CRITICAL MASS: Mental health problems among Colorado children becoming a crisis

AURORA | Nearly two years ago, pediatricians and psychologists from Children’s Hospital Colorado convened a press conference to declare a “state of emergency” for pediatric mental health in Colorado.

Post-pandemic, the state’s young people were suffering from an unprecedented degree of mental health issues, doctors said, and there weren’t nearly enough resources to stem the gap.

“Our kids have run out of resilience,” said Dr. David Brumbaugh, the hospital’s chief medical officer.

Since then, the problems have continued, but so have solutions, with the Aurora area becoming the epicenter of efforts to address the crisis. With everything from the hospital hiring a mental health in chief position, the Cherry Creek School District building its own mental health day treatment center and area lawmakers continuing to pass legislation to help young people, the city has worked hard to meet the scope of the need.

U.S. Surgeon General Dr. Vivek Murthy visited Children’s Hospital in March, where he discussed his own youth mental health advisory that he released in December of 2021, which described the challenges facing today’s youth people as “unprecedented and uniquely hard to navigate.”

“This is a national issue we’re facing,” Murthy said at Children’s.

National problem becoming a crisis

Anxiety over academics. Post-lockdown malaise. Social media angst.

Study after study says American youth are in crisis, facing unprecedented mental health challenges that are burdening teen girls in particular. Among the most glaring data: A recent Centers for Disease Control and Prevention report showed almost 60% of U.S. girls reported persistent sadness and hopelessness. Rates are up in boys, too, but about half as many are affected.

Adults offer theories about what is going on, but what do teens themselves say? Is social media the root of their woes? Are their male peers somehow immune, or part of the problem?

“We are so strong and we go through so, so much,” said Amelia, a 16-year-old Illinois girl who loves to sing and wants to be a surgeon.

She also has depression and anxiety. Like 13% of U.S. high school girls surveyed in the government report, she is a suicide attempt survivor. Hospitalization after the 2020 attempt and therapy helped. But Amelia has also faced bullying, toxic friendships, and menacing threats from a boy at school who said she “deserved to be raped.”

More than 1 in 10 girls said they’d been forced to have sex, according to the CDC report, the first increase noted in the government’s periodic survey. Sexual threats are just one of the burdens teen girls say they face.

“We are trying to survive in a world that is out to get us,” Amelia said.

Emma, an 18-year-old aspiring artist in Georgia with attention deficit disorder and occasional depression, says worries about academics and college are a huge source of stress.

“Lately in myself and my friends, I realize how exhausted everyone is with the pressures of the world and the social issues and where they’re going to go in the future,” Emma added. “All of these things pile up and crash down.”

Zoey, 15, was raised in Mississippi by a strict but loving single mother who pressures her to be a success in school and life. She echoes those feelings.

“School can be nerve racking and impact your mental health so much that you don’t even … recognize it, until you’re in this space where you don’t know what to do,” Zoey said. She’s also had friendship struggles that ended in deep depression and felt the discomfort of being the only Black kid in class.

Several girls said they face added pressure from society’s standards that put too much focus on how they look.

“A lot of people view women’s bodies and girls’ bodies as sexual,” Emma said. “It’s overwhelming to have all these things pushed on us.”

Boys are less aware, they suggest. The girls cite crass jokes, inappropriate touching, sexual threats or actual violence. Girls say the unwanted attention can feel overwhelming.

“We deserve to not be sexualized or catcalled, because we are kids,” Amelia said.

Siya, an 18-year-old in New Jersey, said almost every girl she knows has dealt with sexual harassment. “That’s just been the normal for me,” she said.

“When you’re walking alone as girl, you’re automatically put in this vulnerable situation,” Siya said. “I think that’s so sad. I don’t know what it feels like to not have that fear.”

Makena, a high school senior in Mississippi, said she and her friends sometimes wear baggy clothes to hide their shapes but boys “comment, no matter what.”

She has had depression and therapy, and said she has grown up in a community where mental health is still sometimes stigmatized.

“Often in the Black community we aren’t as encouraged to express emotion” because of what previous generations endured, said Makena, who works with a teen health advocacy group. “We’re expected to have hearts of steel,” she said. “But sometimes it’s OK to not be OK.”

Social media platforms contribute, with their focus on superficial appearances and making perfectionism seem attainable. Girls say they’re just part of the problem.

