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Could we end mental health stigma in our children's generation?

Kids and teens need access to mental health services. Providing those services and starting conversations early could dismantle the stigma around mental illness.

The term “stigma” comes from the Latin word for branding or tattooing the skin. Its origins reveal how stigma functions: external forces (stereotypes, social pressure, discrimination) penetrate the individual psyche, leaving a wound that is difficult to heal.

When it comes to behavioral health, stigma might not literally scar the flesh, but it can have a devastating physical effect over time. Stigma can discourage people from seeking mental health care, undermine recovery efforts, provoke social isolation and contribute to feelings of hopelessness. These feelings can reveal themselves in a variety of ways, including chronic disease, self-harm, substance use and domestic violence.

Attitudes toward mental health are shaped early in life. Dismantling the nearly universal stigma associated with behavioral health care could depend on how we work with children and adolescents.

Imagine the impact if young Americans never fall into the habit of singling out “those with behavioral health needs,” and instead recognized that every person has mental health needs at some level. What if children collectively understood that we all need to take steps to strengthen, preserve and, in some cases, heal our mental health? Could we reframe the narrative at an early age, so that we collectively stop thinking in terms of “mental health” versus “physical health,” and instead just think about “health”?

Working carefully with children and adolescents to normalize behavioral health support could do more than heal the wounds caused by the stigma – it might prevent them from being inflicted in the first place. Moving toward this ideal will require a more robust behavioral health workforce, specifically trained to serve and educate children and adolescents.

Why every community needs a robust network of experts trained to work with children and adolescents

As in many parts of the country, many North Carolina communities do not have the workforce capacity to keep up with rising behavioral health needs among children and adolescents. NC has 100 counties. 94 of the counties are considered mental health professional shortage areas (PDF), and 61 counties have no child or adolescent psychiatrist (PDF).

Complicating matters further is the lack of experts trained to serve students where they are most likely to access behavioral health services: their schools. According to Hopeful Futures America’s School Mental Health Report Card, North Carolina’s schools have:

  • 1 school counselor for every 354 students
  • 1 school social worker for every 1,584 students
  • 1 school psychologist for every 2,527 students

In each category, the ratio of staff to students falls far below recommendations. These deficits likely mean that many children receive help only in a period of crisis (if then), with too little emphasis on taking steps to prevent or catch challenges before they escalate.

Recently, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) committed $2 million to support 11 community-based organizations working to expand pathways to behavioral health care in rural and underserved communities. One of the recipients is the Foundation for Health Leadership & Innovation (FHLI), which received a grant to support a statewide effort to equip the behavioral health workforce to better serve children, youth and their families.

Integral to the FHLI effort is a fellows training program, designed to support both licensed behavioral health specialists and graduate students who share an interest in specialized work with youth mental health. These clinician fellows will serve North Carolina’s children, youth and families in pediatrician offices, outpatient therapy, specialty clinics, hospitals, emergency departments and through school-based services.

Building a system that can provide children and youth more access points to behavioral health services is critical at this historical moment: the Centers for Disease Control and Prevention recently warned of the growing youth mental health crisis, with more than 4 in 10 teens reporting that they feel “persistently sad or hopeless,” and 1 in 5 saying they have contemplated suicide. Helping schools build their capacity to respond to this escalating need is especially important.

The near-term benefits of providing students with mental health services are clear. In part because schools provide a positive, less stigmatizing environment. “Youth are six times more likely to complete evidence-based treatment when offered in schools than in other community settings,” according to the National Center for School Mental Health.

These benefits will likely ripple outward. Building a network of aligned school professionals, specialized school health professionals, and community health and mental health partners – all ready to work with students and families – would promote a positive environment that would make schools safer, students less isolated, and teacher/student relationships more positive.

Furthermore, working in schools to raise awareness of and improve attitudes toward mental health could help reshape the cultural narrative about well-being for generations. Stigmatizing attitudes towards mental illness usually develop early in a person’s life. With strategic intervention, it could be possible to prevent those attitudes from taking root in the first place.

A young adult has spent roughly 15,000 hours in schools by the time they reach age 18. What happens (or doesn’t happen) in these classrooms, hallways and offices can play an important role cultivating a child’s social-emotional health.

Research suggests that folding mental health awareness into school curriculum could lead to significant changes in perspective and behavior, including:

  • A significant increase in knowledge and positive attitudes toward people with mental illness
  • A notable decrease in behaviors that excluded peers with mental health needs
  • An increased likelihood that children will seek and have access to treatment for mental health issues

Youth informed by facts instead of myths related to mental illness are more likely to act with kindness and empathy toward their peers experiencing behavioral health needs. These are lessons that can last a lifetime.

Resilient bodies, resilient minds

Nationally, more than 60% of youth who experience major depression do not receive the treatment they need (PDF). More than half of adults with mental illness do not receive treatment. Stigma isn’t the only barrier to mental health care, but it’s a significant one, and the impact on health, well-being and quality of life is often all too apparent.

Students are well-accustomed to physical education woven into curriculum at virtually every level. As they grow into adulthood, few question the important role exercise plays in building muscles and promoting physical resilience. Not everyone likes to exercise. Some of us might feel self-conscious about what we look like when we work out. But I doubt very seriously many adults would interpret someone else’s workout as a sign of weakness, a cause for pity or a source of shame.

Americans should share the same attitude toward building more resilient mental health. With the right strategic investments, our schools could help make that happen.

Anuradha Rao-Patel, MD

Anuradha Rao-Patel, MD

Medical Director

Anuradha Rao-Patel, MD, is a medical director at Blue Cross NC. She 'ss responsible for the evaluation of the medical necessity, appropriateness and efficiency of the use of health care services, procedures, prescription drugs and facilities under the provisions of the applicable health benefits plan.

Before joining Blue Cross NC, she worked in a private practice doing acute and chronic pain management.

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