Letter 5: Mental Health Myopia

My prescription for non-clinical, ecosystem-level innovations and interventions

Hi! How are you?

🔥  I’m super fired up today, so I’m going to dive in. Plus, May is National Mental Health Awareness month in the US. NB: Why not mental health years? 

But wait. Let me walk-my-words here.

I really mean it: How are you?

Gentle listening ears…👂👂

I’m ok. Fired up, like I said. Shaking a bit as I write with the urgency.

Warning: Frequent use of ALL CAPS might make you feel like I’m yelling at you. I am not. I’m just yelling. 

TL;DR (by yours truly — no ChatGPT this time)

1. In the US, there’s a National State of Emergency in youth and adolescent mental health. Globally, young people aren’t doing so well either.

2. We focus resources on MORE OF THE SAME. More providers. More beds. More clinical supports. Sometimes better. Almost always in the same clinical genre.

3. We will NEVER keep pace with the problem — there are too many young people in need of support.

4. We MUST also look at ecosystem-level, NON-clinical supports to elevate baseline wellness.

5. Routine nature-connection (easily accomplished through nature-based learning design) in schools is PART of the solution.

Dumpster Fire

Our children and adolescents are caught in a dumpster fire of epic proportions. If you are a parent or an educator or pediatric healthcare provider or a human with any connection with young people, you know this. You feel this.

Here are a few facts and stats undergirding your spidey-senses:

🔥🧠 In October 2021: the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association issued a Declaration of a National Emergency in Child and Adolescent Mental Health. 

🔥🧠 Seven of 10 public schools report the number of students seeking mental health services has increased since 2020. 

🔥🧠 By 2021, more than a third (37%) of high schoolers were reporting poor mental health and 44% were dealing with persistent feelings of sadness and hopelessness.

🔥🧠 Suicide is one of the leading causes of death for youths ages 15 to 19 globally.

🔥🧠 In the US, nationwide, suicide is the second-leading cause of death for young people age 10 to 24. (In Colorado, where I’m from, it’s No. 1.)

For more global data, after you finish here, hop over to

Mental: Fighting the fragmentation of mental health one policy at a time

-- and specifically this post: "The Status of Global Mental Health. "

Beds

Conventional mental-health solutions will NEVER keep pace with the children and adolescent mental health problem.

Knowledgeable people in the field, like Dr. K. Ron-Li Liaw, Chief of Mental Health at Colorado Children’s Hospital, know this:

“We are not going to be able to build our way out of this crisis,” she said. “We are not going to be able to build enough beds.” -Dr. K. Ron-Li Liaw

The problem is way bigger than beds, though. 

⏰ According to the American Academy of Child and Adolescent Psychiatry, as of April 2019, there were approximately 8,300 practicing child and adolescent psychiatrists in the U.S. 

AND

(in the U.S.) over 15 million children and adolescents need the special expertise of a child and adolescent psychiatrist.

I’ll spare you the math – 1807: 1 

🛑 This was PRE-PANDEMIC. Remember: since 2020, 70% of schools have seen an increase in students seeking mental health services! 

SEVEN-TY %!

Meaningful progress & myopia

Photo by Oscar Keys on Unsplash

Back in Colorado, Dr. Liaw is making a plan that includes strategies like early intervention by pediatricians and school-based counselors and additional hospital beds. This is a start.

🌟 There are also promising efforts to use Federal Funding to Meet Children’s Behavioral Health Needs in School. Specifically: 

🟢 The American Rescue Plan Act’s (ARPA) Elementary and Secondary School Emergency Relief (ESSER) provides more than $122 billion to help pre-K through grade12 students recover from lost time in schools by supporting their mental health, as well as their social, emotional, and academic needs. 

🟢 The Bipartisan Safer Communities Act of 2022 commits more than a billion dollars in the next five years to support schools in addressing youth behavioral health needs, including funding for school mental health workforce. 

I applaud efforts to deploy ARPA, ESSER, and SCA specifically support mental health. A couple compelling examples: 

👏Oklahoma: $35 million for districts to hire new school counselors, licensed mental health professionals and licensed recreational therapists to lower the student-to-counselor ratio. 

👏 District of Columbia: expanding its Comprehensive School-Based Behavioral Health System to provide more students with access to clinical services in public schools.

I am also over-the-🌙 about Medicaid streamlining efforts to allow school-based supports to qualify for reimbursement. 🎉 Hooray for policy changes that support mental wellbeing!

