Note: This report was created based on the expertise of New York University McSilver Institute staff and participants in the Mental Health Commission, which develops policy strategies to support children and youth across the state . New York University was a key partner in promoting these ideas and distributing data.
Children and youth with complex behavioral health needs, especially those living in New York State, desperately need targeted support from state leaders. The COVID-19 pandemic has exacerbated existing gaps within the nation's behavioral health system, including access to peer interaction, family support, and access to a trained mental health workforce. leading to unmet clinical and social care needs. According to the CDC, from 2011 to 2021, more than 40% of high school students reported symptoms of overwhelming sadness and hopelessness, which severely disrupted their daily lives.1 In New York City, 38% of high school students experienced similar emotions in 2021, with notable disparities among Black and Hispanic students compared to white students.2 This led to increased rates of depression and suicide, especially among non-Hispanic black youth, during the early stages of the COVID-19 pandemic.3
Preferred policy considerations
There are three specific areas that New York State needs to prioritize to improve its behavioral health delivery system for children and youth who are dealing with significant challenges.
- care integration. New York state currently has a gap in its youth behavioral health system, where health care providers treat patients' physical and psychological needs separately. Specifically, there is a lack of a fully realized, integrated behavioral health system in which patients' mental health requirements are identified and appropriately addressed in the clinic. Integrated care recognizes the importance of both medical and behavioral health factors in an individual's overall well-being, and involves primary care and mental health clinicians working together to effectively address patient concerns. Let's deal with it.Four Integrating primary care services with behavioral health and substance use disorder services can improve the overall quality of care for New York patients and foster trust in an evolving continuum of care.Five But New York must first confront long-standing policy challenges that impede provider growth, including a lack of funding for effective implementation and inconsistent provider billing and reimbursement practices.6
- Community-based services. There is a lack of community-based practices and supports that enable young people to voice their concerns. Specifically, there is insufficient investment in opportunities to promote recreational therapy and stress management that can improve health behavioral outcomes.7 This is especially concerning for youth who are neglected or abused or who are experiencing homelessness. Community-based behavioral health access points are inadequate, and hospital systems across the state have little or no capacity to provide care for children and adolescents.8 A lack of peer-to-peer services to support youth in multiple settings also contributes to the state's current mental health crisis. In particular, Clubhouse services need to be significantly expanded in New York to help patients establish healthy connections with like-minded people.9 Many children and young people have experienced severe isolation due to the COVID-19 pandemic at key moments in their lives, and we need to rebuild these connections and gain the tools they need to lead positive lives. I need an opportunity.
- Employee support. Gaps in behavioral health workforce pipeline, compensation, and cultural competency in New York State exacerbate negative mental health outcomes for youth.Ten The COVID-19 pandemic has overwhelmed health care providers, often leaving insufficient resources to provide specialized care and necessary referrals to all youth.11 Additionally, the current mental health care system faces inadequate reimbursement at both the provider and overhead levels, particularly in New York City, where frontline workers are insufficient to provide essential services. They remain unable to earn wages.
