CONTENT WARNING: This article refers to suicide. Be careful when reading. If you need spiritual support, please consult this page for resources.
By Jennifer Fernandez
The battle with mental health issues for North Carolina’s children worsened during the COVID-19 pandemic, according to a new report.
And there are significant differences between groups of students, especially LGBTQ+ students are affected.
The authors of the NC Child Health Report Card urged action on several measures to address children’s mental health needs:
- Remove barriers to accessing mental health care.
- Improve the availability of mental health care and crisis intervention in public schools, especially in rural areas where specialized care is less available.
- Make it more difficult for children and youth to access deadly self-harm drugs, including encouraging families to safely store firearms and prescription drugs.
“Even before the COVID-19 emergency and school closures, children were in crisis,” said Khristian Curry, project director at the NC Institute of Medicine, pointing to the overall increase in youth suicides over the past decade as an example during a May 4 webinar on the report card.
“That crisis is exacerbated by factors such as lack of access to health care, food insecurity or economic insecurity in the family. So it is closely linked to many of the indicators that we have historically tracked in the Child Health Report Card.”
Reporting on children’s health
The report card, which is compiled every two years by NC Child and the North Carolina Institute of Medicine, looks at 15 measures of children’s health. Those measures range from housing and economic security to educational opportunities, birth outcomes and mental health.
The 2023 report card showed that since the last time these statistics were compiled in 2021, the situation has improved in two areas, the results have deteriorated in three others and the rest have remained the same.
For example, the state’s tobacco, alcohol, and substance use rating improved from an F to a D.
The Preconception and Maternal Health and Support category, which tracks data such as how many women receive prenatal care or are insured, improved to a B grade. Despite this, birth outcomes are rated an F, with 6.9 babies out of every 1,000 born in North Carolina dying in their first year. The percentage of premature birth remains above 10 percent.
“We celebrate improved coverage, but that doesn’t always translate into provider availability, consistency of care, of all these other aspects,” Luna Homsi, health policy analyst at NC Child, said during the May 4 webinar. “There’s a long way to go, and the disparities and birth outcomes are proof of that.”
Three areas dropped a level: teenage births to C, education to D, and school health to F.
Numbers are subjective and are awarded by a panel of health experts as a way to draw attention to how the state’s children are doing on “high profile measures of health and well-being,” the report said.
The North Carolina report comes less than two months after the National Youth Risk Behavior Survey also sounded the alarm about the mental health of teens, particularly young girls and LGBQ+ youth. (The survey did not include questions for transgender youth.)
For each report card, NC Child chooses a focus, an urgent problem that needs to be addressed.
In 2019, the nonprofit focused on youth suicide. Just four years later, the organizations turned their attention to the overall mental health of teens.
As teen suicide rates and mental health diagnoses rise, North Carolina schools remain woefully understaffed to address these youth issues, the organization’s leadership said.
While the ratio of school nurses to students has improved slightly since 2018, it remains a far cry from the 750 students per nurse recommended by the Centers for Disease Control and Prevention. According to the latest data available for the Child Health Report Card, the ratio was 1,007 students for every nurse in the 2019-2020 school year.
The American School Counselor Association recommends one school counselor for every 250 students. With 316 counselors per student, North Carolina outperforms the national average of 408, but still falls short.
“We are not currently providing the level of mental health support in our public schools that we need for our students,” NC Child executive director Erica Palmer Smith said in an interview. “We don’t meet national standards.”
The number of psychiatric diagnoses in children is increasing. The number of children ages 3-17 receiving a diagnosis of depression or anxiety increased 49 percent from 2016 to 2020, NC Child said.
In its report, NC Child noted that suicide became the leading cause of death for children ages 10-14 in 2019. The following year, “an unprecedented 67 children” aged 10-18 died by suicide in North Carolina.
In recent years, more teens in the state reported seriously considering suicide attempts. According to the Youth Risk Behavior Survey, the rate of suicidal ideation among high school students has increased from 16.2 percent in 2017 to 22.3 percent in 2021. One in 10 reported having actually made an attempt to end their life to make.
