- Tony, the words trauma informed are not words that I recall from my experience in K through 12.

Tell us what is the importance today of taking a trauma-informed approach to K through 12 education?

- So thank you for having me here.

I think it's important for us to recognize, I think what my colleague stated in the clip, we have to recognize that every single child comes to school or most will come to school having at least some experience with trauma.

I think in our setting, it's important for us to recognize that while we can't eliminate those bumps and bruises that I think our children will have over time, we can give them all of the resources that they need, or we can create environments where I think our students feel safe, where our students can make mistakes, ask questions, and really have this opportunity just to heal.

And we do that with connecting them with good programming, the right people, processes that will honor the fact that we all make mistakes.

And then more importantly, as adults, I think we have to give them the ability to see through us that you can rebound, that you can recover, that you can make mistakes and get back up.

I think we forget that whole resiliency piece is not just talking, but sometimes showing.

So in the K-12 space, we want them to learn, but we also want them to grow.

We also want them to understand, and I use this all the time with the kids, I will tell them, "If you keep hitting the same wall over and over again, don't blame the wall."

We have to give you the strategies to go over it, go under it, go around it, and sometimes even go through it.

But we do that together.

- Love the words healing and resiliency.

Marcus, I'd like you to pick up where Tony has left off.

Tell us a little bit about the trends you've observed contributing to this worrying increase in mental health challenges among young people.

- I appreciate the question.

I appreciate being here.

We have to acknowledge that we are in the mental health crisis of our lifetime.

That our communities and schools and youth and families are all dealing with super-elevated behaviors and experiences that none of us have experience navigating, especially the youth.

Has increased all of the outcomes, our substance-use hospitalizations, out-of-home placements, incarcerations, death by suicide, death by overdose, are all dramatically up.

COVID and the traumas that our communities have experienced, not only socially, but physically and emotionally, are all burdens that we all carry and are not equitably carried, especially the most vulnerable children and families in our community are the ones that'll see it the most.

Contributing, like the most contributing factor feels like the youth and the families seem more disconnected.

So we're more digitally and socially connected than we ever have been before, and less personally and spiritually connected.

And so we need to lean into those spaces.

And so a lot of what I'm seeing with youth and some of the contributing factors is mental health, is that lack of connection, the lack of social connection to their community, to their peers, and to a hopeful future.

- Suzie, you hear all of this, and of course these issues are no stranger to our UNC campuses, but what advice would you give to Tony, to Marcus, to families, to communities as they prepare young people to enter our university?

- Yeah, thank you for asking me that.

And the good news is, is there's lots of ways to prepare students as they enter into higher education experiences or the workforce.

And I think number one, start early and often de-stigmatizing mental health.

Start talking about help-seeking behaviors.

Model those for your students so they know what that looks like.

Make that part of your day-to-day conversation.

I think it's really important to talk a lot about social connectedness, to create and provide opportunities for students to build new friendships and look at what that looks like while continuing to strengthen the existing relationships that they have with their friends, but also trusted adults and make sure that when they head off into their college experience or into the workforce, they have that social support system that exists for them.

The other things I think are really important, very practically start teaching students independent living skills.

How to do your laundry, how to balance your checkbook, what is a budget and how do you stick to it?

How do you make a doctor's appointment?

How do you refill a prescription?

How do you set healthy boundaries with your friends?

So those are some really practical things that I think we can do early and often to help students transition Something akin to- - This helps them to feel less overwhelmed.

- Yeah.

- By the experience.

- It builds confidence, it builds self-esteem, it helps 'em feel independent.

It reduces the stress that surrounds having to do something new for the first time.

When you head off to college, there's so many things that are new that you're doing for the first time.

Let's see if we can give them tools so that they we're minimizing the number of new things that they're having to encounter.

The other pieces of the puzzle are teaching students what healthy coping skills look like.

Self-harm is not a healthy coping skill, using tobacco, alcohol, or drugs, not healthy coping skills, being reckless or taking risks, not healthy.

Exercising is healthy.

Good sleep hygiene is healthy.

Watching your favorite show on Netflix, healthy, you know, in moderation.

So those are things that we need to make sure students hear and see.

So that's another piece of the puzzle.

And then I think, finally, what's really important is talk about the transition.

So talk about what is exciting about it.

Talk about what is, maybe, worrying about it, talk about some of the positive things that students are likely to experience, but also bring up some of the maybe low lows that they might experience too, because they're going to have both and there's gonna be expectations that maybe don't align with the experience.

So set some realistic expectations for what that will look like.

And then tell your student, "Hey, listen, I'm proud of you, but that's not the only thing I'm here for, right?

So if you want to call me and tell me how successful you are, that's great, but I want to hear about your successes and your failures in equal measure.

Do not hide if things aren't going well, do not pretend they're not happening because you're worried I won't be proud of you.

