This is an exclusive BHB+ story
The stakes for making sustainable progress in youth mental health care have never been higher. Yet, amid rising rates of depression and anxiety for adolescents, there are still many things the industry is getting wrong. The biggest mistake? Not giving young people a seat at the table in shared decision-making for care and support.
Policymakers, mental health clinicians and even seasoned behavioral health C-suite executives working in the space still make the same mistakes: they’re not listening to the population they’re trying to serve, a youth mental health advisory and policy advocate told Behavioral Health Business.
“I think there’s a lot of panic around some of the behaviors youth are engaging in: using social media, not getting enough sleep and stressing,” this under-30 youth mental health advocate said. “We can address that, sure. But what is the root cause of that? There needs to be more action to meet young people where they’re at and seeing beyond it. I do think there is a really, really big emphasis on meeting certain standards just to check a box. This is a very systemic issue.”
Of course, logistics and standards matter and there will always be an operations side of the space that has to check certain boxes to continue operations. Still, as an advocate who has held seats at major youth mental health initiatives from the San Francisco Bay Area all the way to Washington D.C., there’s still a major disconnect between mental health decision-makers and youth experiencing mental health conditions, she explained.
“I think a lot of times there is this feeling that a lot of youth mental health advocates are speaking from an entirely different plane of existence than the adults who are trying to meet us where we’re at,” she said. “I appreciate the efforts to meet us where we’re at, but I think the bridge building is what’s so important – and that gets missed.”
Sometimes those conversations completely miss the mark, she said, like slapping a suicide hotline number on the back of student ID cards on college campuses: nice to have, but is that what adolescents and young adults really need?
It’s not on the providers or any single party; instead, real progress on achieving sustainable progress in the ongoing youth mental health crisis has to be a collective effort rooted in community care models.
BHB’s Confessions series provides a platform for professionals in the behavioral health industry to transparently address the pressing issues that affect their businesses and care plans. While anonymity is not something BHB often offers sources, this creates space for executives to share honest observations, feedback, ideas, insights and perspectives that they may not otherwise want to share. The following transcript has been lightly edited for length and clarity.
Do you work in the mental health care, autism services or addiction treatment spaces? Do you want to participate in the “Confessions” series? Reach out to [email protected] for consideration. Confidentiality will be maintained for all sources for this series.
BHB: What do you think organizations building youth-facing behavioral health services should be thinking about that they currently aren’t?
The biggest word that I’m always saying to organizations trying to work with youth and who are having a hard time reaching them is that they aren’t necessarily understanding our drive for ‘agency.’ I think that word is really what a lot of organizations are kind of leaving out of their approaches to mental health.
Especially when we’re talking about the suicide prevention space, a lot of it is rooted in messaging like: “You’re so loved, you’re so needed here in this world, you’re so cared for.” But that’s not necessarily true, and that’s not necessarily reflected in the reality of every young person. A lot of people are living in systems where they don’t feel cared for. So to kind of just say “you’re loved” isn’t very helpful.
A lot of organizations are focused on spreading that positive message, which I think has good intent, but I think it really won’t do much if we don’t center that agency to understand youth have a desire for autonomous decision making, and saying “I’m very sorry that has been stripped away from you and from the systems we have in place.” That’s a big gap that I’m seeing, and I would love to see it addressed.
What does the concept of ‘agency’ built into the existing youth mental health system look like to you?
It means giving young people and people within the behavioral health care system the ability to make decisions about their own treatment. Not only that, but also input into what they are deciding between.
A lot of times, the decisions are between not accessing services at all and really being painted as like, dangerous and harmful to society, or experiencing harmful services that lead to long-term trauma. Agency means expanding beyond that and really working with people in their individual and community contexts to understand what is the best path forward to them, and providing that care and support really unconditionally.
What is one mistake you constantly see behavioral health providers make over and over when it comes to treating youth and adolescents?
This idea of how some behaviors are seen as young people almost doing this to themselves, and hyper-focusing on behavioral changes, rather than mindset changes, rather than just providing that baseline empathy and understanding.
I kind of tend to stray away more so from the term behavioral health, because the ways in which behaviors are pathologized in this country are so interlinked with histories of racism and eugenics and people that present with the same behaviors but come from different contexts and could be pathologized very, very differently. That’s why I try to use the term mental health more.
It’s important for providers to kind of focus on that, and just on their understanding of youth in general.
But that’s what happens when you have a large overwhelm of patients and you have staffing shortages. It’s just the way that the entire system is structured. People are reduced down to check-marking these certain behaviors in treatment so we can let them go, and there’s a very limited amount of follow-through and a very limited amount of whole-person empathy building within youth mental health.
What would you say is the most frustrating thing about trying to push toward progress in mental health as a young leader in the field right now?
Youth mental health advocates are really speaking from an entirely different plane of existence than the adults who work in the field. That’s a personal dissonance that I’m always working through. It’s a dissonance a lot of youth mental health advocates in this space who I talk to can relate to.
A lot of us aren’t on the same page and it can be really hard when the fights are little fights within the fight to meet these basic needs. So how can we really even talk about the entire system?
