Brief Youth Mental Health: States Pursue Prevention, Treatment and Crisis Response

The rates of poor mental health remain high among young people. Suicide is the second leading cause of death for youth ages 10-14. According to the most recent (2023) Youth Risk Behavior Survey, which surveys a subset of high school students across the United States, there were increases in students' experiences of violence, signs of poor mental health, and suicidal thoughts and behaviors compared to 2013. Of the students surveyed in 2023: 

• 40% experienced persistent feelings of sadness or hopelessness. 

• 29% experienced poor mental health during the past 30 days. 

• 20% seriously considered suicide. 

• 16% made a suicide plan. 

• 9% attempted suicide. 

While the Youth Risk Behavior Survey presented some early signs that adolescent mental health improved from 2021 to 2023, such as a recent decrease in the percentage of high school students who experienced persistent feelings of sadness or hopelessness, the rate remains 33% higher than the percentage reported in 2013. There were also concerning increases in students' experiences of violence at school. 

Disparities continue to persist among youth experiencing poor mental health. Female students are nearly twice as likely to experience persistent feelings of sadness or hopelessness and more than 1 in 10 reported a suicide attempt. LGBTQ+ students were nearly 4 times as likely as their peers to have a suicide attempt during the past year.  

According to the Centers for Disease Control and Prevention, the most commonly diagnosed mental disorders in children continue to be attention deficit/hyperactive disorder, anxiety, behavior challenges and depression. Mental and behavioral health support among youth is associated with improved school outcomes, and recent research suggests that early treatment of mental health conditions may lower the risk of developing chronic diseases such as heart disease, diabetes and cancer. On the contrary, feelings of hopelessness can increase likelihood to engage in high-risk behaviors such as the misuse of drugs and alcohol. Further, untreated youth mental health problems have been associated with increased risky behaviors and mental health challenges into adulthood.  

As trends emerge from recent years of state actions to address youth mental health, states have explored a variety of policy strategies including incentivizing early intervention, providing mental health education and training, supporting school-based health services, improving crisis response, and establishing commissions and task forces.  

Incentivizing Early Intervention 

States are enacting legislation to support positive mental health and well-being of young children as a strategy to prevent future negative health outcomes. Rhode Island established a state plan within current Medicaid mental health services to improve screening, assessment, diagnosis and treatment of mental health challenges for infants and children under the age of 6. Arkansas established supplemental Medicaid reimbursement rates to provide children’s mental health services and support positive mental health for families with young children. The rate change came as a recommendation from Arkansas’ 2022 Mental Health and Behavioral Health Working Group to incentivize medical homes to address prevention and early intervention through universal, team-based enhanced primary care services for children.  

Providing Mental Health Education and Training in Schools 

Some states are leveraging school health curriculum to teach students about mental health and resources available to them. New Jersey requires each school district to include instruction on grief for students in grades eight to 12. The instruction must include information on the physical, emotional and behavioral symptoms of grief and coping mechanisms and techniques for handling grief and loss. Resources for in-school and crisis support will also be made available to students. Utah required the University of Utah Huntsman Mental Health Institute to develop a youth behavioral health curriculum in coordination with the state board of education. At a minimum, the curriculum will provide information on the connection and importance of mental health to overall health, tools for maintaining mental health wellness and how to find support for behavioral health challenges in school and in the community. Utah also created a Digital Wellness, Citizenship, and Safe Technology Commission in 2020 to advance the goal of training every student in healthy behavior related to technology use. This includes digital literacy, ethics and etiquette and coordinates programs related to cyber-bullying and suicide prevention. 

Certain states have also used school resources to bolster suicide prevention assistance to youth. Iowa passed legislation in 2023 to require school identification cards to include the crisis hotline telephone and text numbers and as well as the internet address for Your Life Iowa, the state's 24/7 mental health and addiction resource. At least four states—Connecticut, New Hampshire, Oklahoma and Tennessee— enacted similar legislation in 2022. 

