Addressing the Children’s Mental Health Crisis

FULL TRANSCRIPT

Brown: Welcome to the Menttium Matters podcast, where we talk about leadership, life, and the transformative power of mentoring. I’m Solveig Brown, and today I’m joined by Craig Warren, who is the CEO of Washburn Center for Children. Our conversation is going to focus on children’s mental health. A recent Pew survey found that mental health tops the list of things that parents worry about. About 40% of American parents worry that their children might struggle with anxiety or depression. Children’s mental health has become such a concern in the U.S. that it was declared a national health emergency in 2021. Since many of our mentees and mentors are parents, grandparents, or caregivers, we wanted to address this issue.

 

Before we begin our conversation, I’d like to give you all some background information on Craig. Craig Warren was named Washburn Center for Children’s CEO in 2022 and previously served as Washburn’s chief administrative officer. Craig is the first BIPOC CEO in the organization’s 140-year history. Washburn Center for Children is Minnesota’s leading mental health center, delivering transformative mental health services to children and their families at three clinics in over 40 schools, in children’s homes and wherever they are needed.

 

Craig is a social impact catalyst with over 25 years of strategic planning, service delivery, EDI and consulting experience in the public, private, and nonprofit sectors. He is motivated by a desire to create more equitable community outcomes around education, income, employment, and health. Prior to joining Washburn Center, Craig served as vice president of enterprise solutions at Minnesota Children’s Museum. His professional experience also includes leadership roles at Greater Twin Cities United Way, Best Buy, Rockwell Automation, the Coca-Cola Company, Towers Perrin, and the United States Army.

 

Craig earned his master’s degree from the Harris School of Public Policy at the University of Chicago and his bachelor’s from John Hopkins University. He is a qualified administrator of intercultural development inventory. Craig has been a mentor for Menttium since 2019. Welcome, Craig. I am so happy to have you as a guest today.

 

Warren: It’s an honor to be here Solveig, thanks for having me.

 

Brown: Craig, can you please start us off by giving us some context around the growing mental health crisis for American children?

 

Warren: Definitely, and one thing I’d note is that the children’s mental health crisis that we’re currently navigating preceded COVID, and that’s one of the things that’s more troubling about what’s happening. There already was a children’s mental health crisis before COVID. Prior to COVID, one in five children up to age 18 said they were experiencing anxiety, depression, suicidal ideation, grief, or loss. That’s one in five and that was prior to COVID, and that’s only increased with a variety of things that happened during COVID, with the social unrest and reckoning that happened with the murder of George Floyd, and with an increase in the number of school related shootings. That number has only grown since then, but it’s just important to remember that it existed prior to COVID, and it’s only gotten worse, and it’s gotten worse in some scary ways.

 

When you think about the fact that just taking ninth graders for example, I think it was over 9% of ninth graders said that they thought about attempting suicide in the past year, and that’s just looking at ninth graders alone. If you look at some of the other things that are happening, specific to Minnesota, over 43% of the LGBTQ youth in Minnesota have said that the ongoing debates around anti-gay and anti-trans legislation have negatively impacted their mental health. That’s almost 50% of those kids. So, we’re seeing overall just a huge increase in terms of mental health issues that our kids are facing.

 

But that existed before COVID and obviously with the grief and loss that came with COVID, with the grief and loss that comes with violence in schools and the impact that has on kids when violence happens in a school, even if it’s not their school. As we see, things around the economy where caregivers may be losing their jobs. As we see schools moving back from several years of virtual back into in-person. I could go on and on around the things that are happening in the external society at scale that have negatively impacted kids’ mental health. That doesn’t even deal with the things that may be personal to kids. The trauma that an individual child has experienced, that’s not related to any of those things that are happening in the external environment.

 

Brown: Those are sobering and frankly, heart-wrenching statistics and I thank you for noting that this was an issue prior to COVID and COVID just exacerbated an issue that was already prevalent. Washburn Center for Children’s Mission is “to nurture every child and family’s wellbeing and full potential through transformative children’s mental healthcare”. I love that mission statement. Can you tell us more about your mission and what Washburn Center for Children does?