Quite frankly we can talk about getting more sleep and reducing screen time and adding some campus mental health resources and services which is great. But students are worried about feeding their families at some points. They’re worried about the fact that they’re trying to just be students and simultaneously living through genocide happening in other parts of the world.How do you contend with that? They can’t even necessarily have those conversations, because the terms on which we are being provided with progress are really just things like crisis lines on the back of ID cards, tips on self-care, which are great, but aren’t really addressing the root causes of what we need.
What do you think is the biggest disconnect between youth mental health advocates like yourself and older generations of professionals who have been in the industry for quite some time?
There are a lot of folks who are trying to serve youth mental health and maybe come from generations where it wasn’t as destigmatized. I think there are a lot of language like, “Wow. I really do admire Gen Z and younger generations for being able to talk about mental health. We didn’t have these terms when I was growing up.”
It’s really great that we have them, but at the same time, they’re talking about how the very same platforms through which we talk about these things are bad and are harming us. Yes, it’s true, social media platforms do enact harm upon us, but it’s also where a lot of us gained access to this language about mental health. It’s where a lot of us began to understand that and really begin to practice thinking through what it means to engage in your own mental health care and to care about mental health.
There’s a big dissonance where it’s you who are claiming that you admire our generation for destigmatizing this, and in some instances, you’re criminalizing and getting rid of the very same channels or platforms through which we engage in that destigmatization. There needs to be some level of reckoning with that, because it can only be so much longer that people can keep claiming that they admire a generation for destigmatizing mental health while still actively trying to shut down some of the pathways by which we do that.
What do you think is the solution out of that?
In a perfect world, eventually, we could see eye to eye a little bit more. A lot of us are working on that, but the onus really is on young people to explain this to intergenerational partners right now, which is a lot of work. It’s not going to be done overnight, but I do think there needs to be some level of deeper understanding. Whether that’s going to happen in this current situation, I don’t know. The more steps we can take towards explaining that, the better.
That’s why there is so much power in the mental health movement, because it’s one of the only areas in which we do have pretty large support across party lines. So if we can use mental health as an entrance point to talk about how these spaces really are beneficial for people, to talk about the issues that really do matter to youth in their communities, then that’s great.
We can’t actually talk about mental health without talking about so many other systems. There is no mental health justice without housing justice. There is no mental health justice without generalized health care justice, without immigration justice, and a whole range of issues.
There should be a larger reframing of it as an entry point to talk about multi-systemic oppression. It also goes both ways in that youth need to take care of their mental health in order to be able to contribute to this progress. I think that’s a narrative that reaches young people a lot more.
Where are you seeing progress in addressing youth mental health?
I am seeing a lot of progress among discourse coming from young people themselves. When I scroll through social media and see my peers talking about how their mental health care is and is not serving them, and what they wish to see change.
I’m seeing so much hope coming out of the peer support space as well. That really is a way of reframing each and every one of us as somebody who can provide care and support to our own communities. Mental health care doesn’t have to be siloed across the health care system into hospitals and doctors offices – we are each providers of health care in one way or another. I think that seeing peer support grow more and more is something really great. But I think there’s a lot more to be done.
What’s one policy recommendation you think leaders in behavioral health should be paying more attention to right now or that would really create the most change?
Seeing all these contradictory guidelines and even the very same institutions putting out one statement one day and another one the next that are so obviously rooted in hate and moral panic and scapegoating, it’s really showing us that these systems are not here to serve us and we need to serve ourselves.
I think it’s showing a lot of young people the real ugly face of these systems and what they truly are, and kind of forcing us to turn to community care. And that means that we need larger infrastructure to support that community care. It’s changing what the front of this fight is about.
The conversation now is how can we uplift the community care that’s already being done? How can we lean into that? How can we learn from that? How can we scale things like that?
There needs to be a larger investment in that. There needs to be more support for that in terms of legislation, in terms of policy, and literally paying people that provide mental health care.
We also need to see an effort to bring more youth voices to policymaking spaces and to the forefront. We did start to see some of that momentum with the previous administration. That’s something I was glad to see. There needs to be a return to that.
It’s really about inviting those who are at the table to see how we do that work, how we do that groundwork and work with them from there. Because when we’re working from these different levels of understanding and people who don’t match our realities or don’t have the lived experiences that we do necessarily, it can be very hard to legislate and to create policies from a place of real empathy.
How do you hope youth mental health access and solutions change from a business and provider perspective over time? Do you think there should be new service lines and specialties added to better address the range of needs the youth population has? What does that look like?
There needs to be a lot more incorporation of these systemic justice frameworks into the health care that we have right now. I also think a really powerful lever for this is the education system. A lot of young people are kind of getting their mental health care support from their school systems. So I think there can be a lot to kind of explore on that front.
What they’re doing is helping young people build a future for themselves. So, how can you build a future, not just for yourself but for your community?
We’re starting to see some better health care provider representation and affirming health care providers who have lived experiences with a lot of the issues community members are facing, but there need to be more. We need mental health care by the community, for the community. I think there are absolutely ways to implement that bit more into the models that we have today.
