Safe spaces: Collective action emerges on the crisis in youth mental health

"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 begins a Soapbox Media series, Amplifying Youth Voices, to raise awareness of the problem and look at possible community-based answers to it.   

Armed with colored paper, pencils, paint, markers, and glitter, a group of 10-, 11- and 12-year-olds in Cincinnati’s West End are creating handmade Valentine’s Day cards for someone special in their lives.

Local artist Christian Drye leads the group in an after-school program, sprinkling bits of wisdom in between his instructions. “When you give people a greeting card, it changes their whole day,” he says. “So think about someone you want to give a card to.”  

It doesn’t have to be perfect, and don’t be afraid to ask for help, he advises. “If you don’t know how to spell something, that’s alright,” he says.

One of the boys has an important question: “L-O-V-E?”

Assured of the proper spelling, he finishes his message: “To: Mom Thank you for taking care of me and I hope you have a good day. Love …”

These 4th, 5th and 6th graders meet once a week at Seven Hills Neighborhood Houses, a social services organization and community gathering space that has been serving the West End for more than 50 years. The art projects keep their hands and minds engaged while Drye mixes in guidance and encouragement. “Use this time to slow your day down,” he says, as chill music plays in the background.
Christian Drye leads the Guiding Light program in West End.The Seven Hills program, called Guiding Light, is part of one neighborhood’s effort to address what has metastasized into a crisis in Cincinnati and its suburbs, and across the country: a significant decline in the mental health of youth. We are absolutely seeing the mental health of our students deteriorating,” says Amy Macechko, health and wellness coordinator at the Talawanda School District. “That’s what we’re seeing across the nation.”

As parents, schools, doctors, mental health professionals, and others respond to the crisis, community-based programs like Guiding Light are increasingly seen as one piece of a multi-layered answer. The goal of these efforts is preventing mental health emergencies by creating environments that build self-confidence, resilience, and emotional health in kids.

“When we think about what factors are shaping the mental health challenges that young people face, it's about the stressors in our community,” says Ross Meyer, a vice president for Interact for Health, a Cincinnati not-for-profit that works to improve community health. “It's the environments they're in, in schools and homes in the community that are putting an undue burden on them. When we think about what to do to address it, it's not about fixing young people, it's about fixing the conditions around young people in ways that are going to be more conducive to their mental health and well-being.”

It is a long-term response to a situation that has been building for years:
  • From 2009 to 2019, the percentage of high school students seriously considering attempting suicide increased by 36%.
  • The percentage reporting persistent feelings of sadness or hopelessness increased by 40%.
  • In just four years, from 2011 and 2015, youth psychiatric visits to emergency departments for depression, anxiety, and behavioral challenges increased by 28%.
  • Over the ten-plus years between 2007 and 2018, suicide rates among youth ages 10 to 24 increased by 57%. 
These statistics are taken from U.S. Surgeon General Vivek Murthy's 2021 advisory "Protecting Youth Mental Health."  They show what was happening before the Covid-19 pandemic became a nearly all-consuming part of life in 2020. The impact of the pandemic magnified those trends.

Symptoms of anxiety, depression, and other mental health disorders doubled during the pandemic, with 25% of youth experiencing depressive symptoms, and 20% experiencing anxiety symptoms. In early 2021, emergency department visits for suspected suicide attempts were 51% higher for teen girls and 4% higher for teen boys compared to just two years earlier.

“Problems with anxiety and depression were going up even before the pandemic, and when the pandemic hit, that just exacerbated everything,” says Dr. Suzanne Sampang, the medical director of child and adolescent psychiatry at Cincinnati Children’s Hospital Medical Center. “Kids were pulled away from schools, which are a source of social and emotional support. They lost a lot of their activities that they were involved in. Many of them lost loved ones.”

The pandemic also contributed to the sense of a world that’s lost its bearings. Climate change, gun violence, war, the rising cost of housing, and an invisible killer virus can be too much for anyone to process, let alone a young, developing mind. “Life is a lot more complicated in so many ways,” Dr. Sampang says.

