FACT SHEET: Improving Access and Care for Youth Mental Health and Substance Use Conditions
Even before the pandemic, demand for mental health and substance use services was increasing, especially for our nation's young people. The COVID-19 pandemic has only made the situation more challenging, subjecting many young Americans to social isolation, loss of routines, and traumatic grief. Epidemiological data now show alarming rates of behavioral health needs among school-age youth, with significant increases in the number experiencing moderate to severe anxiety and depression. Even more concerning, suicide remains the second leading cause of death among young people between the ages of 10 and 24. Mental health emergencies among young people have increased across the board. In 2020, there was a 24 percent increase in emergency room visits for mental health reasons for children ages 5 through 11, and a more than a 30 percent increase in visits for those between 12 and 17 years old.
Unfortunately, a significant proportion of our nation's youth still lack access to affordable health care coverage. Even for those with coverage, gaps in access to behavioral health care services remain. Significant disparities also exist for young people of color, Indigenous youth, and LGBTQ+ youth, denying many young people the behavioral health services and supports they need to thrive.
Eliminating these barriers and expanding the full continuum of prevention, treatment, and recovery services, as well as prioritizing integration of these services into settings where young people and their families can access them, are key priorities for the Biden-Harris Administration. This is why, today, on the heels of World Mental Health Day, the Department of Education is announcing a new resource, "Supporting Child and Student Social, Emotional, Behavioral and Mental Health," that outlines key challenges in providing and accessing mental health supports in schools and provides evidence-based recommendations for educators, staff, and providers to create a system of supports for students with behavioral health needs and their families.
The release of this new resource builds on the Administration's emphasis on youth mental health and substance use since taking office, including:
Ensuring Access to Quality, Affordable Health Care
Connecting Children to Coverage. Access to coverage is the first step to improving care for mental health and substance use conditions. Medicaid and the Children's Health Insurance Program (CHIP) serve as critical sources of coverage for children and youth, covering nearly 39 million children nationwide and providing robust coverage for mental health and substance use conditions, including services provided at school. The Biden-Harris Administration is committed to continuing the progress made in children's coverage rates since the enactment of the Affordable Care Act (ACA) by making sure children are connected to coverage. In May, Connecting Kids to Coverage, a national outreach and enrollment initiative that reaches out to families with children and teens eligible for Medicaid and CHIP, launched a campaign with a particular emphasis on mental health. This Administration is also committed to ensuring children, youth, and their families have access to quality and affordable coverage through HealthCare.gov and state-based Marketplaces, quadrupling the number of Navigator organizations available to help young people and their families enroll in coverage through HealthCare.gov, Medicaid and CHIP.
Strengthening Quality of Care. The Biden-Harris Administration is also committed to strengthening the quality of care provided to – and health outcomes of – children enrolled in Medicaid and CHIP. This commitment includes supporting state reporting on a range of quality of care measures that encompass both physical and behavioral health. All measures on the Medicaid and CHIP Child Core Set will become mandatory for states to report starting in 2024.
Investing in Community-based Youth Mental Health and Substance Use Care
Dedicating American Rescue Plan Funds to Youth Mental Health. The American Rescue Plan provided $80 million for the Pediatric Mental Health Care Access program, which promotes integrating care for behavioral health needs into pediatric primary care settings, and directed $20 million to support youth suicide prevention programs to help reduce risks and deliver crisis services. In addition, the American Rescue Plan provides $10 million to support the National Child Traumatic Stress Network, which raises the standard of care and improves access to services for traumatized children, their families, and their communities; $50 million for community-based funding for local behavioral health needs worsened by the pandemic; and $30 million for community-based funding for local substance use services. The American Rescue Plan also invested $420 million in the Certified Community Behavioral Health Clinics (CCBHC) expansion grant program, which increases access to and improves the quality of community mental health and substance use disorder treatment services. CCBHCs provide person- and family-centered integrated services, including 24/7 crisis intervention services for individuals with serious mental illness or substance use disorders, including opioid use disorders; children and adolescents with serious emotional disturbance; and individuals with co-occurring mental and substance disorders.
Enhancing Access to Youth Behavioral Health Services Across the Continuum. The Department of Health and Human Services (HHS) has invested approximately $190 million in supporting initiatives to advance access to behavioral health services for youth. This includes:
- Project LAUNCH (Linking Actions for Unmet Needs in Children's Health): Makes grants to promote the wellness of young children, from birth to 8 years of age, by addressing social, emotional, cognitive, physical, and behavioral aspects of their development.
- The Children's Mental Health Initiative: Improves the mental health outcomes for children and youth, birth through age 21, with serious emotional disturbance, and their families. This program supports the implementation, expansion, and integration of the Systems of Care approach by creating sustainable infrastructure and services that are required as part of the Comprehensive Community Mental Health Services for Children and their Families Program.
