[Senate Hearing 117-557]
[From the U.S. Government Publishing Office]
S. Hrg. 117-557
CARING FOR OUR KIDS: SUPPORTING
MENTAL HEALTH IN THE TRANSITION
FROM HIGH SCHOOL TO COLLEGE
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON CHILDREN AND FAMILIES
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
SECOND SESSION
ON
EXAMINING CARING FOR OUR KIDS, FOCUSING ON SUPPORTING MENTAL HEALTH IN
THE TRANSITION FROM HIGH SCHOOL TO COLLEGE
__________
NOVEMBER 30, 2022
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
51-557 PDF WASHINGTON : 2024
COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
PATTY MURRAY, Washington, Chair
BERNIE SANDERS (I), Vermont RICHARD BURR, North Carolina,
ROBERT P. CASEY, JR., Pennsylvania Ranking Member
TAMMY BALDWIN, Wisconsin RAND PAUL, M.D., Kentucky
CHRISTOPHER S. MURPHY, Connecticut SUSAN M. COLLINS, Maine
TIM KAINE, Virginia BILL CASSIDY, M.D., Louisiana
MAGGIE HASSAN, New Hampshire LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota MIKE BRAUN, Indiana
JACKY ROSEN, Nevada ROGER MARSHALL, M.D., Kansas
BEN RAY LUJAN, New Mexico TIM SCOTT, South Carolina
JOHN HICKENLOOPER, Colorado MITT ROMNEY, Utah
TOMMY TUBERVILLE, Alabama
JERRY MORAN, Kansas
Evan T. Schatz, Staff Director
David P. Cleary, Republican Staff Director
John Righter, Deputy Staff Director
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SUBCOMMITTEE ON CHILDREN AND FAMILIES
ROBERT P. CASEY, JR., Pennsylvania, Chairman
BERNIE SANDERS (I), Vermont BILL CASSIDY, M.D., Louisiana
CHRISTOPHER S. MURPHY, Connecticut MITT ROMNEY, Utah
TIM KAINE, Virginia SUSAN M. COLLINS, Maine
MAGGIE HASSAN, New Hampshire LISA MURKOWSKI, Alaska
TINA SMITH, Minnesota JERRY MORAN, Kansas
JOHN HICKENLOOPER, Colorado ROGER MARSHALL, M.D., Kansas
PATTY MURRAY, Washington (ex TOMMY TUBERVILLE, Alabama
officio) RICHARD BURR, North Carolina (ex
officio)
C O N T E N T S
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STATEMENTS
WEDNESDAY, NOVEMBER 30, 2022
Page
Committee Members
Casey, Hon. Robert, Chairman, Subcommittee on Children and
Families, Opening statement.................................... 1
Cassidy, Hon. Bill, Ranking Member, a U.S. Senator from the State
of Louisiana, Opening statement................................ 3
Witnesses
Hoover, Sharon, Ph.D., Professor of Psychiatry and Co-Director of
the National Center for School Mental Health, Univ ersity of
Maryland School of Medicine, Baltimore, MD..................... 6
Prepared statement........................................... 8
Wright, Curtis, Ed.D., Vice President of Student Affairs, Xavier
University of Louisiana, New Orleans, LA....................... 16
Prepared statement........................................... 18
Summary statement............................................ 21
Weiss, Ashley, D.O., M.P.H., Director of Medical Student
Education in Psychiatry, Tulane University School of Medicine,
New Orleans, LA................................................ 23
Prepared statement........................................... 26
Williams, Brooklyn, high school senior and founder of the Chill
Club, Pittsburgh, PA........................................... 28
Prepared statement........................................... 29
ADDITIONAL MATERIAL
Statements, articles, publications, letters, etc.
Casey, Hon. Robert:
Excerpt From the 2020 National Survey on Drug Use and Health. 49
Childrens Hospital Association Statement for the Record...... 67
AAFP Statement for the Record................................ 70
CARING FOR OUR KIDS: SUPPORTING
MENTAL HEALTH IN THE TRANSITION
FROM HIGH SCHOOL TO COLLEGE
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Wednesday, November 30, 2022
U.S. Senate,
Subcommittee on Children and Families,
Committee on Health, Education, Labor, and Pensions,
Washington, DC.
The Subcommittee met, pursuant to notice, at 10:01 a.m., in
room 430, Dirksen Senate Office Building, Hon. Robert Casey,
Chairman of the Subcommittee, presiding.
Present: Senators Casey [presiding], Murphy, Kaine, Hassan,
Smith, Cassidy, Marshall, and Tuberville.
OPENING STATEMENT OF SENATOR CASEY
The Chairman. This hearing will come to order. I want to
thank everyone for being here, especially our witnesses, for
their testimony today and the expertise they bring to bear, as
well as traveling to be with us.
I want to thank Ranking Member Cassidy for his leadership
on these issues, as well as working with us and our two staffs
to arrange this Subcommittee hearing. I don't think it comes as
news to many Americans that our Nation faces a crisis in
adolescent mental health.
At any given time, 1 in 5--1 in 5 adolescents are
experiencing a mental, developmental, or behavioral disorder.
The COVID-19 pandemic placed a heavy burden on young people
struggling with their mental health.
One survey of high school students found that 44 percent
persistently felt sad or hopeless. In addition to that survey,
we know of other surveys that find similar results. We know,
for example, that about half of all people who experience a
mental health condition begin presenting symptoms by the age of
14, making high school a critical intervention point.
The Biden administration and the 117th Congress has
recognized the importance of mental health support in our
schools and have made critical investments in our communities
to this end. It is critical that students, particularly those
with disabilities, feel both academically and emotionally
supported in their schools.
Most schools have some mental health supports in place,
like peer support, one on one counseling, and outside care
referrals. But many students are falling through the cracks. To
reach every student, we need all hands on deck.
That means far more mental health professionals and making
every student, every caregiver, teacher, and school staff
member a part of the solution to teen mental health crisis. In
2021, the average ratio of students to school counselors was
415 to 1, despite a recommended ratio of 250 to 1.
We cannot expect progress in addressing this crisis without
lifting up professionals in such high impact settings. We must
do more to identify and help secondary students in need of
mental health support, especially as they prepare for college.
The transition to college is, of course, both exciting but also
very stressful and a very stressful time for our teens.
Living away from home and an emotional support system for
the first time, it is easy for students to be caught up in
their new life and not get the mental health care that they
need. When students arrive on campus, they may confront new
challenges to adjusting to hectic schedules, making new
friends, and keeping up with academic expectations, which can
compound feelings of stress and despair.
The social isolation of the pandemic left students
unprepared for the social transition to college and less likely
to establish connections with peers and mentors at school.
These forces are compounded for students entering college with
a mental health condition.
Without supports in place, these students care can and
often does lapse just when they need it the most. The task of
navigating a switch to telehealth or finding a new provider in
college largely falls on the students, and if available, their
parents.
Students are left to maneuver the complexities of the
health care system, including insurance coverage. With a
shortage of providers in most areas and many not covered by
insurance, finding an affordable and timely care can be very
onerous.
Data shows that when college students don't get the mental
health care that they need, it can lead to major disruptions in
their education, as unaddressed mental health needs are
associated with poorer academic performance and lower rates of
degree completion.
In a survey conducted in 2021, over 70 percent of
bachelor's and associate degree students who had considered
taking a break from school in the past 6 months said emotional
stress was an important reason.
In order to set students up for success in college, early
identification of mental health needs and ready access to
treatment are, of course, critical. When students move away
from home and transition to college and adult life, continuity
of care and reasonable accommodations help them manage new
stressors and lead--new stressors and lead meaningful,
productive lives.
That kind of support shouldn't be a luxury for students
experiencing mental health conditions, but today,
unfortunately, it is. Families are getting priced out of timely
mental health care and the evaluations needed for mental health
accommodations can cost thousands of dollars out-of-pocket.
Because of gaps in our pediatric mental health care system,
many needs are not being addressed until far too late, if at
all. Accessing timely mental health care that is covered by
insurance shouldn't feel like winning the lottery. It should be
the same as getting care for any other health condition.
That is why Ranking Member Cassidy and I introduced the
Health Care Capacity for Pediatric Mental Health Act, which
would establish grant programs to expand mental health
integration, workforce training, and care capacity among
providers to treat young people.
Senator Cassidy and I also introduced the RISE Act, which
would provide information to students with mental health
disabilities and their families to help them select the right
college and streamline disability documentation requirements so
that the cost of repetitive testing is not a barrier to
reasonable accommodations.
In addition, Senator Portman and I introduced the Investing
in Kids Mental Health Now Act, which would provide guidance to
states on expanding pediatric mental health care capacity, and
a Medicaid payment increase for pediatric behavioral health
services to strengthen the continuum of care for many children.
While we have made strides this Congress to address the
mental health crisis among our youngest Americans, it is clear
that more work needs to be done. When pediatric emergency
departments across the country are overwhelmed with children in
need of mental health care, it is a cry for help.
Young people experiencing mental health challenges need
somewhere to go and get the care they really need in a
supportive environment where they can thrive. So I look forward
to hearing from today's witnesses about how we can expand
mental health support in preparation for and in the transition
to college.
I will now turn to Ranking Member Cassidy for his opening
statement.
OPENING STATEMENT OF SENATOR CASSIDY
Senator Cassidy. Somewhere there is a teenager who will one
day be sitting in that chair, in this chair, and be speaking of
ranking members and chairs and be sitting on the dais, and she
or he is our future leader.
Our obligation to that person is how do we best equip she
or he in order to be the person sitting there are sitting here?
And of course, I hope they are all Republicans, but maybe you
can only hope for so much. And so we have to take that within
the context of what we are currently addressing.
The context which we are currently addressing is that 3
years of COVID have just had their toll upon the mental health
of adolescents and college students. The isolation that
formerly was kind of never there because you were always with
others, under COVID it became so pronounced that those who had
issues could not convey them to others, but rather kept them
within themselves, and we see, if you will, despair.
Now, the studies--the statistics bear out the intuition.
Suicide, third leading cause of death among those 15 to 24 in
2021. Mental health emergency room visits increased 25 percent
in children, 30 percent in teens in 2020. And I go back, this
is more than a statistic, it is our future. So the question is,
how do we care for those teens who are our future?
Now, several people on the dais here, we have worked
together. We need to reauthorize the Mental Health Reform
Reauthorization Act of 2022, which Senator Murphy and I worked
back on in 2016, and we need to reauthorize it. It expired in
September.
There is an urgency here that we need to accomplish. I will
point out, since this law passed, all 50 states now have
wraparound, coordinated specialty care for teens with early
psychosis.
Previewing my question for Dr. Weiss will be, why has the
reach been so limited? When we put this in, we wished to have
those wraparound services so that when the young person has his
first psychotic episode at 16, it is his last psychotic episode
because everything he needs to return him to wholeness is
wrapped around and it becomes a distant memory, but not a life
defining event.
We need to ensure that would occur. We also, as my co-
sponsor of the legislation, Senator Casey spoke out, need to
help with that transition to college from high school. And
again, the Mental Health Reform Reauthorization Act of 2022 can
help achieve this.
Now, we have had success on, aside from the bill I just
talked about, recent success addressing mental health issues.
In response to the Uvalde shooting, there are resources that
are put in that response bill, which are for troubled youth at
risk of suicide, at risk of addiction, of harming others, and
other mental health issues that would be in high schools.
We have increased access to mental health and crisis
intervention services, telemental health and in-school mental
health services. I would just echo what Senator Casey just
said, two bills that we put forward, Health Care Capacity for
Pediatric Mental Health Act, to increase mental health access
outside of hospitals so children can stay at home and don't
miss school.
The RISE Act. A child will get an IEP in a high school,
say, for example, for dyslexia. Then they got to get them
redone when they go to college. The underlying problem leading
to the IEP has not changed.
Why are we putting this obstacle as they transition from
high school to college? Oh, you got to go through it again. If
the condition is not permanent, that can be indicated. But
usually, for example, with dyslexia, the condition is
permanent.
Why do we put obstacles for people to receive the
interventions they need as they are on their pathway to be
filling these halls to be our future leaders. Now, it is so
wonderful you see young people stepping forward.
Ms. Williams, thank you for your example that we will hear
of how you have used grief in your life in order to lead people
your age to mental health wholeness. An example from my own
state, Emma Benoit, who attempted suicide, but after coming out
of that, has used her experience and the kind of the process of
events that led her to that terrible state to help others, to
help her peers avoid it.
That is the way our democracy works, in which it is not
just the folks on this dais helping those younger people who
are our future leaders, but those younger people providing
leadership in and of themselves, so they help prepare
themselves to be our future leader.
With that, I yield.
The Chairman. Thank you, Ranking Member Cassidy. Now we
will turn to our witness introductions. I will provide several
and Ranking Member Cassidy will provide some as well. Our first
witness is Dr. Sharon Hoover.
Dr. Hoover is a licensed clinical psychologist and
professor at the University of Maryland School of Medicine,
Division of Child and Adult Psychiatry. Dr. Hoover is also the
co-director of the National Center for School Mental Health and
the Director of the National Child Traumatic Stress Network's
Center for Safe, Supportive Schools.
We want to thank Dr. Hoover for being here. Maybe hadn't
had to travel as long as some of the others. We are grateful
she could be with us to bring her expertise. For our second and
third witnesses, I will turn to Ranking Member Cassidy.
Senator Cassidy. I get to introduce two people today, two
folks from Louisiana. I will begin with Dr. Curtis Wright. Dr.
Wright is a Vice President for Student Affairs at Xavier
University in New Orleans. He oversees numerous programs
dedicated to improving student life, including education,
wellness, campus safety, and athletics.
Before joining Xavier, Dr. Wright served as the Dean of
Campus Life at Wagner College in New York City, and oversaw
multicultural affairs at New York University, and in residence
education at the University of Arkansas at Little Rock.
Dr. Wright earned his B.A. in Sociology, a Master's of
Education in Adult Education from the University of Arkansas,
and a Doctorate in Higher Education Management from the
University of Pennsylvania. Dr. Wright's experience will allow
him to speak with a wealth of knowledge and experience to us.
Thank you.
Dr. Ashley Weiss. Dr. Weiss is an Associate Professor of
Psychiatry and the Director of Medical Student Education and
Psychiatry at Tulane University School of Medicine. She
received her Bachelor of Science at Loyola University in New
Orleans, and a Master of Public Health at Tulane.
Attended medical school at Lake Erie College of Osteopathic
Medicine in Florida, returned to New Orleans to do a Residency
in Psychiatry and Subspecialty Fellowship in Child and
Adolescent Psychiatry at Tulane.
After developing expertise and caring for the young
person's mental health during her medical training, Dr. Weiss
built the first comprehensive first episode psychosis care
program in New Orleans called Epic NOLA.
She also launched Calm, which is a community education
campaign to increase people in Louisiana's awareness about
emerging psychosis symptoms and available treatment. In my
medical practice, I worked in the same setting as Dr. Weiss,
taking care of the uninsured and the chronically mentally ill.
They would have, I tell you, benefited from your expertise,
Dr. Weiss, so I am grateful that you are here, and we look
forward to hearing how your experience and your education can
improve the support for our youth. Mr. Casey.
The Chairman. Thank you, Ranking Member Cassidy. Our final
witnesses, Ms. Brooklyn Williams. Brooklyn is a high school
senior at Baldwin High School in Pittsburgh, Pennsylvania,
where she has founded the Chill Club, an offshoot of the
Allegheny Health Network's Chill Project.
The Chill Club is an open door mindfulness club aimed at
supporting students coping with the stresses and anxieties of
high school. Brooklyn, we are very pleased to welcome you here
today.
We will turn to our witnesses for their opening statements.
We will begin with Dr. Hoover.
STATEMENT OF SHARON HOOVER, PH.D., PROFESSOR OF PSYCHIATRY AND
CO-DIRECTOR OF THE NATIONAL CENTER FOR SCHOOL MENTAL HEALTH,
UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, BALTIMORE, MD
Dr. Hoover. Good morning, thank you. I want to express my
thanks to you, Chairman Casey, Ranking Member Cassidy, and to
all the Members of the Subcommittee for inviting me here to
speak with you about these important issues, and for your
commitment to the mental health and well-being of our young
people.