I am, it doesn't matter, but I want you to bring me the good and the bad."

Too many students are scared to tell their families, "Things are not going the way I thought they were gonna go."

And that's a huge mistake.

So make sure you have those conversations and set those expectations.

- I love that last bit of advice because it says not only that you're connected, but that those connections are authentic and meaningful.

Tony, when we look across populations, we see differences in how the mental health crisis is affecting young people based on gender, race, ethnicity, sexuality, the list goes on and on.

Talk to us a little bit about the groups that are giving you the most cause for pause.

How are they differently impacted and what are you doing to support them?

- Yeah.

I think right now there are lots of shifts going on in the world of public education and particularly in K-12.

And I think we have to work extremely hard to ensure that, one, we see all of our kids and to build systems that will say to them that you're valuable regardless of who you are, what place you come from, your families, those types of things.

I lose sleep at night because right now I really believe, and I've just had a passion for little brown boys like me who are forced into believing that they have to be tough, who are forced into believing that somehow I'm less because of the stigmas and the stereotypes that they see on TV.

So I really have a heart for those young men that have to live in this, the imposter syndrome for a lot of their school experience because of experiences, because of the expectations that others put on them.

And so I really try so very hard to say to them that you are valuable, you are worthy, you are in fact able to do whatever you want to do.

There's some real challenges around working with those groups.

Again, I think that there are our students who come from many of our underrepresented populations in terms of our low socioeconomic communities, where people have placed stigmas upon them in their own communities about mental health and about seeking help and hearing that you're supposed to be strong.

And we're telling them that strength is being able to ask for help.

Strength is being able to have those real authentic relationships that you talked about.

Strength is really about making those connections with people and owning that you don't have to be perfect all of the time.

So I struggled with that.

I struggled with that for a long time.

My background is, as a music teacher, I had to teach kids how to find their voice as a singer.

And so it's been equally beneficial for me to try to help our school communities find their voice when it comes to providing support for children and having them learn to advocate for themselves with their own voices.

- Marcus, let's talk about voice.

What role do nonprofits play in the social fabric of supporting our young people?

- I appreciate the question.

I have the good fortune to leave a nonprofit out in the far Western counties, the seven western counties in Qualla Boundary.

And I am super passionate about nonprofit and their role in the communities.

They are, in my opinion, the hands and feet of the community.

Like they're the ones that carry hope into the dark corners of your neighborhoods, into your families, the places that schools don't have the resources to reach or government systems don't have the knowledge or specialized access.

We understand the culture of our communities that we work in better than anybody else.

We are passionate about helping the people in our community.

You can't pay someone to be as passionate as the leaders in these nonprofit communities.

These are people that have been deeply affected by the issues that are affecting them and want to bring solutions to the community.

And we were in on of my future conferences that we're in together, one of the leader speakers, and I don't remember her name and I wanna to give her credit, but she said the people closest to the problem are closest to the solution.

And that resonated as the truth with me.

So in the terms of nonprofit world, I feel like we're closer to the problem and so we're closer to the solution a lot of times.

And we were talking earlier about how even the most well-intended initiative or government program doesn't have the needed relationships and partnerships with these local communities to establish effective programs.

You can have the best idea in the world, the best tool in the world, but if that community doesn't identify with you, if they don't trust you, they will never use that tool and that tool is ineffective.

And so if we're not empowering local nonprofits, if we're not empowering local communities to solve local problems, we're doing a disservice and we're gonna miss the mark and youth and children are suffering because of it.

We need to continue to empower local organizations to solve local problems.

That's connecting universities and university systems into our communities, that's connecting all of the foundations and local businesses as well as faith-based communities into solving these local problems.

And so again, it's a super-critical role.

- Marcus has been a key leader in two cross-sector collaboratives we've worked on, one of which was the myFutureNC local educational attainment collaboratives.

It's a great lead-in, Suzie, to this question to you because it is about getting all the right people at the table.

Talk to us a little bit about the risk factors and protective factors that students, families, and community members should be aware of when it comes to this mental health crisis.

- Yeah, this is really important.

So stress, anxiety, and depression are the most commonly occurring mental health issues among young people.

And suicide is the second leading cause of death in 10 to 14 year olds and in 20 to 34 year olds.

So understanding what the risk factors are for poor mental health and what the protective factors are to help strengthen and build resilience and positive mental health are critical for making change in mental health status for our young folks.

So some of the risk factors for college students in particular sort of span this array of spectrum.

So things like psychological, biological, academic, lifestyle, social, and financial.

So if you want to think about that, those would be things like coming into college with an underlying mental health condition that maybe is not diagnosed or currently controlled or cared for.

Having low self-esteem or low confidence.

It would be perhaps having a chronic illness or some other physical challenge that, again, is maybe not well-managed or creates a significant amount of stress.

