Anna Corona

Recently, several members of AMCHP’s Youth Voice Amplified Committee as well as several state Title V Maternal and Child Health (MCH) program staff convened virtually to envision what it would look like for adolescents and young adults (AYAs) to have equitable access to high-quality mental health supports. Much of the dialogue centered around re-thinking the ways in which we provide mental health support for young people to ensure they are receiving care when and how they want it. Below are some of the key concepts and specific strategies that were elevated to help create more equitable systems of mental health supports, as well as the role that MCH programs can play in affecting change:

• Prioritize and support community-centered mental health supports. For a helpful framework on how to conceptualize and implement community-centered mental health supports, check out Mental Health America’s Strength in Communities Toolkit, which highlights alternative mental health supports created by Black, Indigenous, and People of Color (BIPOC) for BIPOC. This framework highlights three approaches: community care, self-directed care, and culturally-based practices. MCH programs can work to identify community-based organizations (CBOs) that are led by young people most impacted by inequities in access to high quality mental health supports. Once identified, MCH programs can strategize on how to respectfully build authentic partnerships that center the needs of CBOs in determining how MCH programs can support their efforts.
• Move upstream. While screening is an important component of identifying mental health concerns early, it is critical that MCH programs integrate long-term strategies to prevent mental health concerns in the first place. Several meeting attendees cited the importance of schools as a setting that provides many of the supports that have been shown to promote optimal mental health among young people, such as: connection with peers, participation in athletics, connection with employment opportunities, and involvement in clubs and activities.[1] MCH programs might consider building meaningful partnerships with school systems to understand how best to support the creation and/or sustainability of spaces and opportunities for young people to participate in the activities listed. Similarly, supporting schools to create spaces free of bullying was elevated as key to promoting good mental health.

Equity in accessing mental health supports requires thinking through how we provide support outside of our traditional medical system. There are several strategies we currently have in place for supporting mental health to consider as we navigate the medical system:

• Eliminate late and no-show fees for missed appointments. At the start of the meeting, a member of AMCHP’s Youth Voice Amplified Committee shared their personal experience with the challenges they faced in accessing mental health care when they needed it. They described difficulties accessing transportation to get to appointments and finding ways to pay for expensive treatment. Charging late and missed appointment fees piles on to financial burdens, exacerbates inequities in access to mental health care, and prevents young people from accessing the care they need.
• Cultivate a mental health workforce that is reflective of those accessing or needing support. Research has shown that patients experience higher quality care and improved outcomes when they receive care from providers that are culturally congruent (meaning that the provider reflects the patient’s culture and applies evidence-based practices that are in alignment with the preferred cultural values, beliefs, worldview, and practices of the patient[2]). There are many resources available that assist providers in improving behavioral health care for identities that have been marginalized. One such resource is the Center of Excellence for LGBTQ+ Behavioral Health Equity which provides behavioral health practitioners with vital information on supporting the population of people identifying as lesbian, gay, bisexual, transgender, queer, questioning, intersex, two-spirit, and other diverse sexual orientations, gender identities and expressions.
• Consider if traditional primary care clinics are the most inclusive spaces for AYAs who seek mental health support. Imagine being 12-18 years old and sitting in a pediatric waiting room surrounded by infants, toddlers, and young children that are 10-15 years younger than you are. Alternatively, imagine being a young adult in a primary care waiting room surrounded by much older and elderly adults. It doesn’t take a stretch of the imagination to conclude that it might be hard to feel like you belong in these settings. Creating clinical spaces that are AYA-friendly can go a long way in creating a sense of belonging in these spaces. MCH programs can promote the Adolescent Health Initiative’s Youth-Led Health Center Assessment Tool with their clinical partners to identify practical ways that clinics can create environments that are welcoming to AYAs.

[1] Youth.Gov. Risk and Protective Factors. Accessed August 20, 2021 from https://youth.gov/youth-topics/youth-mental-health/risk-and-protective-factors-youth

[2]Marion, L., Douglas, M., Lavin, M., Barr, N., Gazaway, S., Thomas, L., Bickford, C., (November 18, 2016) “Implementing the New ANA Standard 8: Culturally Congruent Practice” OJIN: The Online Journal of Issues in Nursing Vol. 22 No. 1.