Youth mental health crisis quietly continues in rural New Jersey
By Chip O’Chang
Editor’s note: The following article is published as part of a collaborative news project covering the 2023 legislative elections. Funded by the New Jersey Civic Information Consortium, the project includes New Jersey news organizations large and small and comprises articles on individual races and broader issues, as well as the NJ Voters Guide.
While the issue of parental rights attracts the most attention in educational policy this election, the ongoing youth mental health crisis continues to impact millions of students across New Jersey and the nation. More concerning, some critical aspects of the crisis have yet to receive meaningful action from policymakers.
Candidates in Legislative District 24 have made statements about the mental health crisis but their comments show a need for a more accurate understanding of the current situation and the policies that are in place.
Statewide, rates of youth in-patient hospitalizations for mental health have risen every year. According to data from the New Jersey Hospital Association, anxiety-related in-patient hospitalizations in adolescents grew 23% between 2017 and 2019, followed by a 54% spike from 2019 to 2021. Depression-related in-patient hospitalizations grew by 6% between 2017 and 2019 and again by 26% between 2019 and 2021.
The crisis continues quietly — and acutely — in rural areas like Warren County, where existing vulnerabilities to mental health have only worsened.
Mental health: The rural context
Rural mental health troubles predate the pandemic. In the 2017 Behavioral Risk Factor Surveillance System Survey, Warren County residents reported a higher rate of depression: 19.2% vs. 14.8% for New Jersey overall. This held steady during the pandemic. In a 2020 New Jersey Behavioral Risk Factor Survey, 19% of Warren County residents reported mental distress for 14 or more days over a 30-day period vs. 13% for New Jersey overall.
The same mental health struggles appear in youth. In a 2022 survey conducted by the Warren County Stigma-Free Communities Initiative, about 20% of students in grades 7–12 reported feeling so sad and hopeless almost every day for two or more consecutive weeks that they stopped their usual activities.
That question asked about pre-pandemic behavior. After COVID, about 37% of the students reported debilitating hopelessness.
Gregor Thomas, the associate vice president of community outreach at the Center for Family Services, sees three common struggles for children with mental illness in Warren County: overloaded outpatient therapy centers, a lack of public transportation services in rural areas and limited entertainment possibilities for adolescents, which means fewer positive outlets.
Warren County has tried to expand its mental health care services, said Laura Richter, the county’s associate director of human services. Families with children and adolescents in distress can reach out to Performcare, a behavioral health service organization that includes a mobile unit. Families in need can also call on the crisis intervention unit at the Center for Family Services, the Warren County Education Association with its network of community partners, and Atlantic Health’s psychiatric hub at Hackettstown Medical Center.
But a survey in the 2020 Warren County Needs Assessment speaks to holes in this network of services, with more than half the respondents complaining that services are little known or advertised, overloaded with long wait lists or likely to give out-of-county referrals that are difficult to reach.
NJ4S: Attempts so far
To address the mental health crisis, the Department of Children and Families implemented the New Jersey Statewide Student Support Services Network, or NJ4S, this fall. The model aims to connect schools to their surrounding mental health and social support infrastructure, with 15 regional hubs acting as coordinating centers.
NJ4s defines three tiers of student support, depending on need. Tier 1 strategies are preventative measures offered to all students, including social-emotional learning and anti-bullying initiatives. Tier 2 strategies include early identification and more individualized services, including classroom support, mentoring and small-group interventions. Students in crisis or with stronger support needs are candidates for Tier 3 services, which generally include a mental health professional for clinical interventions, counseling or referrals.
The Center for Family Services is the regional NJ4S hub for Somerset, Hunterdon, and Warren Counties. The hub “is actively providing Tier 1 presentations across the community and Tier 2 services to schools,” Thomas said, with Tier 3 services planned to roll out as soon as enough clinicians are hired.
It’s a step in the right direction, said Olivia Montuore, vice president of the youth-led mental health nonprofit Reach Out based in Long Valley, but it’s not enough. “More long-term solutions for students who need more than just assemblies on mental wellness need to be considered,” she said, “and that is where NJ4S is falling short.”
What the candidates propose
Northern Warren County is situated in Legislative District 24, which also includes Sussex County.
The Democratic candidates for District 24, Baramdai “Alicia” Sharma running for the Assembly and Edmund Khanoo running for Senate, shared a brief seven-point platform addressing the youth mental health crisis. Their points include: increasing funding for mental health services in and outside of schools; requiring mental health education in the K-12 curriculum; promoting telehealth services; supporting recruitment of mental health professionals; implementing comprehensive health screening in schools; ensuring coverage of mental health care by health insurance; and launching stigma reduction campaigns.