Supporting School-Based Health Services 

School-based mental health services can improve access to care and allow for early identification and treatment of mental health issues. However, staffing shortages and funding constraints are common barriers that limit the school’s capacity to provide mental health supports to students. 

To address workforce challenges, Colorado authorized schools to employ school-based therapists who are not licensed by the department of education but hold a Colorado license for their profession to work in coordination with licensed special service providers to coordinate mental health supports for students. Alabama also passed legislation to require each local board of education in the state to employ a mental health service coordinator and to complete and submit a needs assessment on the available mental health resources to students for the schools under each board’s jurisdiction. 

Recent research suggests school-based tele-behavioral health may reduce student absenteeism. Massachusetts added funding to create a tele-behavioral health pilot program for schools. Florida required school districts to implement a mental health program to allow community behavioral health providers to provide services at schools, including via telehealth. 

States are also increasing funding sources available for student mental health services. For example, Rhode Island requires services provided by school social workers and certified school psychologists be included as health care related services eligible for Medicaid reimbursement. Colorado created the I Matter program during the COVID-19 pandemic with general funds to provide free therapy to students. The program was initially set to expire in 2024 but was recently renewed until 2034.  

Wisconsin appropriated $500,000 for grants to recovery high schools. A recovery high school is a public, private or tribal school specifically designed for students in recovery from a substance use disorder or a mental health disorder that coexists with a substance use disorder. One study found students enrolled in recovery high schools had higher graduation rates and less reported substance use than comparison students. 

Improving Crisis Response  

States are also exploring opportunities to improve responses to mental health crises for young people. According to a study on youth emergency department visits, the proportion of pediatric emergency department visits for mental health reasons nearly doubled from 2011-2020, including a five-fold increase in suicide-related visits.  

Hawaii established a two-year child and adolescent crisis mobile outreach team pilot program in Oahu and another island (to be determined) to expand existing crisis response services.  

Louisiana created the Community Responder Task Force to study the implementation of a partnership between law enforcement agencies, behavioral health providers and hospitals to explore the use of community responders to respond to behavioral health and social services calls. Mississippi will require each county and municipal law enforcement agency to provide evidence-based Mental Health First Aid training to all law enforcement officers by July 1, 2031. 

Some states are exploring solutions to improve capacity or to meet the need for inpatient psychiatric services. Maine required the department of health and human services to submit two reports to the Joint Standing Committee on Health and Human Services on efforts to implement secure children's psychiatric residential treatment facilities. New Hampshire created a commission to study behavioral health crisis programs and limited pre-authorization requirements for emergency behavioral health services. Montana created an enhanced Medicaid reimbursement rate for certain children's mental health providers for in-state psychiatric residential treatment facility services for high-risk children with multiagency service needs.  

Some states also include alternatives to inpatient treatment to support youth with high mental health needs. Illinois passed legislation to require the department of children and family services to develop a strategic plan that addresses timely access to quality residential in-state treatment, evidence-based alternatives to residential treatment and specialized therapeutic foster care for youth in the care of the department who have significant emotional, behavioral and medical needs. 

Establishing Related Commissions and Task Forces 

Task forces, commissions and legislative studies can be an opportunity for states to convene key partners to address problems that impact multiple state departments or agencies. Connecticut established a Transforming Children's Behavioral Health Policy and Planning Committee to evaluate the availability and efficacy of prevention, early intervention and behavioral health treatment services for children and make recommendations to the General Assembly and executive agencies. Mississippi established the Mississippi K-12 and Post-Secondary Mental Health Task Force to assess the public and private resources currently available to youth suffering from depression, trauma and suicidal ideation and determine where gaps exist in service delivery and treatment.  

NCSL will continue to monitor emerging trends in youth mental health legislation, and further examples of enacted bills on children’s mental health services and children’s mental health in schools can be found in NCSL’s Maternal and Child Health Database.  

Flora Fouladi is a policy associate on NCSL’s health program.  

This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $400,000 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. government.