CHI study outlines solutions to address youth mental health crisis in Colorado – State of Reform

On the 24th anniversary of the mass shooting at Columbine High School, the Colorado Health Institute (CHI) presented a series of solutions to strengthen the youth mental health ecosystem. 

Through an analysis of primary barriers to mental health and engagement with youth, parents, community and school-based advocacy groups, and policy thought leaders, CHI developed a report that was shared during a webinar on Thursday. 

The report outlined a plan to advance the youth mental health workforce, community crisis response, and infrastructure through upstream, equitable, culturally competent, timely, sustainable, and evidence-informed measures. 

One of the identified solutions is the creation of culturally responsive safe spaces in schools and communities. 

“Schools, communities, and philanthropic organizations have an opportunity to work together to create these spaces for students that are going to destigmatize mental health, are culturally affirming, and can offer services like peer support [and] mentorship, and allow youth to explore topics like leadership, identity, and belonging,” said Kimberly Phu, a CHI policy analyst involved with the project.

Phu pointed to a program run by Denver Indian Health and Family Services that offers cultural and traditional activities for Native youth in the metropolitan area. The program resulted in an improvement in the mental well-being of its youth population. 

The report also outlined solutions aimed at improving trauma-informed, family-centered programming, and youth-specific crisis response, highlighting the opportunities to equitably improve the ecosystem through philanthropic investment in and partnerships with community groups.

“One of the things that we offer at the Center for African American Health for the Black community specifically in the Denver metro areas [is access to] free therapy sessions through the Therapists of Color Collaborative,” said Alan Harmon, community resource navigator at the Center for African American Health. “[The collaborative] is an opportunity for individuals to get 15 free sessions and for families to get 20 free sessions of counseling [with] therapists that look like them and understand the cultural responses and how culturally we are different.”

During a visit to Colorado Children’s Hospital in March, US Surgeon General Dr. Vivek Murthy joined leaders from across the state in a discussion about how to address the state’s youth mental health crisis. Murthy issued an Advisory on Protecting Youth Mental Health in 2021 that outlined the pandemic’s unprecedented impacts on the mental health of America’s youth and families, and offered institutional recommendations for improving youth mental health. 

Suicide is the leading cause of death for Coloradan youth and young adults. Nearly one in five (18.5%) Coloradan youth reported poor mental health in 2021—double the rate seen in 2017. Close to 40% of high school students reported feeling sad or hopeless over a period of two or more weeks, which prevented them from doing their normal activities. Young people who took part in the research called attention to the generational trauma not being addressed within their own families.

“We’re surrounded by adults who are not taking care of their mental health and so we learned not to take care of our mental health,” said an unidentified high schooler who took part in CHI’s research. “Seeing our families deal with this without getting mental health help makes youth think that they can get away with dealing with stuff without mental health help.” 

The state legislature is considering several measures that address mental health access. Senate Bill 002 would authorize the state to seek federal approval for Medicaid reimbursement of community health workers. Advocates are calling for flexibility in Medicaid reimbursement to cover community behavioral health workers, who they say play an important role in accessing care in Colorado. 

House Bill 1200 would create a behavioral health pilot program that offers vouchers to people who could not access a safety net provider during a behavioral health crisis to fund their treatment through a private provider. The program would be administered through regional behavioral health service organizations with Behavioral Health Administration (BHA) oversight. 

The bill would authorize the BHA to develop a family input form that individuals close to the person in crisis can fill out on their behalf. It would require all behavioral health entities in the state to accept those forms. 

HB 1003 would allow school districts to opt-in to hosting mental health assessments for students in grades 6-12. Sponsors of HB 1003 say the HIPAA-protected school evaluations are voluntary and could connect more students who need therapy to free sessions through the “I Matter” program or ones available through their health plans. 

CHI published an earlier report on supporting the mental health system through the implementation of statewide universal school-based mental health screenings. 

In an interview with State of Reform, CHI Director of Behavioral Health Policy Analysis Emily Johnson said HB 1003 is very much in line with the goals that were outlined in that report.

“Our thinking in the model for statewide universal mental health screenings is putting it in a corollary with the way that probably when we were kids had our vision and hearing tested in schools,” Johnson said. “Schools are a great place to reach kids in terms of initial screens, because most kids go to schools. And so when we talk about doing this universally across the state, it’s really just because that’s the best place to intersect with the young population. It’s not because if one school doesn’t do it, the whole infrastructure falls apart.”

Johnson noted that without solutions to address the ecosystem’s infrastructure and workforce limitations, the provision of care and services to support school assessments would be difficult. 

She highlighted the innovative efforts of Partners for Children’s Mental Health (PCMH), a partnership between Children’s Hospital Colorado and the University of Colorado School of Medicine to improve youth mental health in Colorado. In addition to offering mental health training and workshops on suicide prevention to schools, PCMH has formed a Youth Committee for Mental Health (YCMH) where students guide peers and mental health professionals on the issues and perceptions around youth mental health. 

“[PCMH does] a lot of youth-led engagement,” Johnson said. “The way that they approach that is especially impactful and effective because they have very involved adult guidance throughout so they help [young] people set budgets and gauge realism there. [YCMH] is a youth-led youth advisor program that follows a number of best practices in both youth engagement and mental health systems it supports.

The reason I bring it up is not just because I like their approach in terms of participant engagement, but also their focus on upstream [interventions] like, how do we make sure that people have opportunities to connect with each other? And how do we make sure that people are finding ways to check themselves when it comes to [things like] social media influence?”