering problem and forced adults to pay closer attention to our children.

While we don't yet know the long-term impact, anecdotal accounts from schools, pediatric mental health providers, and our own Mary's Center school-based mental health therapists who serve over 1,000 students across 26 schools, suggest the potential for lasting impact on overall mental health and wellness, as well as academic outcomes. Moreover, students who live below the poverty line, who are disproportionately students of color, will likely suffer greater long-term effects.

Losses due to COVID-19 are higher in these communities, and these losses - of lives, employment, and housing - lead to a decrease in resilience and mental wellness. Our therapists have seen middle and high school students struggling with more severe depression and heightened and more widespread reports of anxiety, as well as a higher incidence of suicidal thinking. In addition, more students report feeling sad and not knowing why, or being more stressed out in school because they have fallen behind.

Data on short-term effects suggest that the lasting impact on these students may be profound, and will vary according to other risk factors. Just as children and families in more vulnerable circumstances were hit harder by the virus itself and by social, economic, and psychological effects of the pandemic, they will also be more susceptible to lingering trauma in its aftermath.

Community Health Centers - also known as Federally Qualified Health Centers - play a critical role in providing health care to the nation's most vulnerable kids. Ninety percent of families served by health centers are low-income, 60% are people of color, and 80% are either uninsured or publicly insured - the groups hit hardest by the pandemic, according to the National Association of Community Health Centers (NACHC). Many parents lack partners and are working in jobs with low wages, few benefits, and little flexibility.

In October of last year, the American Academy of Pediatrics, the Children's Hospital Association, and the American Academy of Child and Adolescent Psychiatry declared a national emergency in child and adolescent mental health. During President Biden's State of the Union address, he announced a strategy to address the "national mental health crisis," which includes expanding access to behavioral health services in schools. Health centers are already providing these services to high-need kids and are well-positioned to expand their reach in schools, where kids can get help without burdening already overwhelmed parents with outside appointments.

So what might this look like for school-aged children?

Federal funds totaling $190 billion - contained mainly in the Elementary and Secondary School Emergency Relief stream, funded by the American Rescue Plan and other pandemic legislation - have been allocated to states for use over the next four years. States must pass on 90% of relief funds to school districts, with broad latitude for how they are spent.

Many states and districts have already put some of these funds toward increased mental health support for students, and others are developing plans to do so. Washington, DC has been ahead of the curve. Since 2014, the school district has invited Mary's Center to partner with them to provide on-site behavioral health services in schools. We offer wraparound care, including psychotherapy, psychiatry, and support services to connect kids and families to health benefits and basic needs such as housing, food, and clothing. Over the last decade, both teachers and therapists have seen first-hand the impact of expanding access to these resources.

Another benefit to partnering with a health center is that we already have a sustainable billing system in place, as well as support services and community partnerships. Washington, DC has made significant investments in the implementation of a public health model of school mental health, through a blended funding model of grant funds and insurance reimbursement. This model supports Community Based Partnerships that can leverage existing programs and supports they offer for not only students but families as well such as psychiatry, social service connections, health care, and educational programs.

The DC school-based mental health program provides a model for how other states and districts can use federal Covid-19 relief funds to partner with health centers to provide behavioral health services in schools.

If we are to truly recover and thrive as a society as the nation begins to put the pandemic in its rearview mirror, we need to deal with the collective trauma we've experienced and its lingering mental health effects. We must ensure children have the help they need to get back on track, as well as having mental health services more accessible to them long-term.

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