How to bridge the gaps in mental health care? One way is students helping students

"Our kids are suffering," is how one Cincinnati professional summed up the mental health landscape that teens and younger are navigating today. The markers of a healthy emotional life were already trending the wrong way before the pandemic, but the isolation and trauma caused by that event led to a surge in rates of depression, anxiety, and mental health emergencies nationally, including suicide. In 2021, three leading U.S. medical associations declared a national emergency in youth mental health.  

It's an urgent problem, and in Greater Cincinnati, leaders from the medical, social services, education, and philanthropic communities are collaborating to work on the issue. Parents, medical providers, care givers, mental health professionals, and youths themselves will be part of the solution. This story is the fourth in the Soapbox Cincinnati series, Amplifying Youth Voices, which raises awareness of the problem and looks at possible community-based answers to it.

With mental health professionals in short supply, wait lists for treatment long, and insurance coverage spotty, community organizations are increasingly turning to new experts to address the crisis in youth mental health – the kids themselves.

Peer counselors, youth advisory boards, and student researchers are filling gaps in the mental health network, serving as sounding boards, gathering information, and practicing early intervention in their own social networks and peer groups. While not a substitute for professional mental health treatment, peer-to-peer activity is seen as a tool to address the growing incidence of depression, anxiety, and suicide among youth. Reaching out to a friend or classmate can be less intimidating than talking to a parent or other adult, as trained peer supporters can be more receptive and less judgmental.

That initial, friendly contact can be a vital to a healthy state of mind as peer support is often an entry point for pursuing treatment, can avert crises and emergency room visits, and is associated with effective coping strategies and decreased loneliness.

“Teenagers are more likely to open up to their friends before they open up to an adult,” says Shantel Thomas, a counselor and CEO of A Sound Mind counseling service. “They'll tell their friends what's happening with them and how they’re hurting or what they're mad about, or if they want to run away or kill themselves before they tell an adult.”

In response to the growing incidence of mental health issues among youth, Thomas established Center for Healing the Hurt, which offers free counseling services to inner-city children dealing with trauma. She and others at the center have trained about 50 students at Hughes High School in the techniques of peer-to-peer counseling. The students learn how to recognize trauma, and how past difficult experiences can affect present day health. They took tests that measured the impact of abuse and neglect on children, and then worked with professional therapists on role playing and case scenarios they might encounter.
"They'll listen to each other more than the adults in their lives."
- Christi Jefferds, program director for NKISP
Through the lightning-fast word of mouth grapevine, or through direct conversation, they may hear about someone struggling or even contemplating taking their own life, and then will be equipped to ask that person if they want to talk about it or see a counselor, a teacher, or other another adult.

“Teens are more likely to open up to other teens before they talk to us,” Thomas says.

She related a story of a 15-year-old client whose best friend and family had moved to Chicago. The friend was miserable there, felt alone and without friends in a new, very big city.  She called her Cincinnati friend to say, “Hey, I love you, but I’m going to commit suicide. I can't believe we moved here. I hate it here. I have no friends.” After that call, the 15-year-old reached out to Thomas for advice on what to do, and she recommended calling the friend’s mother, who was able to successfully intervene. She believes that call may have saved her friend’s life.

Thomas’ team is training high school juniors and seniors to work with their classmates and those in lower grades too. They wear “peer counselor” t-shirts on Fridays so others know who to go to if they want some friendly help. Thomas plans to take the training into churches and other community groups.

She’s particularly attuned to the impact of gun violence and the threat of it on inner-city youth, citing as a recent example the case of Nia Booker, a mother who was shot and killed in her car in Avondale in August 2023. In the back seat, witnesses to the slaughter, were her 7- 8- and 9-year-old children, who will undoubtedly bear the emotional scars for a long time.

In her practice, “We're seeing a lot of gun violence,” she says. “We see a lot of survivors of friends who have committed suicide.”  And children traumatized by the incarceration of their parents is another too-common issue she encounters.

Youth advisory boards gather data
In Northern Kentucky, students in four school districts have been trained in leadership and advocacy and have gathered and analyzed local data on what the most pressing needs are in the school and social environments to improve their peers’ mental well-being. The training and information gathering was done under the auspices of the Northern Kentucky Institute for Strategic Prevention, a nonprofit organization focused on youth mental health and substance abuse prevention.

In each of the districts, institute staff helped create youth advisory boards that will work with adults in their schools and communities on what their research on teen mental states has found. Based on that information, they’ll develop awareness campaigns to communicate to students and the broader community what they’ve learned and what resources are available.