Even gender and age can be risk factors.

Academically, this is huge for our college student population.

Oftentimes we'll see students who maybe were number one in their class in their high school and they come to college and a lot of their self identity is tied up with who they were in their high school as an athlete, as a student, as the leader of their organization.

And they find that they are not that when they come to college and they have to refigure that out.

That's a huge challenge for a lot of our students that they're no longer number one in the classroom and in fact they might actually experience significant struggles and question whether or not they deserve to to be there.

You know, I really relate strongly to what you were talking about Tony, with regards to imposter syndrome.

That's a huge stress.

Things like exams that they're not used to, developing relationships with faculty and other classmates looks very different in the college setting than it does in a high school setting.

And just sort of that, that need to sort of be self-motivated and self dedicated and driven in a slightly different way.

Social is huge.

Social isolation is an enormous risk factor.

So not having a strong connection with a supportive community back home and at the college that you are attending, having a low sort of social engagement, not attending activities or feeling familiar or at home.

Financially, housing and food insecurity, just having inadequate financial resources available to you.

And then lifestyle choices.

So things like using tobacco, alcohol or drugs as coping mechanisms, staying up all night, not having good sleep hygiene, eating poorly.

All of those are risk factors and very common, right?

So then when you sort of flip the coin and think about what are the protective factors that help our students foster this resilience and this sense of wellbeing, we're looking at things like having a strong social network we're talking about having great self-awareness and a help-seeking behaviors, having been sort of trained to seek help and be comfortable with that.

We're looking for students to be comfortable reaching out for resources and accessing those resources that are available to them on campuses.

Having adequate access to things like financial aid.

Really anything that is opposite to the risk factors are gonna be protective.

And so I think really truly the biggest though is what we've talked about on this stage.

Social connectedness is absolutely critical.

You could really put that one at the very top.

If that doesn't exist, we would be very worried about our students.

And that's what a lot of our colleges focus on.

- Wow, and there are many students, who, amidst thousands, tens of thousands of people still feel unconnected.

We've got your back.

Really important words.

Suzie, I wanna start with you.

We saw in this story that demand for services increased during and after COVID-19.

Talk to us a little bit about the impact that had on the issues we're discussing.

- So pandemic is a bit of a touch word.

I feel like we're almost at the point where we could get past the pandemic, but it really did have such a dramatic impact.

And I think when we think about how our colleges responded, they responded by providing responsive services, right?

So critical incident response services, immediate need, increasing sort of the surge capacity to be able to serve the increase.

And as time has gone by, thankfully, we're now sort of creeping towards a place where we can start to introduce more long-term skill building and resilience and services that helps students beyond just the initial impact.

Additionally, when we sort of think about what does that look like from the system standpoint, we want to think kind of like Nash did, that mental health is a very broad spectrum of experiences, right?

So it's some need clinical intervention and some do not.

And that's really important to think about.

So how do we introduce services that can serve our students but aren't necessarily clinically indicated?

And some of that is thinking through who's responsible for providing mental health support to students.

In my opinion, it is everybody.

So this is a campus-wide, it is a community-wide effort.

Everybody on a campus should understand the spectrum of mental health and everybody on a campus live, learning, and working there, should be educated and trained to be able to provide support to students regardless of what their position is on that campus.

And that's very much the UNC system's main priority is getting that training out and making sure with things like Mental Health First Aid, and QPR, suicide prevention program, that everybody has access to a training program so that when they encounter a student who is experiencing acute distress or maybe even is exhibiting suicidal ideation, that they know what signs to look for and how to respond to make sure that that student receives the care that they need.

- Proud to hear that.

I'm gonna turn to you, Marcus, for a different perspective.

Not all places are equally resourced.

Talk to us a little bit about the unique challenges that the communities you serve face in responding to the needs of young people.

- I appreciate the question.

It's not often I get an audience for this particular challenge.

I am very passionate about bringing equitable resources out to our most isolated and rural communities.

I fully believe that our students out in rural communities deserve equal access to quality services, the same quality services that we take for granted in urban communities.

So even as we identify the challenges of like everyone knows that we needed to increase mental health supports because of COVID and some of the corresponding issues, and sometimes we would have the resources to hire those clinicians and sometimes we wouldn't, sometimes even if the funding was there, we don't have the credentialed people to do the service work, right?

So that by the time you get out to Murphy, which is our furthest-west community, it is a crisis to get qualified, credentialed, mental health workers, social workers, teachers, police officers, credentialed souls out into these rural communities.

It's a real issue.

And so again, so we usually share that burden among community nonprofits.

Some are qualified to do the work and some are not.

Some are just passionate about helping people.

And so what is created is in these communities for what we lack in resources, we make up for in our passion for helping and the communities are very unique in the communities that we serve, in that they have a long-standing history of moving together to solve community problems.