Again, my name is Sharon Hoover, and I will be speaking to
you today from my perspective as a Professor of Child and
Adolescent Psychiatry and also the co-Director of the National
Center for School Mental Health and the National Center for
Safe, Supportive Schools, both funded by the U.S. Department of
Health and Human Services.
I also speak to you through my lens as a parent of three
young people, a 9th grader, an 11th grader, and a freshman in
college, so these issues are near and dear to my own heart. We
are all concerned about the growing mental health needs of our
young people.
The good news is that there are many strategies and
effective programs to support and promote youth mental health
and to also support their effective transition from high school
to college. And I hope we can get into some of those programs
today. I am going to share three important ideas with you this
morning.
No. 1, invest early in nurturing environments for families
and schools. We have incontrovertible evidence that the vast
majority of challenges impacting our adolescents and young
adults could be prevented by diminishing, or diminished rather
by creating nurturing environment, starting early, and
continuing into middle school and high school and beyond.
In Dr. Anthony Bacon's book, The Nurture Effect, he details
decades of scientific research into actionable steps to reduce
youth problems and to produce caring--to reduce youth problems
rather, and to produce caring and productive young people.
Just as we were able to reduce the prevalence of smoking
decades ago with a national public health movement, at this
point in time, we need a relentless public health movement to
increase the prevalence of nurturing environments that minimize
toxic conditions and promote pro-social behavior in our young
people.
In the earliest years of children's development, effective
family interventions include things like the incredible years,
nurse family partnerships, the triple-p parenting program,
which exist in many of the states across our Nation but are not
really at full scale as they should be. In elementary years and
beyond, interventions like Family Checkup are helpful to
support parents as they handle some of the common problems of
their children, as they use reinforcement to promote pro-social
behavior, as they monitor their children's behavior and help
set limits, and as they improve family communication and
problem solving.
Students who receive the family checkup program in sixth
grade are much less likely to be depressed, to use substances,
and to actually graduate from high school, and to not be
arrested by the time they are 18.
Schoolwide systems to minimize punitive interactions and to
teach and promote and ritually reinforce pro-social behaviors,
and these include programs like the good behavior game, like
positive behavior interventions and supports, where we have
decades of research, have demonstrated long term positive
impacts on adolescent risk behavior and engagement in college
and career.
First, to optimize the success of our high school and
college students, we must invest in nurturing environments at
every level of their development. No. 2, establish
comprehensive school mental health systems in all schools.
This includes supporting the mental health of all students
in their classrooms through teaching social and emotional
skills and mental health literacy schoolwide, and providing
mental health interventions where they are, in partnership with
families in schools.
Comprehensive school mental health systems not only improve
mental health outcomes for our young people, but they also
have, again, demonstrated success in improving really important
academic indicators like attendance and grades.
In my written testimony, I provide specific examples of
policies to advance mental health in schools, such as
establishing mental health as a state required component of K
through 12 education, like those we see in New York and
Virginia, and requiring health plans to reimburse for mental
health screenings that are conducted on campus.
The Hopeful Futures campaign this year released school
mental health report cards across all 50 states and an
accompanying legislative guide, and this is a great starting
point for policymakers who wish to strengthen school mental
health in their own communities, and it is detailed in my
written testimony.
No. 3, we must equip high school to college transition
skills for all of our students, like self-determination, time
management, emotion regulation, help seeking and navigating
adversity. And again, we have evidence based strategies to do
all of these.
This should begin by middle school and extend into college
and include efforts like self-guided modules to support
emotional health, free well-being screenings at high school and
college campuses, peer to peer mental health education and
support, and texting warm lines where students can report
concerns about themselves or others.
For youth with mental health challenges, we need to provide
tailored transition supports for in-person centered planning.
And two such exemplary programs include the Renew Program which
was developed and studied out of the University of New
Hampshire, and a program called Got Transitioned, developed by
the National Alliance to Advance Adolescent Health.
I want to thank you again for the time to speak. I look
forward to hearing from my fellow panelists and to our further
discussion.
[The prepared statement of Dr. Hoover follows:]
prepared statement of sharon hoover
I want to express my thanks to you, Chairman Casey, and Ranking
Member Cassidy, and to all Members of the Subcommittee, for the
invitation to speak with you today and for your commitment to
supporting the mental health and well-being of our Nation's youth. It
is a privilege to be here with you today to discuss these important
issues.
My name is Sharon Hoover, and I am speaking to you from my
perspective as a Professor of Child and Adolescent Psychiatry at the
University of Maryland School of Medicine. I am the Co-Director of the
National Center for School Mental Health and Director of the National
Center for Safe Supportive Schools, both funded by the US Department of
Health and Human Services. I also speak to you through my lens as a
parent to three teenagers, 9th and 11th graders in high school, and a
freshman in college. So, my remarks are informed by my 25 years of
working with children, adolescents, and their families and schools, and
are also personally meaningful to me as someone who is navigating the
high school and college years of our own children.
Youth Mental Health Needs are Urgent and Rising
We are all concerned about the growing mental health challenges
among our children and adolescents.
This year, U.S. Surgeon General Vivek Murthy as well as some of our
most valued child-serving national institutions including the American
Academy of Pediatrics, the American Academy of Child and Adolescent
Psychiatry, and the Children's Hospital Association have highlighted
the urgency of youth mental health needs. \1\, \2\
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\1\ Office of the Surgeon General. (2021). Protecting Youth Mental
Health: The U.S. Surgeon General's Advisory. U.S. Department of Health
and Human Services. Washington, DC.
\2\ American Academy of Pediatrics. (2021, October 19). AAP-AACAP-
CHA Declaration of a National Emergency in Child and Adolescent Mental
Health. https://www.aap.org/en/advocacy/child-and-adolescent-healthy-
mental-development/aap-aacap-cha-declaration-of-a-national-emergency-
in-child-and-adolescent-mental-health/.
Youth mental health has worsened over the past decade, and this has
only been exacerbated during the pandemic, \3\ with increased rates of
anxiety and depression symptoms and positive suicide risk screens among
youth. \4\, \5\
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\3\ Centers for Disease Control and Prevention. (2020). Youth Risk
Behavior Surveillance Data Summary & Trends Report: 2009-2019. https://
www.cdc.gov/nchhstp/dear-colleague/2020/dcl-102320-YRBS2009-2019-
report.html.
\4\ Mayne, S. L., Hannan, C., Davis, M., Young, J. F., Kelly, M.
K., Powell, M., Dalembert, G., McPeak, K.E., Jenssen, B.P., & Fiks,
A.G., (2021). COVID-19 and adolescent depression and suicide risk
screening outcomes. Pediatrics, 148(3), e2021051507. https://
publications.aap.org/pediatrics/article/148/3/e2021051507/179708/COVID-
19-andAdolescent-Depression-and-Suicide.
\5\ Lantos, J. D., Yeh, H-W., Raza, F., Connelly, M., Goggin, K.,
& Sullivant, S. A. (2022). Suicide risk in adolescents during the
COVID-19 pandemic. Pediatrics, 149(2), e2021053486. https://
publications.aap.org/pediatrics/article/149/2/e2021053486/184349/
Suicide-Risk-inAdolescents-During-the-COVID-19.
Many youth lack the fundamental skills and supports necessary to
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transition from high school to college and career.
The good news is that there are many best practices and strategies
to promote student mental health and successful transition.
As you consider opportunities to promote the well-being of our
youth and set them on a path to successful college and career, I will
share three important ideas for you to consider:
(1) Invest Early in Nurturing Environments in Families and Schools.
Especially in the wake of the pandemic, young people have not had
adequate exposure to well-being promotion. Ask kindergarten and first
grade teachers right now and they will tell you that their students are
not adequately learning and demonstrating the critical social,
emotional, and behavioral skills that will help them to succeed at home
and in school and eventually in career and college. These need to be
taught both at home and in school.
I recognize that we are here today talking about high school and
college students. However, I would argue that the environment of our
youngest learners is what will foster or hinder their ultimate success
at this critical transition. The data would back me up.
We have incontrovertible evidence at our fingertips that the vast
majority of challenges impacting our adolescents and young adults,
those transitioning from high school to college, could be prevented or
diminished by creating nurturing environments starting early and
continuing into middle and high school and beyond.
If I can urge you to add one book to your bookshelf today, it would
be ``The Nurture Effect: How the Science of Human Behavior Can Improve
Our Lives and Our World'' by Dr. Anthony Biglan. \6\ Dr. Biglan is a
Senior Scientist at the Oregon Research Institute and has been
conducting research on the development and prevention of child and
adolescent problem behavior for the past 30 years.
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\6\ Biglan, A. (2015). The nurture effect: How the science of
human behavior can improve our lives and our world. New Harbinger
Publications.
This book distills down decades of scientific research from our
fields of psychology and prevention science into tangible, actionable
steps that policymakers, families, and institutions like schools can
take to reduce youth problems and to produce caring and productive
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young people.
In a nutshell, the research from years of rigorous randomized
trials tells us that all successful interventions make environments
more nurturing in at least three of four ways:
Promoting and reinforcing prosocial behavior
Minimizing socially and biologically toxic
conditions, like poor nutrition and housing insecurity
Monitoring and setting limits on influences and
opportunities to engage in problem behavior
Promoting the mindful, flexible, and pragmatic
pursuit of prosocial values
These interventions can and should be implemented with both
families and schools.
In the earliest years of children's development, effective
interventions include things like Incredible Years, Nurse-Family
Partnerships, and the Triple P Parenting Program. In elementary years
and beyond, interventions like Family Check Up are helpful to support
parents in handling common problems, using reinforcement to promote
positive behavior, monitoring their child's behavior and setting
limits, and improving family communication and problem solving. In a
randomized trial of this program in middle schools in Oregon, the
program significantly increased parents' monitoring and reduced family
conflict. Even more striking is that although this program was
implemented in 6th grade, those young people who received the program
were less likely to use alcohol, tobacco, or marijuana and less likely
to be arrested when they were 18 years old.
Schoolwide systems to minimize coercive and punitive interactions
and to teach, promote, and richly reinforce prosocial behaviors have
demonstrated long-term positive impacts on adolescent risk behavior and
engagement in college and career. When implemented with fidelity, the
promise of programs like Good Behavior Game, Positive Action, and
Positive Behavioral Interventions and Supports to promote prosocial
outcomes in our adolescents and young adults is tremendous.
An ounce of prevention is worth a pound of cure. Every time you
move to invest in downstream interventions, first consider the root
causes and reallocate investment upstream.
(2) Establish Comprehensive School Mental Health Systems in all Schools
Increasingly, schools have comprehensive school mental health
systems, reflecting partnerships between the education and behavioral
health sectors to support a full continuum of mental health supports
and services, from promotion to treatment. \7\ These school-based
mental health supports improve vital academic indicators, including
attendance, grades, and test scores. \8\ Every child deserves to have
this type of mental health support in their school.
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\7\ Hoover, S. A., Lever, N. A., Sachdev, N., Bravo, N., Schlitt,
J. J., Price, O. A., . . . & Cashman, J. (2019). Advancing
Comprehensive School Mental Health Systems: Guidance from the Field.
National Center for School Mental Health, University of Maryland School
of Medicine.
\8\ Kase C, Hoover S, Boyd G, et al: Educational outcomes
associated with school behavioral health interventions: a review of the
literature. J Sch Health 2017; 87:554-562.
Below, I provide specific examples of policies to promote universal
mental health promotion for all students and to expand early
---------------------------------------------------------------------------
identification and intervention services in schools.
Policies to Support Universal Mental Health Promotion and Prevention
Policies
Require the selection of indicators of student mental
health and well-being as a core metric of school performance
under federal education funding, with provisions to assist
schools as they strive to perform well on these indicators.
Indicators may include school climate, student-reported
subjective well-being and distress, and reports of school
connectedness.
Incentivize teaching education programs to include
mental health literacy to improve the capacity of the educator
workforce to: promote mental health of all students in the
classroom, including teaching of social-emotional learning
competencies; identify mental health concerns and link students
to needed supports and services; reduce stigma related to
mental illness; and promote student and family help-seeking.
Establish mental health as a state-required component
of K-12 curricula, with efforts in New York and Virginia as
examples. The federal government could support this state-level
effort by passing a resolution encouraging states to follow
existing state efforts to integrate mental health into
curricula and by providing direct funding for educator training
and ongoing professional development.
Leverage Federal Title I and Title IV funding to
provide universal mental health programming for students,
including social-emotional learning programming. Joint guidance
by the U.S. Department of Education and the U.S. Department of
Health and Human Services could support states as they navigate
these funding mechanisms to support universal mental health in
schools.
Expand federal grants to state and local education
and behavioral health authorities to increase mental health
awareness and promotion in schools. This could include the
expansion of grant programming initiated in recent years by
SAMHSA (e.g., Project AWARE) and the U.S. Department of
Education (School Climate Transformation) that require funded
states to partner with three local jurisdictions to promote
student well-being and mental health training and awareness for
school staff, and then to scale successful efforts statewide.
Policies to Support Early Identification, Intervention, and Treatment
in Schools
Expand existing federal workforce development
programs (e.g., Behavioral Health Workforce Education and
Training Program, National Health Service Corps, Minority
Fellowship Program) to increase the school mental health
workforce. This strategy can also be applied to federal loan
repayment programs by increasing incentives for providers who
choose schools as a service setting.
Expand federal, state, and local funding to ensure
adequate staffing and professional development for student
instructional support personnel, including school
psychologists, school social workers, school counselors and
school nurses. Funding expansion could include increased
investments in Title I of the Every Student Succeeds Act (ESSA)
to provide additional mental health staffing for students
living in poverty and in Title I, Title II, and Title IV of
ESSA and IDEA to increase opportunities for professional
development. State and local investments could include
competitive salary and benefits packages to recruit and retain
school mental health providers and supplementing federal
funding for staffing and professional development.
Strengthen and support funding for mental health
services by investing in school Medicaid programs. Ensure
states and school districts are fully participating in school
Medicaid by modernizing existing guidance for schools to
provide clarity and best practices in school Medicaid,
including those that address mental health prevention and early
intervention.
Require health plans to reimburse for mental health
screenings conducted in schools. Follow guidance from the
American Academy of Pediatrics and the American Academy of
Child and Adolescent Psychiatry to cover universal mental
health screening as a mechanism for improving mental health and
reducing mental illness. Coverage should include screening
conducted during well-child exams in pediatric primary care,
and also extended screening conducted in schools.
Maximize Medicaid, Children's Health Insurance
Program (CHIP) and private reimbursement for school mental
health services, including early identification, intervention,
and treatment. This may include better understanding and
leveraging existing state Medicaid allowances for school mental
health or the initiation of state plan amendments to improve
school mental health coverage. As outlined in the 2019 Joint
Informational Bulletin from The Centers for Medicaid and
Medicare Services (CMS) and SAMHSA, several states already
access Medicaid and other payers, including private insurers,
to cover school and community professionals' delivery of mental
health services in schools. The Centers for Medicaid and
Medicare Services (CMS), the U.S. Department of Education and
the U.S. Department of Health and Human Services could offer
technical assistance to states seeking to improve Medicaid and
other payer coverage of school mental health.
Expand reimbursement and technical assistance for
telemental health services in schools. Given the current
national shortage of mental health specialists, particularly in
rural settings, schools will benefit from access to telemental
health consultation and direct service, facilitated by public
and private insurance coverage and federal- and state-supported
technical assistance.
Implement accountability mechanisms that require the
implementation of high-quality, evidence-based practices that
align with national performance standards for school mental
health. Federal, state, and local investments should shift
their metrics away from counting frequency and duration of
services to measuring the implementation of national best
practices for school mental health care and impacts of school
mental health services provision on psychosocial and academic
outcomes (see www.theSHAPEsystem.com).