“Social media has completely shifted the way we think and feel about ourselves” in good and bad ways, Makena said.

Girls have historically been disproportionately affected by depression and anxiety. But those statistics at least partly reflect the fact that girls are often more likely than boys to talk about feelings and emotions, said Dr. Hina Talib, an adolescent medicine specialist and spokesperson for the American Academy of Pediatrics.

Zoey, the Mississippi 15-year-old, says boys have to keep up a “macho facade” and are less likely to admit their angst.

“I feel like they might feel that way, we just don’t see it,” she said.

A study published in March in The Journal of the American Medical Association found that in 2019, before the pandemic, about 60% of children hospitalized for mental health reasons were girls. A decade earlier, the difference was only slight.

COVID-19 lockdowns added another dimension, thrusting academic and social lives online, Talib said. Some kids entered the pandemic as youngsters and emerged with more mature bodies, socially awkward, uncertain how to navigate friendships and relationships. They live in a world beset with school shootings, a rapidly changing climate, social and political unrest, and restrictions on reproductive care and transgender rights.

The CDC report released in February included teens queried in fall 2021, when U.S. COVID-19 cases and deaths were still high. Other data and anecdotal reports suggest many teens continue to struggle.

“The pandemic as a percentage of their lives is huge,” said Talib.

Expecting kids to be unscathed may be unrealistic.

“It’s going to change a generation,” she said.

Colorado legislation

Democrat Dafna Michaelson Jenet, who represents parts of north Aurora and the surrounding region in Colorado’s House of Representatives, has made youth mental health treatment a focus of her tenure in the legislature. In 2021 Jenet was one of the prime sponsors of the bill creating Colorado’s “I Matter” program, which allows youth to access six free mental health sessions with a licensed professional. 

The program, which was initially allocated to run through last summer, has since been extended. According to information shared by the state legislature, since its inception over 5,500 Colorado kids have taken advantage of the program, with 44% attending at least four sessions.

This legislative session, Jenet has been working on several more mental health related bills, including one that would allow districts to opt-in to hosting mental health screenings in schools.

“School Mental Health Assessment,” House Bill 1003, would create a program housed in the Colorado Department of Public Health and Environment where qualified providers would come into schools and offer mental health screenings to students in 6th through 12th grade. 

Participating schools would be required to notify parents about the program at the beginning of the school year, but under existing Colorado law students 12 and older would not need parental participation to participate.

If the licensed screener believed that a student needed mental health treatment, they would then work with the student and their family to connect them to the appropriate services, including the “I Matter” program. If a student was found to be at acute risk of suicide or self-harm, the parents and school officials would be immediately notified.

Jenet said that with this bill, her focus is on trying to decrease the number of young people who ever reach that crisis level through early intervention.

“Once we get to suicidality we have a much tougher road,” she said. This bill “is all about getting the kids the quickest access to care possible.”

The hope is to make the screenings accessible by having them in schools, where they will likely reach students who would not otherwise have access to a mental health evaluation, Jenet said.

She is also working on legislation to ensure that hospitals treating high acuity pediatric mental health patients are appropriately reimbursed and a bill to expand the types of providers who can provide mental health care in schools.

Mental health professionals are currently required to be licensed by the Department of Education to work in schools. A new bill under consideration would allow districts to hire mental health professionals who are licensed and have experience working with children and adolescents but don’t have a Department of Education license.

“Suicide is the leading cause of death for 10 to 18-years-olds in Colorado,” Jenet said in a statement. “We need to do everything we can to remove unnecessary barriers for Colorado students so they can access the resources they need. With this bill, schools will have greater flexibility to hire mental health professionals so we can provide essential, life-saving services to our kids.” 

Traverse Academy

The Cherry Creek School District’s plans to build its own mental health day treatment facility for district students has attracted national attention, including a segment on CBS News last month.

The academy will serve students with a range of mental health needs, including associated conditions such as eating disorders and substance addiction. It is a partnership between the district, the University of Colorado Anschutz Department of Psychiatry and Children’s Hospital Colorado and is believed to be the first facility of its kind in the nation.

“The crisis that’s facing this country in adolescent mental health is not going to be fixed by separate solutions,” Cherry Creek assistant superintendent of special populations Tony Poole told the news station. “Saying that we’re school and we’re just going to do school, that might have been acceptable 20 years ago; it’s just not going to work.”