And so we've developed systems that force communication and partnerships with social services and juvenile justice and schools and mental health agencies and area nonprofits and businesses and communities of faith that keep us accountable to each other as well as problem solve really complicated spaces.

So in those rural communities, we've got a lot of challenges.

The main is, and the other big ones are isolation.

Again, you mentioned that is such an issue.

The mountains of western North Carolina are some of the most beautiful places on earth, but if you were isolated on one of those mountains, you are certainly isolated.

I mean, you were stuck.

And the creatings, and we understand the connections of isolation and mental health issues and our students transportation is the largest barrier to service in our community, right?

So all the services that we do in our community, we provide all transportation to and from because that's the only way that kid's gonna get help, right?

And so again, the challenges are different, the solutions are different.

Every community is so different.

The issues that we face a lot of times is in urban centers and these places where these ideas originate, these hubs of ideas and resources sometimes either don't have the knowledge of how to reach these rural communities or just don't have the ability to access them.

- Tony, I want you to pick up on this because Chatham County is a very interesting county, quickly urbanizing in some places and very rural in others.

When you talk about making your schools a place for healing, clearly you need to rely on other organizations, government agencies, not-for-profit organizations.

How do you bring these partners into the fold so that you can ensure that the students are receiving the full range of services that they need?

- And so for us in Chatham, you hit it just right.

We are just such a unique community in that we cover just about all of the spectra when you look at socioeconomic, where our students live, the types of neighborhoods, the changes that are happening there.

So as a school system, we've committed ourselves to being the hub, that pivot point, for all of those agencies and cross-sector groups that were mentioned.

One, we have tasked ourselves and I've tasked my internal student services staff with going out and identifying every single partner in our community that would help us reach every single child because it's so very different if you go to Bennett than it is if you go to North Chatham.

And the resources are different.

We have parts of our community, as centrally located as we are, where we can't get providers.

And so we have to really talk about being very creative and using all types of resources.

Telehealth, we have Vaya Health with us.

They're able to have in-home support.

A great partner for us in our area is Renaissance Wellness.

They have been tremendous.

They will go anywhere in our county and they're one of the rare birds who will do that.

We ask them, they will go, it doesn't matter if they're one end to the other.

And what we found is that we have families who have a very difficult time once we identify the resource of getting to the resource because of transportation and distance.

So we've had to be very, very creative.

We've had to use the school as the hub.

We've had to work with families to say, "If that service needs to be provided in schools, then let's do it."

We've tried to break down all of those artificial barriers because here's what I want us to recognize.

These were challenges before COVID.

- That's right.

- Mm-hmm.

- Let not fool ourselves into believing.

COVID exposed these issues for us and I believe that we have to figure out a way to take the opportunity of the pandemic to somehow step forward and say, "Here's how we are going to serve kids differently.

Here's how we're gonna serve families differently."

And then the last thing, I would be remiss if I didn't say this, we talk about kids all the time.

I have another burning issue in my sector and that's the adults who are working with kids because they're bringing equally as much trauma to the table as our kids.

And so now I have this storm that's brewing where I have the adults who are equally as impacted as our kids.

And so we have to sometimes be as focused on developing pathways and support systems for those adults if we want our kids to be okay.

- I see Marcus nodding vigorously as though you're preaching to him.

- Amen.

- I'm grateful for the communities we have working in this field.

The schools are the center of our community.

Public schools are the center of our community help.

The pandemic exposed that.

They were the ones that got food, that got services, that stood in the gaff and we are all grateful.

- So Suzie, talk to us a little bit about the innovations at UNC and what partners are you using?

- Oh my goodness, there's a long list.

I think- - You don't have to give us all of 'em, but you know- - We'll be here all day.

- some categories.

- So I think there's a handful of innovations that really make me very hopeful.

One that has come into focus in the last year or so has been peer support programs.

So I mentioned earlier that with this increase of need we identified that yes, there's an increase of need, but not all of those needs are clinically indicated.

And so it's not possible or even really rational for our counseling centers and our student health centers and our wellness centers to be the ones to serve those students.

There are again, broad spectrum of mental health services.

There's a sector that does not need clinical indication.

They can be supported in a different way and peer support has really filled that gap.

The other thing that really warms my heart about peer support is that in a time where we're still sort of climbing out from behind the computer screen a little bit and students and grownups are learning how to people again, the fact that there is so much interest from student-led organizations in fostering peer support programs is truly a testament to the culture of care at the UNC system and all of the schools there.

So that is one that really speaks to me and peer support is happening in a few different ways.

One of our huge partnerships is with a company called Togetherall, they provide a virtual platform that is still clinically moderated.

So it's like a bit of a step up from from pure peer support, but the students support each other on a virtual platform and that is currently in I think nine of our schools so we're really excited about that.