The Hopeful Futures Campaign, a coalition of national organizations
committed to ensuring that every student has access to effective and
supportive school mental health care, released this year the first ever
``America's School Mental Health Report Card and Action Center,'' with
individual report cards for all 50 states and the District of Columbia.
These school mental health report cards highlight accomplishments and
provide important action steps to help address the children's mental
health crisis in every state. They serve as a great starting point for
policymakers who want to strengthen school mental health supports and
policies in their communities. I also urge you to review The Hopeful
Futures Campaign School Mental Health Legislative Guide released just a
few weeks ago. \9\ This guide offers exemplar legislation across eight
key dimensions of school mental health (detailed below) and can serve
as a roadmap for states and Federal policymakers to advance school
mental health.
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\9\ Hopeful Futures Campaign. State legislative guide for school
mental health. August 2022. https://hopefulfutures.us/wp-content/
uploads/2022/09/State-Legislative-Guide-for-School-Mental-Health-1.pdf.
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School Mental Health Legislative Guide Recommendations and Examples
1. School Mental Health Professionals--We urge states to meet
nationally recommended ratios for school psychologists, counselors, and
social workers, and to ensure that these providers reflect the
diversity of the students they serve. We also urge you to consider how
to broaden your workforce beyond these specialists to include peer
supports, community health workers, and bachelors level professionals
that can receive a certificate in youth mental health.
Delaware and Arizona both passed bills to implement a process of
reaching national ratios for school counselors and psychologists or
licensed mental health professionals.
Alabama requires each local board of education to establish a
school mental health service coordinator.
2. Teacher and Staff Training--Regular training in mental health,
substance use, and suicide prevention can help educators and staff feel
better equipped to identify warning signs of mental health or substance
use problems, to respond appropriately, and to have knowledge of
available resources and effective interventions. While many states have
training in one or more of these topics, few states specifically
require all three topics.
North Dakota is notable for requiring a minimum of eight hours of
youth behavioral health training every two years for teachers and
staff, and specifying a range of topics, including trauma, resiliency,
suicide prevention, bullying, understanding of the prevalence and
impact of youth behavioral health wellness, behavioral health symptoms
and risks, referral sources and evidenced-based interventions,
strategies to reduce risk factors, and evidence-based behavior
prevention or mitigation techniques.
3. Funding Supports--Sustainable funding for school mental health
services is critical and Medicaid can play an important role, bringing
federal matching funds that help state dollars go further. Multiple
state Medicaid programs cover school mental health services, including
via telehealth, for all Medicaid-enrolled students, but many others
limit coverage to students on an Individualized Education Programs
(IEP). Some states have taken the additional step of ensuring that all
school mental health professionals are eligible to bill under their
state's Medicaid program.
Michigan has taken a further step by also including certified
school psychologists and licensed school social workers as Medicaid-
billable providers.
4. Well-Being Checks--Regular checks of mental wellness can help
identify students and staff who may need support. With high rates of
trauma, anxiety, depression, and other mental health and substance use
challenges, it's important to be able to intervene early and provide
the services and supports.
New Jersey stands out for taking a step in the right direction on
well-being checks. In 2021, New Jersey created a $1 million Mental
Health Screening in Schools Grant Program that provides funds for
schools to administer annual depression screenings for students in
grades 7-12.
Illinois followed suit by recently Establishing the Wellness Checks
in Schools Collaborative for school districts that wish to implement
wellness checks to identify students in grades 7 through 12 who are at
risk of mental health conditions.
5. Healthy School Climate--This involves policies that foster safe,
supportive schools help create a positive learning environment and
foster mental wellness for all students, but especially for LGBTQ
students, students of color, and other highly impacted populations.
As of last year, Arkansas Requires every school district to conduct
a school safety audit every three years, including an audit of the
school climate and culture.
In 2019, Utah passed legislation that Requires creating a model
school climate survey that may be used by a local education agency to
assess stakeholder perception of a school environment.
6. Skills for Life Success--Life skills competencies, such as
developing healthy relationships, responsible decision-making, and
self-management, can help students at every age succeed in school and
life. Washington State has gone the extra mile to support students in
gaining age-appropriate K-12 life skills through multiple statutes.
Many states have taken promising steps by adopting life skills
competencies in K-12 but have yet to establish them in statute. One
example is Arkansas, which offers the G.U.I.D.E. for Life program,
which is designed to help K-12 students develop skills in growth
(manage yourself), understanding (know yourself), interaction (build
relationships), decisions (make responsible choices), and empathy (be
aware of others).
7. Mental Health Education--Mental health education, when well-
implemented and fully integrated into K-12 health education, can
increase awareness and understanding and promote help-seeking behavior.
While many states mention mental health concepts in their health
education, states are increasingly passing legislation to ensure
comprehensive, age-appropriate mental health education in every grade.
New York deserves continued praise for its widely lauded mental
health education law, which requires that all schools' health education
programs include mental health.
Utah just passed legislation that Requires the Huntsman Mental
Health Institute and the State Board of Education to coordinate to
develop a youth mental health curriculum in schools.
I love that Utah was intentional about not only sharing this
curriculum with schools, but also with parents and families and other
youth-serving organizations so that we can all be in this together.
8. School-Family-Community Partnerships--Partnering with and
effectively engaging families, youth, and community stakeholders,
including community-based mental health providers, is vital to
successfully implementing and sustaining a comprehensive school mental
health system.
California established the Children and Youth Behavioral Health
Initiative with multiple requirements, including competitive grants to
support school-linked behavioral health services for children and youth
25 years of age and younger. The bill also requires health insurance
plans to cover mental health and substance use disorder treatment
delivered at schools.Last year, Maryland installed The Consortium on
Coordinated Community Support Partnerships to fund community
partnerships to meet students' behavioral health needs, to ensure
partnerships provide services in a holistic and non-stigmatized manner
and coordinate with youth-serving government agencies, and to develop a
model for expanding school behavioral health services and maximize
Medicaid and private insurance participation.3. Equip Students With
High School-to-College Transition Skills Using Evidence-Based
Strategies
In addition to providing early nurturing environments at home and
in school and installing comprehensive school mental health systems in
every school in the Nation, we can invest in evidence-based programming
to equip our students with transition skills like self-determination,
time management, emotion regulation, and coping with adversity.
This programming can begin in high school and extend into college,
and can be fostered at home and in school, including through self-
guided modules.
Examples of Programs to Support High Schooler Mental Health as They
Prepare for College and Career
Postsecondary Resilience Education Program (PREP) is
designed to help ease the transition to college. In this
course, students master the skills needed to reach their
academic goals. The structure of PREP lets students access the
content in any order and to any depth, so they can focus on the
skills that they would most benefit from mastering.
Student Curriculum on Resilience Education (SCoRE)--
Self-Paced helps students cope with the personal, social, and
academic challenges of college life and prepare for future
success. This online course can be purchased by individual
students or offered by colleges and universities as part of a
counseling program, first-year experience curriculum, wellness
program, or student retention initiative.
The JED Foundation (nonprofit that protects emotional
health and prevents suicide for our nation's teens and young
adults):
Y "Set to Go"--information and resources specific to
the transition from high school to college
Y The Transition of Care Guide, provides a detailed
steps for students and families to take during each
year in high school and in college in order to
transition their care. Major steps outlined: learn the
details of your condition and treatment; discuss,
discover, and define your personal needs to find the
best college for you; manage the transition of care
NAMI Mental Health College Guide (developed in
collaboration with the JED Foundation). Provides guidance about
transition from high school to college focused on relationships
and self-care; self-advocacy, HIPAA & FERPA; mental health,
identity, race; taking care of your mental health; staying
safe.
Guidance from American Academy of Child and
Adolescent Psychiatry Provides guidance for students with
mental health challenges and their families on considerations
for colleges (e.g., mental health supports on the campus,
developing expectations about academic workload etc.)
Examples of Programs to Support College Student Well-Being and Mental
Health
Free mental health screenings. Drexel University's
Recreation Center has a mental health screening kiosk. Students
can complete a private, short mental health screening. At the
end of the screening, students receive information for mental
health resources and supports, if needed. The work is a product
of collaboration between Drexel, the Thomas Scattergood
Foundation, a local grant-making organization; Screening for
Mental Health, Inc., a nonprofit geared toward large-scale
mental health screenings; and the Philadelphia Department of
Behavioral Health and Intellectual disAbility Services.
Developing and fostering resilience. Florida State
University launched an online trauma resilience training tool
developed through the Institute of Family Violence Studies and
their College of Social Work. The Student Resilience Project
developers recognized that many students coming to their
university have experienced ``significant family and community
stress'' and that stress can affect their learning. Florida
State University now requires all incoming freshmen and
transfer students to participate in the training, which
features videos, animations, and TED-talk-style informational
sessions to foster student strengths and coping strategies.
Student Resilience Project: https://strong.fsu.edu/.
Encouraging talking about mental health (personal
challenges and talking with peers).
Y Kognito Program. At least 350 colleges use Kognito's
``HigherEd Mental Health Suite'' that ``prepares
learners to lead real-life conversations around mental
health and suicide prevention that build resilience, a
strong campus culture and strengthens relationships.''
Kognito Mental Health Suite: https://kognito.com/
mental-health-suite/
Texting programs. University of Sioux Falls--one of
the first universities to offer free texting hotline for
students called Text4Hope. Aims to guide students who are
concerned about a peer or about themselves. https://
mentalhealthfoundation.ca/text4hope/
Peer-to-peer approaches.
Y Active Minds is a national organization supporting
mental health awareness and education for young adults.
Hundreds of college campus chapters across the country.
Active Minds changes the conversation about mental
health among adolescents and young adults, reduces
stigma associated with mental health conditions, and
establishes a culture of caring on college and
university campuses. Programs and resources are built
for students, faculty, staff, administrators, and the
broad campus community to ensure long-term change at
the individual, campus community, and policy levels.
Active Minds prioritizes the student voice to ensure a
student-driven and student-focused approach in mental
health promotion. We inspire mental health advocates to
have conversations that have the potential to save
lives. Link to information for specific higher ed
programming here: https://www.activeminds.org/programs/
colleges-universities/
Y UVA Project RISE is a peer counseling service that
was established in 2006 by a small group of Black
students. It is a university-sponsored program that
provides free, one-on-one, confidential services to
enrolled University of Virginia students. Program
directly connected through both the Office of African
American Affairs and to the department of Counseling
and Psychological Services in Elson Student Health More
information here: https://oaaa.virginia.edu/project-
rise
Training/resources for university faculty and staff.
Y University of North Carolina recently trained 900
faculty and staff in Mental Health First Aid--aimed to
provide basic skills to support students with mental
health and substance use challenges
Y Penn State "Red Folder Campaign"--guides faculty,
staff, student leaders, and others who are interacting
with students to recognize, respond effectively to, and
refer Penn State Students in various states of distress
(high, moderate, low)
Rapid access to support.
Let's Talk Programs. Many universities across
the country use "Let's Talk" programs to facilitate
rapid access to support. Let's Talk encourages informal
one-on-one sessions with a university counselor. Many
universities offer tele options.
College orientation. More colleges beginning to share
mental health information with students during orientation
sessions. Approaches to these sessions include traditional
presentations and panel discussions, role plays, short videos,
and student testimonials. Goal of these sessions is for
students to understand how to recognize signs of mental health
challenges, know where to access resources and supports, and
learn how to talk with friends who might be struggling with
their mental health. Example from Northwestern University:
Originally, mental health orientation sessions included
information provided by expert speakers. Based on feedback from
students, orientation organizers shifted to student
testimonials that included narratives of alumni sharing their
mental health challenges and how they received help.
In addition to programming for all students to navigate the high
school-to-college transition, it is important to invest in tailored
supports for students at risk for or with mental health needs. There is
good evidence that providing person-centered planning and transition
support for students with specific health care needs, including mental
health, can significantly improve the probability of a successful
transition to college and career.
As one example, colleagues at the University of New Hampshire
demonstrated the success of the RENEW program to promote college and
career readiness for students with significant emotional and behavioral
disorders.
Similarly, the National Alliance to Advance Adolescent Health
developed the Got Transition program to facilitate the health care
transition of youth with special health care needs from pediatric to
adult health care.
Colleagues at the University of Washington have demonstrated the
success of weaving mental health education and support into a
comprehensive college preparation program that supports vulnerable
youth from middle school through successful college graduation.
I want to express my gratitude to you all for opening up this
important discussion and I look forward to hearing from my fellow
panelists and engaging in discussion with you all.
______
The Chairman. Thank you, Dr. Hoover.
Now we will turn to Dr. Wright.
STATEMENT OF CURTIS WRIGHT, ED.D., VICE PRESIDENT OF STUDENT
AFFAIRS, XAVIER UNIVERSITY OF LOUISIANA, NEW ORLEANS, LA
Dr. Wright. Subcommittee Chair Casey, Subcommittee Ranking
Member Cassidy, and the Members of the Committee on Health,
Education, Labor, and Pensions Subcommittee on Children and
Families, thank you for the opportunity to testify today.
It is an honor and privilege to sit before you this morning
as the Vice President for Student Affairs and Interim Vice
President for Enrollment Management at Xavier University of
Louisiana, the Nation's only Black and Catholic institution of
higher education.
I was asked to testify this morning to address the
importance of strengthening the continuum of mental health
support for all adolescents, particularly in the years leading
up to and during the transition to college. I will do that, and
of course, I will also offer a particular lens which allows me
to address the issues confronted by those students who choose
to matriculate at HBCUs.
Chairman Casey, most students who entered Xavier University
in August have never known a world without Facebook or war.
While I learned how to exit the building in a single file line
in preparation for a potential fire, my students have learned
how to run, hide, or fight their ways out of an active shooter
situation.
They are all too familiar with social, political, and
racial unrest in this country, and they have probably
participated in more marches or rallies than most of us in this
room. They have lived through global economic recessions that
resulted in family members losing their jobs, homes, and
overall financial instability.
They are also still in the midst of a global pandemic that
caused the entire world to stand still and reimagine what
normal looks like. Some of these young people lost multiple
family members due to COVID related illness, in part because
they lacked access to affordable health care, and also had
family members whose primary source of income meant their
status as a front line worker was non-negotiable.
Our students were well acquainted with loss long before the
pandemic as they routinely attended candlelight vigils,
memorials, and funerals for friends who died due to gun
violence, drug addiction, and suicide. What our student at
Xavier experience mirrors what their peers across the country
are experiencing.
The prevalence of anxiety and depression is rising across
the Nation, particularly among young people. College students
of all ages are more distressed than ever before, and
increasing shares are enrolling with mental health histories in
terms of diagnosis, treatment, and medication.
Institutions like Xavier are challenged to recreate systems
of care and support to meet the growing needs of a very
different student body. While students and their lived
experiences they bring to campus have changed, the funds who
take care of them have not.
The number of students seeking help at campus counseling
centers have increased almost 40 percent between 2009 and 2015
and continued to rise until the pandemic began. This is
according to data from Penn State University's Center for
Collegiate Mental Health.
We, like so many of our peers, know that we can't do it
alone and are developing strategic relationships with our K
through 12 partners and our parent community. Access to health
care, specifically mental health care, is not always readily
available to students who come from rural areas, inner cities,
or economically depressed communities.
Most colleges and universities were the direct beneficiary
of the CARES Act, the HERF II of the Consolidated
Appropriations Act of 2021, and HERF III authorized by the
American Rescue Plan. These critical legislative lifelines
allow us to maintain university life for our students
throughout the pandemic.
The HBCU bond thrust of 2022 have altered the higher
educational landscape for every single student studying at
historically Black college to better their lives. For this
specific set of institutions, not only to be singled out and
threatened repeatedly, have caused our students untold mental
anguish and stress.
Although the prosecution of those who maliciously caused
the situation is a law enforcement issue, the impact on our
students is not. Specific mental health focus should be
directed to us as the sole recipients of these threats.
Senator Casey, over 20 years ago, a mentor asked me if I
knew the difference between a high school senior and a college
freshman. After often what I considered to be these profound
responses, she replied without emotion, 3 months.