“[We] keep on hearing about climate change and how it's just getting worse, and nothing is being done about it... And the rising costs of college and living expenses… There are a lot of daunting challenges that we're facing, not just as an individual but as society today.” – J., white male, 18  

The crisis is resistant to easy answers, but one may lie with grassroots organizations like Seven Hills Neighborhood Houses that are working to build social skills and provide safe spaces for kids to express themselves.

“How do we help equip all of us, young people included, with the basic skills to understand and manage our emotions and deal with and cope with challenges?” Meyer says. “Unless we're doing that, we're just going to keep responding to crises.”

New report: Greater Cincinnati Youth Mental Well-Being

The challenges are complex and deeply embedded. To begin to understand how they are affecting local preteens, teens and young adults, more than 200 leaders from more than 115 organizations that serve youth met over the last few months of 2023 to identify the top factors affecting youth mental health. In addition to interviews with more than two dozen community leaders, the group gathered feedback from focus groups involving more than 60 youth and their families. The result was an assessment, published in January, called “Greater Cincinnati Youth Mental Well-Being.” Its purpose is to create a shared awareness among the multiple organizations working in the mental health arena so they can act together with focus and create a greater impact working in concert than they can acting separately.

“Greater Cincinnati is grappling with a youth mental health crisis,” the report begins. “Mental health needs have grown more acute, children face challenges at ever earlier ages, mental health providers are strained, and caregivers are overwhelmed. Recent heartbreaking youth suicides have galvanized collective action from committed leaders across the community.”

The report identifies six broad areas of concern to focus on (quotes in italics, below and above, are from the youth focus groups, as published in the report):

Community connection and safety
Communities aren’t safe enough, connected enough, or supportive enough to enable youth to thrive, the study found. “They are coming of age in a time of great social change and dealing with the immediate threats of community violence and discriminatory policies,” it says. “These challenges are compounded for youth from marginalized communities, where systemic racism and underinvestment exacerbate threats to well-being.”

“People don’t have a strong community. People don’t know there are means to get to where you want to go. I think isolation and lack of community takes that away. Feeling like you are in community that cares about me makes me do well.” – V., a white female, 18+

The school environment
Rather than serve as safe, protective environments, schools can be scenes of bullying, stress, and harsh discipline.  Adults in schools are not always well-equipped to protect and support students.

“I know a lot of my friends don't want to wake up and go to school. I think that if it was more supportive and people felt like it was a safe and comfortable [place] to go, then it would be a better time.” –T., a white male, 15-18

Attitudes among parents and care givers
Because of the stigma associated with mental health issues, or because of a simple lack of knowledge, parents and other care givers don’t always acknowledge mental health as a genuine issue in children. Many adults also struggle with their own mental health challenges, which can interfere with caring for children.

One local study found that 90% of parents interviewed said their child's mental health is good, very good, or excellent, while 39% of the students said they feel anxious all or most of the time. 

“There’s a disconnect between parents and how children are actually feeling,” says Jill Miller, president and CEO of Bethesda Inc. and its grantmaking initiative bi3.

“The root causes, it starts at home… We learn what we learn from our surroundings and how we were raised. How can we know or have an understanding of mental health when our parents don't even know? When we go to our parents, and we say ‘depressed,’ they say stuff like, ‘depressed your ass.’” –E., African American female, 15-18

“I feel like it starts with families. Families need to be more open and understanding. A lot of families sweep things under the rug, and they expect you to be fine and okay. I feel like my mother's biggest issue was that she was never okay. She wasn't okay enough to raise children. Her mental health was so messed up that she just wasn't what she was supposed to be for her children.” –S., African American female, 18+

Access to care
Timely access to behavioral health treatment is difficult because services are not adequately funded, making them unaffordable or unavailable altogether. Low reimbursement rates from insurance companies and gaps in insurance coverage are obstacles to receiving proper care.

“Because we as a society have so under-invested in mental health, stigmatized it, and under-invested in the whole system of mental health care, we're only really equipped to address problems when they become crises,” Meyer says.