“Breaking down those barriers and those silos is going to be massively important if we’re going to solve this crisis,” he said.

The academy is designed to function similarly to a regular school, and is being constructed to feel inviting and non-institutional, district officials have said.

The district recently received $1.5 million in federal money for Traverse Academy after inflation and construction delays put the project in the red. It is currently slated to open its doors for the 2023-2024 school year.

Along with having in-school mental health providers, both Cherry Creek and Aurora Public Schools have started working with telehealth provider Hazel Health to provide online mental health services to students. Since December 2021, APS has had 3,266 visits through the program. Cherry Creek has had about 400 referrals, with each student able to receive 8-10 therapy sessions at no cost.

Aurora hospital weighs in

Last winter, Children’s Hospital Colorado brought Dr. K. Ron-Li Liaw on board to fill a new position as the hospital’s first mental health-in-chief, another acknowledgement from the facility of the importance of addressing young people’s psychiatric and behavioral health needs.

Hospitals have been on the front lines of the youth mental health crisis, as in many cases young people experiencing mental health emergencies are taken to the hospital emergency room to wait for a bed because there are no other places they can go.

Liaw had the opportunity to discuss the scope of need at a panel discussion at the hospital last month with “the nation’s doctor,” U.S. Surgeon General Dr. Vivek Murthy. Murthy was the surgeon general under President Obama, and returned to fill the role a second time for the Biden administration.

Murthy has had a longtime focus on the problem of loneliness, which can be particularly acute in young people and which he has described as an “epidemic” fueling many other health problems in the U.S. In 2020 he published a book about the issue called “Together: The Healing Power of Human Connection in a Sometimes Lonely World.”

At Children’s Hospital Colorado, Murthy joined Liaw and several other community members, doctors and politicians to discuss suicide prevention and how mental health issues intersected with issues such as racism, technology and gun violence.

Murthy and Liaw both spoke about the importance of increasing the number of mental health providers of color, with Murthy saying that he had struggled to find mental health resources for some of his own family members who wanted to work with a provider from a South Asian background.

“These struggles are not only real but they’re hurting us,” he said.

Liaw said that recruiting a workforce that is reflective of the demographics of Aurora is a priority for the hospital.

Murthy discussed the importance of young people feeling like they have people in their lives they can trust and can talk to about their feelings. Many young people today are lonely and isolated, he said, and just reaching out to the young people in your life can make a difference.

“When kids have healthy relationships, it improves their mental health,” he said.

He also discussed the impact that violence at schools can have on young people. His visit came two days after a student at Denver’s East High School died of injuries he sustained several weeks earlier during a shooting outside the school.

“We have to make gun violence a priority because it is a public health issue,” he said.

Children’s Hospital Colorado continues to experience high volumes of patients in mental health crisis, who sometimes have to stay in the emergency room for long periods of time as they wait for a spot to open up at an inpatient treatment center. According to reporting from the Colorado Sun, earlier in April one child had been in the emergency room for 40 days.

Almost two years after the hospital’s state of emergency was released, “we are still in a state of crisis,” Liaw said. However she said that she felt hopeful about the long term work the hospital is doing to address the problem, particularly the collaborations taking place between different organizations to come together and support young people and the work being done to increase the diversity of the mental health workforce.

“We have to do this as a model for other states of what’s possible,” she said. “So I feel incredibly hopeful.”

Thais Kenser, the manager for Aurora Mental Health and Recovery’s Child and Family North Clinic, said that more young people are continuing to be referred to mental health treatment prior to the pandemic. The clinic has worked hard to reduce barriers to care, she said.

“I’m proud to say that at Child and Family North, half of our staff are bilingual in Spanish and able to offer services without interpretation,” Kenser said.

She believes part of that is due to an increase in need for treatment and part is due to improvements in referring people who need care. General practitioners, schools and community organizations that work with young people have all become more adept at recognizing symptoms of mental illness in recent years, Kenser said.

The majority of young people the clinic sees are treated for depression, anxiety or trauma, but Kenser said there has been an increase in young people dealing with grief post-pandemic, and that young people also particularly deal with issues stemming from bullying, body image and low self-esteem.

“There’s been a lot of changes in the last few years but we’re doing the best that we can to meet that demand and support folks,” she said.

— The Associated Press contributed to this story