For incoming students, 3 months is the only thing for
separate high school from college. Yet we believe that these
students should arrive on campus fully prepared to not only
make adult decisions, but more importantly, to live within
those adult consequences. It is our responsibility to help them
navigate the contested intersections of university life.
While the landscape as it relates to mental health with
young people can appear bleak, I like my fellow Arkansan
President William Jefferson Clinton still believe in a place
called hope. I am hopeful because of the resilience of our
students and the generation from which they have come.
However, for them to achieve success, we must dismantle our
outdated systems that were not designed for their success. So,
Mr. Chairman, I want to leave you with some recommendations.
First, similar to the guidance offered by the Office of
Civil Rights related to Title IX, the Department of Education
should consider offering guidance on mental health first aid to
support educators and administrators for all K through 16
institutions which receive Federal funding.
No. 2, the Department of Education should extend the
funding period for HERF I, II, and III, as well as the HBCU,
TCU, and MSI set aside funding until August 31st, 2026. HELP
must push the Senate to red line House Resolution 6893, IGNITE
HBCU and MSI Act to improve HBCU facilities in response to the
HBCU bomb threats and increase the sense of security on our
campuses.
No. 4, financial stress is one of the most prevalent causes
of anxiety for students entering college across the country.
Congress should continue to advance common sense legislation to
reduce the costs of higher education and support President
Biden's plan to address college debt through limited student
loan forgiveness.
Last, Congress should follow the lead of Senator Casey and
the distinguished gentleman from the great State of Louisiana
to Senator Cassidy and pass the Health Care Capacity Act for
Pediatric Mental Health and the RISE Act. It has been an honor
to present this testimony, and I thank the Committee for
addressing this important issue.
As a leader in higher education, I know the benefits of
early screening, the impact of developing coping strategies,
and the importance of empowering families to train their
children to become problem solvers.
We must address this mental health concern of our youth as
the stakes have never been higher and our collective work
should be a priority for every American. I am grateful to the
Committee for leaning into this very difficult conversation,
and Xavier University of Louisiana stands ready to serve as a
resource and Committee partner.
For more information and details regarding my remarks, I
ask that you read my written testimony for support for your
review.
[The prepared statement of Dr. Wright follows:]
prepared statement of curtis wright
Introduction
Subcommittee Chairman Casey, Subcommittee Ranking Member Cassidy,
Committee Chair Murray, Ranking Member Burr, and Members of the U.S.
Senate Committee on Health, Education, Labor, and Pension's
Subcommittee on Children and Families, thank you for the opportunity to
testify today.
It is an honor and privilege to sit before you this morning as the
Vice President for Student Affairs and Interim Vice President for
Enrollment Management at Xavier University of Louisiana. Xavier was
founded by Saint Katharine Drexel of the sisters of the Blessed
Sacrament and is the only institution of higher education in the
country that is both Catholic and a historically Black college or
university (HBCU).
Xavier's mission since 1925, in part, has been to contribute to the
promotion of a more just and humane society by preparing our students
to assume roles of leadership and service in a global society. We do
this by cultivating a diverse learning and teaching environment that
incorporates all relevant educational means--including research and
community service. Our students can engage in a world class practical
liberal arts curriculum while living out the mission of our university.
Before the Committee today, I will address the importance of
strengthening the continuum of mental health support for all
adolescents, particularly in the years leading up to and during the
transition from high school to college. I will also address unique
challenges of students who are first generation college students,
students who come from lower socio-economic backgrounds, and those who
are attending HBCUs.
Chairman Casey, most students who entered Xavier University of
Louisiana in August, have never known a world without Facebook or war.
While I learned how to exit the building in a single file line in
preparation for a potential fire, my students have learned how to
``run, hide or fight'' their way out of an active shooter situation.
They are all too familiar with social, political and racial unrest in
this country, and they have probably participated in more marches or
rallies than most of us in this room. They have lived through global
economic recessions that resulted in some family members losing their
jobs, homes and overall financial instability. They are also emerging
from a global pandemic that caused the entire world to stand still and
reimagine what normal looks like. These young people have lost multiple
family members due to COVID related illnesses, in part, because they
lacked access to affordable healthcare. Additionally, for the student
population we serve, the vast majority of their parents were front line
workers, and because of that the members of their households have been
more exposed to the coronavirus pandemic . Whether they are from Staten
Island, Chicago or New Orleans, these students were well acquainted
with loss, long before the pandemic as they routinely attended
candlelight vigils, memorials, and funerals for friends who died due to
gun violence, drug addiction, or suicide.
We, like so many of our peers, know that we cannot confront our
students mental health challenges alone, and we are developing
strategic relationships with our K-12 partners and our parent
community. We have learned that the habits of self-care that our
students bring with them are informed, in part, by their environment.
Access to healthcare, specifically mental healthcare, is not always
readily available to students who come from rural areas, inner cities
or economically depressed communities. Most colleges and universities
are the direct beneficiaries of the Coronavirus Aid, Recovery, and
Economic Security (CARES) Act, Public Law 116-136; the Consolidated
Appropriations Act of 2021 and its Higher Education Emergency Relief
Fund II (HEERF II), Public Law 116-260; and the HEERF III which was
authorized by the American Rescue Plan (ARP), Public Law 117-2. These
critical legislative lifelines allowed colleges and universities, like
ours, to maintain university life for our students throughout the
pandemic. In fact, at Xavier, we were able to expand the reach of our
Counseling and Wellness office by adding additional therapists,
offering enhanced services and training our community on mental health
first aid. In addition to the HEERF funding received by almost every
college and university, the specific funding allotted only to HBCUs,
Tribal Colleges and Universities (TCUs), and Minority Serving
Institutions (MSIs) has been instrumental in the accomplishments above.
We are acutely aware that the provisions of three pieces of legislation
have an expiration date and are working alongside community partners to
identify other resources that may fill the gaps that will be left as
the funding sunsets. However, we would like the Senate HELP Committee
to consider passing an extension of the funding through August 31,
2026.
Mental Health on College Campuses
What our students at Xavier experience mirrors, what their peers
are experiencing across the country, even though there are some real,
unique, and necessary to mention experiences recently at HBCUs. In a
2022 Chronicle of Higher Education article entitled, ``Overwhelmed: The
real campus mental-health crisis and new models for well-being'',
Researchers suggests the following:
The prevalence of anxiety and depression is rising across the
country, particularly among young people. College students of
all ages are more distressed than ever before, and increasing
shares are enrolling with mental-health histories, in terms of
diagnoses, treatment, and medication.'' Institutions like
Xavier University are challenged to recreate systems of care
and support to meet the growing needs of a very different
student body.
According to data cited in a 2022 article in the Journal of
Affective Disorders, ``By nearly every metric, student mental health is
worsening.'' During the 2020-2021 school year, more than 60 percent of
college students met the criteria for at least one mental health
problem, according to the Healthy Minds Study, which collects data from
373 campuses nationwide (Lipson, S. K., et al., Journal of Affective
Disorders, Vol. 306, 2022). In another national survey, almost three
quarters of students reported moderate or severe psychological distress
(National College Health Assessment, American College Health
Association, 2021). While students and the lived experiences they bring
to campus have evolved and changed, the funding to take good care of
those students has not although the demands for that funding have
increased dramatically.
Penn State's Center for Collegiate Mental Health shared, ``That
rising demand (for mental health care) hasn't been matched by a
corresponding rise in funding, which has led to higher caseloads.''
nationwide, the average annual caseload for a typical full-time college
counselor is about 120 students, with some centers averaging more than
300 students per counselor (CCMH Annual Report, 2021). The number of
students seeking help at campus counseling centers increased almost 40
percent between 2009 and 2015 and continued to rise until the pandemic
began, this is according to data from Penn State University's Center
for Collegiate Mental Health (CCMH), a research-practice network of
more than 700 college and university counseling centers (CCMH Annual
Report, 2015).
The Xavier University Community Response
At Xavier University of Louisiana, and institutions like us, we are
working across the campus to address the growing mental health
challenges of our students. At Xavier specifically, we have expanded
the reach of our Counseling and Wellness office by using HEERF funding
to add additional therapists and mental health counselors. Relatedly we
expanded offerings around campus to empower students with the tools to
address commonly known stressors, which include:
Mindfulness and Meditation
Time Management/Study Skills/Financial Literacy
Workshops
Creating Virtual Parent Communities
Enhanced Fitness and Wellness Options
Recognizing the need to deepen the pool of individuals prepared to
respond in emergency situations, we engage in Mental Health First Aid
training. These workshops provide student leaders, faculty, and staff
with basic skills in identifying mental health concerns and connected
them with resources to support students before a crisis arises.
One of the major projects introduced at Xavier University is the
``Take A Minute RU Ok'' campaign. Guided by the notions of connection,
commitment and community, students, faculty and staff are encouraged to
engage in intentional self-care. Through workshops, social media and
random acts of kindness, the community is routinely exposed to
information about how to connect to something outside of themselves,
challenged to follow-through on commitments, and invited to be involved
in a community that cares.
Our unfinished work requires us to build alliances with faith
communities, K-12 partners, and community groups, to share resources.
We know that our students come to us from communities that have not
always placed value on asking for help. Central to our efforts will be
exposing our students and families to resources in their communities
along with the need to reduce the stigma attached to accessing mental
healthcare. We are heartened by the work that lies ahead.
HBCU Bomb Threats
The HBCU bomb threats of 2022 have altered the higher education
landscape for every student studying at an historically Black college
to better their life. For this specific set of institutions, only, to
be singled out and threatened repeatedly has caused our students--Black
students already who have likely overcome significant societal
pressures to find themselves on the verge of a life changing degree--
untold mental anguish and stress. Although the prosecution of those who
maliciously caused this situation is a law enforcement issue, the
impact on our students is not. Specific mental health focus should be
directed to us as the sole recipients of these threats. The Commerce,
Justice, and Science (CJS) Appropriations bill for fiscal year 2023
should have language that guides the funding for National Joint
Terrorism Task Force's ability to harden campuses specifically to HBCUs
instead of generally extending the funds to states who do not report
back to Congress which institutions receive it and likely award the
funding to their ``flagship institutions.'' Additionally, the Senate
HELP Committee must pass the IGNITE HBCU and MSI Excellence Act (H.R.
6893) to improve HBCU facilities, harden the campuses to reduce the
likelihood of these kinds of threats, and allow the cyber-related
infrastructure to be strengthened enough to track these threats when
they occur.
Commonsense Solutions
As it relates to mental health and our young people, the national
landscape can appear bleak. However, I have much in common with my
fellow Arkansan, President William Jefferson Clinton: I still believe
in a place called Hope. I'm hopeful because of the resilience of our
students and their generation. For them to achieve success, we must
dismantle outdated systems that were not designed for their success.
So, Chairman Casey and Ranking Member Cassidy, I want to leave you with
some recommendations:
Similar to guidance offered by the Office of Civil
Rights related to Title IX, the Department of Education should
consider offering guidance on mental health first aid to
support educators and administrators for all K-16 institutions
which receive Federal funding.
The Department of Education should consider extending
the funding period for the HEERF I, II, and III as well as the
HBCU, TCU, and MSI set aside funding until August 31, 2026,
which will allow colleges and universities to continue to
provide uninterrupted coordinated care to our students as they
transition to campus.
HELP must push the Senate to ``redline'' H.R. 6893,
the IGNITE HBCU and MSI Act to improve HBCU facilities in
response the HBCU bomb threats and increase a sense of security
on the campuses. The fiscal year 2023 CJS Appropriations bill
must also include guiding language to direct funding to HBCUs
to harden their campuses in response to the HBCU bomb threats.
Financial stress is one the of most prevalent causes
of anxiety for students entering college across the country.
Congress should continue to advance common-sense legislation to
reduce the costs of higher education and support President
Biden's plan to address college debt through limited student
loan forgiveness.
As previously mentioned, students arrive on campus
with few coping skills as well as co-morbidities that impact
their academic success. Earlier intervention would provide
those students with the strategies and resources that they
could equip them with tools for success. With that being said,
Congress should follow the lead of Senators Casey and Cassidy
and pass S. 4472 the Health Care Capacity for Pediatric Mental
Health Act and S. 2550, the RISE Act.
Conclusion
It has been an honor to present this testimony. I thank the
Committee for addressing this important issue. As a leader in higher
education, I know the benefits of early screening, the impact of
developing coping strategies, and the importance of empowering families
to train their children to become problem solvers. We must address the
mental health concerns of our youth as the stakes have never been
higher and our collective work should be a priority of every American.
I'm grateful to the Committee for leaning into this very difficult
conversation and Xavier University of Louisiana stands ready to serve
as a resource and community partner.
______
[summary statement of curtis wright]
Subcommittee Chairman Casey, Subcommittee Ranking Member Cassidy,
Chair Murray, Ranking Member Burr, and Members of the U.S. Senate
Committee on Health, Education, Labor, and Pension's (HELP)
Subcommittee on Children and Families, thank you for the opportunity to
testify today.
It is an honor and privilege to sit before you this morning as the
Vice President for Student Affairs and Interim Vice President for
Enrollment Management at Xavier University of Louisiana. Xavier was
founded by Saint Katharine Drexel of the sisters of the Blessed
Sacrament and is the only institution of higher education in the
country that is both Catholic and a historically Black college or
university (HBCU).
Xavier's mission since 1925, in part, has been to contribute to the
promotion of a more just and humane society by preparing our students
to assume roles of leadership and service in a global society. We do
this by cultivating a diverse learning and teaching environment that
incorporates all relevant educational means--including research and
community service. Our students can engage in a world class practical
liberal arts curriculum while living out the mission of our university.
I was asked to testify before the Committee today to address the
importance of strengthening the continuum of mental health support for
all adolescents, particularly in the years leading up to and during the
transition from high school to college. I will do that, and of course I
will also offer a particular lens which allows me to address the issues
confronted by African Americans and those choosing to matriculate at
HBCUs.
Chairman Casey, most students who entered Xavier University of
Louisiana in August, have never known a world without Facebook or war.
While I learned how to exit the building in a single file line in
preparation for a potential fire, my students have learned how to
``run, hide or fight'' their way out of an active shooter situation.
They are all too familiar with social, political and racial unrest in
this country, and they have probably participated in more marches or
rallies than most of us in this room. They have lived through global
economic recessions that resulted in some family members losing their
jobs, homes and overall financial instability. They are also still in
the midst of a global pandemic that caused the entire world to stand
still and reimagine what normal looks like. Some of these young people
lost multiple family members due to COVID related illnesses, in part,
because they lacked access to affordable healthcare and, also, had
family members whose primary source of income meant their status as
front line workers was non-negotiable. Whether they are from Staten
Island, Chicago or New Orleans, they were well acquainted with loss,
long before the pandemic as they routinely attended candlelight vigils,
memorials and funerals for friends who died due to gun violence, drug
addiction, or suicide.
What our students at Xavier experience mirrors what their peers are
experiencing across the country. In a 2022 Chronicle of Higher
Education article entitled, ``Overwhelmed: The real campus mental-
health crisis and new models for well-being'', researchers suggest:
The prevalence of anxiety and depression is rising across the
country, particularly among young people. College students of
all ages are more distressed than ever before, and increasing
shares are enrolling with mental-health histories, in terms of
diagnoses, treatment, and medication.'' Institutions like
Xavier University are challenged to recreate systems of care
and support to meet the growing needs of a very different
student body.
According to data cited in a 2022 article in the Journal of
Affective Disorders, ``By nearly every metric, student mental health is
worsening.'' During the 2020--2021 academic year, more than 60 percent
of college students met the criteria for at least one mental health
problem, according to the Healthy Minds Study, which collects data from
373 campuses nationwide (Lipson, S. K., et al., Journal of Affective
Disorders, Vol. 306, 2022). In another national survey, almost three
quarters of students reported moderate or severe psychological distress
(National College Health Assessment, American College Health
Association, 2021). While students and the lived experiences they bring
to campus have evolved and changed, the funding to take good care of
those students has not although the demands for that funding have
increased dramatically.