 

Warren: Our focus at a macro level, and this is what kind of gets me up every day, is we provide hope. If you have a child in your life who is suffering from some type of mental illness, it’s not like when you break an arm or you have a fever where it’s clear you have a fever. We know where to go for that. You break your arm, or you have a strain, you know where to go for that. It’s clear what the symptoms are and what you’re dealing with. When you’re dealing with children and mental health, often it’s not clear and people may not intuitively think that something is a mental health issue. They may think there are other things going on, it’s just part of their development. As you’re struggling with that as a caregiver, it can be hard to even suss out that what you’re dealing with may be a mental health issue. It can be a confusing and long nonlinear journey for you to figure out if there is something going on with your child and I think it’s a mental health issue and I need to go to a mental health provider.

 

But once you figure that out, you may not know where to go. I feel we bring hope because when people figure out there is a place that all we do is take care of kids and families, we don’t do anything with adults who are not part of the ecosystem of a child. There’s a place where whatever’s going on with my child, I can go to this place, and they focus on mental health with children. All our work is primarily from an outpatient perspective, but we have a wide continuum of care from someone who may need to see one of our clinicians once a month or once a week, to crisis stabilization where someone’s on the cusp of needing residential treatment or inpatient treatment, or they’re coming out of one of those environments and we want to prevent them from going back in. We have where we go in people’s homes multiple times a week. So, whatever a child needs up to the point where they may need to be hospitalized or they may need residential treatment, we have a wide continuum of care that we provide.

 

We’re community based, so you don’t just come to our office. We do have three offices around the Twin Cities, but we also have partnerships with several school districts where we have clinicians embedded in over 40 schools. We have partnerships with several healthcare systems so that before someone is discharged, we get them connected with a therapist so that they don’t have to go through, my child’s been discharged. How do I go find someone? Nope, you’re already connected with your therapist before you’re discharged. There’s a certain number of visits you get with that. We have this robust continuum of care focused on supporting the mental health of kids and their families.

 

Brown: That is an amazing and much needed grouping of resources that you provide for the community. I like that analogy that if your child has a broken leg, you know what to do. But like you said, mental health issues aren’t always so clear cut. So, I like that you are a place where people can get the resources they need and find out what they don’t even necessarily know about this journey with their kids.

 

Craig, there is currently a nationwide shortage of mental health professionals. I’ve heard people talking, especially during COVID, about how they could not get in to see a therapist or find a therapist. A recent report states that 150 million Americans live in areas that are federally designated as having a mental health professional shortage. There is also a gap in who has access to mental healthcare. How did we get here?

 

Warren: I believe it’s because there’s been systematic underinvestment in creating a broader mental health system. A broader mental health system really does not exist at a national level and when you dial that in for kids, there’s even less of a system that was built for that. That goes back to frankly at a high-level societal perceptions regarding mental health. If you think about this and go with what I was talking about earlier, when you break your arm or you have a fever, you go to a doctor. There’s a societal value for doctors. How many medical TV shows are there? There’s always a show about people being doctors or nurses because that’s raised up as an honorable profession. You can make a good income doing that. Going to medical school is a revered type of thing. There’s an income associated with the profession because society places value on that, therefore you are compensated for doing that work, and it translates into policies, more resources, and reimbursement rates where that is at a different rate where people invest in because frankly, there’s resources allocated, and you can make money on that.

 

If you look at mental health, how many people do you know who as a child or a four- or five-year-old were saying, I want to grow up and be a therapist or a mental health professional? How many times have you seen that profession represented in a cartoon, on TV or anywhere that people are talking about doing that? That has an impact in terms of people’s willingness to even be aware that mental health is a thing that is an illness that you need support for and for people valuing investing in the care around that. It starts with this stigma and perception that has existed around mental health, that has translated into investing from a government perspective and even from a commercial perspective in those services and valuing them. That translates into people not valuing it.

 

I have nothing against professional sports, but the fact that you have someone who plays a sport for a living, and they get millions and millions of dollars, and they don’t even play for the full year. The season is not the full year, and they get millions and millions of dollars if they’re at the top of the game for playing this sport. But we have folks like teachers and mental health professionals where we struggle to find people and struggle to get them an equitable wage, who have a huge impact on our society, and society does not value them in the same way, and you see the resources put against that.

 

There’s been a structural underinvestment into the reimbursement rates for mental health, which are much slower than the reimbursement rates are for things like getting a broken arm or getting admitted to the hospital for that. If you look at the schools, even structurally within the schools, you must be licensed to be a mental health professional. You must go to graduate school and get a master’s degree or get a doctoral degree and you must do an internship, a practicum, while you’re in school. In Minnesota with the licensing board, you can’t get paid for that internship. So, you’re going to school in a field that’s not one that’s valued or where people are paying top dollar, you’re probably going to have to take out a student loan, and while in school, in addition to your class load, you have to do an internship, and on top of that you have to work. Some people may be thinking, I don’t know if I want to go into that profession, I may do other things. There’s not a robust pipeline of people going into the schools because of some of these challenges with not being paid, taking on debt, the income you earn outside of that and what people are able to pay tied to the reimbursement rates.