And then we have several of our schools who are leading either faculty-led or student-led peer support programs that are providing in-person capacity and those are fantastic.

And then the other piece, as I sort of mentioned, is the shift from maybe responsive services to more resilience-building services.

And so one of the things that we have been able to do with the wonderful funding from the Governors Emergency Education Relief Fund is fund almost $1.7 million worth of resiliency programs across several of our institutions.

And those have been really, really powerful.

And there's a couple that I would like to highlight if we have time.

One is through university libraries.

University libraries has identified more than 2000 different sources of information that provide education about mental health, resilience, and wellness.

And they've taken it a step further.

They have packaged them into toolkits and they have hired student workers that connect faculty with those toolkits so they can embed that work in their courses.

That's truly fantastic.

That's the best way to get to students is through the courses that they're already taking.

It's not an extra thing they have to- - Meet 'em where they are.

- It's just part of the culture that we're creating.

And then another is with our North Carolina School of Science and Math, so that's our K through 12, it's our high school.

They have coordinated to create a training for parents, so a training for parents to coach their own children in being resilient, to coach their students in wellness practices, and to be able to have candid conversations with their children about mental health, again, to aid in this transition to going on to college or into the workforce.

And so that's just a couple of the innovations that I'm really excited about.

But the other piece of this is how much investment and interest we are seeing from all of our schools across the system, from all of the community colleges that we partner with.

There is more requests than there is money to hand out.

And that's a good place to be, right?

That's a good place to be.

I think it really is a testament to how much people genuinely and authentically want to make a difference and how mental health is truly a priority, not just for the UNC system, but for North Carolina as a state.

- It's very, very heartwarming.

Thank you for sharing the things that give you hope.

I'm sure they give everyone in this audience some hope.

I'm gonna turn to audience questions right after I ask a final question to Marcus.

So if you've got a question, there's a mic in the back, please just line up and get ready to ask questions to these great panelists.

Marcus, you know, near and dear to my heart are those young people who may have been in Tony's K through 12 system, but they are now not in school, they are not working, they're 16 to 24 and many of them are suffering from the mental health challenges we've talked about, but they're not connected to an institution that would support them.

How are you identifying these young people and supporting them?

- That's a great question.

So first of all, you can't, cannot, uncouple mental health and community wellness with workforce, with social connections, with housing, with all the social determinants.

Like there's no breaking of those things.

And so when you say like what opportunities are for those students that aren't university bound?

Generally you're talking about students with opportunity or students without opportunity.

There's either those students with the opportunity they've had, people that have believed in them or mentored them or grown and allowed them and shown them the vision of the pathway forward.

We believe fully that every student graduating high school should have a clearly identified path to opportunity.

Whether that is a job, whether it's in the trade industry or some sort of connection, military, credential, an employable credential or university system.

Like we need to get better at creating and attaching the current students to the future programs.

And we've got a bunch of innovative programs, the Southwestern Workforce Commissions, our area Workforce board does a great job working with the myFutureNC actually of going to all of our local colleges, all of our local high schools, CTE programs, and talking to those teachers and creating connections to employable credentials.

And then the opportunity youth work we're doing at the Carolina Across 100, and Our State, Our Work and how important it is.

So heights, and our role of it.

So we're looking to, I think it's 6,400 students across the state.

We have identified those students as the most vulnerable for self-harm and community violence in our community.

Students that aren't engaged in school and aren't engaged in work are in real trouble.

And so in our communities we're aggressively trying to identify them.

We're going through roll books of high schools of like who engaged and who didn't, we're looking at mental health agencies where we're working with juvenile justice and police forces of like, let's find these kids, let's identify what the issues are that's keeping them from engaging in a pathway forward and then try to bring them the resources they need to stabilize and move forward.

In our rural community, WIOA youth, W-I-O-A, funding is the only funding that we have in our communities that help move these kids forward.

It pays for paid internships and apprenticeships, vocational opportunities, all the things a kid needs to be able to move into a path to employment is youth WIOA services.

And right now those services are in serious risks of being cut.

Like those budgets are being determined right now in the next week or two.

And so well-intentioned people just don't understand the real consequence in rural community like ours.

- I'm struck by you saying you cannot decouple these issues.

Wellbeing is wellbeing and I think the language we've heard about whole student, whole person is so critical to understanding where many of our young people find themselves.

Thank you for that.

All right, we're ready to take some questions from the audience and I know you all have some.

Wait, there are a number of people who promised me they had great questions as they were coming in.

I'm looking at you.

[panelists chuckle] - She's looking at students in here.

- Hello.

Hi, I'm Jonathan with the UNC School of Social Work.

So I know that trauma-informed practice is being implemented in sectors like social work and education.

What are some tips or what are some suggestions to help see people who may not be thinking along those lines to help them see the benefits of trauma-informed systems and to think along those lines so it's the whole community, not just certain sectors thinking about being trauma-informed.