Penn State's Center for Collegiate Mental Health shared, ``That
rising demand (for mental health care) hasn't been matched by a
corresponding rise in funding, which has led to higher caseloads.''
nationwide, the average annual caseload for a typical full-time college
counselor is about 120 students, with some centers averaging more than
300 students per counselor (CCMH Annual Report, 2021). The number of
students seeking help at campus counseling centers increased almost 40
percent between 2009 and 2015 and continued to rise until the pandemic
began, this is according to data from Penn State University's Center
for Collegiate Mental Health (CCMH), a research-practice network of
more than 700 college and university counseling centers (CCMH Annual
Report, 2015).
We, like so many of our peers, know that we can't do it alone and
are developing strategic relationships with our K-12 partners and our
parent community. We've learned that the habits of self-care that our
students bring with them are informed, in part, by their environment.
Access to healthcare, specifically mental healthcare, is not always
readily available to students who come from rural areas, inner cities
or economically depressed communities. Most colleges and universities
are the direct beneficiaries of the Coronavirus Aid, Recovery, and
Economic Security (CARES) Act, Public Law 116-136; the Higher Education
Emergency Relief Fund (HERF II) of the Consolidated Appropriations Act
of 2021, Public Law 116-260; and the HEERF III authorized by the
American Rescue Plan (ARP), Public Law 117-2. These critical
legislative lifelines allowed colleges and universities to maintain
university life for our students throughout the pandemic. In fact, at
Xavier, we were able to expand the reach of our Counseling and Wellness
office by adding additional therapists, offering enhanced services and
training our community on mental health first aid. The traditional
HEERF funding along with the funding allotted specifically to HBCUS,
Tribal Colleges and Universities, and Minority Serving Institutions
(MSI) were used to increase these services. We are acutely aware that
these funding sources have an expiration date, and while we are working
alongside community partners to identify other resources that may fill
the gaps that will be left as the funding sunsets, one of our asks
today is that sunset deadline be extended through at least August 31,
2026.
The HBCU bomb threats of 2022 have altered the higher education
landscape for every student studying at an historically Black college
to better their life. For this specific set of institutions, only, to
be singled out and threatened repeatedly has caused our students--Black
students already who have likely overcome significant societal
pressures to find themselves on the verge of a life changing degree--
untold mental anguish and stress. Although the prosecution of those who
maliciously caused this situation is a law enforcement issue, the
impact on our students is not. Specific mental health focus should be
directed to us as the sole recipients of these threats. The Commerce,
Justice, and Science (CJS) Appropriations bill for fiscal year 2023
should have language that guides the funding for National Joint
Terrorism Task Force's ability to harden campuses specifically to HBCUs
instead of generally extending the funds to states who do not report
back to Congress which institutions receive it and likely award the
funding to their ``flagship institutions.'' Additionally, the Senate
HELP Committee must pass the IGNITE HBCU and MSI Excellence Act (H.R.
6893) to improve HBCU facilities, harden the campuses to reduce the
likelihood of these kinds of threats, and allow the cyber-related
infrastructure to be strengthened enough to track these threats when
they occur.
While the national landscape as it relates to mental health with
young people can appear bleak, I like my fellow Arkansan, President
William Jefferson Clinton, still believe in a place called Hope. I'm
hopeful because of the resilience of our students and the generation
from which they come. However, for them to achieve success, we must
dismantle outdated systems that were not designed for their success.
So, Madam Chair, I want to leave you with some recommendations:
Similar to guidance offered by the Office of Civil
Rights related to Title IX, the Department of Education should
consider offering guidance on mental health first aid to
support educators and administrators for all K-16 institutions
which receive Federal funding.
The Department of Education should consider extending
the funding period for the HEERF I, II, and III as well as the
HBCU, TCU, and MSI set aside funding until August 31, 2026,
which will allow colleges and universities to continue to
provide uninterrupted coordinated care to our students as they
transition to campus.
HELP must push the Senate to ``redline'' H.R. 6893,
the IGNITE HBCU and MSI Act to improve HBCU facilities in
response the HBCU bomb threats and increase a sense of security
on the campuses. The fiscal year 2023 CJS Appropriations bill
must also include guiding language to direct funding to HBCUs
to harden their campuses in response to the HBCU bomb threats.
Financial stress is one the of most prevalent causes
of anxiety for students entering college across the country.
Congress should continue to advance common-sense legislation to
reduce the costs of higher education and support President
Biden's plan to address college debt through limited student
loan forgiveness.
As previously mentioned, students arrive on campus
with few coping skills as well as co-morbidities that impact
their academic success. Earlier intervention would provide
those students with the strategies and resources that they
could equip them with tools for success. With that being said,
Congress should follow the lead of Senators Casey and Cassidy
and pass S. 4472 the Health Care Capacity for Pediatric Mental
Health Act and S. 2550, the RISE Act.
For more information and details regarding my remarks, I ask that
you read my written testimony submitted for your review.
______
The Chairman. Dr. Wright, thanks very much for your
testimony.
Dr. Weiss.
STATEMENT OF ASHLEY WEISS, DO, MPH, DIRECTOR OF MEDICAL STUDENT
EDUCATION IN PSYCHIATRY, TULANE UNIVERSITY SCHOOL OF MEDICINE,
NEW ORLEANS, LA
Dr. Weiss. Thank you for having me here, Chairman Casey,
and Ranking Member, Dr. Cassidy, and the rest of the Committee.
Again, my name is Ashley Weiss. I am a Child and Adolescent
Psychiatrist at Tulane School of Medicine in New Orleans,
Louisiana. I specialize in first episode psychosis. Psychosis
is a symptom typically associated with the onset of
schizophrenia and bipolar disorder.
These illnesses can have devastating consequences, from the
increased risk of cardiovascular disease and premature death,
to the ramifications of being chronically marginalized by
society. Why am I bringing up illnesses like schizophrenia in a
hearing about mental health and high school and college
students? It is because this is where they start, in our young
people and not by any fault of their own.
Adolescence is a time of incredible brain maturation, and
for some, this maturing process goes awry, leading to the
emergence of severe psychiatric disorders. These illnesses
don't discriminate. They were present pre-COVID, and they are
still present now with a little bit of a different context.
Globally, these illnesses lead to the greatest costs, both
directly and indirectly. So what is psychosis? Psychosis can be
described as a loss of touch with reality. Examples of
psychosis symptoms are hallucinations, confusion, and
delusions.
These experiences start small, like mishearing sounds as
voices or beginning to feel as if people are watching you. This
paranoid feeling could turn into a belief, a delusion, where
one is convinced the world is literally out to get them. And it
is difficult but very necessary to imagine what this might feel
like for a young person.
Some facts about psychosis. 3 out of 100 people will
experience psychosis in their lifetimes, mostly occurring for
the first time between ages 16 and 25. For every one person
experiencing psychosis, six other friends or family are
directly impacted.
In the U.S., the average time one experiences psychosis
prior to treatment is 72 weeks, not days, weeks. 1 in 10 will
attempt or complete suicide with the highest risk being after
the first episode.
To give these statistics a local context, George Washington
University enrollment is about 26,000 students, which means
almost 800 will experience psychosis annually and will not
receive appropriate care for over a year.
Over 4,500 friends and family are impacted. Nearly 80 will
attempt or complete suicide. So there is a sense of urgency
because time is not on our side. The impact of the brain can be
deteriorating.
The last three decades of research show that specialized
intervention as early as possible after psychosis onset
improves outcomes across the board. There is no time to wait.
The same philosophy is already accepted in stroke intervention
and should be accepted in psychosis intervention as well.
In 2015, I started the Early Psychosis Intervention Clinic
in New Orleans. We have treated nearly 100--nearly 1,000 people
since we opened our doors. Our multidisciplinary team provides
coordinated specialty care, including medication management
from psychiatrists, individual family, and group therapy, and
wellness coaching.
All treatment is deeply individualized, with the goal of
getting young people back on track, and that often means back
to school or graduating or to their first job. But what we do
in the clinic is not enough. Because of the need for early
treatment in psychosis, we are forced to think about early
detection.
We have a robust early detection campaign called Calm,
which was mentioned, and this aims to educate the community
about psychosis, debunk myths, reduce stigma so hopefully
people will feel comfortable and safe coming forward for
treatment.
Our goal is that an individual comes forth on their own and
they don't have to wait for someone else to bring them in, and
they certainly don't have to wait for the police to pick them
up having an acute psychosis and take them to the emergency
room.
There are significant challenges and barriers that must be
considered. For most people, recovery can take many, many
months, but time continues to pass for everyone else in their
lives. Their friends have often moved on, graduated, moved away
to college, or started their first job. They often feel
misunderstood, ashamed, quickly leading to the loss of
confidence and increased isolation.
There is a conspicuous gap in school based recognition of
these needs for these individuals and keeping them engaged or
even welcoming them back after their recovery. I have multiple
college students in my program.
Students in every college in Louisiana, actually, which
makes me very proud, who didn't even know that they were
eligible for retroactive medical leave that would erase
incompletes from their transcripts, who have crushing student
loan debt from the semesters that they became ill. We are often
the first place to provide guidance in how to approach these
issues. There are financial threats to programs like ours.
Although our program is committed to long term care, most
programs like ours don't go beyond two to 3 years. We are now
realizing that people lose their gains when they lose
specialized care. But how do we pay for continued care?
We have subsidized our growth through the Congressional
legislation mandating a portion of the SAMHSA block grant be
set aside for early, severe mental illness. We appreciate this
opportunity because it covers the necessary care that is not
covered by insurances.
In our State of Louisiana, Medicaid and commercial insurers
do not reimburse any of the coordination of care that is
required to provide this model. No case management, no record
review, no coordination with community partners like schools or
hospitals, no treatment team meetings.
Without the coordination, the risk of relapse increases
exponentially. And commercially insured patients might have two
co-pays a week, that will quickly add up after a month, and
that becomes unattainable.
People in this age group fall off their parents' insurances
and they might not even qualify for Medicaid. And then barriers
exist beyond our clinic. There is a pervasive lack of education
coupled with ample misinformation about psychosis and what it
even is.
This gap in education exists in the general public but
extends even to mental health professionals. Psychosis is not a
topic in health education curriculums for high school or
college students, even though their age group is most at risk.
Psychosis education is not a prominent part of the
curriculum for those interfacing with high risk groups.
Psychosis intervention is far from being considered an
essential part----
The Chairman. Doctor, we have to wrap up.
Dr. Weiss. Okay. Can I have a 10 second wrap up?
The Chairman. Sure.
Dr. Weiss. Okay. I am here today to say out loud for the
record that our youth and young adults are the vulnerable ones
to these illnesses, and we cannot ignore this fact as a society
any longer.
These illnesses are not curable, but they should not be
associated with an inevitable lack of productivity and
institutionalization. They are not preventable, but there are
strategies to mitigate risks, such as early detection. They are
manageable, and management does not mean doing the bare
minimum.
That approach has not served us well historically, and we
need to do better for our people. It is a necessity for them.
We must be ambitious in our commitment to these youth and young
adults so that their recovery is supported while they explore
their opportunities that they deserve and expand their futures.
[The prepared statement of Dr. Weiss follows:]
prepared statement of ashley weiss
My name is Ashley Weiss. I am a child and adolescent psychiatrist
at Tulane School of Medicine in New Orleans, Louisiana. I specialize in
first-episode psychosis. Psychosis is a symptom typically associated
with onset of schizophrenia or bipolar disorder. These illnesses can
have devastating consequences, from the increased risk of
cardiovascular disease and premature death, to the ramifications of
being marginalized by society. Why am I bringing up illnesses like
schizophrenia in a hearing about mental health in high school and
college students? Because this is where they start, in our young
people, and not by any fault of their own. Adolescence is time of
incredible brain maturation, and for some, this maturing process goes
awry, leading to the emergence of severe psychiatric disorders.
What is psychosis? Psychosis can be described as the loss of touch
with reality. Examples of psychosis symptoms are hallucinations,
confusion, and delusions. These experiences start small, like mis-
hearing sounds as voices, or beginning to feel as if people are
watching you. This paranoid feeling could then turn into a belief, a
delusion, where one is convinced the world is literally out to hurt
them. It is difficult, but necessary, to imagine what this may feel
like.
Some facts about psychosis:
3 out of 100 people will experience psychosis in
their lifetimes
Y Mostly occurring for the first time between 16 and
25 years old.
For every 1 person experiencing psychosis, 6 more
friends and family are directly impacted.
In the US, the average time one experiences psychosis
prior to treatment is 72 weeks
1 in 10 will attempt or complete suicide with the
highest risk after the first episode
To give these statistics a local context:
George Washington University enrollment is about
26,000 students
Which means, almost 800 will experience psychosis
annually and will not receive appropriate care for over a year
Over 4500 friends and family are impacted
Nearly 80 will attempt or complete suicide.
There is a sense of urgency because time is not on our side when it
comes to psychosis and its impact on the brain. But the last 3 decades
of research shows that specialized intervention as early as possible
after psychosis onset improves outcomes across the board. There is no
time to wait. The same philosophy is already accepted in stroke
intervention and should be in psychosis intervention as well.
In 2015, I started the Early Psychosis Intervention Clinic in New
Orleans. We have treated nearly 1000 people since we opened our doors.
Our multi-disciplinary team provides coordinated specialty care,
including medication management from psychiatrists, individual and
family therapy, groups, and wellness coaching. All treatment is deeply
individualized, with the goal of getting young people back on track,
and often this means back in school.
But what we do in the clinic is not enough. Because of need for
early treatment of psychosis, we are forced to think about early
detection. We have a robust early detection campaign called CALM-Clear
Answers to Louisiana Mental Health that aims to educate the community
about psychosis, debunk myths and reduce stigma, so hopefully people
will seek help for themselves or their loved ones sooner than later.
There are significant challenges and barriers that must be
considered. For most people, recovery can take many months, but time
continues to pass for everyone else in their lives. Their friends have
often moved on, graduated, moved away to college, or started their
first job. They often feel very misunderstood and ashamed, quickly
leading to loss of confidence and increased isolation. And there is a
conspicuous gap in school-based recognition of the needs of these
individuals, in keeping them engaged, or welcoming them back during
recovery. I have multiple college students in my program who didn't
know they were eligible for retroactive medical leave that may erase
incompletes from transcripts, who have crushing student loan debt from
the semesters they became ill. We are often the first place to provide
guidance in approaching these issues.
There are financial threats to programs like ours. Although our
program has committed to long-term care, most programs like ours do not
go beyond 2 or 3 years, and we are realizing now that people lose their
gains when they lose specialized care. But how do we pay for continued
care? We have subsidized our growth through the congressional
legislation mandating a portion of a SAMSHA block grant be `set-aside'
for early severe mental illness. We are appreciative of this
opportunity because it covers the necessary care that is NOT covered by
insurances. In our state, Medicaid and commercial insurers do not
reimburse ANY of the coordination of care services-no case management,
no record review, no coordination with community partners like
hospitals and schools, no treatment team meetings-and without the
coordination, the risk of relapse increases exponentially. If
commercially insured, patients may have 2 co-pays a week for treatment
which quickly adds up and becomes a burden. People in this age group
also fall off their parents' insurance but may not qualify for
Medicaid.
Barriers exist beyond the clinic. There is a pervasive lack of
education (coupled with ample misinformation) about what psychosis even
is. This gap in education exists in the general public but extends even
to mental health professionals. Psychosis is not a topic in health
education curriculums for high school or college students, even though
their age-group is the most at-risk. Psychosis education is not a
prominent part of the curriculum for those interfacing with the high-
risk groups, for instance teachers and school-based mental health
professionals. Psychosis intervention is far from being considered an
essential part of school-based healthcare. At this point, we should not
be surprised when a college freshman experiences psychosis, we should
be anticipating this, working to disseminate knowledge about early
warning signs, and strategically planning with community partners to
ensure students get back on track once well.