The Youth Risk Behavior Study found that LGBQ+ students in schools in North Carolina were about three times as likely as their heterosexual peers to report seriously considering suicide, planning suicide or attempting suicide, according to data from the Youth Risk Behavior Study. survey.
“There are things we just can’t accept,” said Palmer Smith. “Our kids are committing suicide because we’re not making sure they get the support they need. That’s just not something we can accept.”
From 2011 through 2020, 525 North Carolina children ages 17 and under died from firearm injuries.
“The rise in gun deaths, along with data showing how easy it is for many high school students to access a loaded gun, is quite concerning,” Kella Hatcher, executive director of the NC Child Fatality Task Force, previously told NC Health News.
In 2021 alone, the number of child deaths caused by firearms will reach 121.
The task force’s report found that by 2021, children will die from firearms in more than seven in 10 percent of child suicides and homicides. For older children – ages 15-17 – the number rose to 83 percent.
More than nine in ten homicides of children over the age of 4 involved firearms.
Gun safety topped the task force’s recommended action items for state legislators released earlier this year.
The legislature followed part of the recommendation: creating a program to promote the safe storage of firearms and facilitate the distribution of gun locks as part of a larger measure that relaxed the ability to obtain a firearm. However, Senate Bill 41 did not include funding for the program. The Child Fatality Task Force had recommended a minimum of two years of funding of $250,000.
Senate Bill 41, which became law in March after Republicans overruled Gov. Roy Cooper’s veto, also removed the requirement for a gun-buying permit and relaxed restrictions on some concealed permit holders.
So far, no money has been allocated for safe storage of firearms in the Senate or House versions of the budget. The two chambers are working to fit their spending plans into a final state budget.
In an effort to address gun violence in the state, Cooper used his executive powers to create the North Carolina Office of Violence Prevention in March. The new office aims to help law enforcement and public health communities reduce violence through training efforts and organizational models that build on successful community-based programs.
North Carolina’s struggle with gun deaths among children reflects a national trend.
While the overall infant mortality rate in this country has been declining for decades, that trend began to reverse during the pandemic.
However, it wasn’t COVID-19 that was killing children at the time, according to Steven Woolf, director emeritus and senior advisor to the Center on Society and Health at Virginia Commonwealth University.
In a May 10 presentation, he blamed four main culprits for that reversal: accidental drug overdoses, motor vehicle accidents, suicides, and homicides.
Firearms accounted for about half of the increase in all-cause deaths for teens in 2020 and 2021, Woolf said during the National Institute for Health Care Management’s “The State of Our Children’s Health” webinar.
However, mass shootings at schools or other locations are responsible for a small fraction of gun deaths among teens, Woolf said.
“It mainly comes from shootings that happen one by one every day in communities across this country,” he said. “…A lot of those relate to our youth, and they’re such a huge number that it’s driving this shift in all-cause mortality.”
Using the data
Now that the data is available, advocates will use it in their discussions with lawmakers. County-level data will be released in the summer, timed so the local data can be shared with lawmakers before returning in the fall, she said.
Homsi said the report card could also be used by nonprofits, agencies and parents.
The data and numbers can serve as “an important starting point for essential work in our state,” she said.
Non-profit organizations can use the information to identify areas of interest. For parents, it can be a resource when they talk about what they are passionate about with friends and community members.
“If your community is debating whether or not to open a new supermarket, you can use this data to show why children need accessible, healthy food to grow,” she said. “…And if your school doesn’t have a counselor, you can use this to show why funding mental health providers is so important.”
Past efforts to enact change have led to the state’s Children’s Health Insurance Program, NCIOM president and CEO Kathy Colville said in an interview.
“We can make policy changes that make a difference in children’s lives,” she said, noting that the push for child insurance is paying off because nearly 95 percent of children have that access.
“This is part of our responsibility as adults in North Carolina…to look into this [data] and understand them and take action,” she said.