New York University McSilver Institute Roundtable Discussion
New York University's McSilver Institute hosted the 2024 Behavioral Health Panel aimed at generating actionable strategies for the youth mental health crisis. Panelists represented various levels of mental health care in New York, including health care providers, administrators, advocacy, and policy-level experts. In general, panelists expressed concern about the silos in youth mental health treatment and the lack of long-term support for needed services. The proposals focused on improving child and youth agencies in their approach to mental health and ensuring the new goals outlined in the New York State Behavioral Health Roadmap address the majority of the public's concerns.12
Panelists' suggestions during the discussion included:
- Improving the affordability and accessibility of mental health training programs for patients
- Provide compensation for youth to actively participate in youth-led initiatives with experienced individuals
- Leverage programs like ThriveNYC (the city's roadmap to building a sustainable mental health system)13 or Project Unite, a platform by the Children's Defense Fund that aims to ensure youth services are led by trauma-informed care.14
- Developing policies aimed at reducing the harmful mental health effects of social media on young people, especially those experiencing feelings of isolation and hopelessness
- Address mental health stigma among parents who fail to recognize complex behavioral health issues in their children and encourage them to seek help from trained professionals
Policy strategies for long-term support
There are several viable policy strategies that New York State can implement to effectively address the youth behavioral health crisis. Two low-investment, high-impact strategies are:
- Strengthen the base of available behavioral health services. New York State should prioritize improving its current set of Medicaid mental health services, which have come under intense scrutiny for not meeting federal standards.15 The initial focus should be on strengthening child and family therapeutic support services (CFTSS), including family support, youth peer advocacy, crisis intervention, and other critical components.16 These services aim to provide essential clinical and developmental support to targeted youth while improving access to mental health professionals in times of crisis. Additionally, a concerted effort to expand home and community-based services (HCBS) aimed at providing supports and services to non-institutionalized children and promoting the integration of youth into the community. is necessary. However, as of 2020, only 8% of eligible New York state youth received CFTSS and 10% received HCBS, activating policy efforts is urgently needed. It has been shown that17
- Expanding and supporting the behavioral health workforce. New York State needs to remove barriers that make mental health professionals feel overburdened and undervalued while providing essential services. Key initiatives include raising the minimum wage for both clinicians and non-clinical staff, such as social workers and home health aides, to ensure they receive fair compensation for their demanding work. will appear. Introducing incentive programs tied to superior performance can further motivate these professionals and prevent them from moving elsewhere in search of adequate compensation.18 Additionally, streamlining certification requirements for professionals who work with children with behavioral needs will strengthen the talent pipeline and ensure representation in diverse communities. While recognizing the importance of clinical supervision, national policy makers need to protect the quality of services by ensuring that barriers to entry do not prevent the participation of skilled workers.19
New York City is working to overhaul its behavioral health system, alleviate the youth behavioral health crisis, and support communities in need by expanding existing mental health services and investing in the talent pipeline. We have the opportunity to move forward.
1 https://www.cdc.gov/healthyyouth/data/yrbs/pdf/yrbs_data-summary-trends_report2023_508.pdf
2 https://www.nyc.gov/assets/doh/downloads/pdf/mh/care-community-action-mental-health-plan.pdf
3 https://publications.aap.org/pediatrics/article/151/3/e2022058375/190657/Youth-Suicide-During-the-First-Year-of-the-COVID?autologincheck=redirected
Four https://integrationacademy.ahrq.gov/about/integrated-behavioral-health
Five https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2016/2016-01_integrated_care_faqs.htm#integrated
6 https://www.commonwealthfund.org/blog/2023/making-care-primary-integrated-behavioral-health-care
7 https://journals.sagepub.com/doi/10.1177/10538259231190844?icid=int.sj-abstract.citing-articles.4
8 https://omh.ny.gov/omhweb/statistics/youth-mh-listening-tour-report.pdf
9 https://www.nyc.gov/site/doh/about/press/pr2023/nyc-to-reach-more-new-yorkers-with-serious-mental-illness.page
Ten https://www.nyc.gov/assets/opportunity/pdf/evidence/availability-accessibility-mental-health-services_findings.pdf
11 Same as above
12 https://omh.ny.gov/omhweb/statistics/youth-mh-listening-tour-report.pdf
13 https://www.nyc.gov/site/operations/projects/thrivenyc.page
14 https://www.childrensdefense.org/wp-content/uploads/2023/08/UNITE-Recommendations-5.26.23.pdf
15 https://www.propublica.org/article/new-york-state-failed-to-provide-legally-required-mental-health-care-to-kids-lawsuit-claims#:~:text=plaintiff%20allege %20Medicaid in %20 states, %20access%20critical%20 services unavailable.
16 https://ocfs.ny.gov/programs/managed-care/cftss-hcbs.php
17 Same as above
18 https://nashp.org/addressing-health-care-workforce-challenges-spotlight-on-new-york/
19 https://www.washingtonpost.com/education/2023/08/31/mental-health-crisis-students-have-third-therapists-they-need/
