2022-2023 CHAIR’S INITIATIVE
Strengthening Youth Mental Health
The United States faces a nationwide youth mental health crisis. The roots of this crisis existed before COVID-19, but the pandemic has both exacerbated and highlighted the scope of the challenges in addressing this issue. The time is right and the need has never been more apparent to discuss proven and innovative solutions for states.
Governors Lead Roundtable on Access and Affordability of Care
In response to rising rates of mental health distress among young people, NGA Chair New Jersey Governor Phil Murphy introduced his NGA Chair’s Initiative last July. Through the Strengthening Youth Mental Health initiative, Governors from across the nation are collaborating to develop bipartisan solutions.
During a two-day roundtable event in Detroit, held April 19-20, 2023, Governor Murphy and Michigan Governor Gretchen Whitmer held discussions with First Spouses, private sector leaders, and policy and subject matter experts focused on the role of states in ensuring access and affordability of quality youth mental health treatment and care. New Jersey First Lady Tammy Murphy, North Carolina First Lady Kristin Cooper and North Dakota First Lady Kathryn Burgum spoke at the event, which also focused on expanding access and quality of care for maternal and infant health.
“Every single kid deserves to have their mental health supported. As governors, we’re committed to ensuring that the young people in our states – and every state – can access the mental health support they need to thrive.”Governor Phil Murphy and Governor Gretchen Whitmer (Detroit News)
If you or someone you know is having thoughts of suicide or experiencing a mental health or substance use crisis, 988 provides 24/7 connection to confidential support. There is Hope. Just call or text 988 or chat 988lifeline.org
State Policy Solutions Discussed At The Roundtable Include:
Access And Affordability
- Conduct a fiscal mapping of the sources and allocation mechanisms of funding streams for youth mental health to understand gaps and opportunities for improvement
- Identify additional sources of funding, such as private and philanthropic funds, to support upstream community services that support prevention and resilience-building
- Develop innovative payment models and policies that allow for a greater integration of services among primary, pediatric, and behavioral health care providers, and drive high-quality, evidence-based, equitable outcomes for children
- Invest in integrated care and wraparound models such as coordinated specialty care for early psychosis
- Reevaluate Medicaid reimbursement rates compared to service costs for local providers
- Ensure compliance with the EPSDT mandate and expand preventative mental health services to all Medicaid-eligible students
- Identify solutions to provide patients with the right level of care for their needs, including digital tools and non-clinical support
- Appoint state insurance regulators to collect and review commercial insurance plans’ parity analyses and data reporting, including youth-specific parity compliance, to assess the equivalence of medical/surgical and mental health and substance use disorder coverage
- Continue post-pandemic support for telehealth and digital technology services, including supporting legislation and guidance, encouraging appropriate reimbursement, and exploring waivers for continuous enrollment and wraparound supports for youth and their families
- Leverage lived experience perspectives to help identify policies and regulations that create barriers to care for consumers, or unnecessary burdens for providers
- Explore care or compensation models for non-clinical professionals, like peer mentors and community health workers or home-visiting workers.
- Explore incentivizing upskilling for primary health care providers and pediatricians on youth mental health, and formalize connections between these providers and psychiatrists and psychologists to enable advice-sharing and easier referrals
- Train early childhood professionals and school-based or community health workers to support prevention and screening activities, and manage the early signs of mental health challenges
- Increase high school and college student awareness of career paths in the youth mental health care workforce and pathways into these occupations, to develop a long-term pipeline of diverse talent
- Explore new or increased tuition subsidies and loan forgiveness programs for mental health professionals, potentially in exchange for work in specific communities or in private or public networks
- Promote a team-based and integrated approach to care in general medical education and by engaging multi-disciplinary providers to expand capacity of highly credentialed or severe-acuity providers, like psychiatrists
- Review licensing and scope of practice regulations requirements for mental health professionals to maximize the ability of mental health professional to work to their license, while maintaining education and training standards that align with high-quality care
- Examine telehealth and cross-state state licensing flexibility and agreements, including multi-state compacts, as a means of supplementing pediatric network capacity and maximizing the scope of practice for providers across states
- Eliminate culturally or otherwise outdated questions from the licensing testing process that could discourage potential applicants
- Bolster administrative support for under-staffed licensing offices and modernize application processes
- Encourage the composition of licensing boards to reflect demographics, and comprise multiple areas of expertise required in a team-based approach to youth mental health
System Alignment And Innovation
- Meet children and adolescents where they are through the provision and reimbursement of mental health services in schools, community locations, and primary care settings
- Compel and formalize collaboration to reduce silos between youth-focused government agencies that oversee mental health and other services to address the social determinants of health, such as food security and housing
- Convene community stakeholders–including providers, payers, caregivers and others along the care continuum–to discuss challenges and to promote collaboration
- Map capacity standards across youth mental health patient journeys to understand supply, demand, and gaps
- Enable data sharing amongst youth-facing state agencies, including law enforcement, to ensure accurate and up-to-date information can be employed to treat individuals’ mental health challenges
- Identify the different points of entry into the system, and develop infrastructure to ensure there is “no wrong door” to accessing help
- Invest in upstream prevention and intervention, including addressing social factors and services to reduce pressure on downstream crisis services and in-patient capacity
- Integrate youth-specific crisis response services (including services accessed through 988, mobile crisis, crisis receiving and stabilization, community programming, warm lines, peer supports) into the broader youth mental health landscape, to enable connection to the continuum of care
2023 NGA Winter Meeting
NGA Chair New Jersey Governor Phil Murphy opened the the 2023 NGA Winter Meeting with a plenary session on Strengthening Youth Mental Health. In response to rising rates of mental health distress among young people, Governor Murphy first introduced his NGA Chair’s Initiative in July of 2022. Through the Strengthening Youth Mental Health initiative, Governors from across the nation are collaborating to develop bipartisan, state solutions. Governor Murphy and Utah Governor Spencer Cox provided opening remarks before turning the discussion over to moderator Dr. Alfiee Breland-Noble, Founder, The AAKOMA Project.
