WUOT’s Carole Myers: Let’s get started with a focus on Tennessee. The Sycamore Institute recently released a report on child and adolescent mental health in Tennessee. Mandy, what are the key takeaways from the report and what did you glean from the data you analyzed and what questions were unanswered?
Mandy Spears: We produced this report in an effort to create a comprehensive picture of the mental health of children and adolescents in Tennessee by trying to draw from every available local data resource and what we found is that a grown share of Tennessee adolescents are reporting poor mental health, symptoms of depression and attempting suicide. They have been trending in the wrong direction for about a decade and were exacerbated by the effects of the COVID-19 pandemic. But, from there it is really hard to dig a lot deeper because of the limitations of the information that is currently available. So, there are a lot of data sources, but none of them are perfect. So, for example, some of the surveys we relied on, for example, only surveyed high school students so that leaves us with little information about kids that are younger and anecdotally we have heard that mental health crises are becoming more common among younger kids. We don’t know what’s going on there because of these limitations. None of the information sources give us a really good picture of how these things vary across the state. Most of these surveys are done at the state level so we can get some state level estimates, but we don’t really understand are kids in Memphis doing worse than kids in Knoxville or are kids in the Tri-cities doing better than the kids in Nashville. Also, sometimes these data lump a bunch of behavioral health conditions together. So, we know how many kids have at least one of maybe 10 different conditions that are all lumped together and these 10 conditions can include everything from autism spectrum disorders to anxiety to tourette's syndrome. Knowing the differences there is really important for how you act on that information. And then adding to these limitations is the bias that can come with any sort of information about people’s mental health. Who you are asking the questions of and how you are asking about it. So, for example, there is still a lot of stigma associated with mental health conditions and we know that that can manifest in different ways across cultures and generations. Sometimes these surveys ask about actual medical diagnoses and sometimes they ask about symptoms. But, all together these things probably mean that there are a lot more issues going on in Tennessee among youth than these surveys are capturing.
So, I appreciate that the data doesn’t have a level of discreteness, completeness or comparability, but are there still some things you can say in general terms about what you learned from looking at this imperfect data.
So, there are some things we can see that are going on with trends and how Tennessee compares with other states and where some challenges really stand out. So, we know things are trending in the wrong direction. That’s something that is going on in Tennessee. It’s something that is going on across the country. Particularly over the last decade. Some of the biggest challenges that really stand out is we’re seeing that almost twice as many youth died by suicide in Tennessee in the last 10 years than in the decade before. So, about 200 youth died by suicide in the 2000’s and that jumped to nearly 400 in the 2010’s to 2020/2021. Around suicides, we also see that girls are more likely to struggle with mental health and are more likely to have suicidal thoughts and even make a plan and attempt it yet boys are much more likely to die by suicide in Tennessee. And we also see that access to mental health providers may be uneven across the state which is not really a huge surprise given how rural our state is. So some of the same access issues we see in other areas we also see in children’s mental health. In terms of how Tennessee compares to other states, so how common some of these conditions and feelings are, what we see are Tennessee youth are in line with their peers nationally so we are seeing similar rates, similar trends. But, a couple places where we do seem to stand out a bit, youth with behavioral and mental health conditions are less likely to receive treatment in Tennessee than most other states and we are seeing that our boys are dying at higher rates from suicide.
So, they are less likely to receive treatment. Can we unpack that a little bit? Is that because of a lack of availability of services?
It is really hard to get to the bottom of it with the information that we have available, but these are based on questions that have been asked for years in national surveys about ‘your child has a mental health condition are they receiving specialized treatment for it’ and you see that we rank pretty low in the percentage that do. Only about half of parents report that kids with behavioral health conditions are getting any sort of specialized treatment. Then when we try to unpack other data that is available to us what we see is that access to providers is very uneven across the state but even then we are just looking at behavioral health providers from like a macro perspective so adult behavioral health providers and we don’t even know the availability of pediatric specialists in these cases. We also have some information on school systems employing social workers and counselors and psychologists and we see that that varies greatly from school system to school system. Sometimes there’s just stigma associated with going and actually seeking treatment for things and we know that across the state based on culture, history and even within communities based on different neighborhood norms and preferences.
Thank you, Mandy. What is next for the Sycamore Institute on this topic? Is this a topic that you will continue to study?
Yes. So, next we do know that although the stats do look really bad right now there are a lot of efforts that are going on across the state both in the private sector and public sector to try and get a handle on this. So, we are working on a report that tries to really capture everything we are doing in Tennessee to address that full continuum of need from prevention to treatment all the way to crisis management and in every setting: school, community, home and clinic settings. Then once we fully publish that report that we have to have out by the end of the year, we will be asking what else we can be doing. So, we will do another report on some policy options. What kinds of promising or untapped approaches that Tennessee could explore to really make some positive gains in this area.
We know that mental health was one of the issues set to get some focus during the special session of the Tennessee General Assembly so at least there is some convergence there.
This transcript has been lightly edited for content.
