Children’s Mental Health

Over the past two decades, rates of Texan children who have felt hopeless, struggled with anxiety or depression, and have experienced suicidal ideation have been rising.1 It is incumbent on communities, youth-serving systems, and the state to put every resource toward strengthening protective factors in communities that prevent youth deaths by suicide, overdose, and violence. Texas should continue moving towards mental health and substance use prevention, early intervention, and community-based care.

The state’s investments in crisis response, diversion, and the Texas Children’s Mental Health Care Consortium (TCMHCC) have effectively equipped more pediatricians, law enforcement agencies, courts, and schools to recognize and respond to mental health needs. TCMHCC, for example, has effectively supported more pediatricians through Child Psychiatry Access Network (CPAN) and schools through Texas Child Health Access Through Telemedicine (TCHATT) in identifying children who are in mental health distress and need support. However, these are not meant to be long-term solutions for mental health prevention.

Every community should have available, affordable, and accessible mental health supports for families to choose from. While appropriating funds to responsive programs for kids and families with acute needs or who are in crisis is important, we must also equally invest in preventative and continued care in the community. Full continuums of care must be available across the state to ensure every child, youth, and family has the appropriate and adequate resources needed before and after crisis as well. Alongside increased referrals, it is imperative to simultaneously bolster services to be referred to. There is an urgent need to address the dearth of mental health resources in communities.

Unfortunately, an increased number of mental health concerns are being identified and treated through systems not designed to appropriately address children’s mental health. Youths’ poor mental health is often being identified too late throughout systems not designed to meet their complex needs. Emergency rooms, hospitals, law enforcement agencies, classrooms, and child welfare and juvenile justice systems are already overburdened without the unfair responsibility of assessing and treating youth mental health. These systems’ resources should be expended on combating the other immense challenges they face.

COVID-19’s Long-Term Impact on Youth Mental Health

As we better understand its long-term effects, COVID-19’s impact on mental health is evident. In 2020, mental health-related visits to hospital emergency rooms rose 24 percent for children ages 5-11, and 31 percent for children ages 12-17 as compared to data from 2019.2 Children endured school closures, social isolation, gaps in health and mental health care, financial insecurity, and loss of loved ones. Through December 2022, over 275,000 children had lost parents or other in-home caregivers to COVID.3 We know that as result of COVID, mental health concerns, including trauma, depression, substance use, and suicidal ideation, have risen in youth.4

Research shows a continuation of these increases, and that elevated depressive symptoms and worsened mental health observed among both adolescent girls and boys during the pandemic have not improved.5 In 2023, the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association released a joint policy statement warning that emergency rooms are unable to respond to the surge in youth and families seeking emergency mental health care without more local resources.6 Emotional and behavioral effects of trauma are known to spike more than a year after trauma exposure, suggesting continued need to support the mental well-being of young Texans well into the future.7

Youth were also affected by the pandemic’s impact on their families and communities, including unemployment, financial and emotional stress, and food and housing insecurity. One third of Texas high school students report a parent or other adult in their home lost their job during the pandemic.8 Some youth were also forced to spend more time in unsafe environments due to quarantine requirements and school closures, facing higher risks of domestic violence and child abuse.9 While youth mental health and well-being were undoubtedly affected by the pandemic, it is more accurate to describe the pandemic as exacerbating already existing poor mental health. Even before the pandemic, an estimated one in three Texas kids and adolescents experienced a mental health disorder in any given year.10

Sense of Safety and Mental Health

Other societal issues continue to undeniably affect the sense of safety and well-being of our kids. Youth have witnessed mass shootings targeting schools, bullying and violence among peers, contentious national conversations on race, and extreme weather events. These experiences have profound and lasting impacts on children’s mental health. The lingering mental health impacts from the pandemic and the 2022 Robb Elementary School shooting in Uvalde, TX brought a greater awareness and focused conversation to the longstanding challenge of how to support children’s mental health. Our youngest Texans deserve to feel safe and supported regardless of where they live, learn, work, play and pray.

While all kids have challenges, it is important to recognize that certain youth face additional difficulties that impact their mental health and well-being. According to the U.S. Surgeon General’s Advisory on Protecting Youth Mental Health, there are groups more adversely impacted or have additional barriers to support such as “youth with disabilities, racial and ethnic minorities, LGBTQ+ youth, low-income youth, youth in rural areas, youth in immigrant households, youth involved with the child welfare or juvenile justice systems, and homeless youth.”11 Further, many of these youth are at higher risk for adverse childhood experiences (ACEs) that increase their likelihood for violence, chronic health problems, mental illness, and substance abuse in adulthood.12

Adverse Childhood Experiences (ACEs)

Adverse childhood experiences (ACEs) are events that occur before the age of 18 and are potentially traumatic such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide.13 ACEs can also include incidents that impact a child’s sense of safety or stability such as parental substance use, parental mental health, or instability resulting from familial separation or incarceration of a household member. These experiences can have a wide range of long-lasting effects on health, behaviors, and life potential, increasing the risk of injury, mental health programs, chronic diseases, employment, graduation rates, and total in the hundreds of billions of dollars each year in economic and social costs.14