- Marcus, you wanna take that?

- Sure.

We have to find ways to find common ground, right?

And this world we're in is so divided for all the reasons.

Helping youth that need help is one of the easiest places I've ever found common ground from the furthest right-leaning politician to the furthest left professor.

I can talk about like meeting- - Wait, why do the professors have to be the people on the left?

- All right, so we can switch that if you would prefer.

North Carolina's a weird state.

- No, I just had to ask.

- And you talk about helping kids and you've got that common ground.

Like there are very few things that people can argue about like how important it is to protect these children as we move forward and finding those places and finding that language and finding those opportunities to find that common ground is critically important.

We have to find ways to stop the division and move together or we will not make it.

- Tony, is that language you use in your K through 12 system and is that language you use with your partners?

- I tend to focus in on a very simple conversation with the community and that is what if we don't?

What if we ignore this?

What will the outcomes look like three, five years from now?

And I really do, I try to encourage the community to think through the true consequences of inaction right now.

I try to use levity sometimes and I say to them that right now we get to pick their nursery schools, but they pick our nursing homes and so we'd better be nice to them- - You're not wrong.

- So that they will treat us well and that they're well prepared.

- That's really cool.

- To do what we need done at that time.

So that's a real conversation that we're having in our community.

Inaction is unacceptable.

Indifference is unacceptable.

We have to talk about what the future, it's their future, it's not our past.

We've gotta talk about what it looks like on the other side for our kids in a world that's gonna be very different for them.

And so I tend to be so very intentional about one thing, talking with our communities about being honest and authentic with our kids in that conversation.

- [Anita] Yeah.

- We tend to have them think that at 18 they're finished products and they're not.

And we still have some of us who are 30, 40 years old still trying to find ourselves.

But we continue to promulgate this illusion with the next generation that at 18 when you walk across the stage, you're a finished product.

That's never been true because if the truth were told, many of us, we weren't that hot at 18.

[panelists chuckle] - Speak for yourself!

[panelists laughing] - Well, except you.

And so we have work to do and I think we have to be authentic in that conversation with our kids because they're watching us.

- Yeah.

- Mm.

So.

- Terrific question.

And everybody else I'm side eyeing who promised me they had good questions.

Just continue to line up.

Yes.

- Hi there.

My name is Jeremy Fine.

I'm an MD PhD student at UNC and I study mental health crisis systems.

And when I'm working in the emergency room, the crisis that I see is that kids are waiting for weeks for an inpatient bed and just oftentimes just sitting there.

And, you know, talking about trauma-informed care, emergency room's not a very fun place, much less an inpatient unit can be a really traumatizing place to supposedly get better.

So what I'm wondering is what are we doing to help kids access like less restrictive care like mobile crisis units or 988, how are we equipping our young people with the knowledge and the tools to access care that might be in a little bit more friendly of a place?

- Great question.

- I'll be happy- - Yeah.

- to start with that one.

Super important question and, again, that is an issue that is age old and I absolutely agree with you.

It's really a difficult place to be in an emergency room when you're experiencing an acute mental health crisis.

That is not a good place to be.

And it's also really hard for parents and families.

I think the key to this is education, education, education.

Ultimately, our goal would be to address a mental health crisis before it becomes a crisis.

So if we are able to create stepped care models so that we can address issues as they arise before they reach a critical need for an emergency service intervention, then we're going to eventually reduce the number of students or others that have to be in inpatient care and we can do something that is less restrictive.

We can do outpatient care, we can connect them with therapeutic services.

One of the things I think the UNC system introduced, and this really speaks to sort of your perspective, Marcus, about the rural communities, was a shared telepsychiatry program that was originally piloted at institutions and in communities that did not have psychiatry available on their campuses, that did not have psychiatry available in their communities, one of which would be Western Carolina University all the way up on the mountain.

So it started with three, we're now up to nine.

And one of those actually includes NC State simply because it's so big and because Raleigh is such a central hub to serve more than just the student population, that those hospitals, those emergency rooms, and those inpatient services are overloaded and unable to provide services in a timely fashion.

So by outsourcing some of those services to students, that weren't available, we're able to avoid it reaching a critical mass.

I mean, that's not the only answer, but I think a lot of the work that we're doing in introducing training university-wide to make people more aware, reduce the stigma around mental health, encourage help-seeking behaviors is going to slowly start to mitigate that crisis build.

And I think that's a huge step towards solving that problem.

- Thank you.

Yes, ma'am.

- Hi, I am definitely excited to be here.

So right off the bat, the main thing that I thought about was how do you help the parents?

And I know Tony, you touched on that a bit as far as what's the point in helping the kid at the school with all of these services, if you send them right back home to a place that's not safe, not healthy, and the parents don't have the emotional ability and strength to continue helping their child grow.