I'm here today, to say out loud and for the record, that our youth
and young adults that are the topic of this hearing are the vulnerable
ones, where the severe mental illnesses strike. We cannot ignore this
fact as a society any longer. These illnesses are not curable but they
should not be associated with inevitable lack of productivity and
institutionalization. They are not preventable but there are strategies
to mitigate risks associated with earlier onset such as substance use.
They are manageable but management doesn't mean doing the bare minimum.
That approach has not served us well historically. A specialized
approach may require a weekly meeting with their team for years,
however, if that means individuals have more opportunities, more
graduations, more jobs, more meaningful relationships, improved quality
of life, then we are in a better place. If our communities have fewer
suicides, fewer inpatient psychiatric hospitalizations, fewer ER
visits, fewer people living in poverty, then we are in a better place.
We collectively benefit from a progressive and more accurate narrative
about psychosis, but for our young people, it is necessity. We must be
ambitious in our commitment to these youth and young adults, so that
their recovery is supported while they explore opportunities and expand
their futures.
______
The Chairman. Doctor, thanks very much.
We will conclude now with Brooklyn Williams.
STATEMENT OF BROOKLYN WILLIAMS, HIGH SCHOOL SENIOR AND FOUNDER
OF THE CHILL CLUB, PITTSBURGH, PA
Ms. Williams. Senator Casey, Senator Cassidy, thank you for
listening to my story. And everyone else here, thank you for
listening to my testimony. Looking at me, you might not suspect
that I am dealing with a lot of internal struggles.
I am speaking in public so you might not suspect that I
have severe social anxiety. I cover my eye bags, and no one
tells that I struggle with insomnia. I ate my entire breakfast
this morning, but I still have bulimia.
I got out of bed and did my hair, so to not look depressed.
Just because I did not fit the description of someone with
mental health problems that does not mean that I am fine, and I
feel like we as a society overlook people with these health
issues because they do not fit into the concrete mold in the
textbooks of mental health symptoms.
There is a fluidity in the way each of us experience mental
health, and I feel like schools and communities only intervene
when it becomes intensely severe, or in unfortunate cases too
late. In my experience, mental health highs and lows happen in
waves, always sporadic, and most recently due to being a high
school senior, in my last year of childhood.
As a child, I do not remember feeling there was any
disordered thinking in my life. Yet looking back on it, I feel
that mental health was not ever a topic of conversation at
school or home until I was 18.
When I was 13, my mom passed away from stage four
metastatic breast cancer after a 10 yearlong battle with the
disease. Losing her devastated my family and I, and I felt like
a portion of myself died with her. As much as I love my dad and
my siblings, my mom was my lifeline and my best friend.
Although we tried to prepare as much as possible for her
passing, it was the worst feeling that I have ever experienced.
The following year was a blur of numbness and therapy sessions,
but the pandemic caused everything to shut down and I felt
alone.
To combat those feelings of grief, depression, and
isolation, I started to paint and do crafts to cope. It helped
me express and lose myself in an activity rather than sulk in
my emotions. Once school started up again, I thought, if this
is making me feel better, then maybe it will make others feel
better too.
I started the Chill Club where we do activities like
meditation, yoga, crafts and painting every month as a group to
come together and talk about our shared emotions and not worry
about the problems in our lives.
From starting my club 2 years ago, I have been graced with
many opportunities that helped me to share my story and cope
with the loss of my mom and the struggles resulting from that,
but I feel there is a long way to go. Incorporating mental
health topics from an early age would be the first
steppingstone I would take to support people's needs.
Talking about these issues with teens before they are
reaching for help. Providing more accessible outreach
professionals in schools, having all students speak to these
professionals and not only the ones that come for help.
Allowing for mental health absent days to be excused, just
like having physical illnesses, because mental health and
physical health are equally as important. Allowing for
anonymous assistance would also be effective because it is
evident that most teens do not want to ask for help publicly.
Last, professionals working with teenagers should be more
open and equipped to talk about mental health struggles by
being provided with the correct necessities to help teens work
through their problems. As a high school senior, I have grown
to see that the process of moving from adolescence to adulthood
is tricky enough with college essays, picking a major, and
knowing that I will leave my childhood behind.
Providing teens with assessable professionals to speak with
will only benefit our communities. Everyone needs to be aware
of their mental health because it is not selective or to be
stigmatized or to be put aside because it is too hard to
understand.
Working through these issues will not only give
opportunities for teens to grow and flourish into adults, but
also to allow our communities to be stronger as we improve the
way of life one kid at a time. Thank you.
[The prepared statement of Ms. Williams follows:]
prepared statement of brooklyn williams
Thank you to all who listen to my story. Looking at me you might
not suspect I am dealing with a ton of internal struggles. I am
speaking in public so you would not suspect that I have severe social
anxiety. I cover my eye bags so no one can tell I struggle with
insomnia. I ate my entire breakfast this morning but I still have
bulimia. And I got out of bed and did my hair, but I do not ``look
depressed''. Just because I do not fit the description of someone with
mental health problems does not mean that I am fine and I feel we as a
society overlook people with these health issues because not all of us
fit into the concrete mold in the textbooks of mental health symptoms.
There is a fluidity in the way each of us experience mental health, and
I feel schools and communities only intervene when it becomes intensely
severe or in unfortunate cases, too late.
In my experience, my mental health highs and lows happen in waves.
Always sporadic and most recently due to me being a high school senior
in my last year of childhood. As a child I do not remember feeling like
there was any disordered thinking in my life, yet looking back on it, I
feel that mental health was never a topic of conversation at school or
home until I was a teen. When I was 13, my mother passed away from
stage 4 metastatic breast cancer after a 10-year long battle with the
disease. Losing her devastated my family and I felt like a portion of
myself died with her. As much as I love my dad and my siblings, my
mother was my lifeline and best friend and although we tried to prepare
as much as possible for her passing it was still the worst feeling I
have ever experienced. The following year was a blur of numbness and
therapy sessions, but the pandemic caused everything to shut down and I
felt alone.
To combat those feelings of grief, depression, and isolation, I
started to paint and do crafts to cope. It helped me to express myself
and lose myself in an activity rather than sulk in my emotions. Once
school started again I thought ``if this is making me feel better maybe
others will feel better too''. So I started the Chill Club where we do
activities like meditation, yoga, crafts, and painting every month as a
group to come together to talk about our shared emotions and not worry
about the other problems in our lives.
From starting my club 2 years ago to now I have been graced with
many opportunities that have helped me to share my story and cope with
the loss of my mom and the struggles resulting from that, but I feel
there is still a long way to go.
Incorporating mental health topics from an early age would be the
first stepping stone I would take to support people's needs. Talking
about these issues with teens before they are calling out for help.
Providing more accessible outreach professionals in schools and having
all students speak to these people, not just the ones that come for
help. Allowing for mental health absent days to be excused just like
having a physical illness because mental health and physical health are
equally as important. Allowing for anonymous assistance would also be
effective because it is evident that most teens do not want to ask for
help publicly. Last, professionals working with teenagers should be
more open and equipped to talk about mental health struggles by being
provided the correct necessities to help teens work through their
problems.
I have grown to see that the process of moving from adolescence to
adulthood is tricky enough with college essays, picking a major,
knowing I will have to leave my childhood behind. So providing teens
with accessible professionals to speak with will only benefit our
communities. Everyone needs to be aware of their mental health because
it is not selective or to be stigmatized or put to the side because it
is ``too hard'' to understand. Working through these issues will not
only give opportunities for teens to grow and flourish into adults, but
to also allow our communities to become stronger as we improve the way
of life one child at a time.
______
The Chairman. Well, Ms. Williams, thanks very much for your
testimony. And I want to thank the testimony of all our
witnesses, and especially to you for demonstrating uncommon
courage at any age, but we have rarely heard testimony like the
testimony you presented today, so we are thankful that you are
here with us.
I will start a round of questions. I will just do one
question to expedite our schedule a little bit. I will start
with Dr. Wright. In your testimony, you described how a large
number of students at your university are struggling with
mental health.
Given that around half of mental health conditions begin by
age 14, it is likely that many of the challenges that you are
seeing, of course, started long before college. In addition to
school staff, parents can be a child's strongest advocate to
help with getting the needed support that they require. But
these families, these parents need to know what to watch out
for in their children.
How should we begin engaging families so that they are
aware of the signs that their child may have a mental health,
developmental, or learning disability?
Dr. Wright. Thank you, Senator. That is an amazingly
profound question. And when you think about the intersections
of our students and their families, where they are coming from.
Many of our students come with these undiagnosed
challenges. So when they first have their first moment, we
don't know what to do, and neither do they.
I really believe that the work that you all are advancing
in your bill, the Pediatric Access Act, will help with that
because providing more touch points, training folks from the
very beginning, having mental health first aid in our high
schools and our elementary schools, but also in our community
centers and in our churches.
Faith communities. I think so many of our families have
been told that mental health is a secret, and they won't allow
their students or kids to get help. So we have got to create
some level of understanding that mental health is tantamount to
having diabetes.
If someone has a heart attack, we don't keep them hidden
away but we rush them to the hospital. And when someone is
having these symptoms, we need to do it. So removing the stigma
of mental health is one of the first things, but then educating
their parents on how to connect them with folks in the
community.
In rural spaces that might be harder. So working with them
in their schools, with their counselors, working with them in
their--in some spaces in their housing authority places or
their therapist or their counselors there, but I do think being
able to expand the reach of qualified mental health
professionals in these spaces will allow those parents to see
those warning signs, because many of our students' parents may
not have been trained to know what to look for.
But providing schools, community organizations, resources
to help them, I think will be essential in that.
The Chairman. Great. Doctor, thank you very much. I will
turn to Ranking Member Cassidy. I will reclaim some of my time
later.
Senator Cassidy. I will defer to Senator Tuberville and
allow a colleague to go.
Senator Tuberville. Thank you very much. Thank you for
being here today. This is important. I don't think people
really know how important it is. I coached for 40 years. I
coached in eight states.
I went to high schools all over this country, and in the
80's and 90's we had a mental health problem. But after 2000,
after the internet and this thing right here came out, it has
devastated our kids, and I saw it every day. So this is a huge
problem. It is going to get worse before it gets better.
Dr. Wright, I am like you, faith based family--I mean, that
is how we are going to overcome a lot of this. It is going to
have to come through that, but we have got to be prepared. We
have got to be able to recognize a problem.
Dr. Hoover, for years I saw kids come play for me and a lot
of them came in, and early in my career, with very little
problems. Last 20 years, they came in and they had ADHD. They
said they did, and we were giving them drugs right and the
left. We weren't--the doctor were prescribing them.
Do we have a medication problem in this country when it
comes to mental health?
Dr. Hoover. It is a good question. And first of all,
Senator Tuberville, I want to thank you for your coaching
years, because we know that all of the adults, as was said
earlier, by Chairman Casey, all of the adults have a
responsibility to take care of the mental health of our young
people, including our coaches.
I was on a plane yesterday next to a school bus driver, and
I was telling her that she has one of the most important jobs
when it comes to actually supporting the everyday experience of
our young people and their mental health.
In terms of medication and the diagnoses that seem to be
increasing, part of it, I would argue, is really that we are
just becoming more aware of the mental health needs of our
young people. I would say that our medications are far from
perfect.
In fact, many would argue that they are imperfect solutions
to the mental health challenges of our young people.
But there is also strong evidence that some of the
medications for our children and adolescents, including for
ADHD, as you mentioned, and other mental health challenges,
have been effective, but they are most effective when combined
with other interventions, and that includes mental health
interventions provided by licensed counselors, social workers
and psychologists, but also the everyday supports, whether it
is from the faith community, from families, or from schools.
It is not a one size fits all approach and it is not a one
intervention approach. In fact, most of the data would agree
that medication, combined with other interventions, is probably
the most effective for some of our most debilitating disorders.
Senator Tuberville. Thank you. Dr. Weiss, we locked these
kids down for several years. Fortunately, in Alabama, we didn't
do as much. And we had a study come out not too long ago.
We went from 49 to 39 in some areas of our scores
improving. We went from 40th in the country to first in the
country in graduation rate because we stayed in school. My
question is, we have already spent so much money on a lot of
these problems.
In your opinion, how do we best direct these funds in the
future to help with mental health?
Dr. Weiss. I have to--full disclosure, I am from Alabama
and grew up with Auburn football, so----
[Laughter.]
Senator Tuberville. Well you did good. I should have asked
you in the first place----
[Laughter.]
Dr. Weiss. The work that I do is addressing severe mental
illnesses that have long been underfunded. This--we don't have
a good track record historically of taking care of those with
the most severe mental illnesses and they really weren't given
opportunities to complete school, to go to higher education.
Now we have them actually getting well after their first
episode with a severe illness, just like you could get well
with diabetes diagnosis early, just like you could get well
with other major medical problems.
The cost needs to be reflective and encompass what it takes
to scaffold them into these opportunities that they really
haven't had before. And that might be more costly than to
support a kid with ADHD from high school to college.
However, we are just really learning now in the last 10
years what that is going to look like for this country. So
because early intervention and severe mental illnesses is such
a new concept, and literally we are talking about the last 10
years of clinics, the last 20 years of research.
Senator Tuberville. Dr. Hoover, I know we are talking about
going to high school to college. Half the kids in this country
don't go to college. They get a job. They get in the military.
How do we help them? How do we evaluate them? Because most kids
that go to college get some kind of valuation through the
process of higher education. How do we help those kids don't go
to college?
Dr. Hoover. It is a great question. And when I saw the
subject of today's hearing, I was hoping that it was--it would
go beyond just college, because we know so many young people
don't go on to college.
I would wish that we had better supports in place for them.
I mean, I do think it really speaks to the first issue that was
brought up that we need to start earlier. The supports that we
are talking about from high school to college are critical.
But what is more critical is that we put systems in place
from pre-K to K-12 to actually identify and provide scaffolding
and structured support for their mental health. And that
doesn't just mean--I think our young panelist, as usual, said
it best, which was we can't wait until there is a crisis.
We can't wait until things get really bad to provide
services. We need to be doing mental health literacy in the
classroom. We need to be putting systems of identification into
their hands, whether it is in schools, on college campuses, or
in their communities. I think the efforts to support
integration into primary care are critical.
For those who do go on to career, maybe not college, they
can get some of those same supports in their primary care
setting. Or in other natural settings, whether that is their
faith community, whether that is their family.
There are many interventions that can support families to
better equip them to support their young people, including as
they transition to adulthood. So we need to not just put these
services in schools or primary care, but we need to put them in
the hands of families.
Senator Tuberville. Dr. Wright, you got to comment on any
of that, about kids that don't go to college? You see probably
a lot of those.
Dr. Wright. We do in just--in communities in general. And I
think as she was describing, being able to put those--have them
access those resources in other spaces. There is dignity and
honor in our work but sometimes we privilege, this transition.
The way that--my profession.
But being able to make sure that they have access to an
affordable health care so that they can afford to take
advantage of that, whether it is through state sponsored
Medicaid or private insurance. But I do think that being able
to recognize that we all live within the context of our lives
and learn within the context of our lives, that there is
support in their spaces of work and worship.
Then they have the ability to talk with their family
because, again, secrets are the things that kill us. And so
but, yes, I absolutely agree with what she said.
Senator Tuberville. Thank you.
Thank you, Mr. Chairman.
The Chairman. Thank you, Senator Tuberville.
We turn next to Senator Smith.
Senator Smith. Well, thank you, Senator Casey and to
Senator Cassidy, who I believe had to leave, for pulling
together. I really appreciate. It is a great panel.
I think the people here in this room today believe that
mental health care is health care and that every young person
deserves access to the mental health care that they need. And
yet, I think we also know that we failed in that mission, but
we are working hard on it.
Everybody in this room, I think, in one way or another on
this side has been working to expand access to mental health
care in schools. I certainly have with legislation that I have
introduced.
Let me ask you, Ms. Williams, if I could, so I first
realized that I was suffering from depression when I was in
college. I am quite sure now that I was having that experience
when I was in high school, but I didn't quite understand what
was going on. I didn't really see how it was incapacitating me.