 

For Washburn, we’re community based, so your income will not be a barrier to you receiving services from us. What that means is, over 50% of the clients that we serve get some of their insurance through some type of either Medicaid or state medical assistance program. The state determines those rates. If the state determines that we are going to reimburse more for you to go to the hospital for a broken arm or for a fever then we do for mental health, and we’re relying on that for our funding model that’s going to constrain how we can recruit people and how we can pay them to say, I’m going to school and make my money back on that.

 

I could go on and on about this, but there are structural underinvestments in a variety of aspects of our mental health system that make it challenging to attract people to the field and challenging for them to stay in the field and that has contributed to that shortage and the work has gotten harder. One of the, and I hesitate to call it a silver lining, but during COVID, one of the things that’s happened was a shift in the stigma regarding mental health. Even at the beginning of it, with the actions of Naomi Osaka and Simone Biles that were very visible, these top tier athletes who were struggling with mental health issues and talking about it. I think there is still a stigma, but that stigma shifted with that. Everyone saw the impact of COVID on kids. Everyone who had a kid or knew a kid felt there was something going on and it wasn’t great for that.

 

So, there’s a broader understanding of the mental health challenges that kids were facing come out of that, combined with a shift in the stigma, which meant demand went up. Well, demand went up within a system that we had under invested in, so there wasn’t much capacity to meet that demand. You hear these things where there’s a wait list because there’s not capacity in the system to deal with this demand. There are not people going to school for this in large numbers. The people who are doing it, it’s been hard if you’re a mental health professional during the last couple of years. So, some people are like, I don’t want to do this anymore. It’s not even I want to do it to make more money or something, it’s because this is hard. I want to go do something else because carrying the burden and walking alongside these families is tough and I’m burnt out. I just don’t want to do it anymore. They’re leaving the field and there’s not a strong pipeline of people coming in. All that is contributing to this perfect storm of factors that’s making it challenging for families and kids to get the support they need because there just is not capacity in the system because we haven’t built that capacity in the system at a structural level.

 

Brown: Craig, thank you for providing that context of how that underinvestment is playing out now and that there’s a lot of work to be done to fix the system. But right now, there’s a squeeze on the resources for every reason that you pointed out. Like you said that silver lining is that there’s less of a stigma on it, so hopefully that will shift into different legislation, different practices, but that takes time and we’re still at this point right now.

 

Many of our listeners are parents, grandparents, aunts, and uncles. What are the signs that caregivers should look for that a child may be experiencing anxiety, depression, or other mental health challenges?

 

Warren: I think it really varies developmentally, so I just want to point out that depending on the age, it can look very different. But I would say in general, across all ages, changes in your relationship with the children in your life, if there’s some energy or change in the dynamic, that could be an indication that there’s a mental health issue. Changes in how the child or children in your life talk about themselves. Were they optimistic and positive about themselves, and now you hear disparaging or derogatory comments directed at themselves or at other people? That can be an indication that there’s a mental health issue. Noticeable changes in their habits, they’re not sleeping enough. They’re not sleeping straight through the night. They’re sleeping more than they were. They’re not bathing as frequently. They used to be very fastidious about how they dressed and now they don’t care about their appearance. So, things in their daily habits that are routines where you see something in the routines have changed.

 

Most obviously, if a child experiences some type of trauma, you can almost presume independent of any type of behavioral change, if they experienced a traumatic event, if they experienced a loss such as going through a parental divorce or a separation, or they had a loss in the family or the loss of a pet or something like that. Any type of traumatic event should be a flag for a caregiver to be mindful of how is the child responding to this and are any of these other things showing up?

 

I’d say for younger children, they can’t articulate their feelings as well. So that may look like they’re having nightmares, more frequently having nightmares, or they never had nightmares before. They’re having nightmares, or they have difficulty falling asleep. Whereas before they used to sleep like a log and now they’re struggling to fall asleep. Are they having difficulty playing? Are they worried and having anxiety to the point that it gets in the way of them playing with people or learning in school where they’re distracted in school or they’re not following directions to the degree that they did in the past? Are they more irritable or angry or have this rage that you feel comes out of nowhere that’s atypical of how they typically acted? With a younger child who may not be able to fully express themselves, it’s going to play out in these behaviors that you must be mindful of. Those behaviors may be representative of a mental health issue or trauma, not just a child acting out, and it’s just normal child behavior, but you must be attentive to that.

