“By all accounts,” says NYU Silver School of Social Work professor Ramesh Raghavan, “it’s really hard to be a kid in America today.”
While the past five decades have seen numerous strides in population health—deaths from smoking and driving accidents have plummeted, for example—the pattern has not been replicated in mental health outcomes for children and adolescents. In fact, Raghavan notes, a little under half of American youth say they feel persistently sad, one-third say their mental health is poor, and a fifth report seriously contemplating suicide.
Prevention and treatment have failed to reach the most vulnerable, whose conditions can worsen into adulthood if left untreated. And federal, state and local funding for programs and services is uneven and often thin. Raghavan, who worked on child mental health issues in the Obama administration in 2015 and has led several studies on the efficacy of and access to care for children in underserved communities, explains that we’re in the midst of a full-blown crisis. In a new book, Investing in Children’s Mental Health, Raghavan and co-author UCLA health economist Daniel Eisenberg, make the case for a boost in government funding and new policies that support “social vaccines,” which address the health of children’s social ecology and everyday environments. Their book provides what Iceland’s minister of education and children, Ásmundur Einar Daðason, calls a “roadmap” to investments and strategies representing “the most profitable choices that societies can make” to address child mental health.
NYU News talked with Raghavan about the underlying causes of these issues and his recommendations for a way forward.
Given that today’s kids are dealing with the recent COVID pandemic, divisive messages on social media, wars, environmental degradation, I can certainly see why you’ve depicted child mental health as one the most important problems facing the US.
It is! Kids are growing up in a very heightened state of mental vulnerability, clearly. The Surgeon General and the CDC, among others, point to a child mental health crisis, for which there are many complex causes, of course. But the mental health of young people is particularly problematic because problems are showing up at an early age, affecting developing brains in ways not fully understood, and potentially persisting into adulthood. This is why improving youth’s mental health has to be a national priority.
That would have to begin with an increase in government support, right?
While the road to improvement is not solely a function of funding, a lack of funding by local, state and the federal government is a primary reason why we don’t have the kinds of services and supports needed to improve children’s mental health consistently and widely.
Even when we do have the funding in place, we don’t always use that money to fund the best services or practices. Our book highlights several highly effective and cost-effective programs that can help, including a number of home visiting and social-emotional learning programs. Unfortunately, in many instances these proven programs only reach about 5 percent of all children at school or home who need them.
What is also concerning is that kids are receiving services in programs that do not have any basis in evidence of success. Just one example, out of many, is the Drug Abuse Resistance Education, or DARE, in which law enforcement officers visit school classrooms to talk about how to resist high-risk behaviors like using drugs. It continues to be relied upon even though it does not appear to work, according to an NIH study among others.
There’s also a documentary playing on Netflix now, Hell Camp. It follows a program in which they take a group of kids who are acting out—at least one of them is kidnapped from her house in the middle of the night!—and send them to a boot camp in the desert in Utah. There is zero evidence that any of it works. While, to be fair, some of the most egregious programs have been shut down, a lot of non-evidence-based, so-called “treatments” persist.
In comparison, there are a number of tested school-based programs with curricula that have been shown to effectively address the risk of substance abuse and other risks facing younger adolescents. One is called Life Skills Training. Another, Family Matters, is for families in which children and teens exhibit early substance use, coupled with rebelliousness or delinquency.