Mental Health and Well-Being: Executive Summary
Despite an increased need for mental health and psychosocial support services across the country, the funding available for mental support services and mental health treatment has decreased. New Hanover County, North Carolina, has taken an innovative approach to address these gaps within their community by fostering resiliency through trauma-informed community care across through a multi-sector effort. Similar whole-community approaches for trauma-informed child welfare programs should be promoted alongside calls for increased funding for government programs.
What Are Communities Saying?
Scroll to the left or right to see what communities across America are saying about mental health services for children in the area.
Spotlight on: New Hanover County, NC
In 2018, the Resiliency Task Force was formed in New Hanover County, North Carolina. The Task Force addresses adult-onset mental health issues, as well as financial and social problems within the community by focusing on the root cause of adverse childhood experiences (ACEs). ACEs can include household experiences ranging from child abuse to divorce, or community experiences such as environmental pollution and historical trauma, or even environmental disasters such as natural disasters and climate crises. When children experience four or more traumatic events, they are at heightened risk of suffering in adulthood from chronic health diseases, substance abuse, severe mental illness, and financial hardships, among other issues.[i]
The New Hanover Resiliency Task Force involves over 400 individuals representing over 100 community agencies and organizations dedicated to the mission of creating a more trauma-informed and resilience-focused community. Agencies include key child-serving institutions in the county that work directly with children and families, among others. Part of this initiative involves training personnel to recognize their own individual signs of stress and techniques to regulate their own bodies using various resilience models. Additionally, the task force focuses on providing training for organizations to provide one-on-one services for children who experience stress in their household, community, and environment.
Community leaders and health professionals acknowledge that there is no way to completely prevent the experience of hardships, but that there are meaningful interventions and approaches to alleviate the resulting emotional burden and mitigate long-term consequences. A trauma-informed approach leads to service providers who are better able to address issues related to trauma and positively interact with community members who have experienced trauma during childhood. Being trauma-informed is more than a new or additional service provided – it’s an approach to how all services are delivered to community members. The task force trains health, education, and social service providers to address trauma in their communities, especially among the most vulnerable and historically marginalized populations. This can lead to new opportunities that improve early childhood, academic, health, and social outcomes across the community as a whole.
This innovative community approach to addressing ACEs and mitigating the long-term risks of unaddressed responses to trauma is part of a growing national movement, benefitting children and families with strong research translated into practice.
Map of Social Services in Schools Across America
This interactive map shows the distribution of social services in states and RC/RC communities across America. Use the arrows at the top to visit each location to observe how many students are under the care of a single mental health provider.
Meeting the Mental Health Needs of America’s Children
Trauma and adverse life experiences, especially in childhood, can have a lasting impact on an individual’s ability to recover and rebound from the social and physical setbacks of disasters. Following disasters and throughout prolonged periods of instability, affected populations can suffer from emotional distress, anxiety, depression, and post-traumatic stress disorder. These psychological impacts of disasters, including the pandemic, have a more profound impact on vulnerable and marginalized populations such as children.[ii]
It is estimated that over 7.4 million children and youth in the United States have a serious mental disorder. Unfortunately, only 41% of those in need of mental health services actually receive treatment.[iii] Despite these numbers, the 2019 federal budget for Children’s Mental Health Services was scarcely enough to serve 13,595 children with serious emotional disturbances – less than 0.2% of all children across America. In addition, it could only finance the training of 5,100 mental health professionals, or fewer than one additional provider per distressed area. From 2018 to 2019, funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) decreased 16%, and a total of only 3% of funds were provided for the benefit of children.[iv] Prior to the COVID-19 pandemic, telehealth services including mental health services within the Health Resources and Services Administration (HRSA) were nearly halved by 50%.[v] In 2018, a scant $9 million was authorized for Pediatric Mental Health Care Access Grants; this sum was intended to last through 2022.
The pandemic puts measurable strain on national mental health, with pediatric mental health emergencies increasing 24 – 31% nationwide through 2020.[vi] Despite this, the 2020 budget proposal for fiscal year 2021 contains no increases to mental health services within HRSA, instead it proposes completely eliminating all Pediatric Mental Health Care Access Grants as well as all support for maternal behavioral health along with Infant and Early Childhood Mental Health programs within SAMHSA. [vii] Additional proposed cuts include halving mental health workforce development programs and reducing the National Institute of Mental Health (NIMH) budget by 15%.[viii]
Within schools, the 2020 budget proposal for the fiscal year 2021 completely cuts specific mental health programs in the Department of Education, instead consolidating 30 programs into 1 block grant. By conglomerating the competitive grant programs authorized by the Elementary and Secondary Act (ESEA) into a single program, known as the Elementary and Secondary Education for the Disadvantaged Block Grant (ESED Block Grant), mental health services will have to compete with drug abuse and the opioid crisis, school safety, job training, family services, career counseling, health and nutrition. Counseling after violent events like school shootings is still funded as School Emergency Response to Violence under a specific provision within the ESED Block Grant.[ix] The block grant is intended to minimize reliance on federal support in schools, but the data shows how few resources are available at the state level (see map above).
