Karla Reid-Witt: DC’s youth urgently need real investment in mental health support
District children are hurting.
The social isolation from friends, the strain of the pandemic on their families, and the stress of making distance learning work for more than a year have all taken a toll.
DC’s health care providers are reporting big increases in severe cases of depression, anxiety and self-harm incidents among children. Behavioral health-related emergency room visits are up some 24% for children ages 5 to 11 and 31% for 12- to 17-year-olds. Add to this the unreported neglect, abuse and violence some children have experienced while out of school and it is no exaggeration to say our kids are likely to return to school next fall with unprecedented behavioral health needs. A push to get kids back on track academically, while fully necessary, must be balanced with a rush of support for student social-emotional well-being. We must also finally build a full continuum of mental health care for District children.
As a parent, I have seen the holes in the behavioral health system for our city’s children and felt the stinging impact firsthand. The system is opaque and full of dead ends. It is centered on a crisis intervention service model and lacks services for children who need intensive mental health care but do not need to be hospitalized. No DC provider offers partial hospitalization or intensive outpatient mental health services for children, although many provide such services for adults. In order to access intensive outpatient behavioral health services, DC students must travel an hour into Maryland or Virginia, making it almost impossible to receive services while simultaneously attending school. Children who need but cannot access these services experience difficulty with concentration, focus and comprehension; furthermore, they are likely to have poor school attendance and behavioral challenges when they do attend.
Far too often, without the needed level of intervention, children go back into crisis — and the cycle begins again. The DC Council took a positive first step last year by requiring all local schools to have a so-called “home and hospital instruction program” that provides academic instruction and support to students facing absences due to physical health or psychological challenges; however, more must be done.
Students and families need to have experts within schools who can provide guidance when students face mental health challenges. Teachers need experts to support and guide them on techniques of supportive and flexible instruction and necessary accommodations for students with mental health challenges. Black and brown students are more likely to have experienced direct loss from the pandemic; however, they are also far less likely to be identified as needing behavioral health services and to be connected with them.
Currently, we as a society simply do not “see” how anxiety and depression manifest in Black and brown children as clearly as we do in their white peers. Culture impacts the presentation of mental health challenges. Educators need school-based mental health experts who can guide them on how to recognize symptoms as they present and on how to educate students facing mental health challenges. Mental health challenges are not intuitive and are often confusing, confounding and misinterpreted, even by the person experiencing them. Teachers are not mental health experts, and we should not expect them to be.
Fortunately, Mayor Muriel Bowser has pledged to complete the expansion of school-based behavioral health services so that all public schools have these essential supports. The DC Council can fully fund this expansion by adding $841,000 to the mayor’s proposed budget for our growing public education system. Even with these welcome investments, the coming wave of need is likely to overwhelm the school-based system — both in the number of students who need support and the acuity of the challenges those students face.
We will also need the expertise and capacity of our community-based behavioral health providers more than ever. Unfortunately, last year our community providers saw a total cut in DC funding of some $9 million — putting more strain on an already overburdened mental health care system. The availability of federal matching funds means we can return funding to fiscal year 2020 levels with a local investment of just $4 million, less than half of last year’s cut. Given the increased need of our children and adults, however, this should be the floor, not the ceiling, of our city’s investment in community-based providers. In a $17.5 billion budget, doing more should be easily achievable.
The pandemic’s effects on the well-being of District children and families will not be undone in a few weeks, a few months or even a few years. Investments in our city’s mental health infrastructure will need to be sustained. If they are, the whole city will benefit. Building an adequate children’s mental health care system will mean healthier, happier and more successful students, families and communities. The return will be far greater than the investment.
Attorney Karla Reid-Witt is an advocate on children’s mental health and disability issues and is active in many local organizations committed to child well-being. She lives with her family in Ward 7.
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