Addressing the outsized and growing adolescent behavioral health crisis is far from an easy task. As the number of adolescents suffering from behavioral health conditions has increased over the last decade, disparities by location, race, sex, and sexual orientation—as well as significant gaps in care—have persisted across New York City, the state, and the nation.
On July 18, United Hospital Fund hosted a webinar to delve into these and other findings from its recent report on the ripple effects of this crisis, prepared with analytic modeling and expertise from Boston Consulting Group (BCG). Joined by colleagues from the Montefiore School Health Program and Callen-Lorde Community Health Center, the discussion offered on-the-ground insight into the scope, challenges, and promising opportunities to tackle both treatment and prevention.
“As we thought about where adolescents can most efficiently and effectively access appropriate services... we immediately knew we wanted to focus today on school-based care and the unique needs and services that are needed for the LGBTQ community,” UHF Senior Vice President for Policy and Program Chad Shearer told more than 70 attendees. “At UHF, we have a focus on where we think there are great opportunities to enhance access and reduce health inequities.”
The two experts joining the UHF webinar agreed that behavioral health concerns are both varied and on the rise for adolescents treated by their programs. The UHF report found that nearly 6.7 million adolescents reported a behavioral health condition in 2022.
“Over the years, the severity of the symptoms and frequency...has really increased,” said Erica David, PsyD, director of mental health services for the Montefiore School Health Program, which operates in more than 30 schools across the Bronx and Yonkers. Providers have specifically seen an increase in severe depression and anxiety, social stressors, substance use, family mental health difficulties, grief and bereavement, addictive tendencies with technology, and exposure to trauma, Dr. David said.
Aruna Krishnakumar, managing director of adolescent & mobile health at Callen-Lorde, noted the disproportionate behavioral health challenges faced by LGBTQ+ youth. Callen-Lorde provides health care and related services for New York’s lesbian, gay, bisexual, and transgender communities. According to the UHF report, high schoolers identifying as lesbian, gay, or bisexual were more than three times more likely to consider suicide than their heterosexual peers in 2021.
Providing care to adolescents facing these behavioral health challenges comes with significant barriers. Both Dr. David and Ms. Krishnakumar pointed to staffing shortages, limited capacity of specialists providing longer-term therapy, and reimbursement issues as major obstacles to care. The UHF report found that only 39 percent of adolescents in need of mental health care for a major depressive episode were able to access it in 2021.
Plus, stigma surrounding behavioral health and ensuring adolescents are aware of the services that are available also poses a challenge, the experts noted.
Though with its own hazards, technology offers promising ways to increase visibility of services. Both Montefiore and Callen-Lorde have implemented telehealth options to reach adolescents who, for example, aren’t coming to school or are hesitant to visit a clinic, including transgender youth worried for their safety.
Social media and the Internet can also be tools in reducing stigma and getting help, the experts said.
“It’s really important for us to not completely negate the importance of social media and the ability for young people who may be very isolated to connect to one another,” Ms. Krishnakumar said. “Especially for LGBTQ youth, the Internet provides a space for them to connect and ask questions about their sexual health, their mental health, and talk to their peers as well as professionals.”
Dr. David noted that social media can negatively affect sleep and attention spans and create addictive tendencies. “We want people to learn to utilize social media and electronics in a reasonable, helpful, healthy manner,” she said.
As noted in the UHF report, addressing the behavioral health crisis among adolescents will require not only treatment and crisis interventions, but prevention.
At Callen-Lorde, Ms. Krishnakumar pointed to the importance of LGBTQ competency training, health education provided by their mobile health unit, and community engagement tables set up at fairs, schools, or other events. Dr. David noted that in addition to medical screenings, Montefiore’s school sites share resources with teachers, guardians, and counselors to help identify behavioral health concerns early, and are consistently connecting students to community programs that can promote their overall health and well-being.
“While we’re intervening, we’re also trying to highlight all of the great resources in the community to help build skills that will help them be successful and do well,” she said.
See below for video of the event.