• Article
  • August 3, 2020

Commentary: Transforming a Youth Mental Health System

As behavioral health needs explode, children's hospitals have an opportunity to lead the conversation and create a unified vision for change.

By Shannon Van Deman, MBA

As the COVID-19 pandemic continues to surge, behavioral health needs for children and youth are exploding across the country. For example, 70% of teens say they're experiencing struggles with mental health in this stressful climate. Many are turning to unhealthy coping mechanisms, like more time on social media or in bed. More support is undeniably needed.

Mental health crisis

Unfortunately, the crisis we're facing is not entirely new. Even before COVID-19 hit, kids were struggling to access the behavioral health care they need to thrive. In Colorado, suicide is the leading cause of death among youth. About 226,000 children and teens have a diagnosable mental health condition, but only 21% receive professional care. Plus, geographic location or ability to pay can have a significant effect on the quality of mental health services families receive.

A unified path forward

The current state of pediatric mental health is not due to a lack of expertise, dedication or effort aimed at reform and improvement. There is valuable work in progress in many states and communities. The problem is lack of coordination.

In Colorado, as with many states, responsibility and authority for children's behavioral health care is spread among multiple state agencies and local governments. A child may be involved in lots of different systems, from schools to the courts to social services, without those entities talking to each other. Those fighting for improvement are working in a variety of directions and largely operating in silos. The result is slow progress or patchwork solutions.

To truly create sustainable systemic change, we need to come together with a unified vision and voice.

Partners for Children's Mental Health

That's why Children's Hospital Colorado created Partners for Children's Mental Health (PCMH). PCMH is a community-led center designed to serve as a cross-system resource, training, evaluation and implementation hub. The center's overall mission is to bring communities together to improve behavioral health outcomes for children and families.

At a statewide level, PCMH is focused on:

  • Enabling lasting partnerships and reducing fragmentation across the system.
  • Gathering and sharing critical data to inform policy and advocacy efforts.
  • Creating consistency and standardization of care models to reduce the burden on providers and families.

In local Colorado communities, PCMH is working to:

  • Implement suicide prevention initiatives in schools and primary care.
  • Increase the availability of evidence-based practices.
  • Improve mental health equity, particularly in rural and low-resourced areas.

Since the launch of PCMH in 2017, Colorado has moved from 48th in the country for access to youth mental health care to 33rd. Our goal is to be among the top 10.

A roadmap for system reform

Before PCMH was established, Colorado lacked a comprehensive plan to address challenges and improve outcomes in the children's behavioral health system. Changing that was our first major initiative. PCMH convened more than 100 stakeholders-community partners, advocates, government officials, and families-and facilitated a strategic planning process for the state of Colorado.

This process resulted in a four-year strategic roadmap that identified and prioritized a series of goals focused on improving quality and expanding access to needed behavioral health services for Colorado's children and youth.

Legislative success

Several of these roadmap goals became the foundation for a bipartisan bill to help children and families across the state by improving access to high-quality behavioral health screening. Last year, Colorado Governor Jared Polis signed the bill into law-a big win for everyone fighting for system change. PCMH has since been supporting implementation of each component of this sweeping legislation.

The roadmap was also used to kickstart the work of the children's subcommittee of the Behavioral Health Task Force, a group tasked by Governor Polis with creating a blueprint to overhaul the behavioral health system in Colorado.

Suicide prevention strategies

In addition to our work to facilitate partnerships at the statewide level, PCMH partners directly with Colorado communities to develop and implement suicide prevention strategies. The initial focus: schools and primary care.

In Colorado high schools, we're providing free training and technical assistance to increase staff capacity to effectively identify, intervene, and support students at risk for suicide.

In primary care, there's a significant opportunity to better equip providers with the knowledge and resources to identify and treat warning signs. More than 80% of youth who die by suicide have seen their primary care provider within a year of their death, many within the previous month. PCMH has developed a "Zero Suicide" care pathway focused on universal suicide screening for pediatric patients.

Challenges ahead

Through these initiatives and many others, PCMH and its partners have made great strides to reform the system and get quality services to Colorado youth. However, the COVID-19 pandemic presents new challenges. As behavioral health needs are increasing, funding to support these needs has been slashed due to extreme state budget cuts.

We now need to ramp up advocacy efforts to keep behavioral health funding as a critical component of COVID recovery efforts. As we continue to navigate the unknown, one thing is certain: system overhaul is needed now more than ever.

An opportunity for children's hospitals

The behavioral health crisis is not unique to Colorado. Across the U.S., 13% of youth between 8 and 12 years old live with mental illness severe enough to cause significant impairment in their day-to-day lives. This figure jumps to 21% in youth 13 to 18 years old.

As children's hospitals, we have a platform to lead the behavioral health conversation in communities and create a unified vision for change. Hospitals have an opportunity to form centers like PCMH to create large-scale systemic reform in their own localities. Kids, youth, and families throughout the country are struggling. Change is possible. Children's hospitals can help make it happen.

Shannon Van Deman, MBA, is vice president of the Pediatric Mental Health Institute at Children's Hospital Colorado and executive director of Partners for Children's Mental Health. She also serves as co-chair of Colorado's Behavioral Health Task Force children's subcommittee and a board member and Treasurer of Mental Health Colorado. Send questions or comments.