ACEs and their subsequent impact are preventable through both addressing underlying risks as well as supporting safe, stable, nurturing relationships and environments for all children. Evidenced-based strategies to mitigate the impact of ACEs include15:

  • Strengthen economic support to families through policies that support household financial security and family-friendly work policies;
  • Promote social norms that protect against violence and adversity through public education campaigns and reducing corporal punishment;
  • Ensure a strong start for children including early home visitation models, high-quality and affordable childcare, and preschool enrichment programs with family engagement;
  • Teach skills early through social emotional learning, healthy relationship skill programs, and skill-based parenting and family relationship programs;
  • Connect youth to caring adults and activities through mentoring and after-school programs; and
  • Intervene to lessen immediate and long-term harms through enhanced primary care, victim-centered services, therapeutic interventions and other supports to address the social, emotional, and behavioral risks associated with ACE exposures, and family-centered treatment for substance abuse.

Environments children grow up in can promote and create systems to help them learn and thrive or contribute to experiences that often perpetuate generational trauma, negatively impacting youth and family’s mental health and well-being. A comprehensive effort across the state requires multiple systems reflecting on the necessary changes needed to prevent retraumatizing children in their care, as well as improved responses to mental health and substance use, which includes the healthcare, educational, child welfare, and juvenile justice systems. There are proven solutions known to ensure all children have safe, stable, nurturing relationships and environments, and it is within Texas’s ability to support initiatives that help protect children and achieve lifelong health and success.

References

  1. Centers for Disease Control and Prevention. (2024). 1991-2021 High School Youth Risk Behavior Survey data, Texas. http://yrbs-explorer.services.cdc.gov/. ↩︎
  2. Leeb, R.T., Bitsko, R.H., Lakshmi, R., Martinez, P., Njai, R., & Holland, K.M. (2020). Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3 ↩︎
  3. Imperial College London. (2022). COVID-19 orphanhood, United States [dataset]. https://imperialcollegelondon.github.io/orphanhood_calculator/#/country/United%20States%20of%20America ↩︎
  4. Panchal, N., Kamal, R., Cox, C., Garfield, R., & Chidambaram, P. (2021). Mental health and substance use considerations among children during the COVID-19 pandemic. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-use-considerations-among-children-during-the-covid-19-pandemic/ ↩︎
  5. Teschon, J. (2023, April 11). What you need to know about the pandemic’s last effects on adolescent mental health. Teachers College Newsroom. Columbia University. https://www.tc.columbia.edu/articles/2023/april/need-to-know-about-the-pandemics-lasting-effects-on-youth-mental-health-/#:~:text=Post%2DPandemic%20Mental%20Health%20Worsened,two%20years%20into%20the%20pandemic. ↩︎
  6. Saidinejad, M., Duffy, S., Wallin, D., Hoffmann, J. A., Joseph, M. M., Uhlenbrock, J. S., Brown, K., Waseem, M., Snow, S., Andrew, M., Kuo, A. A., Sulton, C., Chun, T., & Lee, L. K., (2023). The management of children and youth with pediatric mental and behavioral health emergencies. Pediatrics, 152(3), e2023063255. https://doi.org/10.1542/peds.2023-063255 ↩︎
  7. Saxton, J. (2020). Mental health and school climate: Recommendations on HB 18, HB 19, and SB 11. Texans Care for Children. https://static1.squarespace.com/static/5728d34462cd94b84dc567ed/t/5f7644d3f1af7c18bcff4723/1601586387674/testimony-house-pubed-charge1c-1f.pdf  ↩︎
  8. Ingram, A. (2022). Texas youth health survey data brief, COVID-19 pandemic. Department of State Health Services. https://www.dshs.texas.gov/sites/default/files/chs/yrbs/attachments/202210_covid19.pdf ↩︎
  9. Sufrin, J. (2020, May 22). COVID-19 and children’s mental health. The Hogg Foundation for Mental Health. https://hogg.utexas.edu/podcast-covid-19-and-childrens-mental-health ↩︎
  10. Meadows Mental Health Policy Institute. (n.d.). Children, youth & families. Retrieved November 7, 2022, from https://mmhpi.org/work/children-youth/ ↩︎
  11. U.S. Department of Health & Human Services. (2021, December 7). U.S. Surgeon General issues advisory on youth mental health crisis further exposed by COVID-19 pandemic [Press release]. https://www.hhs.gov/about/news/2021/12/07/us-surgeon-general-issues-advisory-on-youth-mental-health-crisis-further-exposed-by-covid-19-pandemic.html ↩︎
  12. Programs for Parents. (n.d.). Adverse childhood experiences (ACEs). Retrieved April 1, 2024. https://programsforparents.org/adverse-chilhood-expereinces/ ↩︎
  13. Centers for Disease Control and Prevention. (2019). Adverse Childhood Experiences (ACEs) prevention resource for Action:  A compilation of the best available evidence. National Center for Injury Prevention and Control, Division of Violence Prevention. https://www.cdc.gov/violenceprevention/pdf/ACEs-Prevention-Resource_508.pdf ↩︎
  14. Ibid. ↩︎
  15. Ibid. ↩︎

Updated on December 13th, 2024



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