Still. Even with all of that goodness, these and other primarily clinical strategies are both: 

1. absolutely critical

2. woefully inadequate 

Clinical supports alone will NEVER keep pace with the problem. So, WHY THE HELL ARE WE MYOPICALLY RELYING ONLY ON CLINICAL INTERVENTIONS? 

🫁Breathe

My (almost entirely) non-clinical, (mostly) nature-based playbook:

Let’s design upstream, ecosystem-level, creative, way-OUTDOORS-of-the-box innovations and interventions to improve baseline wellness.

I know nature-based learning design (which I wrote about here) isn’t a panacea. Still, my proposal includes a fair dose of nature. Lest you think I’m a one-trick pony, there’s some other stuff in here too.

1. Integrate Nature-Based Learning Design into daily instruction to elevate baseline mental wellness among all students and educators. A growing body of evidence shows nature connections (which can be facilitated through nature-based learning practices) support social & emotional aspects of learning including improved collaboration, reduced behavior challenges, and more cooperative relationships among students and teachers. Nature also improves mental and physical health through reduced stress and improved fitness. And, recent data suggests it can help mitigate the negative impacts of ACEs (Adverse Childhood Experiences). We need to lean into nature-based learning¹ and other “non-clinical” – but nonetheless preventive and curative – interventions that can be “administered” as part of ordinary instruction. No prescription necessary.

2. Creatively apply the Community Health Worker model in schools: Empower trusted community members – all of our teachers – to deliver wellness information and non-clinical treatments for health and wellbeing through their routine instructional practices (let’s NOT ask teachers to do more!). With simple training in nature-based learning pedagogical practices and classroom design we can increase the number of people providing frontline mental health support by ~3.6 Million² nationwide by the start of the 2023-24 school year and empower teachers with skills that make them more effective at their job! 

3. Leverage schools for social prescribing: Children and adolescents are in schools. Health-care dollars (insurance companies and state/federal aid, step it up!) should be allocated to support making schools sites where “a range of local, non-clinical services support…health and wellbeing.” In addition to nature-based learning design, non-clinical services include things like peer-to-peer interventions and therapy animals (which are arguably nature-based interventions too, especially when they’re sitting outside like this guy…but I digress).

   

   Photo by Ryan Stone on Unsplash

4. Take care of teachers. When teachers are healthy, they create healthier classroom environments which are better for student mental health. So, first, increase teacher pay so they can better take care of themselves. And, simultaneously, implement routine, preventive and palliative nature-based wellness supports for teachers (e.g., hold meetings in garden areas; ensure teacher spaces reflect biophilic design³ by filling them with green plants, nature imagery, indoor water sound features, other nature soundscapes and more; hold walking meetings – especially outdoors). Also, lean into and support (fund!) *both* clinical and non-clinical mental health work being done with educators by rad organizations like The Teaching Well, edwell, and Teach Well and other powerhouse organizations and independent consultants with deep expertise in educator wellness. 

5. Reorient government involvement & resources in schools: Government’s primary involvement in schools needs to be providing resources for student and educator health and wellbeing. This doesn’t mean ignoring standards and accountability to academic achievement; rather it reorients government involvement (and funding) by focusing on Maslow’s hierarchy of needs. Of what use are phonics if students are suicidal? “The School Breakfast Program” is an example of a “Maslow’s approach” — where we fed kids at school when it dawned on us that students can’t learn if they have empty tummies(!). We might ask ourselves: how much learning will happen if students are in trauma?

I am not so naive and myopic myself as to suggest that nature-based learning design will be able to do it all. We do absolutely need clinical mental health support. More social workers. More counselors. More mental health interventions integrated in schools. AND. It’s definitely an AND:

Nature-based learning and other non-clinical wellness interventions should be part of the solution.

Un abrazo fuerte,
Becca 

P.S. Please share this with one person you care about.

1. Nature-based learning is a set of practices for learning outdoors or bringing elements of nature indoors for learning, that can be used in any 🔬📚 content area and any grade level…🌈 by anyone, 🗺️ anywhere, with 🌻 any curriculum/school design model, and 🦋 in service of educational evolution and revolution.

2. 3.6M is the estimated number of public school teachers in the US

3. Biophilic design is “an innovative approach to architecture and design that emphasizes the necessity of maintaining, enhancing, and restoring the beneficial experience of nature in the built environment.” -Stephen Kellert