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The Kids Are Not Alright: Addressing the Youth Mental Health Crisis

March 1, 2022

The announcement came in late 2021: Youth mental health was declared a national emergency by pediatric experts across the country, underscoring how children and young adults are left reeling by the COVID-19 pandemic.

Yet, youth advocates say, younger people have struggled to get age-appropriate, timely mental health care since before the pandemic. Leaders from across Dell Medical School at The University of Texas at Austin are coming together to address these urgent needs locally, alongside crucial community partners like Integral Care, Travis County’s mental health authority. The methods and partnerships are as varied as the mental health conditions addressed, but the aim is the same: ensuring that adolescents and young adults get the support they need as soon as they need it.

“It’s hard to overstate the urgency of what’s happening with young people at this moment,” says Charles Nemeroff, M.D., Ph.D., chair of Dell Med’s Department of Psychiatry and Behavioral Sciences. “Finding them the right answers — and the right care — is about more than just one individual’s mental health; it’s also about looking ahead to how these conditions affect future generations, and creating chances to break cycles of trauma.”

Three individuals are illustrated together, shoulder to shoulder, with clouds in front of part of their faces.

Getting to the Root of the Problem

In a rigid dichotomy of pediatric versus adult care, the unique mental health needs of adolescents and young adults — “transition-age youth” — are commonly overlooked. The team at the Center for Youth Mental Health in Dell Med’s Department of Psychiatry and Behavioral Sciences are working to address these gaps in care by leveraging research strengths and identifying at-risk young adults with early signs of serious mental illness to coordinate care.

Since 2018, the center — made possible by the Michael & Susan Dell Foundation — has collaborated with community partners to better understand what care should look like for adolescents and young adults, seeking a happy medium between pediatric and adult care.

“Through interviews and surveys with our partners, we’ve learned that young adults view mental health services with a scarcity mindset, thinking ‘I should figure this out on my own. Someone has it tougher than I do, and I don’t want to take space from them,’” says Deborah Cohen, Ph.D., assistant professor of psychiatry and co-lead for the center. “After conducting various research with our partners, we’ve started taking steps to address gaps, like training providers to have more comfort working with this unique age group.”

After Psychosis, Relief

One of the most acute psychiatric conditions experienced by young people and adults alike is psychosis, which can indicate underlying illnesses like bipolar or schizoaffective disorders. Cohen works with Molly Lopez, Ph.D., research associate professor in the Steve Hicks School of Social Work, to oversee data collection and assessment for EPINET-TX, a regional, federally funded network of mental health clinics in Central Texas that supports younger people experiencing psychosis. The collaborative team of researchers from Dell Med and the Steve Hicks School of Social Work, including Cohen and Lopez, hope this study leads to making system-wide improvements.

These are developmentally critical years that set the tone for adulthood.

Christine Bartow, D.O.

One of the clinics in the EPINET-TX network represents a key community partnership: Dell Med faculty and residents have partnered with Integral Care who runs the national Recovery After an Initial Schizophrenia Episode (RA1SE) program in Travis County, dedicated to supporting 15 to 30-year-olds who have recently experienced their first episode of psychosis. The RA1SE-coordinated specialty care team includes peer support specialists, a nurse, a primary clinician, a physician assistant and more. The team works with patients for up to three years — providing psychiatric care and giving them the tools they need to build coping skills and meet their goals at school or work. Integral Care has offered the RA1SE program in the community since 2016.

“The purpose of RA1SE is to engage in a meaningful way with young people in our community who have severe, chronic mental illness,” says Christine Bartow, D.O., staff psychiatrist for the local program and assistant professor at Dell Med. “These are developmentally critical years that set the tone for adulthood, and the services we offer are beyond what you might think of as part of psychiatric care — helping someone fill out job or college applications or coordinate logistics for support services, for example.”

Help Is Just a Phone Call Away

A six-year-old girl, “Anne,” began exhibiting disruptive behaviors at school last year — hitting, kicking and shouting at those around her. For someone like Anne, who lives in a rural area of Central Texas, specialized psychiatric help isn’t always immediately at hand. Dell Med works with the Texas Child Mental Health Consortium to meet critical mental health needs for children at home, at school and in the offices of primary care physicians through two key programs.

One of them is the Texas Child Health Access Through Telemedicine program, which makes telepsychology and telepsychiatry services are available for 21 Central Texas school districts and 295 campuses, serving roughly 224,000 students so far in a partnership with Integral Care and Bluebonnet Trails. When school staff members identify a child like Anne needing mental health services, they can reach out to TCHATT for a series of five sessions to develop a short-term intervention and plans to ensure continuity of care.

And similarly, through the Child Psychiatry Access Network, the Dell Med team runs a hotline that has already been used by nearly 900 primary care physicians to discuss treatment options for their patients in the course of typical primary care. In Anne’s case, her parents took her to their family doctor, who sought guidance from a pediatric psychologist through CPAN to determine a path forward for diagnosis and treatment.

“We have the opportunity to make a difference for both individual students and staff by supporting physicians, parents and schools,” says Puja Patel, Ph.D., assistant professor at Dell Med and co-clinical director of TCHATT and CPAN alongside Nithya Mani, M.D. “At a time when the volume and severity of cases we’re seeing is high, we’ve seen also kids who were unable to attend school because of anxiety who are now back at school, successfully using the tools we gave them through these programs.”