Strategies to Support Children and Youth Mental Health Needs in New York State

Health Highlights

April 02, 2024

Note: This Report was informed by the expertise of the NYU McSilver Institute staff and the participants of their mental health panel to develop policy strategies to support children and youth across the state. NYU was a key partner in facilitating these ideas and distributing the data.

Children and youth managing complex behavioral health needs, particularly those residing in New York State, are in desperate need of targeted support from state leadership. The COVID-19 pandemic has exacerbated existing gaps within the nation’s behavioral healthcare system, leading to unmet clinical and social care needs such as peer interaction, family support and access to a trained mental health workforce. According to the CDC, from 2011-2021, over 40% of high school students reported symptoms of overwhelming sadness or hopelessness, severely disrupting their everyday lives.¹ In New York City, 38% of high school students experienced similar feelings in 2021, with a noticeable disparity between Black and Hispanic students compared to their White counterparts.² This has translated into increased rates of depression and suicide, especially among non-Hispanic black youth, during the early stages of the COVID-19 pandemic.³

Priority Policy Considerations

In New York State, there are three specific areas that require prioritization to improve the behavioral health delivery system for children and youth grappling with significant challenges:

Integration of Care. New York State currently experiences gaps in its adolescent behavioral healthcare system, where providers treat their patients' physical and mental needs separately. Specifically, it lacks a fully realized integrated behavioral health system, wherein a patient's mental health requirements are identified in the physician's office and appropriately addressed. Integrated care acknowledges the importance of both medical and behavioral health factors in an individual's overall well-being, enabling collaboration between primary care and mental health clinicians to address patient concerns effectively.⁴ The integration of primary care services with behavioral health and substance use disorder services can enhance the overall quality of care for NYS patients and foster trust in the evolving continuum of care.⁵ However, New York must first confront longstanding policy challenges that hinder provider growth, including a lack of capital for effective implementation and inconsistent billing and reimbursement practices for providers.⁶
Community-Based Services. There is a deficiency in community-based practices/supports that empower youth to voice their concerns. Specifically, there is insufficient investment in opportunities to promote recreational therapy and stress management, which can improve behavioral health outcomes.⁷ This is especially concerning for neglected/abused youth and those who experience homelessness. There are insufficient community-based behavioral health access points, and little to no capacity for child and adolescent care delivery in hospital systems throughout the state.⁸ Shortages in peer-to-peer services for assisting youth across multiple settings also contribute to the current mental health crisis in the state. Notably, clubhouse services require significant expansion in New York to enable patients to establish healthy connections with like-minded individuals.⁹ Many children and youth experienced severe isolation due to the COVID-19 pandemic at crucial moments in their lives and require opportunities to rebuild these connections and acquire the necessary tools to lead positive lives.
Workforce Support. Gaps within behavioral health workforce pipeline, compensation, and cultural competence in New York State exacerbate negative mental health outcomes among adolescents.¹⁰ The COVID-19 pandemic has overwhelmed providers, often leaving them with inadequate resources to provide specialized care or necessary referrals for every adolescent.¹¹ Additionally, the current mental healthcare system faces poor reimbursement both at the provider and overhead levels, leaving on-the-ground workers without adequate wages to deliver essential services, particularly in New York City.

NYU McSilver Institute Roundtable Discussion

NYU McSilver Institute hosted a 2024 behavioral health panel aimed at generating actionable strategies for the youth mental health crisis. The panelists represented various levels of New York's mental health continuum of care, including experts from provider, management, advocacy, and policy levels. Generally, the panelists expressed concerns about the silos within adolescent mental health treatment and the lack of long-term support for necessary services. Suggestions focused on improving children and youth agency within mental health initiatives and ensuring that the new goals outlined in the New York State behavioral health roadmap address the majority of public concerns.¹²

Panelist suggestions during the discussion included:

Improving affordability and accessibility of mental health training programs for patients
Providing compensation for adolescents to actively participate in youth-led initiatives alongside individuals with lived experience
Leveraging programs such as ThriveNYC (the city’s roadmap to create a sustainable mental health system)¹³ or Project Unite (a platform by the Children’s Defense Fund with goals to ensure youth services are led by trauma-informed care)¹⁴
Creating policies aimed at reducing the harmful mental health impact of social media on adolescents, particularly those experiencing feelings of isolation or hopelessness
Addressing the stigma of mental health among parents who may not acknowledge their children’s complex behavioral health issues and encouraging them to seek assistance from trained specialists

Policy Strategies for Long-Term Support

There are several actionable policy strategies that New York can implement in order to effectively address the adolescent behavioral health crisis. Two strategies that have lower investment and higher impact include:

Strengthening the foundation of available behavioral health services. New York must prioritize improving its current array of Medicaid mental health services, which have come under scrutiny for not meeting federal legal standards.¹⁵ The initial focus should bolster the Children and Family Treatment and Support Services (CFTSS), which encompass family support, youth peer advocacy, crisis intervention, and other essential components.¹⁶ These services aim to deliver essential clinical and developmental assistance to eligible youth while improving access to mental health professionals during crises. Additionally, there should be concerted efforts to expand the Home and Community Based Services (HCBS), which are designed to offer support and services to children in non-institutionalized settings, facilitating youth integration within their communities. However, as of 2020, only 8% of eligible NY adolescents received CFTSS and 10% received HCBS, indicating the urgent need for revitalized policy efforts.¹⁷
Expanding and supporting its behavioral health workforce. New York must eliminate barriers that leave mental health professionals feeling overburdened and undervalued while delivering essential services. A key initiative involves raising the minimum wages for both clinicians and non-clinical staff, such as social workers and home health aides, ensuring they receive fair compensation for their demanding work. Implementing incentive programs tied to performance excellence can further motivate these professionals and prevent them from moving elsewhere for adequate compensation.¹⁸ Additionally, streamlining certification requirements for professionals working with children with behavioral needs can enhance the talent pipeline and ensure representation in diverse communities. While acknowledging the importance of clinical supervision, state policymakers must ensure that entry barriers do not hinder the participation of skilled workers, thereby safeguarding service quality.¹⁹

Through broadening its existing array of mental health services and investing in its talent pipeline, New York has the opportunity to overhaul its behavioral health system, advancing efforts to mitigate the adolescent behavioral health crisis and support communities in need.

_{¹ https://www.cdc.gov/healthyyouth/data/yrbs/pdf/yrbs_data-summary-trends_report2023_508.pdf}

_{² https://www.nyc.gov/assets/doh/downloads/pdf/mh/care-community-action-mental-health-plan.pdf}

_{³ https://publications.aap.org/pediatrics/article/151/3/e2022058375/190657/Youth-Suicide-During-the-First-Year-of-the-COVID?autologincheck=redirected}

_{⁴ https://integrationacademy.ahrq.gov/about/integrated-behavioral-health}

_{⁵ https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2016/2016-01_integrated_care_faqs.htm#integrated}

_{⁶ https://www.commonwealthfund.org/blog/2023/making-care-primary-integrated-behavioral-health-care}

_{⁷ https://journals.sagepub.com/doi/10.1177/10538259231190844?icid=int.sj-abstract.citing-articles.4}

_{⁸ https://omh.ny.gov/omhweb/statistics/youth-mh-listening-tour-report.pdf}

_{⁹ https://www.nyc.gov/site/doh/about/press/pr2023/nyc-to-reach-more-new-yorkers-with-serious-mental-illness.page}

_{¹⁰ https://www.nyc.gov/assets/opportunity/pdf/evidence/availability-accessibility-mental-health-services_findings.pdf}

_{¹¹ Ibid}

_{¹² https://omh.ny.gov/omhweb/statistics/youth-mh-listening-tour-report.pdf}