I am quite sure now that my experience wasn't unique. It
seems like with physical health care we do a lot of thinking
around preventative care and early intervention, but yet what
happens with mental health care is you get to a crisis point
where you are really incapacitated and then you are sort of
starting from behind.
I am wondering if you could just say from your perspective,
like what that might look like in a high school setting where
you are getting at it, getting at people's challenges earlier
rather than later?
Ms. Williams. Yes, so I feel like in my experience, I
really--I was behind like how you said. I started becoming
really low in my depressive state before I thought to seek
help. But I feel like now, nowadays there is a lot more--it is
a lot more noticeable because of social media or being online
and talking.
Like people just say anything nowadays and they talk about
all the things in their lives. So like really just getting out
there and saying that they are not feeling like the way they
should or something. It really brings out the topic more. But I
feel like starting at a young age, I feel like that would be a
lot more beneficial for kids to learn about what is going on
and start seeing the signs.
If they don't feel like they want to go outside or go to
school or not feel the way they should feel, or they feel like
they might be a little bit different, they should always have
someone to talk to. And I feel like the first step to do that
is to get everyone, get everyone like the care they need
beforehand so nothing will escalate and get too great that no
one can control it.
Unfortunately, there is so many cases of suicides and
people going to psychiatric wards and stuff like that because
they haven't got the help that they needed. And I have
definitely seen that in my personal life. There is a lot of
kids in my surrounding schools and even in my school that have
lost their battle to depression or anxiety and stuff.
I feel like that should be a lot more preventable if we
take the steps to reach out to their therapists and get them
into schools more. Because I definitely see that also we have a
school therapist on my school, but there is not that many
people that are aware that there is a school therapist or have
access or know the way to get to the therapy that they need or
talk to the counselors, because there are thousands of kids
inside one school at one time and there are four or five
counselors for those thousands of kids.
Senator Smith. Right, right. The part of it is not having
enough--not having enough providers of therapy in schools. And
part of it is making sure that people see the pathway from the
way that they are feeling to the help that is there that they
might not even realize is there, right?
Ms. Williams. Yes.
Senator Smith. Let me just ask really any of the other
panelists, I am very interested in how we can integrate
physical health care and mental health care in a doctor's
office setting too. And at the pediatric level, what kind of
integration can we do there?
I am just wondering if you have any insight for us as we
think about that, because it seems to me that a lot of folks,
assuming they have access to health care, and God knows not
everybody in this Country does have access to health care,
physical health care. Kind of what we have seen.
Maybe, Dr. Hoover, you would like to address that.
Dr. Hoover. I would be happy to. Thank you for the
question, and I appreciate your asking, again, our youngest
member of the panel first, because I think when we speak to our
youth about kind of their ideas of how we can get services and
supports to them, they usually have the best answers.
With respect to better integration into primary care, first
of all, it can happen out in our pediatric, mental health
clinics, and our young adult clinics. We often have this
bifurcation. It is a really artificial bifurcation between
pediatric medical care and adult medical care.
I would argue that we shouldn't just drop young people off
at the age of 18 and say that they have to switch to an adult
provider, that is No. 1. But in terms of integration into
primary care, it can happen both in those health care settings,
but also in health care settings in schools.
School based health centers, I appreciate the investment in
school based health care. More young people are able to access
primary care when it is offered in the context of school based
health.
Whether it is out in the community, in primary care, or in
the context of a school based health center, we have wonderful
examples of mental health, behavioral health providers situated
in those settings, but we also have many examples, especially
in a more rural or smaller campuses, where they don't have the
provider network to be situated physically in the building.
We actually have wonderful examples of effectively using
telemental health to integrate right there into the mental
health--or excuse me, into the primary care setting. And the
last thing I will note is just the increased investment in the
child psychiatry access programs are now called the primary
care, the mental health and primary care access, where you have
primary care providers that can pick up a phone or get on tele
and actually reach out to a specialty mental health provider,
have been instrumental.
I really appreciate the expanded coverage of that. We have
seen it not only in primary care can be critical, but also in
the context of schools.
Senator Smith. Thank you. Chairman Casey, I know I am out
of time. I am going to submit for the record a question that I
have also around the sort of--the plethora proliferation of
mental health care apps. And I am trying to understand the
efficacy of those and what kinds of consumer protections we
need to think about for those. Thank you very much.
The Chairman. Thank you, Senator Smith.
I will turn next to Ranking Member Cassidy.
Senator Cassidy. I will defer to Dr. Marshall.
Senator Marshall. Thank you, Senator Casey. Thank you,
Senator Cassidy. Again, thanks to all of our panel for being
here. And especially Ms. Williams, thank you for coming. You
are absolutely the most courageous person I will meet today, to
come and share your story. You may be the most courageous
person I will meet all week and all month, and I got a question
for you in a second.
My first question is going to be for Dr. Weiss and Dr.
Hoover. Prior authorization, access to care has been a bigger
issue--is the No. 1 physician administrative concern in
America. As an obstetrician, I saw the issue delay care for
infertility patients, for high risk patients.
My friends in orthopedic surgery tell me that it is getting
harder and harder to get the joint replaced and maybe that the
process delays it three or 4 months' time. And meanwhile, we
get the patient addicted to two narcotics.
I am just curious, in your clinical experience, when it
comes to mental health issues, are you seeing any challenges in
the prior authorization realm? Dr. Weiss, why don't you go
first.
Dr. Weiss. It is mind numbing.
Senator Marshall. Mind numbing.
Dr. Weiss. Yes our clinic bills for services and we also
have some money that subsidizes what is not covered.
But even the services that are covered, and I deal with a
lot of antipsychotic medication and long acting antipsychotic
injectables that are not preferred on formulary, but that are
the best medications of certain classes of medications that are
more appropriate for young patients versus the older ones for
many, many more reasons, like less side effects.
It will take weeks sometimes. Getting prior authorization
for community based mental health services can sometimes take
weeks, and then every 3 months they want you to repeat the
authorization.
In Louisiana, Medicaid has been privatized, so there are
five companies that provide Medicaid services, each requiring a
different type of pre-authorization or prior authorization for
services. So this is a job of two or three people.
We have a census of about 170, so it is hard to finance
that because I am, aware that businesses need to be financed in
a fiscally responsible manner. But the amount of administrative
support you need to get these things done is astronomical.
Senator Marshall. Yes. Dr. Hoover, do you have anything to
add?
Dr. Hoover. The only thing I would add is I certainly agree
with everything you said. And yet, of course, we need some
authorization in place, especially for our most vulnerable
youth, who may, for example, experience polypharmacy.
Young people in the foster care system, for example, we
know may be on multiple medications. There needs to be some
authorization and process for understanding the medications
that they have been prescribed so that it is done responsibly.
But the wait times for getting into mental health care, as
you said, it is mind numbing, astronomical, and for families
can be really impossible to navigate.
Senator Marshall. In my experiences, what was most
frustrating is after my nurses had spent days and days in the
back and forth with faxes, not emails or on online, but faxes,
eventually I get to talk to a person and maybe it was a
neurologist trying to explain to me why we shouldn't be using
progesterone for pre-term--have you ever had that same
frustration? I wouldn't begin to want to tell you the drugs you
should be using.
Dr. Hoover. Yes. I left inpatient work specifically because
of this. I would be told that someone did not qualify for
inpatient psychiatric hospitalization because they weren't
actively trying to kill themselves or someone else.
I would say, so what about like hearing the demon and
coming to get you, and you can't even get out of your bed or go
to your house or eat food--you don't qualify for inpatient
services. And I just----
Senator Marshall. I just want to reassure you that we do
have legislation that we could get across the finish line that
would impact Medicare, this prior authorization issue. And then
we will go after CHIP and Medicaid and some of those others.
I am running out of time. I want to go to Dr. Wright and
Ms. Williams for a second as well. One of the tragedies in this
country is fentanyl poisoning. And this is an editorial written
by a mom from Kansas who lost her son, Cooper Davis, a little
bit over a year ago.
A 16 year old who ordered a half of a Percocet tablet via
Snapchat, unknowingly laced with fentanyl and the child died.
Dr. Wright are you seeing any problems with--the high risk
group we are talking about, I am afraid oftentimes they are
trying to find Xanax or Adderall or uppers, downers, and they
are being laced with fentanyl.
Are you seeing any of this in your world, Dr. Wright?
Dr. Wright. Specifically at my institution, no. We don't
see--that is not the drug of choice for our student population.
However, prior to Xavier, I lived in Staten Island, and I
worked in a private liberal arts college on Staten Island where
we saw a huge problem with the drugs that were laced with
fentanyl.
Students who were--whose prescriptions had lapsed, and so
now they are going out and finding other ways. And so, yes,
that is a huge problem that our young people are dealing with.
It is partly because as Senator Tuberville said, they came
medicated, and now they don't have access to those medicines
now, and they are trying to find it any way they can. But it is
a growing problem, particularly for students who are trying to
take care of themselves.
Senator Marshall. Sure. Thank you. Ms. Williams, and I
certainly don't want to get too personal. I always tell my
patients, you can pass on any of my questions, but are do you
see any problems, any--are students able to find those types of
things online? Do you see it in your school or any concerns
about it?
Ms. Williams. You mean drugs?
Senator Marshall. The specifically fake pills laced with
fentanyl. Like people are trying to find Xanax or Adderall and
my goodness, it has been laced with fentanyl.
Ms. Williams. Never in my experience have I heard of anyone
doing that, no.
Senator Marshall. All right. All right. Well, thank you so
much. Dr. Weiss, you want--do you have anything to add?
Dr. Weiss. I just--I think one thing that you bring up is
important, that every community is different in terms of what
very emergent substance use problem is going on. In New
Orleans, we have a major problem with synthetics and people
smoking mojo and becoming psychotic----
Senator Marshall. I don't know what that is.
Dr. Weiss. The point that you can't get them--well, it is
just a fake marijuana. I can buy it in a grocery store. I mean,
just and it can ruin your kidneys. So you have to be attentive
to what is happening in different areas for sure.
The Chairman. Senator Marshall, thank you.
We will next turn to Senator Kaine.
Senator Kaine. Well, thanks to Senator Casey and Cassidy
for pulling this together. And what a great panel. I want to
talk a little bit about before college and then want to talk
about the transition of college.
I spent Thanksgiving with family and friends, and one of
the friends I spent time with is an administrator in the St.
John County Florida school system, which includes Saint
Augustine, and her responsibility includes all the guidance
counselors.
She was telling me, we don't have enough, and they are
doing college guidance and helping people with financial aid
forms and trying to be counselors. And there are some Florida
laws now that are making it even harder because they can't talk
about everything with the student without letting parents know.
But setting that aside, the point she was making is there
is just not enough people here. So, Ms. Williams, let me just
ask you. You go to Baldwin High School in Pittsburgh. How big
is Baldwin High School? How many kids?
Ms. Williams. It is like 1,400, but it is also with the
middle school and high school.
Senator Kaine. It is all--that is all together.
Ms. Williams. Yes.
Senator Kaine. When you decided, hey, I need to seek help
from somebody because of the many issues I am dealing with. And
as you described, death of your mom and COVID and there are so
many, was it--where did you go? And was it easy to get help or
was it hard to get help?
Ms. Williams. I think I did it the wrong way. But I went to
my principal first because I was having trouble with like just
trying to get to school and get to do things I wanted to do
with my friends and everything. So I went to the principal
first because I was closer to him because I didn't have the
same guidance counselor of years in my high school.
Senator Kaine. You were getting assigned a different one?
Ms. Williams. Yes. There was--I think I have had five in
the past 4 years, so it was just a little----
Senator Kaine. Is that because you get assigned a different
one each year, but also just there is some turnover and people
coming in and out.
Ms. Williams. Yes. It is because--we were supposed to have
the same one all 4 years, but because of, COVID and everything,
and some people taking maternity leave and different things
like that, it was just not consistent, so we just didn't have
the same----
Senator Kaine. Well, let me ask Dr. Hoover a question. I am
going to come back to you in a minute about college, Ms.
Williams. Dr. Hoover, do you think families utilize the IEP
process sufficiently to help children deal with emotional and
mental health issues?
I have been a Mayor and worked with my school system and am
really familiar with IEPs. One of my three kids had an IEP. But
commonly for something like a speech therapy or a very narrowly
defined learning disability, families can use the IEP process
for getting accommodations for students to deal with emotional
mental health issues.
Do you think we use that enough in the K-12 space?
Dr. Hoover. Thank you, Senator Kaine, for the question and
for your support of mental health in schools. So the simple
answer is, yes, families can use IEP process, and no, they
don't use it probably as often or as well as they should have,
in part because they are not often aware of how to do it. They
don't have the family peer support to help them navigate the
process. Of course the stigma----
Senator Kaine. To the extent that there is still any stigma
about mental health issues too, that would probably be an
additional variable----
Dr. Hoover. Hugely detrimental. But the other point I want
to make, so we need to increase awareness, decrease stigma
about using special education accommodations to support mental,
emotional, behavioral issues.
But we also need to provide supports that go outside of or
beyond the special education system. There are a lot of young
people who could get mental health supports in schools that
would not require an IEP, but they can still get mental health
support in schools.
Senator Kaine. I want to go over to the college side. So
Ms. Williams, you are a senior. So when--are you thinking about
going to college next year?
Ms. Williams. Yes.
Senator Kaine. When you go to college, with the experience
you have had and you have now found some support systems that
have helped you, and you have created support systems that have
helped others, but you are going to show up on a campus where
like you will be one of maybe hundreds or thousands and you
will be kind of a free agent day one.
What are you going to do when you go to college to try to
make sure you have the services that you need? And I ask you
this because there might be a lot of people just like you
listening to this hearing that would want to hear the way you
are going to do it, since you have been appropriately sort of
assertive in trying to find the help that you need.
Ms. Williams. I am thinking about joining different clubs
and different social settings that will help me with mental
health and other people that deal with the same things that I
deal with, and different groups that deal with kids with a
parent that passes or a person that deals with depression or
anxiety or something like that.
I wanted to join different groups. But I also talked with
my therapist a little bit about how to transition from her
being my child therapist to becoming--having an adult
therapist.
What they were planning on doing is like overlapping sort
of the time between her leaving my life and having a new
therapist so we can--so she can talk me through the way I
should interact with the new therapist and try to overlap them
and try to, I don't know, get a way through the----
Senator Kaine. I get you--the transition, yes----
Ms. Williams [continuing]. Process easier--the transition
easier.
Senator Kaine. That is good advice for others. And Mr.
Chairman, could I ask one more question of Dr. Wight. We have
had two really tough situations in Virginia in recent years.
One, when I was Governor, a tragic shooting at Virginia Tech,
and then recently a tragic shooting on the University of
Virginia campus.
In both instances, there is some differences, and I don't
want to make them sound exactly similar when they are not. But
in both instances, the individuals who carried out these
grievous crimes had tough high school years but had found
supports in high school where they were able to be successful,
successful students, successful athletes.
But then when they went to college, it was like none of
that information that helped them succeed in the high school
setting, it is like none of it went to the university setting.
In each instance, and we are still learning more about the
University of Virginia situation, it seems like there was sort
of a downward spiral, and maybe partly because they didn't have
the support services surrounding them that knew their situation
and knew how to help them succeed when they were in high
school.
The RISE Act, which you all have introduced, would take, if
somebody has an IEP, it would take that information from high
school and not just make it easier for them to continue it in a
university setting, but it would also transfer the knowledge
about how to help this young person succeed to the college
setting.
But how do you deal with that in your institution? This
coming into a place where you are brand new and it is all you
were expecting after 3 months to be an independent adult, make
good choices, and maybe you have a past history that doesn't
really--it is not--it is not made known to anybody on campus.
How do you help students in that transition at Xavier?
Dr. Wright. Sure. So there is peer to peer training that we
conduct so that the freshmen are paired with what we call peer
deans, who are upper class students who help connect them to
not only the social side of university life, but also those
resources that will help them navigate the university.