The Republican candidates for LD-24 are Commissioner Dawn Fantasia and Mayor Mike Inganamort running for Assembly and Assemblyman Parker Space running for Senate. Their statement criticized Gov. Phil Murphy for closing schools “for a much longer period of time than was deemed necessary” during the pandemic, leading to a spike in mental health struggles.
The Republican statement mentioned several mental health measures that Assemblyman Parker Space supported alongside the rest of the Legislature. NJS2811, A4435, and A4433 all passed unanimously in December 2021 and January 2022. The statement also lists seven mental health-related bills proposed by other Assembly Republicans and criticizes the early efforts of Murphy and the DCF to defund school-based mental health programs before they backtracked and retained existing programs in the final rollout of NJ4S.
Neither statement refers to the current iteration of NJ4S. Both also propose measures that overlap with existing policy. For example, a 2019 bill already mandates mental health education in K-12 curricula, as suggested by the Democratic candidates, and mental health providers already receive the suicide prevention and mental first aid training that Republican proposals would mandate. Others add more requirements to an already-beleaguered and limited workforce of mental health providers.
Both statements also make passing reference to a pressing problem: a critical shortage of the mental health professionals that many proposals and NJ4S’s Tier 3 rely on.
The mental health provider shortage
Mandating referrals, health screening, and intervention from mental health professionals won’t help if those professionals don’t exist. Nationwide, a critical shortage of child and adolescent psychiatrists, school psychologists and school counselors delays treatment for millions.
According to their professional organizations, the ratio of student counselors to students in NJ is 337 to 1 vs. a recommendation of 250 to 1. It’s a similar situation for school psychologists, with a ratio of 659 to 1 vs. a recommendation of 500 to 1.
But the situation is most dire for children and adolescent psychiatrists (CAPs). A total of 341 CAPs work in New Jersey, according to the American Academy of Child and Adolescent Psychiatry’s Workforce Maps posted in May 2022. There are two in Sussex County and three in Hunterdon. In Warren County, the map gives a CAP count of zero for 21,178 children.
Since the map’s publication, two CAPs have begun practicing in Warren County: Dr. Jean Ying-Chang, medical director at the Center for Family Services, and Dr. Adam Silberman, a newly hired child and adolescent psychiatrist at Hackettstown Medical Center.
With few CAPs available to provide formal diagnoses and sustained treatment, it’s difficult to assess how many children need mental health care in Warren County. According to 2016- 19 CDC data, about 9.4% of children ages 3 to 17 will have received an anxiety diagnosis at some point in their lives, and 4.4% will have received a diagnosis of depression. If these percentages are applied to Warren County’s under-18 population, that would imply an estimate of about 1,990 children with anxiety and 930 with depression. That’s almost 3,000 children for two psychiatrists.
According to Josha Langberg, director of the Rutgers GSAPP Center for Youth Social Emotional Wellness (CYSEW), the provider shortage is driven by two factors: extensive schooling that leads to equally extensive student debt, and a long clinical training process that requires a large corps of supervisors.
The CYSEW has developed models to rapidly scale up paid clinical training opportunities for would-be CAPs, defraying costs and simultaneously allowing trainees to serve their communities. Implementing those models on a mass scale would require funding and coordinated action from state and county officials, on par with efforts to address the shortage of health care workers and teachers. So far, these efforts have yet to manifest.
The road ahead
The mental health crisis did not occur in a vacuum, Langberg said. The issues that drive it — increased social isolation, bullying, school shootings, and performance pressure — seem to have staying power.
“We need our legislators, families, and schools talking about mental health regularly, openly, and encouraging regular scheduled yearly assessments and appointments, just like we do for health checkups and vaccines,” Langberg said.
What would count as a mental health “vaccine”? For Montuore with Reach Out, one specific support would have helped her as a struggling high school student. “More mental health professionals that can work one on one with students who are struggling would be the thing that schools could do best,” she said.
In the ongoing shortage of mental health professionals, the state’s efforts to coordinate services may amount to building a doctor’s office with nobody inside.
Chip O’Chang covers education for the Ridge View Echo, a local news source based in Blairstown.
This story is part of the NJ Decides 2023 voting guide, a project of NJ Spotlight News supported in part by the Center for Cooperative Media at Montclair State University and funded by the New Jersey Civic Information Consortium.
