Last week, the state Department of Health and Human Services held its eighth in a series of statewide town halls on mental health. In Winston-Salem, the discussion focused on the crisis in youth mental health in North Carolina and across the nation.
“Behavioral health is essential to health,” DHHS Secretary Kody Kinsley told the standing-room-only crowd in the Forsyth County Board Commissioners chamber Thursday. “For far too long we have divided up physical and behavioral health. And for far too long we just didn’t fund and support behavioral health in a way that made it foundational. And we’re changing that – one conversation at a time, one strategy at a time.”
The stress and trauma of the COVID-19 pandemic, which upended American life and took well over a million lives in this country alone, worsened the existing mental health crisis, especially among young people.
“Over the last two and a half years we’ve seen first-hand isolation and stress and trauma that has touched every single person in this state, grief and loss that has touched every single person in this state,” Kinsey said.
“And that bears out in the data. We see increasing rates of anxiety and loneliness, disproportionate among our younger people, people who don’t have the same resiliency and framework as older folks may have. And at a time when we had unprecedented fear and frustration in the midst of the pandemic, everybody was confused. We see this now bearing out with 350 people sleeping in emergency rooms without a place to go, people sleeping in DSS offices without access to treatment.”
Decades of underfunding and stigma around mental health treatment converged with the pandemic crisis to create an unprecedented disaster. But, Kinsey said, the upside is that people are talking about the problem more than ever — and lawmakers have begun addressing it through proper funding.
Last month, after nearly a decade of resistance by Republicans in Raleigh, state lawmakers announced they had reached an agreement on expanding Medicaid in North Carolina. Earlier this month, Gov. Roy Cooper announced a plan to invest $1 billion in mental health services, a number both Democrats and Republicans agree is necessary.
“We need to take the signing bonus from expansion and invest it thoughtfully over time to really change a system that has been antiquated,” Kinsey said.
Today, a by-the-numbers look at the national youth mental health crisis as evidenced by the latest data from the Centers for Disease Control and Prevention’s national Youth Risk Behavior Survey and the NC Youth Risk Behavior Survey.
17,000 — Number of students who participated in the national Youth Risk Behavior Survey in 2021. That survey marked a decade of the CDC gathering this data and was the first since the onset of the COVID-19 pandemic.
The survey, conducted every two years, looks at myriad indicators, from drug and alcohol use and sexual behavior to feelings of depression and suicidal ideation. A new report with more current CDC data is scheduled for release this spring.
152 — Number of schools that student participants in the survey represent across the country
37 — Percentage of high school students who reported experiencing poor mental health “most of the time or always” during the COVID-19 pandemic. That number was 31% for the 30 days before the survey was taken.
42 — Percentage of students who reported persistent feelings of sadness and hopelessness during the year before the survey
In North Carolina, that number was slightly higher at 43%. That was up from 28% a decade ago.
57 — Percentage of female students who reported persistent feelings of sadness or hopelessness during the year before the survey
69 — Percentage of LGBQ respondents who reported persistent feelings of sadness or hopelessness during the year before the survey
The survey did not include a question about gender identity and therefore uses LGBQ (lesbian, gay, bisexual, other or questioning) rather than LGBTQ throughout — omitting “transgender.” The CDC is correcting that omission in its new surveys.
LGBQ students consistently reported poorer mental health outcomes across a variety of categories, according to the report.
“Although differences by race and ethnicity were detected for each of these three variables, no consistent patterns were found,” the report read. “The prevalence of poor mental health during the pandemic was higher among gay, lesbian, or bisexual students and other or questioning students than among heterosexual students.”
22 — Percentage of students who had seriously considered attempting suicide in the 12 months before the survey
Those numbers were higher for female students (30%) than for male students (14%) and dramatically higher for LGBQ students (45%).
In North Carolina, the percentage for male and female students matched the national data. It was higher for LGBQ students (48%).
10 — Percentage of students who attempted suicide over the same period
Those numbers were higher for female students (13%) than male (7%) and much higher for LGBQ students (22%).
The total percentage for students in North Carolina was also 10% and similar among LGBQ students (21%).
53 — Percentage of students who said they did not feel close to people at school and who had experienced feelings of sadness and hopelessness over the previous 12 months
The percentage of students who felt sad and hopeless was much lower (35%) for students who said they did feel close to people at school.
CDC data links feeling close to people at school — other students, teachers, coaches or counselors — with lower rates of isolation, suicidal ideation and suicide attempts.
61 — Percentage of students who said they feel close to people at school
Those numbers were lower for female students (58%). They were higher for Asian students (67%) but lower for all other non-white students (60%) for multi-racial students; 58% for Latinx students; 54% for Black and for Native American/Alaskan Native students).
They were lowest for LGBQ students.
Medical and psychological experts warn laws and policies that make LGBTQ students feel more isolated at school lead to more frequent mental health issues, including depression and isolation. In North Carolina, they have warned two specific bills could have those impacts.
Senate Bill 49 would, among other provisions, require teachers to notify parents if a student questions their own gender — effectively outing many young trans people before they’re ready to tell their families, who might be hostile to their identities.
House Bill 43 would make it illegal for transgender people under 18 to receive gender affirming care even if it is recommended by their doctors and approved by their parents.
Dr. Sarah Wilson is an assistant professor in Duke University’s Department of Psychiatry and Behavioral Sciences and co-lead of the Duke Sexual and Gender Minority Health Program. She points to studies establishing the measurable harm of such legislation on LGBTQ people — especially youth and people of color.
“There are downstream effects of that increased exposure to stigma, violence and hate crimes where North Carolinians who are LGBTQ+ reported feeling increased depression and anxiety,” Wilson said. “This is a group that already faces disproportionate rates of discrimination, harassment, stigma, and these bills serve to potentially have an amplifying effect for these inequities we already see.”
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