The panel, consisting of Governor Murphy, U.S. Surgeon General Vivek Murthy, Dr. Richard Besser, CEO, Robert Wood Johnson Foundation, Reina Chiang, a college student and founder of the nonprofit, “u matter apparel,” and First Lady Tammy Murphy discussed elevating and expanding the national conversation around youth mental health and the close link between youth mental health and maternal and infant health. Watch the full session.
“As leaders, one of the most important and sacred responsibilities is protecting the health and well-being of our kids, and for far too long, mental health and well-being of our young people has been overlooked, and the consequences are impossible to miss. From small towns to big cities, America’s youth mental health crisis is playing out in homes, schools, hospitals and beyond.”Governor Phil Murphy
Governor Murphy and Governor Polis Join Forces To Tackle Youth Mental Health Crisis
The second roundtable of the 2022-2023 NGA Chair’s Initiative: Strengthening Youth Mental Health was held on January 24-25, 2023, in Santa Monica, California. During the two-day roundtable, NGA Chair New Jersey Governor Phil Murphy and Colorado Governor Jared Polis held discussions with parents, physicians, pediatric psychologists, educators, policymakers and other mental health experts. Over the two days, roundtable discussions unpacked the Initiative’s second pillar focusing on themes of building a foundation of diversity and equity in addressing stigma, reducing the stigma of mental health and seeking help, and increasing awareness around youth mental health.
Compared to previous generations, young people today are much more open to talking about mental health and want to play an active role in reducing the stigma surrounding mental health challenges to promote mental wellbeing. Throughout the convening, the young leaders in attendance shared impassioned stories of both their own mental health struggles and the many ways in which youth are organizing to break the stigma. Despite this progress, stigma continues to be a major barrier to young people reaching out for help. Although half of mental health disorders begin by age 14, treatment is often delayed by a decade or more as youth and their families grapple with feelings of fear and shame. Stigma is a reality across different settings: cultural disconnects or generational divides within the home can make it difficult to talk about mental health, and misconceptions continue to pervade attitudes in educational settings, places of worship, and workplaces. Bias, conscious or unconscious, within the healthcare system, can also have a stigmatizing effect on those who need respect, understanding, and support from providers.
Solutions To Break The Stigma And Support The Conversation Around Mental Health
Governors can increase awareness and reduce stigma by supporting:
- Existing community-based mental health organizations’ awareness-building efforts: Ensuring funding and other resources get to organizations with deep knowledge of their communities’ mental health challenges
- Targeted anti-stigma campaigns with a focus on storytelling: Developing efforts driven and co-designed by young people, that reach young people on social media, and are focused on diverse populations, including youth of color and Indigenous youth, LGBTQIA+ youth, youth involved in the foster care system, etc. Governors can also humanize mental health by using their platforms to share their personal journeys with mental health
- School mental health curriculums: Growing capacity for mental health literacy for youth and their families by implementing age-appropriate awareness of the spectrum of mental health, bolster mental wellbeing, and encourage youth to seek help, as well as adopting family engagement plans and public-private partnerships to tap into the knowledge and support of thought leaders in the private or nonprofit sector
- Suicide stigma reduction: Normalizing discussing suicide and suicidal ideation, making them less “scary” and unbroachable topics by training youth peers, as well as the adults who live and work with youth, on appropriate and compassionate responses to someone who is experiencing intrusive thoughts can help to reduce the silence around suicide
- Sensitivity training for adults interacting with youth: Enabling sufficient support, care, and treatment for youth experiencing mental health challenges through bias, sensitivity, and cultural responsiveness training for healthcare professionals, educators, and others
- The power of peer networks: Recognizing a recent Active Minds survey that found that 67% of young adults first tell a friend they are feeling suicidal before telling anyone else – supporting the development of a diverse mental health workforce of peer supporters and community health workers to complement a workforce that is able to provide culturally competent care when and where families need it at the level that is needed; including through trainings on mental health identification and crisis management
- Crisis services that meet youth where they are: Protecting young people’s privacy and enabling trust through innovative services such as anonymous text lines or apps and in building youth-specific crisis response systems including home-crisis models
- Delivery systems improvements to promote trust and safety: Addressing the experience patients have when they seek care after breaking the stigma of seeking help, including addressing the trust gap between patients and the health care system
- Increased awareness of people working in programs that support the well-being needs of youth: increasing awareness of youth mental health among all state systems and agencies that touch the lives of youth and their families, including public health staff, human services staff, youth employment systems, out of school time staff, justice, or housing and child welfare systems
- Safe and supportive school environments: Implementing mental health awareness and stigma-reducing tools in schools such as anti-bullying measures and adding information on seeking mental health (988) to student IDs, utilizing yearly school climate improvements surveys to understand current youth needs; incorporating trained peers into campus programming; and considering alternatives to exclusionary discipline
governors and states meet on prevention and resilience in youth mental health
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.