 

With teens, I would say it’s a little bit easier because you have more of a pattern of behavior and they can express more of what’s going on with them. But if they’re hiding or isolating, where someone who was outgoing and engaged with family or friends, and suddenly you’ve noticed they’re not hanging out with friends anymore, or they’re withdrawing from the family, that would be an indicator. If they’re not focused, like they were locked on and they had a thing that they did all the time, and suddenly they can’t seem to focus on that thing, like their academics. Or maybe they were doing a sport or playing an instrument and they’re not as focused as they were in the past, that may be indicative of something. An increase in aggressive behaviors with a teen, where someone who wasn’t particularly aggressive before suddenly begins behaving an aggressive or direct manner, that may be indicative of something. If they’re having panic attacks or depressive episodes, that’s indicative of something. If their friendships fall off, and they used to have a close group of friends that they’ve known forever and suddenly they don’t have those friends anymore or their friends have changed. Those are just some of the things that differ a little bit by age that can be indicative of someone may need additional support and it’s worth talking or exploring with someone around seeking support.

 

Brown: That’s a good point. If you suspect your child is having mental health challenges, what should you do or how do you go about getting that support that they need or that you might need?

 

Warren: I’d start with the school. Most of the children that we deal with are school age, either in a daycare environment, elementary school, or high school. If your child is in an academic environment, talk to the teachers. The school may have talked to a teacher, may have a social worker, the school may even have a mental health professional that is on staff in the school that the district has access to. I’d start with those places.

 

Another place to start with is a pediatrician. If you’re experiencing something with your child, check in with your child’s pediatrician and say, this is what we’re seeing. Check in with the pediatrician to have them dig a little deeper into it or perhaps make a referral. You could always find a provider to do a holistic assessment that developmentally, socially, and mentally assesses your child to see how they’re doing. Most of the things that I’ve talked about apply if your child is not in crisis.

 

Obviously if you feel like some of the things, I talked about are at a crisis level, you want to go to an emergency room or something like that and get your child immediate care. That sort of assumes that you feel like something’s going on, but you don’t feel it’s at a point of crisis where your child may be harming themselves or harming others. If you are in that type of situation, going to an emergency room, there’s the 988 Suicide and Crisis Lifeline, and then some counties also have crisis teams that you can access depending on where you live. I’d also just say the internet because the web is ever present. There is the National Alliance on Mental Illness (NAMI) that has a phenomenal set of resources across all ages, for adults, children, and everyone. Mental Health America has a website that has great resources for parents and caregivers. The U.S. mentalhealth.gov site is another site that has resources. If you’re in Minnesota or not, washburn.org, we have a decent website that has quite a few resources to support parents and caregivers as well.

 

Brown: Thank you for providing that practical advice on what you should do. What would you suggest as some best practices that parents and caregivers can teach children to help them be more resilient?

 

Warren: I think a part of that is around taking care of yourself. Kids watch everything that the adults they’re around do, whether you think they’re watching it or not. As we’re experiencing more and more kids who may be struggling with a mental illness, your role modeling, what does that look like? You role model expressing what’s going on for you. You role model listening to the child and other people around you and what’s going on with them. You role model as you get stressed out, and by how you react and respond. When you experience anxiety or you get stressed out or experience things, how are you responding to that? Are you taking time to breathe? Are you taking time to pause? Are you taking time to be curious and get support? Your kids watch those things more than you would think, so how you role model and show up when you’re dealing with your own stuff really is role modeling for your kids and how they can navigate through things.

 

Brown: Yes, that’s great advice. A recent study indicates that one in 14 children has a caregiver with poor mental health, which is in line with the World Health Organization study that found that the pandemic has triggered a 25% increase in anxiety and depression worldwide. What are your suggestions for how people can address their own mental health issues, especially if they are a parent or caregiver?

