Pandemic highlighted mental health crisis, activated reforms

Movers & Makers assembled a panel of community advocates who are working to improve mental health care in Ohio. Answers have been edited for length.

Brian Cunningham
Brian Cunningham

Brian Cunningham, chief operating officer and acting director of Grant Us Hope, is an advocate for the organization’s important mission – “Saving Young Lives, Together!” His experience includes 25 years of executive coaching, strategic consulting, organizational development and lean operations expertise.

Loren McCauley
Loren McCauley

Loren McCauley is the new southwest regional leader of Youth Motivating Others through Voices of Experience (YouthMOVE) Ohio. She graduated from Loyola University of Chicago in 2019 with a B.S. in psychology and Africana studies and has held research fellowships with the Ronald E. McNair Scholar Program and Loyola University’s Center for Urban Research and Learning.

Kate Schroder
Kate Schroder

Kate Schroder is president and CEO of Interact for Health, a foundation advancing health in the 20-county Greater Cincinnati region. A Cincinnati native, she has 20 years of experience working internationally and domestically to solve complex community health challenges – particularly bringing together health partners, government, non-governmental organizations, businesses and foundations to reduce preventable deaths in kids.

Movers & Makers: What happened to you that led you to do this work? 

Cunningham: My wife is a teacher. We met and got married in college. From the beginning, we have always shared a passion for helping children. I started by speaking to high school students while I was in college about “Making High School Count,” a program sponsored by Procter & Gamble. After graduation, I consulted with nonprofits focused on making a difference in the lives of children and families, which eventually led me to working for Cincinnati Children’s Hospital Medical Center for 10 years and ultimately to Grant Us Hope.

One of the primary initiatives of Grant Us Hope is to implement a proven peer-to-peer suicide prevention program called Hope Squad in schools across Greater Cincinnati. We train school administrators, counselors and teachers to become advisers for Hope Squad students. We then equip and empower our young people with the skills they need to identify their classmates who might be struggling, empathetically communicate with them, then connect them to trusted adults who can get them the help they need.

I’m also passionate about this work because when my son was 12 years old, he attempted suicide, but we didn’t learn about it until years later. Much like our founder Diane Egbers’ son, who died by suicide, my son was academically exceptional, athletically and musically talented, and had tons of friends. We had no idea he was struggling, but his friends knew. If his school would have had a Hope Squad at that time, then one of his friends would have known what to do to help him – to refer him to a trusted adult – and he may have gotten the help he needed before the attempt. With help, he is doing well now. My experience with my son’s suicide attempt fueled my deep passion to ensure our youth and their parents access with the right tools and support to address mental health concerns quickly and effectively.  

McCauley: What is unique about my position is that you must have lived experience with mental illness or substance use disorder to be in this role. I have struggled with mental illness since childhood and into my adult years. There was a time for me when getting out of bed was the hardest and scariest task in the world. Today, I get to work in a field I am extremely passionate about, and with young people who inspire me to be better every day.

Schroder: Since its inception 25 years ago, Interact for Health has served as a convener and collaborator who works with partners to tackle the most critical issues of the moment. Today, that issue is mental health. Interact for Health has prioritized mental health in our recently released five-year strategy. We started by listening to partners, grantees and community members. Across all geographies and demographic groups, the number one request was for a focus on mental health – particularly among youth. According to the CDC, the suicide rate has doubled for teenagers since 2007 and tripled for those ages 10-14. Locally, over half of teens reported frequent mental distress and more than one in four indicated a desire to be alone all the time, according to a 2022 PreventionFirst Survey of more than 26,000 7th-12th grade students in Greater Cincinnati.

M&M: What are we doing right and wrong regarding mental illness, especially regarding youth?

McCauley: Ohio is a progressive state when it comes to mental and behavioral health services. The Ohio Department of Mental Health and Addiction Services requires training and certification for all who work in the prevention field. I believe that greater training and experience lead to more effective prevention and intervention. The biggest area of improvement we must make revolves around the implicit bias that Black children face when addressing mental health. According to ACLU Ohio, during the 2021-22 school year, black students in CPS were six times more likely to receive out-of-school suspension, and eight times more likely to be expelled without instruction. We must recognize that problematic behaviors often stem from trauma, and that intervention, rather than punishment, is necessary.

Cunningham: One positive thing that came from the COVID-19 pandemic is that we seem to be more open to talking about our mental health and our well-being. We have started to understand that it is a part of being human. We know students talk to other students before they will tell an adult about things they are struggling with. So the progress we have been making with supporting peer-to-peer programs in our K-12 schools, like Hope Squad, has been an area where we are starting to get it right. School boards, school administration, and state and local legislators are continuing to talk openly about the struggles with youth suicide and mental health and the need to provide funding and support to meet the challenge. We are raising awareness and starting to break the stigma – but we are not going far enough, fast enough.

