Survey shows NH second nationwide for children's health and well-being, but mental health challenges are large

CONCORD — A nationwide survey by the Annie E. Casey Foundation ranks New Hampshire the second best state overall for children’s health and well-being, but places the Granite State among 40 states where rates of youth anxiety and depression have been rising even before the pandemic began two years ago.

“Over the last several years, COVID-19 has exposed and intensified the mental health challenges facing our children like never before,” said Rebecca Woitkowski, Kids Count policy director for New Futures, a NH health policy and advocacy group.

The survey released Monday in the 2022 Kids Count Data Book tracks changes from 2016 to 2020, and includes mental health data from the Department of Health and Human Services’ National Survey of Children’s Health. It also includes responses as recent as this year.

According to the report, the number of children ages 3 to 17 experiencing anxiety or depression rose from 5.8 million in 2016 to 7.3 million in 2020, and mental health effects of the coronavirus linger.

In state-by-state rankings, NH ranked fourth nationwide for economic well-being, even though the cost of living here hovers at 20% above the national average. The state ranked fourth in education, but seventh for the number of 3- and 4-year-olds not attending early education, which is key for children’s development and long-term success, according to the report.

NH ranked second in markers of family and community health.  But the survey found that the number of NH children living in single-parent families is rising, reaching 29% in 2020, up from 27% between 2009 and 2012.

Health markers measure of the percentage of low birth-weight babies, children without health insurance, child and teen deaths per 100,000, and children and teens ages 10 to 17 who are overweight or obese. The Granite State ranked second best in the nation, but seventh for child and teen deaths per 100,000 individuals ages 1 to 19.

The nationwide figures show an increase in the child and teen death rate across the U.S., with 2020 having the highest rate since 2008. The rise is believed to reflect increases in drug overdoses and in homicides, particularly in large urban areas.

NH’s 4% jump in anxiety and depression — from 14.4% in 2016 to 18.4% in 2020 — represents an increase of 27.8%. During the same time period, youth anxiety and depression rose by 50% in Massachusetts (the state ranked number one overall for children’s well-being), and by 40% in Vermont, compared to 70% in California.

In 2020, NH, Massachusetts, Vermont and Maine reported the highest rates nationwide in anxiety and depression for ages 3 to 17, with Vermont topping the list at 19.2%.

Youth mental health has been called a national crisis by federal and state leaders.

Roughly 9% of high school students attempted suicide in 2019, with the percentage higher among Black and biracial students. According to the report, 25% of American Indian and Alaska Native high school students attempted suicide in 2019, and 23% of those students identified as gay, lesbian or bisexual.

The report found that more parents think their children could benefit from mental health counseling —  73% earlier this year compared to 68% in 2021.

Although NH has made significant strides in improving access to mental health services for young people — including through its purchase of Hampstead Hospital for residential mental health treatment and its implementation of rapid response mobile units to serve adults and children experiencing mental health crises — access to ongoing outpatient mental care remains a stumbling block statewide.

NH and states across the country are reeling from a shortage of mental health workers to handle increased demand, including for mental health counselors, school counselors, social workers, psychologists and psychiatrists.

“People are struggling to access resources because there are not enough people in the positions,” said Emma Sevigny, children’s behavioral health policy coordinator for New Futures.

Turnover has been high in counseling, teaching and nursing professions with high burnout rates exacerbated by the pandemic. Medicare and Medicaid reimbursements for social workers continue to be comparatively low, according to state mental health experts. This depresses wages and makes it harder to attract newcomers to the profession and the state, where the cost of living exceeds the national average and housing remains in short supply.

“The workforce issue is a national problem that communities are facing. In New Hampshire, low reimbursement rates, the lack of affordable housing and complicated licensing policies make the state a less attractive place to work,” said Bernie Seifert, deputy director of NAMI New Hampshire, the state chapter of the National Alliance on Mental Illness. NAMI NH “has heard from several families that their children’s counselors have left the mental health field for other work,” Seifert said.

Turnover is a major challenge for community mental health centers, she said, and it’s difficult for children and families to cope with changing providers.  Trust and continuity are especially important to young people who have experienced trauma.

Although NH raised its Medicaid reimbursement rate by 6.2% between 2020 and 2021, its reimbursement rate is still lower compared to many other states, according to health care advocates.

“The Medicaid piece is especially important because it provides services to people who can’t otherwise afford them,” said Jake Berry, vice president of policy at New Futures. “The more Medicaid reimbursement dollars coming into an organization feeds the budget, which theoretically allows then to hire more mental health practitioners.”

Especially affected are community mental health centers, which serve many people who are at lower income levels.

SB 70, which was tabled in 2020, would have required private health insurers to cover the costs of emergency mental health services and case management, Berry added.

Another key to addressing mental health in youth is increasing the front-line staff in schools. The Annie E. Casey Foundation urges schools to meet the 250 to 1 ratio of students to counselors recommended by the American School Counselor Association, because research shows that early intervention is critical to emotional well-being.

Charlotte Hassett, director of child and family services at Lakes Region Mental Health Center, said increasing community need has made it a challenge to keep up with the demand for services. Since January, the mental health center has been able to accommodate 84 new patient and intake requests for children age 17 and younger. Since the beginning of the year, LRMHC has served 174 patients in that age group, for a total of 346 visits. The current wait time for a new youth patient appointment is four to six weeks, and 31 young people are currently on the waiting list. Higher-risk patients are prioritized, Hassett said.

Telehealth has enabled LRMHC to increase access to care overall, Hassett added, but it presents challenges particularly for younger children. While teens may be comfortable in such a setting, it’s more difficult to engage younger children.

Hassett said feedback from parents and clinicians alike indicates that in-person counseling is preferable because it improves interaction and engagement, and allows counselors to observe body language and hygiene, particularly for children who are at higher risk for depression.

Lakes Region Mental Health Center is currently hiring for many positions and will hold a job fair at its Laconia location at 40 Beacon St. E. on Wednesday, Aug. 24, from 4 to 6 p.m.