We also think about those spaces where students are going
and try to marry. So we know that students are going to see our
campus ministry office, right. So training those folks to be
able to help identify when they hear things, get them the
counseling.
Similarly doing that same work in the classroom because
sometimes faculty will interact with students, and they will
see something in a report that they have written.
Or they will come to them, and they will say, I missed
class today because of x. Or they will also let us know when
they start to see things that are different. But I do think
that the other--one of the most important things that we have
been doing is really engaging our students' parents.
We want to respect them as full adults, but we also
recognize that we can't do it without a full support system for
them. And so working with those parents will oftentimes get us
information that we didn't know that will then help us connect
with their previous therapist.
Senator Kaine. Thank you. Thank you for that. I appreciate
your letting me go over.
The Chairman. Thank you, Senator Kaine.
Senator Cassidy.
Senator Cassidy. Dr. Wright, just to follow-up the kind of
same thread as did Senator Kaine, and I think this is more for
the audience watching so I just want you to kind of document by
your testimony, if somebody does have an IEP as in a high
school and they are trying to transfer to Xavier or another
university, are you able to access that information at all? Can
you access it even though there is difficulty in terms of
utilizing or using that information. Can you comment on that,
please?
Dr. Wright. We can't access it unless they give it to us.
So they have to bring it to us. And then when they bring it to
us, even if it is outdated, what we will do is provisionally
provide those accommodations and set them up with a coordinated
care plan to get them the evaluations that they need.
But unless they bring it to us, we don't have access to
that, because in our admissions process, we are not allowed to
ask them information about their mental health. Doctor----
Dr. Weiss. I was just going to add, and what you I think
demonstrated so beautifully, is that when there is a mental
health team involved with a high school student that is going
to be transitioning to college or to a job, whatever they want
we are very aware of what is going on in the senior year of
high school.
We are sort of anticipating and preparing ahead of time of
where they are planning on going, the application process. I
have had to read a lot of personal statements for college
applications.
We have already identified the key players in their new
community. Whether it is a--they need a first episode program
in their community. We have already reached out to them. We
don't have----
Senator Cassidy. Sorry, excuse me. What you are telling me
is a best practice is that the high school counselor would then
be seeking a HIPPA form release that she or he could send the
information to the college, and the college could just again
continue that sort of enveloping we are going to support you?
Dr. Weiss. Yes.
Dr. Wright. Correct.
Senator Cassidy. Do you have a sense of----
Dr. Weiss. You can be clear about what----
Senator Cassidy. Do you have a sense of how often this best
practice is actually implemented?
Dr. Wright. Very little.
Dr. Weiss. Very little. I mean, it is----
Senator Cassidy. Is it not implemented well or implemented
so little, is that the problem with the university or is that
the problem of the high school? Or what is going on here?
Dr. Wright. I think that there is many, many things going
on depending on what the situation is that you are dealing
with. Via if it is an academic disability, then it would be----
Senator Cassidy. But we are speaking specifically of mental
health.
Dr. Weiss. Mental health.
Senator Cassidy. Now, by the way, our RISE Act, if you have
dyslexia, that doesn't change with lifetime. Forever you are
dyslexic.
Dr. Weiss. Right.
Senator Cassidy. That is easily taken over.
Dr. Weiss. Right.
Senator Cassidy. Mental health is obviously a different
issue.
Dr. Weiss. Right.
Senator Cassidy. Again, if you had to tell us what is the
problem between the person who is helping someone like Ms.
Williams, sending that information to the college which she
chooses to attend, and then that seamlessly moving into the
counseling that she needs. Because if not, it ends up with the
tragic consequences that Senator Kaine just referred to. What
is the problem there? What can we do?
Dr. Weiss. Coordinating care from both sides.
Senator Cassidy. Yes, ma'am, I get that. But what is the--
--
Dr. Weiss. People are answering the phones----
Senator Cassidy [continuing]. Mechanism where we forced
that marriage, if you will. It sounds like it is just not
happening, and it sounds like it is just not happening because,
it is a too strong to say, a lack of effort? Dr. Hoover.
Dr. Hoover. Well, I would just say that we have to have
some protections in place for health care privacy and----
Senator Cassidy. But signing a HIPPA form would be----
Dr. Hoover. That is exactly right. So we need to educate
our young people as they transition to adulthood about their
privacy rights and how to sign a HIPPA form.
Senator Cassidy [continuing]. Because that really should
be. I am a health care doctor----
Dr. Hoover. Yes.
Senator Cassidy. If somebody comes to me and I know they
are moving to another state, I say, listen, I need to send your
records to Mississippi and I need you to sign this form. I
don't think it is incumbent upon the patient to understand that
there is a form which she needs to sign.
Dr. Hoover. But it is incumbent upon them to understand
whether they would wish to. A lot of college students, one of
the biggest hindrances of college students to actually having
the--to actually getting services is because they don't
necessarily know or want those services when they get to
college.
Senator Cassidy. But we are talking about something
different. What we are talking about, because you and Dr.
Wright, I think, spoke of, and Dr. Weiss spoke of proactively
reaching out.
But that suggests that they have been informed that there
is an issue. Now, I will say that the nice thing about somebody
being 17 or 18, mama is still there.
Dr. Wright. Correct.
Senator Cassidy. I find that mamas are--like we couldn't
live without them.
[Laughter.]
Senator Cassidy. But she can come in and make sure, dear, I
know that you need to sign this form, and I am going to sign it
with you if you are a minor, and we are going to send those
records. I am not sure I will accept the excuse that the
student is unaware. Yes, that is true----
Dr. Hoover. Not an excuse. I just think they need to be
educated and I wholeheartedly agree.
Senator Cassidy. But the initial sending of that record
should be incumbent upon the guidance counselor or the social
worker or whomever.
Dr. Hoover. With the permission of the family, absolutely.
Senator Cassidy. Exactly. I think what is not--what I am
pushing, but what I am not quite sure I am receiving a yes that
is true from, is there a problem, is there a lack of follow
through on the behalf of the typical high school guidance
counselor or social worker to trigger that?
Dr. Hoover. Yes.
Dr. Weiss. Yes.
Senator Cassidy. Okay. Now, is there likewise a
sufficient--insufficient pull through, the university gets it
and what do we do with it? Oh, that is great, put it in the
file.
Dr. Hoover. Yes.
Dr. Weiss. Yes.
Senator Cassidy. As opposed to we are going to jump on this
and make sure it doesn't happen?
Dr. Weiss. Yes.
Dr. Hoover. There is often a requirement for reassessment,
which as you alluded to earlier, is often completely
unnecessary.
Dr. Weiss. Right.
Senator Cassidy. Right. Our RISE Act addresses some of
this.
Dr. Hoover. Correct.
Senator Cassidy. By this, I hope all my colleagues now will
claim co-sponsors. But there is also, beyond Federal law, there
is the lack of awareness in the high school and the university
as to their respective roles.
Dr. Wright. Correct. Senator, it is skill versus will, can
we or will we. And I--can we? Absolutely, we can. But I do
think that we sometimes hide behind policies, that will limit
what we will do.
Senator Cassidy. No, I totally get you, Dr. Wright. Oh, my
gosh, people retreat because they are just so scared of their
shadow, and they use that as an excuse.
Dr. Wright. Right.
Senator Cassidy. It is an incredible frustration of mine.
Dr. Wright. Right. But I do think the RISE Act would help
provide some Federal guidance on what we should be doing. And
so----
Senator Cassidy. But it is more than that, and I don't
quite know what it is--it is probably----
Dr. Wright. I think clinically if you are a clinically
astute therapist with a high schooler, then you should be
talking about these things. And it shouldn't be the day before
you go, oh, let's send your mental health information.
It should be this whole transition and what is going to
happen to make them feel safe and comfortable with like
continuing their mental health care in the next phase of their
life.
Senator Cassidy. I will say, on the Federal level, there
are some times that we can do best practices and we judge
different organizations by best practices. And can you do an
audit of your charts and see how many X, Y and Z?
I just say that for my colleagues, for us to start thinking
about. I am out of time. I actually had other questions for you
all, but I will submit those for the records, particularly for
you, Dr. Weiss, as regards to how you are using the wraparound
services and the need to augment Medicaid, which seems--just
seems crazy. But we will get back to you. We will send you the
letter for the record. Thank you.
The Chairman. Thank you, Senator Cassidy. And I will, I
know we have to wrap up soon, but I will exercise a Chairman's
prerogative by just adding maybe one more question for Brooklyn
Williams.
But to our three doctors, if you can each, if you want to,
provide anything else for the record that you hope you would--
we have on the record, in 30 to 1--30 seconds to 1 minute each,
if you can do that. This is kind of a quick lightning round
before I will wrap up with Brooklyn, and then we will do our
closings.
Dr. Hoover. Glad to. So the one thing that I want to
emphasize is that while we do need to invest in child mental
health specialists and increase the numbers of counselors in
schools, psychologists, etcetera, we really do need to make it
that every adult and peer has education and training to support
mental health.
That can be through things like mental health first aid and
youth mental health first aid. There is also a free, federally
funded mental health training for all educators called
Classroom Well-Being Information and Strategies for educators
or classroom wise.
We have many tools at our fingertips to train everybody in
the system, and that would include in mental health literacy in
the K through 12 curriculum. It can't rely--we can't rely
solely on mental health specialists to cure our way out of this
mental health crisis.
The Chairman. Thanks, Dr. Hoover.
Dr. Wright.
Dr. Wright. I also want to echo Dr. Hoover in the need for
mental health first aid. As someone who has sat and attended
far too many funerals of students over the course of my career
who had bright, brilliant futures but they weren't able to see
that, this is an important conversation, and I am so grateful
to the Committee for engaging in it.
But we also need to recognize that teacher preparation
should involve a certain level of understanding how to navigate
these spaces because they are the front line. So, thank you.
The Chairman. Thank you. Thank you, Dr. Wright.
Dr. Weiss.
Dr. Weiss. I echo as well and think that this mental health
first stage should also include specific and more severe
illnesses and not just be a generic approach, because dealing
with some of these more misunderstood mental health conditions
can be very challenging for someone that doesn't have the
background.
I just want to stress that while we talk about early
intervention, we have to think about early detection and beyond
schools, like to the communities.
The Chairman. Doctor, thanks very much. I am told Senator
Kaine, you had something you wanted to say.
Senator Kaine. If I could just quick, and this is back to
Senator Cassidy, this point on best practices. A university
probably wouldn't want to try to get a student's medical record
before the student was admitted because the student and family
might wonder, well, maybe they will turn me down if they see
something in my metal record they don't like.
But once a university admits a student the first letter
that goes out is, hey, you have been admitted and here is the
deposit you have to put down, and it has a whole lot of other
information in it.
That letter from a college could say, we can help provide
services on day one that will help your students succeed if we
know as much as we can about what services help the students
succeed in high school, if you will fill out this HIPPA form
and send it back to us, we can get the schools full record, not
just the transcript, but the full record so we can do that.
There are--the RISE Act is a really good one. But I also
think there is best practices at that moment. Everybody is
going to eagerly devour that letter, you are in and here is the
deposit, but here is information, and that is a good moment to
have that discussion.
I just kind of wanted to put that on the record for anybody
from colleges that might be listening to this hearing.
The Chairman. Good point. Well, Brooklyn, you are going to
be the last answer of the hearing. But I want to particularly
thank you for not only being here. That is difficult enough. I
could never do what you are doing when I was your age. Not even
close.
But also, as much as it is inspiring to have you here and
to hear your testimony, and to listen to the answers to
questions, your story, what you have had to overcome personally
is not just inspiring to people here but will inspire countless
young people across the country. So we want to commend you for
that.
I guess sometimes we don't often--often we don't listen
enough here in Washington. We don't take enough time to hear
the perspectives of young people. So I guess just by way of
conclusion, what was your hope that we would hear? What point
do you want to make before we conclude?
Ms. Williams. I would say just like try to take advantage
of the young people that want to come and work with you guys,
and just try to get them to reach out to the people around
their age more because talking to people that are around your
age is a lot I would say easier than trying to talk to people
that have not like grown up the same way you have.
There is a lot of different experiences from when I would
say when everyone here is like younger than whenever, like me
now, like being a 17 year old in 2022. I would say just having
more like ears and having the constant communication is very
beneficial.
Without that, I feel like there is a lot--there would be a
lot less good in what we are trying to accomplish. And I just
wanted to say thank you for letting me talk among these doctors
and all of you very insightful, like professional people.
It is just a really nice experience, and I am eternally
grateful.
The Chairman. Brooklyn, thanks so much. We are honored by
your presence as we are by all of our witnesses. I will have a
closing statement and then I will turn to Ranking Member
Cassidy for his. We know that in today's hearing we heard very,
very powerful testimony about how to address the crisis in
adolescent mental health and set our Nation's young people up
for success in college and in life.
We also discussed creating systems of comprehensive mental
health support in schools and communities to identify and
respond to unprecedented mental health needs among our young
people.
We also talked about gaps in the continuum of mental health
care that must be filled through care integration in health
care, and health workforce development, and a greater variety
of timely care options. Long before the pandemic, there was a
significant rise in mental health conditions among our Nation's
young people.
Their mental health challenges have only been exacerbated
by isolation and stress in recent years. Too many of our young
people are not even able to show up as their full selves to
fully enjoy the many experiences that make high school and
college special.
Too often they don't have that opportunity to perform at
their best and to achieve meaningful goals. Young people across
our Country have unbounded potential and their whole lives
ahead of them, and yet suicide is the second leading cause of
death among people ages 10 to 14, and the third leading cause
of death among young people ages 15 to 24.
We can't accept this. We must do more. We must do more here
in Washington and across the country to help get young people
the support they need. Congress must continue to support
successful programs and legislation like those we have talked
about today.
I look forward to working with my colleagues to achieve
that, and to make sure that young people have the future that
they deserve. So I will turn to Ranking Member Cassidy for his
closing remarks.
Senator Cassidy. Very briefly. Thank you all. What a great
conference. In one sense, oh my gosh, there is so much to do.
But there are tangible things that can be done that came out of
this.
This room, as your example, of youth groups, peer to peer,
if you will, helping others. The whole conversation regarding
pre-authorization and how that can be better. And the whole
idea that maybe we get to have Medicaid provide those sorts of
services, those kind of coordination services, that therefore
the SAMHSA grant would not be used for a lower calling, if you
will, but could be a higher level of service.
Dr. Wright, thank you so much for Xavier doing best
practices. Dr. Weiss too as regards how to take a child who is
leaving high school in those 3 months later enrolling. Dr.
Hoover, you have kind of seen the whole spectrum.
Thank you all. I think what we learned from this is a set
of--a set of measures that, if taken, can make the situation
better. And there is nothing more we could have asked for from
this hearing. Thank you once more.
The Chairman. Thank you, Ranking Member Cassidy, and thanks
for your work in helping us arrange this hearing.
I wanted to first, before we conclude also, in addition to
thanking each of our witnesses for their testimony and their
presence here today, I also want to ask unanimous consent to
add two statements to the record. And I will describe them.
The first is a statement from the Children's Hospital
Association on the need to ensure children and adolescents
receive the mental and behavioral health services they need to
prepare them for healthy, young adulthood.
The second is an excerpt from the 2020 National Survey on
Drug Use and Health that includes current statistics on
substance use, mental health, and treatment among adolescents.
So ordered that they are made part of the record.
[The information referred to can be found on page 49:]
The Chairman. If any Senators have additional questions for
the witnesses or statements to be added, the hearing record
will be kept open for 7 days until next Wednesday, December the
7th.
Thank you all for participating. This concludes today's
hearing.
ADDITIONAL MATERIAL
EXCERPT FROM THE 2020 NATIONAL SURVEY ON DRUG USE AND HEALTH
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
CHILDRENS HOSPITAL ASSOCIATION STATEMENT FOR THE RECORD
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
AAFP STATEMENT FOR THE RECORD
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
[Whereupon, at 11:34 a.m., the hearing was adjourned.]
[all]