On October 18-19, 2022, in Salt Lake City, Utah, National Governors Association (NGA) Chair New Jersey Governor Phil Murphy and NGA Vice Chair Utah Governor Spencer Cox held the first of four roundtables to discuss the 2022-2023 NGA Chair’s Initiative: Strengthening Youth Mental Health. A strong state contingent was represented, including Alabama, Arkansas, Minnesota, New Mexico, and Pennsylvania. States were joined by over fifty community leaders, academic experts, and representatives from partner organizations and funders. The convening centered on practical solutions for the first of the initiative’s four pillars: prevention and resilience building. Discussions forged connections across the public and private sectors, shared best practices across states and territories to amplify their impact, and aligned on ways that Governors can further support youth mental health.
Key themes on prevention and resilience were unpacked across three discussions that centered the voices of those with first-hand experience of youth mental health from different perspectives; focused on applying the brain and behavioral science of resiliency, specifically to provide opportunities to build and rebuild mental health in youth; and oriented the group towards practical and implementable solutions. Credentials spanning academia, government, business, and community service were interwoven with personal stories of delegates’ lived experience.
Despite the immense challenge, the roundtable discussion coalesced around hope: evidence shows that prevention and resilience building in childhood and adolescence can fundamentally change the trajectory of a child and family’s life. Given supportive environments and the right skillset, the effects of adverse childhood experiences (ACEs) and exposure to toxic stress can be successfully managed to prevent mental health challenges from developing or worsening. Strengthening youth mental health, starting with prevention and a focus on resilience, needs to be a key priority within all levels of government, and across all sectors of society.
How Governors can help: Policies, programs, and practical initiatives
Prevention speaks to the promotion of mental wellbeing and the prevention of mental health conditions. Both of these are fundamentally supported by building resilience: the ability, when faced with stress or adversity, to maintain or return to a positive state of mental health and function. Considering the emerging data on the impact of the pandemic on learning, addressing children’s mental health and emotional well-being takes on added importance. Given the lives at stake, how states implement strategies is as important as what solutions they choose. Key themes emerged that are integral to our work on youth mental health:
- Leading with lived experience: Those with lived experience of the challenges and opportunities within youth mental health should have a real seat at the table, not only when problems are being discussed, but also when policies and programs are being developed.
- Listening to young people: Youth will express their needs, verbally and non-verbally, and it is important that adults interfacing with them respond with attunement, in a way that resonates with the developmental science of children and adolescents and allows them to feel understood and valued.
- Meeting children and families where they are: Prevention and resilience building activities should take place in culturally affirming settings that are convenient for children and families, including schools, primary care, community clinics and centers, places of worship, and after-school activity or sports centers.
Informed by these themes, attendees identified levers for Governors to drive action on youth mental health: convene cross-sector stakeholders effectively, work with legislators on supportive bills, and champion practical solutions shown to work.
Building resilience through life-skills
The youth mental health crisis extends to the very youngest children and it’s important to incorporate solutions that address child brain development at all stages of childhood. During the event, Governor Cox shared a compelling note about tracing the leading indicators of high school graduation back to early childhood development and the birthing parent’s stress in-utero – it is never too early to start! There is a clear need to proactively foster strong youth mental health rather than retroactively repair it. State education agencies should consider supporting resilience building, through teaching practical life-skills such as relationship skills, self-management, decision making, and self-awareness. For older children and adolescents, systems should also look to enhance positive community-building, including participation in community service programs and sports to encourage strong social connections, an important factor that contributes to mental wellbeing. Additionally, prioritizing teacher, caregiver, and parental supports advances the collective ecosystem of protective factors that foster positive youth mental health development and buoys the role of parents as primary actors in addressing their child’s mental health challenges.
Prevention of mental illness and promotion of mental health
Universally available age-appropriate mental health screening for young people in schools and primary care promotes wellbeing (e.g., screening for protective factors, such as connectedness and sense of belonging) and prevents illness (e.g., screening for anxiety and depression risk factors or markers). This should be done early and regularly, to enable course-correction early. Critically, screening is most effective when utilized within a system of care and linked with the appropriate health care providers to reduce time taken between identification and appropriate action, safeguarding against undue burden on schools and educational systems. Parents and other caregivers are integral and should be supported as they are looking for guidance on prevention efforts within the home. Transparency and access is key so parents have tools and understanding to aid in their child’s mental health development; cultivating parents to be champions of support can help combat stigma with both their peers and their own children. Addressing the social determinants of health (screening for food insecurity, for example) is also vital, given their interdependence with mental health and wellbeing. Standout state solutions to integrate social services platforms with mental health programs and supports can offer a “no wrong door” approach where the pathway to family support services is as seamless as possible for the consumer.
Enablers to drive change: A set of common tools emerged to successfully drive prevention and resilience building efforts
- States need to utilize data to track consistent metrics over time to measure the problem, target solutions based on an understanding of risk factors, and to measure success of prevention efforts over the long term.
- Using technology effectively is an important component of addressing the youth mental health crisis, as it enables solutions to reach young people where they are: on digital applications. However, these tools must be well-integrated into a system of care to ensure impact.
- States need to focus on innovating and expanding payment and funding mechanisms, reinvesting savings into further prevention efforts, and working with purchasers of health care, including employers, Medicaid programs, and health insurance providers . States can work with payors to prioritize access to prevention services (i.e. screening) regardless of income and expand coverage for preventative activities, and enable flexible payment strategies across various settings, including schools and primary care settings.
Due to the severe shortage of mental health professionals, notably for children and adolescents, states can build prevention workforce capacity by leveraging primary care services as well as drawing from alternative sources of support where appropriate, for example, increasing peer-to-peer support structures.
Additional roundtables for the 2022-2023 NGA Chair’s Initiative will take place in the first half of 2023, centering on the other three pillars: increasing awareness and reducing stigma, ensuring access and affordability of quality treatment and care, and training and supporting caregivers and teachers. If your state or territory is interested in becoming more involved in the Chair’s Initiative, please contact Jordan Hynes (jhynes@nga.org), NGA Program Director for Children and Families.