And some parents don't agree with some of that mental health help they're getting at the schools.

So how can the community and nonprofits build more and do more in the school systems with the school systems to support the parents, teach the parents, mental health help for the parents so that their kids can flourish.

So what are your thoughts on that?

- So I wanna bifurcate that question if I can.

Tony, I wanna know within the school system, how are you dealing with a situation where parents need to be involved but may or may not want to be involved?

And then Marcus, I wanna turn to you to talk about how do we deal with not just whole student, but whole family.

- I think it speaks to what I said earlier around, typically when we see a child in crisis, it's usually a family in crisis.

In a lot of cases we see families that want to do the right things and they just don't have access to resources sometimes and they don't have access to all of those tools.

And so what we try to do as one partner, we want them to understand that we are here, we have the resources available to them, to us.

We will again be that hub where if you're uncomfortable with that, a lot of families are uncomfortable bringing people into their homes.

We've said we use the schools.

So we build out MOUs with a lot of these agencies to say, if it's okay with the parents, we will offer that service here at the school if that will make it a lot better on the families.

We work with them to provide and point them towards family support.

Now, a lot of times we try to fix the kid and as you said, they go back into environments that maybe are not as supportive as we want or they just need some support to be able to do a better job for this student.

So we try to balance that out and really be a partner in the process.

We recognize that ultimately our goal is to help that parent realize the hopes and dreams or have that child realize their parents' hopes and dreams for them.

And so whatever it takes in that regard, we're willing to push through.

It's difficult sometimes for a lot of the reasons you said that sometimes there are stigmas attached to getting help.

There are stigmas attached to, "I'm not ready to accept this yet."

And so our focus, so very intentional around building and being partners in this process and helping them get to that place where we want your child to be healthy and whole.

That's what we tell them upfront.

We want your child to be healthy and whole.

How can we make that happen together?

- So Marcus, as a community-based organization, how do you make the family whole?

How are you focused on family?

- Well again, that idea that you can't uncouple anything from anything, like it's all attached.

And so also the vision of, so we co-locate, so we're based in schools and social services and with juvenile justice and consider these critical access points where we identify these students who are the most vulnerable students in our community to work with parents is a challenge, especially in our communities.

Again, we go back to that resources of we don't have a lot of those resources, especially in the recovery community.

In the far west, there are very little recovery resources out out there that we can refer to where we would help stabilize the parent to stabilize the family, to stabilize the kid.

- [Anita] You mean substance use recovery?

- That's right.

Substance use, substance use recovery, reunification outta prison, outta jail.

All the things that, again, we just don't have a lot of those resources.

So a lot of times it's left to a clinician or a counselor or a community-based program to, again, it's finding that common ground.

Even if they don't identify with us, even if we're different.

I've never worked with a parent who didn't care about their kid even if they had their own challenges.

- That's right.

- I've never worked with a parent who was against that kid getting help.

And so we get in there and you identify, oftentimes you identify that they lack resources.

Oh, and y'all need food.

Like, y'all need transportation.

You're truant those 16 days because you don't have a way to get your kid to work and you leave before the bus gets there.

Oh, well we can help that.

And so identifying those challenges and trying to meet those families where they're at.

And then if you can't, if you do run into those family challenges, then you double down on that kid.

You help 'em every chance you get, you get 'em every opportunity you can and you push those independent living skills.

And we understand like, these are generational problems, right?

We've been getting here for generations.

It won't be solved here in this next few weeks and it'll take a long process and hopefully we can institute some of that healing now.

- [Anita] Thank you.

Yes.

- Hi.

So you mentioned connectivity with youth and them making friends in their school and having connection with their community.

I was wondering how social media could affect that connectivity and how hiding behind the screen could negatively impact how children and youth connect with each other?

- Great question.

- I'll jump in from the college end of things.

Unpopular opinion, but not all social media is bad.

Going back to the pandemic, social media and screens provided the only connection that existed for many folks.

And so maybe that's not the most popular opinion, but I don't believe that all social media is negative.

Did it create opportunities where folks who might already have some social anxieties or challenges in connecting with folks the opportunity to continue to hide behind the screen and maybe lose some of those skills?

Absolutely.

And so I think what we are now post-pandemic, I'm gonna call it the post-pandemic period, what we're now facing is trying to marry these two things together.

The pandemic provided opportunity in ways that we didn't ever have the chance to test out before.

So we are seeing new virtual platforms showing up that are actually creating community in ways that we didn't previously have.

And they're reaching populations that maybe experience mental health as more stigmatized than others and providing access to those populations in ways that they didn't have before.

So there is significant amount of positivity in that.

I think social media also presents an opportunity for students to find each other.

Now our job at the college level is to also provide ways to transition students from behind the screen, from behind the app, to have in-person conversations and to teach them and train them and support them in doing that so that they can sort of re-enter an in-person social connection way of doing things, if you will.