I believe we are on the verge of another pandemic  – this one of youth mental health. 

There needs to be more focus on proactive prevention, early identification and earlier evidence-based intervention. All of these are suffering due to limited access to mental health care providers – including, but not limited to, psychologists, therapists, social workers and school-based mental health supporters – and also due to limited funding. Most funding is focused on immediate crisis intervention. 

Schroder: We are talking about mental health more than ever. Stigma is reducing. We also have the 988 suicide and crisis lifeline – available 24/7 for anyone who is struggling. These are promising developments. At the same time, we need significant improvement in access to quality services when someone needs help, especially for youth; it’s hard to find an appointment, waiting times are long, and we lack more flexible options like mobile response teams and in-home services. And much more needs to be done to help young people develop strong social-emotional skills to prevent mental illness in the first place.

M&M: COVID-19 was devastating for many. How have mental health clinicians, counselors and caregivers responded, from your perspective?

Cunningham: They stepped up big time. There are many healthcare heroes out there. They are doing the best they can, for as many as they can, in the best way that they know how. The issue is that the lines outside their offices continue to grow faster than they can help. The waitlist and the time it takes to get an appointment, for all but the most urgent cases, is staggering. That means that proactive prevention can take a back seat. Now it is imperative that we start working more upstream to collectively find where and why our youth are falling into the river in the first place, and focus many more resources there. 

McCauley: I believe mental health clinicians, counselors, and caregivers are superheroes. During COVID-19, clinicians had to pivot how they provided care from direct to virtual. This allowed them to be able to reach more people, but they are now overworked and overwhelmed. I‘ve observed a lot of clinicians move toward private practice and life coaching, and while those are incredibly impactful, this creates a greater barrier for low-income folks who need mental health services. There are fewer clinicians that accept Medicaid and those that do have a large caseload and even longer waiting lists. There is a dire need for more mental health professionals. 

Schroder: Mental health clinicians and counselors are on the front lines of this crisis and doing incredible work. But there are not enough of them. Most healthcare positions have experienced high rates of turnover and burnout since the pandemic, and mental health workers are no different. It’s an incredibly challenging situation as demand for mental health services is rising at record rates, and at the same time, too many people are leaving the profession. We need an all-hands-on-deck approach to strengthening our behavioral health workforce, including increased recruitment and retention, more competitive pay and greater diversity.

M&M: What can policymakers do to enhance mental health care in America?

Cunningham: For youth mental health, policymakers could begin to treat our current youth mental health crisis with the same level of gravity that they did during the COVID-19 pandemic. They could align federal, state and local funding and policies to optimize our mental health systems to be able to support our young people, especially around proactive prevention. They could work with both public and private entities to collaboratively build a comprehensive and coordinated array of readily accessible services and supports. This would include embedding these services and supports within our schools where our youth spend the majority of their time. Finally, policymakers could establish, publicize and promote a “State of the Union on our Youths’ Mental Health,” the same way they did for the COVID-19 pandemic. Then maybe we could get in front of this crisis – before it becomes a pandemic.

McCauley: COVID-19 was a collective traumatic experience. Many people in this country were already dealing with mental illness, but during the pandemic, more people realized the mental challenges they faced. We have an increase in people who are seeking mental health services but a decrease in the number of providers and resources. Policymakers need to create and pass bills to increase the number of accessible resources and mental health services. This includes adequate housing, counseling services and medication management, among other services.

Schroder: Policymakers can incentivize increased recruitment and retention in the mental health workforce. They can also ensure that payment for mental health services covers the cost of those services. Although parity laws exist to provide similar access to physical and mental health services, these laws are often not enforced; lower payment rates for mental health services contribute to less competitive salaries and workforce shortages. Policymakers also have a role to play in increased investment in prevention and research. 

M&M: Final thoughts?

Cunningham: I have a tremendous amount of hope. We all should. There is so much we now know about our youths’ mental health and so many wonderful things we have right at our fingertips to be able to make a significant, positive difference – proactively. We just need to all agree to row in the same direction together – and fast.

McCauley: While we have made leaps and bounds, we still have a long way to go, especially in addressing the stigma of mental health in BIPOC (black, indigenous, people of color) communities. I believe everyone deserves to live a healthy and full life and that includes mental wellness. 

Schroder: The U.S. surgeon general issued an Advisory on Social Media and Youth Mental Health – urging parents and policymakers to understand the “profound risk of harm” and to set limits on exposure and use. As a parent of 8- and 10-year-olds, the risks and challenges hit home for me. I see firsthand the ever-present pull of peer pressure to be on social media and know the impact this can have on sleep, in-person interactions and feelings of self-worth. There are no easy answers, but understanding what is causing the skyrocketing rates of mental health challenges in our youth – and conversely, what is most effective at promoting connection and belonging – is a calling for all of us.