The National Association of Social Workers (NASW) recommends one social worker for every 250 students at each school.[x] Ninety percent of students attend schools that fail to meet these mental health guidelines, and only three states meet the recommended student to social work ratio of 250:1. Additionally, depression, anxiety, and attention deficit and hyperactivity disorder diagnoses have been steadily increasing in school-aged children (6 to 17 years old), further highlighting the need for mental health professionals in schools.[xi] Despite rising levels of mental illness and the increased probability of experiencing stressors and trauma, schools lack the critical staff necessary for early diagnosis and intervention. Some states are suggesting removing mental health screening from schools entirely.[xii]
Legislation over the last several years has failed to adequately address the mental health crisis affecting children in America, and recent legislation for pandemic relief is no different. A package for COVID-19 relief passed as part of Public Law No: 116-260 in December 2020 allocated a mere $60 million to the exclusive purpose of aiding children’s mental health and mitigating the traumatic stress caused by the pandemic.[xiii] The American Rescue Plan Act allocated $80 million for pediatric mental health specifically, but through the entire coronavirus pandemic children have still been allocated under $1 billion in mental health resources.[xiv]
- Increase resources for mental health and supportive services in schools.
- Expand trauma-informed practices across communities nationwide.
- Recognize and support practices that take a root-cause approach to improve mental and physical health outcomes.
[i] Centers for Disease Control & Prevention. (2020). Preventing Adverse Childhood Experiences. CDC | Injury Center | Violence Prevention. Retrieved from https://www.cdc.gov/violenceprevention/aces/fastfact.html.
[ii] Makwana, N. (2019). Disaster and its impact on mental health: A narrative review. Journal of family medicine and primary care, 8(10), 3090–3095. https://doi.org/10.4103/jfmpc.jfmpc_893_19.
[iii] Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 144863. Rockville, MD: Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf
[iv] US Department of Health and Human Services | Substance Abuse and Mental Health Services Administration. Justification of Estimates for Appropriations Committees | Justification for Fiscal Year 2019 (pp. 18-19). Retrieved from https://www.samhsa.gov/sites/default/files/sites/default/files/samhsa-fy-2019-congressional-justification.pdf.
[v] US Department of Health and Human Services | Health Resources and Services Administration. Justification of Estimates for Appropriations Committees | Justification for Fiscal Year 2019 (p. 296). Retrieved from https://www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-justification-fy2019.pdf.
[vi] Leeb, R., Bitsko, R., Radhakrishnan, L., Martinez, P., Njai, R., & Holland, K. (2020). Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR. Morbidity And Mortality Weekly Report, 69(45), 1675-1680. https://doi.org/10.15585/mmwr.mm6945a3.
[vii] First Focus. (2019, March). Impact of the President’s FY 2020 Budget on Children’s Health. Retrieved from https://firstfocus.org/wp-content/uploads/2019/03/FACT-SHEET-Presidents-2020-Budget-Childrens-Health.pdf
[viii] US Department of Health and Human Services | Health Resources and Services Administration. Justification of Estimates for Appropriations Committees | Justification for Fiscal Year 2021. Retrieved from https://www.hrsa.gov/sites/default/files/hrsa/about/budget/budget-justification-fy2021.pdf.
[ix] US Department of Education. (2020). Fiscal Year 2021 Budget Summary. Retrieved from https://www2.ed.gov/about/overview/budget/budget21/summary/21summary.pdf.
[x] National Association of Social Workers (NASW). (2018, March 27). News Releases. Retrieved from https://www.socialworkers.org/News/News-Releases/ID/1633/NASW-Highlights-the-Growing-Need-for-School-Social-Workers-to-Prevent-School-Violence.
[xi] National Center on Birth Defects and Developmental Disabilities, & Centers for Disease Control and Prevention. (2020). Data and Statistics on Children’s Mental Health. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/childrensmentalhealth/data.html.
[xii] Mental Health America. (2016). Position Statement 41: Early Identification of Mental Health Issues in Young People. Mental Health America | Policy Issues and Statements. Retrieved from https://www.mhanational.org/issues/position-statement-41-early-identification-mental-health-issues-young-people
[xiii] House Committee on Appropriations (2021, January). H.R.133 Division-by-Division Summary of COVID-19 Relief Provisions. United States House of Representatives. Retrieved from https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/Summary%20of%20H.R.%20133%20Coronavirus%20Relief%20Provisions.pdf
[xiv] Senate Budget Committee (2021, March). Amendment to H.R.1319. United States Senate. Retrieved from https://www.budget.senate.gov/imo/media/doc/American%20Rescue%20Plan%20Act%20SENATE.pdf.
Last updated: April 9, 2021