- The Infant and Early Childhood Mental Health Grant Program: Improves outcomes for young children by increasing access to high quality infant and early childhood mental health promotion, prevention, early intervention, and treatment services.
- The Native Connections Grant Program: Helps American Indian and Alaska Native communities identify and address the behavioral health needs of Native youth.
- The Statewide Family Network: Supports statewide, nonprofit, family-run organizations supporting families with children with serious emotional disturbance.
- The Youth and Family TREE Grant Program: Enhances and expands comprehensive treatment, early intervention, and recovery support services for adolescents), transitional aged youth, and their families/primary caregivers with SUDs and/or co-occurring substance use and mental disorders.
Preventing Youth Substance Use. In September, the Office of National Drug Control Policy (ONDCP) announced $13.2 million in grants for 106 Drug-Free Communities Support Programs across the country. The grants provide funding to community coalitions working to prevent youth substance use through evidence-based prevention strategies. In June, ONDCP announced $3.2 million for 65 communities nationwide for its Community-Based Coalition Enhancement Grants to Address Local Drug Crises Program to reduce youth use of opioids or methamphetamines and misuse of prescription drugs. All these programs support the Biden-Harris Administration's Drug Policy Priorities for Year One, which include evidence-based efforts to prevent and reduce youth substance use.
Increasing School-Based Behavioral Health Supports
As students have returned to school this fall, supporting their mental health is a top priority for the Biden-Harris Administration. Research shows that students are more likely to receive behavioral health supports if they are offered at school. This summer, the Department of Education launched its Return to School Roadmap, which highlights as one of three landmark priorities supporting students' social, emotional, and mental health needs.
Supporting Student Mental Health with American Rescue Plan Resources. To support our students hit hard by the pandemic, the American Rescue Plan provided $122 billion in relief funds for schools to help them reopen safely and address the mental health, social, emotional, and academic needs of students. The Department has strongly encouraged school districts to use these funds to hire school psychologists, counselors, social workers, nurses and other health professionals to address the behavioral health needs of students and fund other strategies to support students' mental health. States and school districts are using these and previous rounds of relief funding to expand access to services for students and their families. For example:
- The Oklahoma State Department of Education is creating the Oklahoma School Counselor Corps grant program, which will provide funds for school districts to hire school counselors and other school-based mental health professionals.
- The Iowa Department of Education is providing grants to school districts to help them meet mental health needs and provide wraparound services for students and families. In addition, the Iowa Department of Education is partnering with the University of Iowa's Baker Teacher Leader Center to establish a new Center for School Mental Health that will provide training and professional development to both student teachers and practicing teachers.
- The New Hampshire Department of Education has teamed with the Community Behavioral Health Association to use relief funding for mental health training for summer camp counselors and enable mental health staff to be on-site at camps.
- The Arizona Department of Education is investing federal recovery dollars to hire school counselors and social workers.
- The Cleveland Teachers Union and Cleveland Metropolitan School District are working together to increase student access to highly qualified school health professionals. The District has announced plans to hire 50 school nurses and 45 licensed practical nurses for 94 campuses in the 2021-2022 school year.
- The New York City Department of Education plans to hire 500 social workers this year and has already hired more than 90 percent of them. City officials say the infusion of new mental health support staff — which includes school psychologists — will ensure every school has at least one full-time social worker or mental health clinic.
The American Rescue Plan also included $30 million for Project AWARE, an HHS grant program for state and tribal education agencies to advance wellness and resiliency for children and youth in school-based settings. This program funds school-based activities designed to increase awareness of mental health issues among school-aged youth, provide training for school professionals to help them identify and respond to mental health issues, and to connect school-aged youth to services. Project AWARE sites have been established in Indiana, Montana, North Carolina, and Washington, as well as the Saginaw Chippewa Indian Tribe of Michigan, among others.
Creating mental health resources for schools. The Department of Education has provided multiple resources that highlight evidence-based practices to support students' social, emotional, and mental health needs that the American Rescue Plan can fund, including the COVID-19 Handbook, Volume 2: Roadmap to Reopening Safely and Meeting All Students' Needs, the Safer Schools and Campuses Best Practices Clearinghouse, COVID-19 Handbook, Volume 3: Strategies for Safe Operation and Addressing the Impact of COVID-19 on Higher Education Students, Faculty, and Staff; and other guidance. The Department also featured approaches to supporting student mental health in the Lessons from the Field webinar series and the Summer Learning and Enrichment Collaborative, which brought together and supported state, district, and community leaders in using American Rescue Plan funds to implement meaningful summer learning and enrichment opportunities, particularly for students most impacted by the pandemic. In addition, the Department's technical assistance centers—the Comprehensive Centers, the Center to Improve Social and Emotional Learning and Improve School Safety, the Center on Positive Behavioral Interventions and Supports, and the National Center on Safe and Supportive Learning Environments—provide resources and support on addressing trauma and supporting students' mental health. Last week, the Department released a Dear Educator Letter, and, along with the Department of Justice, released a fact sheet and Dear Colleague Letter that provide information on Federal civil rights laws that protect students with mental health disabilities and grant an equal opportunity to learn.
