Presented below one of my research projects that I worked on during my Masters in Public Health Internship with the Children’s Advocacy Alliance. Included are my Recommendations for how improvements can be made at the systems-level.
*Recommendations and opinions are my own and do not necessarily reflect those of CAA or my employer*
Introduction
There is no lack of passion or drive among Nevadans who want to improve the state of children’s mental health. Mental health professionals, advocates, and program administrators operate in an environment of resource scarcity and disjointed systems. Because there is no single cure-all, it can be disconcerting to those involved about what steps to take to improve our persistently low national ranking.
Mental wellness for our children is meeting developmental and emotional milestones, learning age proper social skills, and cultivating appropriate coping skills when problems arise. Mental illness for our children means that there are obstacles or unformed ways in which children behave or handle their emotions. Specific disorders under the umbrella of children’s mental health are as diverse as the issues that may arise under physical health. The causes are vast, ranging from a child’s neurochemistry, genetics, brain structure, exposure to trauma or loss, injury, or illness. Additionally, the age of onset of mental or behavioral health challenges can happen at any time. Interventions must match this wide source of contributing factors in both treatment and prevention efforts.
State Numbers
Mental Health America’s 2018 State of Mental Health ranked Nevada as 51st for prevalence of mental illness and access to appropriate mental health care for our youth (2018). Other studies provide more detail on the prevalence of youth mental illness and a lack of access to care in Nevada. For example, the most recent Nevada Youth Risk Behavior Survey (YBRS) found that one out of every three middle school students 11 – 14 years old reported feeling sad or hopeless. The study also found that from 2015 to 2017, there was no change in the prevalence of suicidal thoughts among Nevada’s middle school students. Nearly half of middle school students reported not receiving the kind of help they needed when they were sad, empty, hopeless, angry, or anxious (Lensch et al., 2018). One in ten high school girls in Nevada reported in 2017 to have attempted suicide and a quarter of middle school girls have seriously thought about killing themselves (YRBS, 2017).
Data also indicates that for the social-emotional measures used in the YBRS, there either has been no change or an increase in traumatic experiences over the past 10 years the survey has been conducted (Questions 24 – 29 in Nevada High School Survey 10-year Trend Analysis Report, 2018). Substance use is usually a predictor to mental illness in adolescents as it can be exhibited as a coping mechanism to deal with their ongoing emotional challenges. Compared to the national averages high school students in Nevada reported using methamphetamines (3.2% – NV; 2.5% – US), synthetic marijuana (7.3% – NV; 6.9% – US), cocaine (5.4% – NV; 4.8% – US), inhalants (7.1% – NV; 6.2% – US), heroin (2.4% – NV; 1.7% – US), and ecstasy (6.1% – NV; 4% – US). A bright spot in the 10-year Trend Analysis is that high school students in Nevada did note a significant decrease in reports of relationship partner violence, bullying behaviors at school, and reported school violence. The work of the legislature, school districts, and activists in passing much needed and comprehensive safe and respectful school environment programs starting in 2009 are contributing factors to this trend further providing evidence that systemic change can happen.
Behavioral Health Care Matters
The determinants linked to mental health are as diverse as the solutions that are needed to overcome our 51st place ranking. There has been much research connecting childhood mental health to the causes and conditions of trauma, gender, income level, education level, sexual orientation, neighborhood, crime and violence, housing quality, presence of social supports, early childhood education, maternal mental health, ethnoracial health disparities and inequities, among many other factors.
It is estimated that on a national scale, only 40% of students with behavioral healthcare disorders graduate high school (U.S. Department of Education, 2001). Untreated behavioral health issues at school not only cause problems for the individual student but can also “derail an entire an entire lesson,” according to the Child Mind Institute (Rappaport & Minahan, 2018). Expulsions happen at every level, from preschool to high school because of discriminatory zero-tolerance policies combined with the lack of services and preparation to manage behaviors within the school environment.
Seven out of every ten children in the juvenile justice system have a diagnosable behavioral healthcare condition (National Center for Mental Health and Juvenile Justice, 2013). Child involvement in the justice system predicts adult involvement in the justice system (Bernburg & Krohn, 2003). Our adult jail and prison population is a result of decades of mental health stigma, criminalization of those living with mental illness, and inattention to mental health prevention and treatment. By changing how we address children’s mental health now, we are creating a more just society for the future.
The Children’s Advocacy Alliance was founded 20 years ago and the picture of children’s mental health in Nevada seems like a mirror of today. The headlines Area social services face unclear future (Przybys, 1998) and More mental health care coverage urged; insurers cite costs (Vogel, 1998) could easily run again in today’s news. During testimony for the 1998 Legislative Interim Subcommittee on Health Care, it was brought up that the prisons are the largest treatment centers in the state, that mandating mental health care as essential benefits would cause premiums to skyrocket, and that there are not enough providers in the state to meet the growing need. Twenty years later, our justice system and institutional care acts as the largest caretaker of those living with mental illness, and complete health insurance coverage and access is still a struggle for mental health services.
There are plenty of specific data points on children’s mental health that can corroborate our current situation. Over the years, many reports have detailed the gaps, goals, and objectives to achieve optimal mental wellness for children. The Clark County, Washoe County, and Rural Children’s Mental Health Consortia (NRS Chapter 433B); the Commission on Behavioral Health (NRS Chapter 433); the Governor’s Behavioral Health and Wellness Council, also known as the Dvoskin Council named after chair Dr. Joel Dvoskin (NV Executive Order 2013-26), the Regional Behavioral Health Policy Boards, the Governor’s School Safety Taskforce, and many stakeholders at community advocacy groups have been working on the issues of children’s mental health for years. Las Vegas Sun reporter, Jackie Valley, noted in her 2015 series on children’s mental health that the 2013 Dvoskin Council found, “Nevada invests very little in prevention and early intervention for children and teens.” These multijurisdictional and interprofessional groups know that children in Nevada do not have adequate access to preventative wellness programs, early intervention initiatives, and treatment. Picking one approach, one solution, or one policy recommendation will always set an inadequate table that will not result in any meaningful progress.
Read the Entire Paper including the Recommendations for Improving Children’s Mental Health
Timothy K. Taycher 