The school district surveys, done in 2021, are deep dives on the state of mind of middle school and high school students, and cover drug and alcohol use, cigarette and vaping, bullying, sexual threats, social media, depression, anxiety, suicidal thoughts, and much more. They found, for example, that 23.1% of high school seniors in the district experienced serious psychological distress, such as anxiety or depression, in the previous 30 days.  More than 18% of seniors had cut or harmed themselves on purpose, and nearly 14% of sixth graders had done so. Nearly 14% of both high school seniors and eighth graders had seriously considered attempting suicide in the previous 12 months.

“There has been a lot of discussion in prevention circles about how to most effectively reach our kids,” says Christi Jefferds, program director for NKISP. “The consensus and the data show that peer-led programs are much more effective and impactful than adult-led programs. They'll listen to each other more than they'll listen to the adults in their lives.”   

After being briefed on the statistics, the youth boards developed educational campaigns to help their peers cope in healthy ways with what may be troubling them. Informational brochures, wallet-sized cards with QR codes that link to mental health resources have bene distributed during lunchtimes, and a school-wide assembly to share information is planned at one district.

The generation gap has, for many generations, been recognized as a chasm between the values, interests, and behaviors of parents and their children.  But with the startling increases in depression, anxiety, and even suicide among teens and younger, it’s become essential that the gap be bridged.

“In order for us as an organization to be effective, we want to make sure that we're actually talking about things that are relevant to the kids,” Jefferds says.

Focus groups of teens that her group helped organize found that many youth said adult and school priorities need to be realigned. “Y'all need to stop talking to us about vaping because that's not the problem,” is how Jefferds describes one of the focus groups’ discoveries. “The problem is our mental health. And that's not what you're talking to us about. Our school needs to be focused more on our mental health. That's why kids are vaping and drinking.”

'Ask us what we need'
At the Talawanda School District in Oxford, Ohio, middle school and high school students have been trained in methods for gathering information from their peers so they can build a database to identify key stressors in their lives, how they deal with those, and what they would like adults to know about them. The students were trained by experts at Miami University, and then went back to their schools to collect information from their classmates. School was often singled out as the main stress point in their lives, as well as drama with friends, and family issues, says Amy Macechko, the district’s health and wellness coordinator. Sports and extracurricular activities, as well as family and friends, were both sources of stress as well as benefits to mental health, she says.

For high school students, balancing a job, school work, and extracurriculars were leading causes of anxiety and other issues.  Teachers, coaches, and pets were often cited as supports to emotional health, she says.

A key theme that emerged was that students need adults to listen to them, Macechko says. Listening to music is a boost to emotional health, they reported.  And both middle school and high school students said they need alone time to do the things that make them feel better.

“Adults may see that as wasting time when they need to be doing homework or something else,” she says. “They wanted them to know they’re not wasting time. It is something they need to do for their mental health. I thought that was that was very insightful.”
Hugs, compliments, homework help, and support for their interests were all beneficial. So is creating good memories through positive relationships. “The way adults react to their problems has a big effect on youth mental health,” Macechko says. “Instead of telling us how to fix our problems, ask us what we need to get better,” the students reported.

The next step is to share this information with the school board and the broader community, possibly through a video the students will help produce. The hope is that the schools and community organizations will act on what they’ve learned from the student researchers. “Do we need more training for community members and coaches and parents, people who interact with young people?” Macechko says “Do we need to boost our peer-to-peer efforts in school and make sure our young people are more equipped to handle those conversations when they see something on social media post or when a young person confides in them? And how does that young person convey that information back to a caring adult in the school?”

The training and student research is a first step in sharing student concerns with the community and getting them closely involved in working on solutions.

“This was an opportunity to empower young people,” Macechko says. “To set them up for success, give them roles, be a part of the process, and hear straight from the young people about what they're dealing with, who is there to support them and what they want adults to know.”

And all that, it is believed, will inevitably lead to greater happiness, self-esteem, and effective coping, as well as less depression, loneliness and anxiety.

The Amplifying Youth Voices series is made possible with support from Interact for HealthTo learn more about Interact for Health's commitment to mental health and well-being, please visit here. 

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Read more articles by David Holthaus.

David Holthaus is an award-winning journalist and a Cincinnati native. When not writing or editing, he's likely to be bicycling, hiking, reading, or watching classic movies.