The mental health of Vermont's children and youth is at a crisis level never seen before.
Children's mental health in Vermont and across the U.S. is in crisis!
In October 2021, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children's Hospital Association (CHA) declared a National State of Emergency in Children's Mental Health, highlighting the widespread challenges facing children and adolescents. This declaration was reinforced by the U.S. Surgeon General, who also recognized children's mental health as a national crisis. More recently, in August 2024, the Surgeon General issued an advisory addressing the impact of parental stress and mental health on society and the economy, underscoring the urgent need for policymakers and advocates at all levels to prioritize the well-being of children, adolescents, and their families and communities.
"In addition to the traditional challenges of parenting - protecting children from harm, worrying about finances, managing teenagers who are searching for independence - there are new stressors that previous generations didn't have to consider. These include the complexity of managing social media, parents' concerns about the youth mental health crisis, and an epidemic of loneliness that disproportionately affects young people and parents, just to name a few." (From Parents Under Pressure: U.S. Surgeon General Advisory on the Mental Health and Well-being of Parents. Online at: https://www.hhs.gov/surgeongeneral/priorities/parents/index.html)
Of the Vermont youth responding to the most recent Youth Risk Behavior Survey, 2023, 23% or about 3,589, reported cutting or burning themselves without intent to die. On the same survey, 14% or 2,184 youth reported making a plan to kill themselves in the past year. LGBTQ+ youth are three times more likely to report making a plan to kill themselves.
Several factors contributing to the current crisis include the isolation youth experienced during COVID and the dramatic increase in divisiveness and intense conflict in our communities. Such conflict, alongside feelings of loneliness and social disconnectedness, contributes to the acuity of stress in the community and especially for youth. This creates a social context in which chronic stress is becoming more widespread, which interferes with youth development and overall wellness. Efforts to destigmatize mental health and trauma are key strategies to break down barriers that prevent youth from seeking help.
The challenges facing youth today are not only growing in scale but also in complexity and acuity. Increasingly, more teens require crisis stabilization, and many present with significantly heightened levels of depression and anxiety compared to previous years. As highlighted earlier, suicidal ideation is alarmingly common among teens, with a growing number acting on these thoughts. The most frequent method of suicide attempts involves medication, ranging from over-the-counter remedies to prescriptions intended for themselves or family members. Tragically, these attempts often occur in moments of impulsivity during periods of intense emotional distress.
Firearms further exacerbate the risk. Easy access to lethal means, particularly during acute emotional crises, dramatically increases the likelihood of fatal outcomes. It is crucial for adults to recognize the severity of these risks and proactively limit access to both medications and firearms within their homes. By taking these preventative steps, we can help safeguard youth as they navigate the complexity and challenges in their lives.
Workforce challenges across the state in schools, designated and specialized service agencies, and other youth supporting organizations are significantly impacting our ability to support our children and youth. The workforce challenges are in large part due to chronic underfunding as well as increased acuity. Consequently, any child-serving program or school may either serve fewer children or maintain the same level of service as before. As is the case for everyone, when our issues are not effectively dealt with, they become more pronounced and for youth this often means they need more intense services. The idea is to prioritize investment in more affordable, community-oriented services to prevent dysfunctional processes and address potential issues early on. This is called moving services up stream.
These workforce challenges, coupled with the growing need for upstream services, highlight a critical gap in Vermont's ability to provide sufficient support for its youth, particularly in the foster care system. Throughout the COVID pandemic and now, Vermont is experiencing a serious shortage of foster families. Vermont has historically relied heavily on foster families for youth who can't stay at home for a time. The staffing shortage also means that fewer staff are available for community-based in-home services. Many youth with intense needs can be successfully served in these programs instead of going to a children's residential treatment program. Without adequate staffing of children's community-based services and foster care, however, more youth are being referred for children's residential care.
It is especially challenging to retain and recruit staff for children's residential treatment programs. Potential staff can be put off by working the evenings, nights, and weekends, or with kids who need intense support and who may become emotionally and/or behaviorally dysregulated. Several children's residential treatment programs have closed in the last few years.
Some programs, despite facing staffing shortages, have managed to keep serving certain children by limiting services to just five days a week or by closing for certain periods. However, these adjustments reduce access for youth, particularly for those who lack family support during the days the program is closed or operates on a limited schedule.
NFI, one of the Vermont Care Partners network agencies, is a statewide non-profit specialized service agency providing intense mental health services and special education through several programs across Vermont. Some NFI programs provide intensive outpatient services, others include psychotherapy and consultation, in home community-based wrap around programs, community-based residential programs, and licensed independent schools.