Developing K-12 mental health promotion toolkit. The Centers for Disease Control and Prevention has also funded a project to synthesize the best available research and practice into a toolkit that describes how to develop, implement, evaluate, and sustain a comprehensive, developmentally and culturally appropriate, mental health promotion program in K-12 schools. This guide for K-12 schools will help them identify and prioritize a comprehensive and integrated set of strategies to promote equitable mental health and resilience, and reduce symptoms associated with poor mental health, such as depression and anxiety. The primary end users of this technical package are school district and school-level administrators.
Establishing interagency working group. In addition, the Departments of Health and Human Services and Education have established an interagency working group to improve the delivery of health care services in schools, including mental health and substance use services. The interagency working group will primarily focus on school-based health services reimbursed by Medicaid, and will work to strengthen the interagency coordination for these vital services, and identify more actions the federal government can take to support this work.
Laying the Groundwork for Future Improvements in Youth Mental Health and Substance Use Prevention and Treatment
Engaging Youth in Solution Setting. The Department of Health and Human Services recently announced a collaboration with MTV Entertainment Group to host a Youth Mental Health Forum in early 2022. The forum will focus on inspiring and encouraging young people to take steps to improve their own mental health and to check in on each other.
Enhancing coordination across HHS. In May, HHS formed a new Behavioral Health Coordinating Council (BHCC) to serve as a coordinating body across the Department. One of the five BHCC focus areas includes child and youth behavioral health. Led by the Administration for Children and Families and the Center for Medicare & Medicaid Services, this work will help to drive improvements and integration of child, youth and family-centered behavioral health programs and activities across HHS. Over the coming months, the youth work of the BHCC will include a focus on improving the coordination and access to behavioral health services for children, youth, and parents involved or at risk of entering the child welfare system; ensuring that children and youth are accessing behavioral health services and supports in the most integrated setting possible; and identifying opportunities to support resilience in children and youth affected by trauma and disasters.
Highlighting the Pandemic's Impact on Youth Mental Health. The Office of the U.S. Surgeon General is launching an effort to highlight the pandemic's impact on youth mental health and promote recommendations to support the mental health of young people. In the coming months, this will include convening stakeholders, engaging in school visits, and developing resources to better understand the unique challenges that young people face and ways the federal government can further address these challenges.
FY 2022 Budget. President Biden's FY22 discretionary budget calls for more than doubling the funding to address mental health and substance use. These additional resources would be used to support youth with behavioral health needs and their families, partner mental health providers with law enforcement, expand suicide prevention, and support the hiring of school-based health professionals. This includes:
- $1 billion for a new School-Based Health Professionals program that will help build the pipeline and support the hiring of school counselors, nurses, social workers, and school psychologists, working towards the President's goal to double the number of these staff.
- $443 million for community schools, an increase of more than $400 million, to establish schools that offer wraparound services for students and their families, including supporting mental health, through partnerships with community-based organizations.
- $1.6 billion for the Community Mental Health Service Block Grant, which doubles the funding over the prior fiscal years. This funding serves as a critical safety net for mental health services for the nation's most vulnerable populations, including children with serious emotional disturbances.
- $191.5 million for Project AWARE, an increase of more than $60 million.
- $375 million for Certified Community Based Behavioral Health Centers (CCBHCs) an increase of $125 million over prior years. This funding will support a new cohort of 158 grants and 22 continuation grants, and serve to increase access to and improve the quality of community mental and substance use disorder treatment services, including for children and adolescents with serious emotional disturbance.
- $36.9 million for Youth Suicide Early Intervention and Prevention Strategies, which includes funding to support the Garrett Lee Smith Youth Suicide Prevention Grant programs. These programs deliver critical early intervention and suicide prevention services through State/Tribal grants as well as Campus grants.
- $10 million for the Pediatric Mental Health Care Access Program, which will continue to support the development or improvement of statewide or regional pediatric mental health care telehealth access programs. These programs provide tele-consultations, training, technical assistance and care coordination for pediatric primary care providers to assist their work in managing children with behavioral health conditions.
This is only the beginning. The Biden-Harris Administration will continue its work to improve youth mental health, expanding access to affordable, quality services across the continuum of prevention, treatment, and recovery, and eliminating the stigmatization of those who need help.
For more information, see Fact Sheet: Efforts Across HHS to Promote Behavioral Health for Children and Youth | HHS.gov
Joseph R. Biden, FACT SHEET: Improving Access and Care for Youth Mental Health and Substance Use Conditions Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/352991