- [Narrator] Coming up on NC Impact.

- Our young people are experiencing a mental health crisis.

I hope you'll join us for this NC Impact Town Hall, as we explore the challenges and solutions shaping the wellbeing of the next generation.

- [Announcer] NC Impact is a PBS North Carolina Production in Association with the University of North Carolina School of Government.

Funding for NC Impact is made possible by.

- [Narrator] Changing the course of people's lives, That's the impact UNC Health and the UNC School of Medicine work to deliver every day.

Our 40,000 team members across the state of North Carolina are committed to caring for you, our patients and communities, as well as educating the next generation of healthcare professionals.

Individually, we can do a little, but collectively we can do a lot to create impact.

- Hello and welcome to NC Impact.

I'm Anita Brown-Graham.

I'm joined today by a live studio audience and three experts for one of four town halls, focused on the troubling rise of mental health challenges in our communities.

Tonight we'll talk about our future, youth and young adults.

These residents should grow, thrive, and live long, healthy lives.

However, the percentage of youth and young adults experiencing mental health disorders has risen significantly in recent years.

This sobering reality is a call to action.

NC Impacts', David Hurst, shows us how Cumberland County schools are bringing mental health resources to the classroom.

- [Natasha] Okay.

John.

- [David] Natasha Scott is in charge of student services for Cumberland County Schools.

Every time she walks into a school, she's aware of the fact that most of the students are carrying trauma.

- The research does tell us, that for most people by their 18th birthday, they will have experienced some type of trauma.

- You can tell them.

- [David] Scott says trauma can impact students in many different ways.

She's especially seen this with the trauma students experienced during the pandemic.

The school district saw an uptick in disciplinary issues when students returned following Covid-19 related school closures.

- We do recognize that trauma is more prevalent than we think and some of the misbehavior, some of the stress that you can see in children is a result of traumas that they've experienced.

- [Teacher] You need your bag.

- [David] It's one of the reasons why the school district is working towards becoming a trauma sensitive school district.

District leaders say being trauma sensitive is not about one single program.

It's an overall awareness of the pervasiveness of trauma and how it may impact students.

- Students need additional support.

We need to understand where they are, understand the challenges that they've gone through and then we need to implement programs that address those unique needs.

- [David] One way the district is addressing these unique needs is by providing a calm corner in each school.

The goal is to help misbehaving students regulate their emotions.

Another includes the Sparks program.

It's a trauma-informed small group counseling program that's facilitated by trained school counselors and school social workers.

- Thinking about the whole child, that we're not just here to teach them reading, writing, and math, but we're also here to help them just be productive, healthy citizens when they leave our school system.

- [David] And while the pandemic created a lot of challenges for students in Cumberland County and around the state, it also helped break down some of the stigmas around mental health and created a platform for students to talk about it.

- We can't prevent students' trauma, we can't change their trauma, but we can certainly help them to build their skills to be resilient.

- [David] For NC Impact, I'm David Hurst.

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

Tell us what is the importance today of taking a trauma informed approach to K-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.

It 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 to 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.

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 their 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 re-figure 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 be there.

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 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 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.

Student suicide rates have steadily increased.

It's now the second leading cause of death among people aged 15 to 24 in the United States.

These numbers, very concerning numbers, highlight the need for colleges and universities to address the mental health issues of their students.

NC Impacts' Even Howell shows us how a program at Nash Community College is working to serve the whole student.

- Oh wow.

The students are great.

- [Evan] Cheska Pringle was a single mom when she got to Nash Community College in Rocky Mount in 2016.

- I had no experience in absolutely anything besides childcare.

That's right.

- [Evan] She'd moved to Nash County from Washington DC to take care of her mother.

With few resources to rely on, she walked two miles of school every day for three years.

This caused a lot of stress for Pringle, but she found a program that will be soon called Blue Love, a holistic wellness program started in 2014.

It's designed to meet basic needs of students, including food, gas cards, and mental health services.

- Being able to have that resource, to have someone to talk to, be able to release and vent, and then be able to have a clear mind to be able to study, to be able to, you know, just provide and just be a healthy mom.

That made a huge difference in my life and my children's life.

- [Evan] Helping students where they live off campus is part of the services offered and is driven by data like zip codes.

By using that information, staff can help them locate nearby food pantries, transportation hubs, and mental health service locations.

More and more students began relying on the program during the Covid-19 pandemic, where the impacts of isolation and anxiety drove a 170% increase in clinical service utilization.

- I really think the alleviating of anxiety, the building of that campus culture of love, having students feel supported, and being supported, not just feeling supported, but being supported by our campus.

And it's holistic and it's campus-wide.

- [Evan] Because of Blue Love, staff hopes that students will become more resilient and learn how to better advocate for their own health than ever before.

- It positively impacted students a lot, because I know students personally who needed those benefits and it helped them be able to get gas cards and the food pantry and the clothes pantry, where it helped them be able to have clothes and food to survive to be able to come to school.

- [Evan] Meanwhile, Cheska Pringle says, she's proud to work with a program like Blue Love.

- Making sure that we let them know that we care.

Letting them know that, you know, we've got your back.

- [Evan] For NC Impact, I'm Evan Howell.

- [Cheska] We're really doing this thing.

- Marcus, you know, near and dear to my heart are those young people, who may have been in Tony's K-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 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.

Those students with the opportunity have 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 and employable credential, or university system.

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 My Future NC, actually of going to all of our local colleges, all 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 in 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 who engaged and who didn't.

We're looking at mental health agencies.

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, 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.

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

- 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 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 to find common ground, from the furthest right-leaning politician to the furthest left professor.

I can talk about like meeting kids.

- Wait, why do the professors have be the people on the left?

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

North Carolina's a weird state.

- It's all right, I just had to ask.

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

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

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 finished product.

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

- Speak for yourself.

- And we're, 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, 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 oftentimes just sitting there, and talking about trauma-informed care, emergency room is 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 less restrictive care, 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 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 tele-psychiatry 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.

- 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.

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 applause] [upbeat music] ♪ [upbeat music] - [Announcer] NC Impact is a PBS North Carolina Production in Association with the University of North Carolina School of Government.

Funding for NC Impact is made possible by.

- [Narrator] Changing the course of people's lives.

That's the impact UNC Health and the UNC School of Medicine work to deliver every day.

Our 40,000 team members across the state of North Carolina are committed to caring for you, our patients and communities, as well as educating the next generation of healthcare professionals.

Individually, we can do a little, but collectively we can do a lot to create impact.