 

Warren: I know it’s somewhat cliched, but self-care is a real thing for your broader holistic health and certainly for mental health. Some people used to talk about mental health days and that was said pejoratively and negatively, as if it’s not a real thing. But it is a real thing, particularly if you’re a caregiver. Your self-care, your physical wellbeing, and your mental wellbeing, and the two are connected; you taking care of your physical health impacts your mental health and vice versa. So, being mindful of are you taking care of your physical health and mental health? Are you taking the time and have the opportunity to do so? Not everyone may have the opportunity or the support to be able to do that, but where you are, you taking advantage of that is important. Because as I said, kids are watching you, so that has the impact on you being at a place physically, emotionally, and mentally where you can support their kids if they are navigating something. Just for you to do that for your own self, to have the energy for that, is so important and just being calm and being self-aware.

 

I will say for an adult, there still are stigmas around this, but you might need mental health support yourself, getting a therapist for yourself independent of anything else can be something that can support your mental health. Because as you said, there’s a crisis for kids, but it’s not great for adults either coming out of that. We all would benefit from that support and being open and transparent around getting mental health support if we need it so that we can be there to support our kids if they need to navigate something as well.

 

Brown: Craig, thank you for that great reminder of the importance of self-care. I hear over and over from people that they’re so busy that tends to be the thing that falls off their plate, so I appreciate that you are reminding people that it is essential, especially if you’re a caregiver and a parent. You’re not only modeling that self-care, but it also makes you better able to deal with whatever comes up at work, personally, or with your kids.

 

Craig, we have time for one final question. I want to circle back to the state of where we are at right now with the structural situation. What can individuals do to ensure that legislation gets passed to support equal access to mental healthcare to help fix a system that is clearly broken?

 

Warren: Find out who your legislators are and make them aware of the fact that you care about mental health and children’s mental health and what your story is at all levels of that. We’re in Minnesota and in Minnesota, the state has quite a bit of control over the investments that are made in that and they invest quite a bit of money in that. There is an opportunity to reach out to the state senators and the state representatives and make them aware of the fact that there are constituents who care deeply about children’s mental health.

 

In Minnesota, Washburn is a part of an organization called the Mental Health Legislative Network, which is a grouping of 40 provider and advocacy organizations that advocate for mental health more broadly. We come together in draft legislation that we advocate for during the state legislative session. If there’s an organization like that in your state where there’s a collective of mental health organizations, or there’s a particular mental health organization that has a policy agenda, support that organization, understand what their legislative agenda is, and if their bills are moving through the process, make sure you’re tracking that and letting your legislator know, I support whatever senate number school linked mental health funding, and my child benefited from this, and I want you to know that and I’m one of your constituents.

 

Because that makes a huge difference at the state level because I know there’s debates around what’s the value of voting and everything like that. I’m a proponent of voting, and particularly at the state level. Most people don’t engage with their state legislators. When you get five or 20 people that come in on an issue, even with a legislator where that may not be their issue, they’re going to pay attention to the fact that a lot of people don’t connect with me and I’ve got people across a wide range of my constituency that are passionately talking about this, I need to pay attention to this and figure out what my position is or solidify my position on that. So, engaging in that process at the state level, at the county level, at the municipal level, and understanding wherever you’re at, there are levers that can be pulled legislatively and engaging with those elected officials to make them aware of how important this is.

 

Brown: That is great advice of how important that is. I think you’re right that people sometimes feel like, it doesn’t matter. It won’t make a difference. But like you said, because not a lot of people are reaching out, if you get enough people, suddenly that will be on their mind that this is an important issue for parents and constituents.

 

Thank you so much for being my guest today. I appreciate you sharing your expertise on defining the current mental health situation, on how to respond to mental health challenges, your call to action to get legislation passed to support better mental health care, and above all, you’ve provided us a sense of hope that things can get better for our kids and our future.

 

We will put the resources that Craig mentioned on the show notes of this episode, but I just also want to note that Washburn Center for Children’s website has fantastic resources for caregivers and clinicians in dealing with mental health issues that affect children such as anxiety, stress, depression, bullying, adapting to change, self-esteem, interpersonal communication, feelings, community violence, grief and loss, friendships, identity, school, learning, nutrition, and sleep. They’ve got fantastic articles and it is just a great place to start. As I said, the other resources that Craig mentioned will be in the show notes.

 

Craig, thank you for all that you and your entire team at Washburn do to nurture every child and family’s wellbeing and full potential through transformative children’s mental healthcare. It has been truly inspiring to sit down and have this conversation with you, and please tell your team that we at the Menttium community appreciate everything you’re doing to help our kids.

 

Thank you all for listening to this Menttium Matters podcast. Children’s Mental Health is such an important topic, so please share this episode with friends and colleagues. We have many great episodes lined up, and we look forward to having you back next time.