About the Initiative
Governor Phil Murphy’s 2022-2023 Chair’s Initiative is focused on four key pillars to address youth mental health:
Addressing Prevention and Resilience Building
Providing youth with the supports and tools necessary to cope with stressors and challenges, helping them to thrive and reduce likelihood of engaging in unhealthy or damaging behaviors.
Increasing Awareness and Reducing Stigma
Promoting awareness of mental health resources and foundational mental health knowledge by expanding easy access points to education, helplines and state services.
Insuring Access and Affordability of Quality Treatment and Care
Addressing the barriers that prevent youth from accessing care including ensuring high quality care is available in the places, spaces, and timeframes that youth want and need, and that costs and lack of insurance coverage do not prevent access.
Training and Supporting Caregivers and Teachers
Examining not just the core issues around youth mental health, but also considering the impacts of youth mental health challenges, including the tie-in to academic recovery.
Expanding existing training and supports so that those caring for and interacting with youth daily have the tools and understanding to identify mental health needs and how to facilitate access to supports for youth
Improving Maternal and Infant Health
In addition, First Lady Tammy Murphy is leading an effort focused on maternal and infant health (MIH). This has been a significant area of focus in New Jersey throughout the Murphy Administration and this effort seeks to elevate and expand the conversation around maternal and infant health nationwide.
The four pillars of this effort are:
- Centering Women’s Voices in MIH Policy – This area focuses on the importance of integrating the voices of mothers and women of color in the policymaking process, making sure they have a seat at the table before the table is even built.
- Improving and Utilizing Maternal and Infant Health Data – Improving data systems by incorporating qualitative data on maternal health experiences, linking state data and increasing accessibility to data to improve accountability.
- Expanding Access and Quality of Care – Identifying ways for states to ensure citizens have access to high quality maternal and infant care, including various MIH Medicaid policies that states can look to implement.
- Elevating Innovative MIH Polices, Programs and Technologies – Identify and highlight innovative and novel approaches to MIH policy, including highlighting effective programs and examining the role of technology to improve MIH outcomes.
2022 Summer Meeting
Insights – Youth Mental Health & Maternal and Infant Health
NGA has collated a variety of resources from stakeholders to assist Governors and their staff with strengthening youth mental health, and improving maternal and infant health. These resources leverage the expertise of NGA partners to provide insights to assist with delivering specific program areas and cross-program tools and best practices.
Shifting Upstream: State Actions to Support School-Based Mental Health Screening
Addressing the US’s youth mental health crisis requires us to screen more children for relevant conditions to enable appropriate intervention earlier. Universal screening can be advanced by meeting kids where they are: in schools.
America’s School Mental Health Report Card
School mental health services play an important role in supporting youth and helping every child thrive. This report highlights what each state is doing to support school mental health services and provides policy recommendations and examples of policy pacesetters from across the country.
Supporting Adolescent Health and Development
A brief highlighting the specific findings on youth behavioral health from two National Academies of Sciences, Engineering, and Medicine reports: The Promise Of Adolescence: Realizing Opportunity For All Youth and Promoting Positive Adolescent Health Behaviors And Outcomes: Thriving In The 21st Century.
Addressing Maternal Health Disparities: Doula Access in Medicaid
This report discusses how women using doulas in Medicaid have fewer inpatient hospital admissions during pregnancy, are more likely to attend their postnatal visit, experience lower odds of cesarean delivery, have lower odds of postpartum depression or anxiety, and have lower overall costs compared to women not using doulas.
Funders for Adolescent Science Translation
Penner Family Foundation