Care is poorly coordinated
The behavioral health system is “siloed,” making it difficult for young people and their families to find good, consistent, quality care. The situation is worse in historically marginalized communities.

“I was noticing things with my child... nobody clocked that it could possibly be autism…We didn't get to autism until after the third mental health hospitalization because my child was experiencing suicidal ideation to point where they made a plan [to take their life].” – Local parent

Burnout among health care providers
“Behavioral health providers leave the field due to stressful work environments, heavy workloads, limited support, and low pay, with few opportunities for on-the-job training and growth,” the report says. The trend is aggravating already long wait times to see specialists.

“Who's going to really take the time to get to know me and really help me and not just pass me around? A lot of times I know that people in that field is overworked as well, so they're just sifting through people and not really taking time to get to know them as a person.” – E., African-American female, 18+

It’s a nationwide problem that cuts across all demographic lines of race, income, and gender. But it’s aggravated by poverty and race.

“I see a lot of pain daily,” says Terana Boyd, who directs programming at the West End neighborhood center. “I see a lot of trauma. When our youth come in, most of them are tired. That can be from the home situation, to stress in school situations,” she says.

Terana Boyd
A lack of stable housing, abuse or neglect at home, and increasingly, gun violence close to home cause trauma that can leave emotional and psychological scars. In Cincinnati, shootings involving juveniles increased 36% just from 2022 to 2023, according to a Cincinnati Police report quoted in the study. Shootings in which a juvenile was a victim increased 66% during that time.

“You're at this age where your friends are dealing with guns and you're attending your friend's funeral,” Boyd says. “How do you think that continues to play on your mental health? Then you're going home, you're watching your mom struggle. You might not even have a home, so you're going to someone else's place. It’s a cycle and when does it end?”

“Some neighborhoods can be rough. If it was a safe community and less violence and stuff like that, I just feel like people should be out there having great communication with their community. Once upon a time everybody was getting along in their little neighborhood, and everybody knew each other.” –Z., African American female, 18

Youth in rural communities and the suburbs also feel the weight of a world with issues magnified by social media and the dark corners of the internet. “Our local data tells us that students are reporting that they're anxious, they're nervous, they're sad, they're depressed,” says Talawanda Schools’ Macechko, who runs a program supported by a community coalition in the Butler County district.

The prevalence of social media has magnified the problem. “While there are some positive aspects to social media and the tech age that we're in now … I believe that it’s aggravating it,” Macechko says. “The need to compare yourself to others that you see on social media, the desire to have your posts liked … that definitely is affecting the mental health of our students.”

Amy Macechko
Terabytes of information, images, and video are available on the internet, much of it negative. “There’s so much access to information, whether it's substance-use trends or self-harm,” she says.  “A student alone in a room seeing that, that's a lot to process for a young, developing brain.”

Bullying, which has been a problem in schools forever, can now happen around the clock thanks to the ubiquitousness of personal phones, and can be amplified by the algorithms of social media providers.

“Some rumors started and me and my friend both kind of experienced cancel culture… We were receiving death threats… Being on the other side of [the rumor] was definitely a different perspective and difficult to go through.” – A., white female, under age 15

The community assessment is a first step that brought together multiple organizations and people working in the mental health arena. “There’s been groundswell in terms of bringing people together in the community to say, ‘Yes, we want to improve youth mental health, and we all need to get on the same page and get rowing in the same direction,’” Miller says.

It’s meant to provide an agreed-upon base of information that the organizations are using to create a comprehensive plan to work on the problem. Organizers say they expect to release that plan this summer.

“This assessment phase is meant to get us all on the same page about what are we dealing with, and do it in a way that really is based on what young people are telling us,” Meyer says.

What results should be more than a temporary fix.It's actually trying to build a comprehensive mental health system for youth,” Dr. Sampang says. “From a parent, neighborhood, and community level, it's engaging with youth individually, making sure to connect with them, having conversations about their mental and emotional well-being, and intervening early.”

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. 

Enjoy this story? Sign up for free solutions-based reporting in your inbox each week.

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.