But I think social media has its place.

I really do.

- So Tony, do you agree from the K through 12 perspective that social media augments or compliments in-person connections or do you think for some young people it has replaced them in a detrimental way?

- I'm still looking for the switch to turn it off.

No, no.

[panelists laughing] Honestly, I too believe that there's some good applications of social media.

I believe that as a teaching organization, we have to demonstrate and show our students how to use it positively.

I find it amazing that we have this amazing tool and it seems that the only thing we can do is find how it can be used negatively.

I really wish that we could use as much energy or invest as much energy in figuring out ways to use it to help, support.

I use it positively.

My grandson is in Maryland.

I get to see him far more than I would have prior to social media, prior to a video conferencing and so it's a positive thing there.

But if I'm using it negatively, the outcomes are gonna be negative.

And so I really encourage our teachers to find those positive ways.

If we don't teach them how to use it and we leave it up to them, then in fact they're going to use it in a negative way.

And so I just believe that if we were to just build out ways that we could help our students recognize that this is a tool, it could be a tool for good, just like everything else and that if they would just take the time to begin to try to build community using it.

But we have to use, in the school setting, opportunities to practice, opportunities for them to try things and fail, opportunities for us to say, "No, that's not a good way to use this.

Here's a better way."

And not make everything a choice consequence, a punishment because you did it wrong and we've left them alone to figure it out on their own.

So I think we have to own part of that and really start talk.

I don't think it's too late.

I think we have the opportunity to really open doors for our young folk to say, "This is an amazing tool."

Some of them will never leave their homes.

We're talking about preparing them for the workforce.

Some of them, this will be their workforce.

They will have to learn how to operate in a world where they will never go into an office or where they will never interact face to face, but they have to learn appropriately how to interact and build relationships with people using this very tool that we're questioning.

So I want to challenge us to be far more open about that and even embrace the mystery of not figuring all of this out.

- Lovely.

- Or knowing the answers.

- We're gonna take one more question and then we will close this wonderful panel.

- Thank you.

Mark Simon.

I'm a recent master of public health graduate from UNC and I've had the privilege of working with the Carolina Across 100 initiative for my last year on the project to reengage opportunity youth.

I know it was mentioned earlier about work being a social determinant of health and I'm familiar with the great work being done to connect youth to education employment opportunities.

But I'm wondering if any of the panelists could elaborate on any ongoing efforts or plans to establish a framework to leverage work specifically to build mental health resilience.

Could be creating and designing jobs that support people with mental health conditions or manager training or anything like that.

- Thank you Mark.

Marcus, do you wanna take a stab at starting there?

- Sure.

I appreciate the question.

It's complicated.

So again, like to do the work we do, it has to be funded.

And so I mentioned the WIOA funding and how that's possibly in jeopardy, how it complicates things.

But in that space, like we've got a lot of organizations that work hard to step in and understand the connection between mental health and behavioral supports in workforce.

And that's adult and youth, right?

So most of our workforces are starting to establish programs that understand that addiction services and substance use services are critical to maintaining a healthy workforce.

And the young people, it's in that same line.

And so that's starting to fund.

And so as we are moving into the schools and moving younger and younger to try to create direct pathways to employment from high school, from schools into young adults, then that is baked into the process.

And there's CTE programs and our schools and our community's organizations and in the workforce programs that we do, the importance of self-care, the importance of taking care of yourself and getting the mental health access and taking the medicines and doing the things and staying connected to a community of wellness.

All the things that we know go into healthy young people and healthy adults.

And so again, the further we go down this road, the more our communities understand that those two things are inseparable and here in this new world of employment, I think that that's the future.

- It's interesting, our organization did focus groups across North Carolina with employers and it was the first time in my career that, without exception, every employer talked about the importance of mental health supports on the job.

And that was true of course for young adults, but not exclusively for young adults.

So I think that point in the last question about connecting more intentionally employment and support for mental health is something that we will see continue to develop over the next few years.

And that's great.

You can get 'em to college, you can get 'em in K through 12.

For a lot of people, the place you're going to be able to support them is the workplace.

Suzie, Tony, Marcus, I wasn't quite sure about this conversation.

I thought I might leave it feeling a little overwhelmed and just a bit despaired.

The reality is, I'm leaving it feeling hopeful knowing that your leadership at very different places in our state is reflective of lots of people who are trying to get their arms around this issue.

The numbers are alarming, there's no question about that.

But to the extent that they stand as a call to action, I'm really very proud of the way our state is stepping up and responding to the call.

Thank you all so much for being here for this conversation.

I hope you too are leaving hopeful that we can reverse some of the trends.

And I would like to ask you before we leave for the reception to give this panel a wonderful round of applause.

[audience applauding]