Even as the declared public health emergency for COVID-19 ended on May 11, two other public health emergencies continued. The first such emergency, the opioid crisis, was initially declared in October 2017, more than two years before COVID-19. A second emergency was declared for youth mental health in October 2021 by three major national associations, including the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association. This emergency, too, continues.
COVID-19 has exacerbated pre-existing challenges for youth behavioral health, which include provider workforce shortages, inadequate reimbursement and inpatient bed shortages. According to the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, 8.5 percent of adolescents ages 12 to 17 had a substance use disorder in 2021, and more than 20 percent had a major depressive episode.
Amidst these challenges, one step the Department of Health & Human Services could take is to form a Youth Behavioral Health Advisory Committee to obtain youth input and guidance on such mental health and substance use disorder issues as health care coverage, stigma and discrimination, bullying and school climate, access to behavioral health care, and youth peer services. This committee could be modeled on those formed by other federal agencies, including the Federal Emergency Management Agency (FEMA) and Environmental Protection Agency.
FEMA formed its Youth Preparedness Council (YPC) in 2012. The council is open to US students in grades 8 through 11. Parent/guardian consent is required for applicants. The application seeks input about why the applicant seeks to join the council, time management skills, extracurricular activities and a potential preparedness project the member would seek to work on during their term. The application also requires applicants to explain their interest in emergency preparedness and skills in “emergency management, technology, communication, problem solving/critical thinking [and] research.”
Letters of recommendation also are required. Terms of service are for one-year during which members work on preparedness projects, serve as “preparedness champions” who attend conferences and events and in some cases are selected as “team leads” who have additional tasks such as “coordinating team meetings and communication, setting goals and milestones, liaising with YPC staff, and monitoring team progress.” YPC members may also meet with FEMA staff to attend an annual YPC summit. Members participate in team lead calls and bimonthly council calls.
More recently, the Environmental Protection Agency announced plans to form the National Environmental Youth Advisory Council. As explained in the Federal Register, “[t]he purpose of this council is to provide independent advice and recommendations to the EPA Administrator on how to increase EPA’s efforts to address a range of environmental issues as they relate to youth communities, with an emphasis on communities below 29 years of age. The EPA has determined that this Federal advisory committee is necessary and in the public interest to provide a critical perspective on how the impacts of climate change and other environmental harms affects youth communities.”
The council is planned to last for two years and is reported to be open to those age 16 and older. A recent Federal Register notice requested nominations by August 22, 2023. According to a new council website, nominees should be between ages 16 and 29 and will be appointed for two-year terms. The EPA will emphasize recruiting members who reside or work in disadvantaged communities and nominees from environmental and community groups, private industry, academia, and state, local and tribal governments, among others, will be considered.
Council members can anticipate devoting 15 hours per month to such activities as meetings and developing recommendations for EPA. This is not new for EPA as a previous workgroup for the National Environmental Justice Advisory Council, focused on climate change impacts, also was youth-led. The group included 16 members ages 19-29 and developed a report and recommendations in 2018.
Building on these examples from EPA and FEMA, a Youth Behavioral Health Advisory Council could be housed in the Substance Abuse and Mental Health Services Administration, complementing its other advisory councils. Alternatively, the council could be placed within other HHS offices or agencies, such as the HHS Office of Minority Health. Once developed, the council would complement other significant HHS and federal efforts to engage and inform youth. Modeled on EPA and FEMA, the council could solicit youth input on topics and challenges confronting the nation’s behavioral health system.
Reflecting that some communities are more affected by mental health conditions and substance use disorders than others, the council can seek to recruit staff from all backgrounds and from locations throughout the nation, including both rural and urban areas. As with FEMA’s Council, a youth behavioral health council could suggest and oversee specific projects relevant to youth mental health, substance use, and co-occurring disorders.
The council also could provide input on such issues as transition to adulthood, challenges for racial, ethnic, and other minorities, school behavioral health services, telehealth, privacy and confidentiality issues, and many other topics. As the nation continues to confront challenges in providing mental health and substance use disorder services, including for youth and young adults, it makes sense for these youth to have a voice in programs that affect their health. A Youth Behavioral Health Advisory Council would be one important step in this direction.
Mitchell Berger is a public health advisor. The opinions expressed are solely those of the author and should not be imputed to any other individual or to any public or private entities.