NFI has two hospital diversion programs for adolescents ages 13 to 21 years old who are experiencing a mental health crisis. These are alternatives to an acute inpatient psychiatry treatment program for youth. Each program serves a maximum of 6 youth. Due to a lack of funding and staff vacancies, they have only been able to serve a portion of the 6 youth in each program. The average length of stay remains at 7 to 10 days. Referrals and admissions continue to demonstrate a high need for crisis stabilization services. Most youth are referred due to self-injury and/or suicidal ideation or attempts.
Of the 381 hospital diversion program discharges last year, 85% reported suicidality as a primary reason for admission. In addition, 83% of the youth accomplished at least 75% of their treatment goals and 97% were discharged back to a lower level of care. These are extremely high rates of success for youth in acute mental health crisis served for only 7 to 10 days. Years after leaving, NFI hears incredible success stories. One graduate is an officer in the armed services, another is a trained engineer, and each one represents the future of our state.
NFI also operates Crossroads Intensive Outpatient Program (IOP), providing group and individual therapy several hours a day, 5 days a week, which is often an alternative to inpatient treatment and accepts referrals from hospital emergency rooms. NFI Crossroads started with an adult program and added an adolescent and a Transitional Aged Youth Program for emerging adults ages 18 to 29 years old, at 45 San Remo Drive in South Burlington. All Crossroads use Dialectical Behavior Therapy (DBT), which is an evidence-based practice, and assists adults and adolescents with urgent mental health needs. Referrals are from the emergency departments and inpatient units, as well as less acute settings and the public. Of the adolescents served by Crossroads, 90% report suicidality as a major concern and 100% of Transitional Aged Youth report suicidality.
NFI extends its commitment to evidence-based practices and urgent mental health needs by prioritizing justice, equity, diversity, and inclusion across its programs and community. As a trauma-transforming organization, NFI collaborates with Dr. Ken Hardy of Drexel University, who has led impactful discussions on race and systemic differences, attended by over 400 professionals, including therapists, attorneys, and educators. Dr. Hardy provides frameworks to understand systemic racism, our roles within it, and actionable steps to foster greater justice and equity.
VCP network agencies serve children and families struggling with anxiety, depression, self-harm, as well as behavioral challenges resulting from trauma and other adverse childhood experiences. Across the state, agencies practice with a family-centered approach, meeting families where it works best for them - in schools, homes, and other community settings. In calendar year 2024:
Vermont must take action to address the crisis in children and youth mental health. Providers, state officials, schools, and other youth involved organizations must focus on both short-and long-term services and solutions working together to ensure Vermont's children and youth are safe and healthy. To achieve this we must: increase resources for children and families; establish a taskforce to establish comprehensive solutions; reinstate and fund best practices that we know work; address the erosion of community-based services by committing to sustainable and predictable funding that enables robust programming; support Success Beyond Six; align the crisis continuum with supports for children and youth; invest in the workforce serving children and families; and at large, place a greater focus on prevention and early intervention.
Children are complicated with many different needs and there are multiple effective solutions. Preventing issues and intervening early are not only the humane thing to do but also are extremely cost effective. Prevention and early intervention, often called upstream services, reduce future mental health and substance use challenges and decrease future costs. Children's upstream mental health services are community-based and of less intensity. Easy access to effective upstream mental health services diminishes the need for residential mental health services, juvenile justice services, substance use services, youth homelessness, and incarceration rates.
Unfortunately, chronic underfunding and subsequent limited community-based options result in needing more intense services, often decreasing options as youth move into adulthood. Our youth need our support. The VCP network agencies have effective evidence-based programs that will help our youth succeed but we need sufficient resources to hire, train and retain skilled staff to do the work of providing access to quality services that every Vermont family deserves. Schools need sufficient funding that includes ensuring adequate resources for upstream mental health services. We all need to talk with the children in our lives with the goal of understanding how they are doing. It is essential to a child's well-being that they know the adults in their lives care about and understand them.
Our children are our future. Last year, the House Healthcare Committee in Vermont conducted hearings on mental health services. During a session focused on children's mental health, a Representative urged his colleagues to engage in conversations with the children in their lives - whether family or friends. The representative shared a deeply unsettling conversation he had with children in his own extended family. He asked the children how they were coping, and the concerns they shared left him alarmed about the well-being of children both in his family and across the state. They spoke of overwhelming anxiety about various matters, including their future. These children came from a loving, supportive family. In his passionate address, the Representative urged his fellow lawmakers to talk to children they know, stressing the urgent need for more action. As he passionately stated, "They are our future!" And they are.