Last year saw a stream of dismal headlines about kids' mental health. Children and teens in the US are struggling with higher levels of depression and anxiety. Rates of suicides and eating disorders are on the rise. But now there's reason to be hopeful: an ambitious experiment in Oregon could point the way to a novel solution.
Much of the last two years has been spent trying to parse the root cause of the alarming statistics rather than discussing what to do about them, though there has been some positive change. New guidelines recommending widespread screening for childhood anxiety and depression were a good start. So was the Biden administration's investment in helping better connect families to behavioural and health services. And several states have expanded training for educators and improved access to telehealth.
But none of those can fully address a fundamental problem: The number of kids who need help exceeds the number of available mental health providers. The paediatric mental health workforce hasn't expanded despite ever-growing demand. A 2019 study that used data from the National Survey of Children's Health found that about half of the kids with a mental health disorder did not receive treatment. The shortfall is likely even worse now.
"We need to try something new -- something that's radically different than what we've been doing, which is clearly not working," child clinical psychologist Katie McLaughlin told me.
That's where the Oregon experiment fits in. Prof McLaughlin recently left Harvard to be the executive director of the Ballmer Institute for Children's Behavioral Health, which was launched at the University of Oregon in 2022 with the goal of rapidly expanding the workforce by creating a new type of mental health provider. The endeavour was made possible by a US$425 million (14.6 billion baht) gift from Connie and Steve Ballmer.
The bachelor's-level position, called a child behavioural health specialist, will work in community settings to identify struggling kids and offer brief and early interventions to help them.
During their last two years of college, students enrolled at Ballmer will receive intensive, hands-on training on evidence-backed interventions. They will gain experience first at Portland-area elementary and high schools, and could later choose to embed at paediatricians' offices, community centres or preschools. When they graduate, they will be ready to go out into the field. These students won't replace school counsellors or psychiatrists who have graduate-level degrees. But in an ideal world, brief interventions could prevent some kids from ever needing more intensive resources, freeing up people with advanced degrees to focus on those who need them most.
There's good reason to believe the Oregon experiment will work. The UK pioneered a highly successful "low intensity" mental health workforce as part of a 2008 plan to expand access to services. Part of that effort involved establishing a new type of provider called a "Psychological Wellbeing Practitioner," who offers brief interventions to struggling adults. Anyone who doesn't benefit is referred to more intensive therapy. An analysis found that the programme had a major impact on lowering levels of depression and anxiety in the UK.
So, the model is sound, but the experiment in Oregon still has plenty to prove. Prof McLaughlin will need to produce robust data that her students are having a positive impact on children -- but that evidence shouldn't take long to collect. The first cohort heads into classrooms next autumn. Prof McLaughlin says anyone who interacts with a Ballmer student -- whether that's a child, parent, school administrator or paediatrician -- will be handed an iPad to offer feedback on the experience, allowing a quick assessment of whether a child or family was satisfied with their experience and, in time, whether the services provided actually improve kids' mental health.
The Ballmer Institute is essentially creating a new profession, which entails some practical challenges. The first hurdle was cleared in late 2022 when the state higher education commission approved the programme. The next is working with policymakers to establish standards for becoming certified as a child behavioural health specialist, as well as defining the kind of services such a professional will be allowed to deliver. And then there's convincing insurers, including state Medicaid programmes, that the care provided by these new professionals is worth paying for.
But if this experiment works, other institutions might consider adopting the new degree, in theory helping to establish a new layer of support for children around the country.
The price tag of the Ballmer's experiment can't be ignored. Not every institution will be handed more than $400 million to try to fix the mental health crisis. But if Ballmer can show the concept works, it shouldn't be too hard for others to follow. The price of the status quo is just too high to ignore. Bloomberg L.P.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.