Health Systems

Moving Past the “Don’t Ask Don’t Tell” Era of Mental Health: Children’s Health’s “Beyond ABC” Report

Increasing access to mental health for children is the overall recommendation in Children’s Health’s biannual report, “Beyond ABC,” which takes a deep dive into the health, economic security, safety, and education of the children in Dallas County and the rest of North Texas.

Communities Foundation of Texas hosted a panel to accompany the launch of the report, with discussion centering around increased access, higher insurance rates, and improved and expanded mental health services to the region’s children. “The strength of our community can be measured by how well we care for our youngest people,” Children’s Health President and CEO Christopher Durovich noted.

Over 14 percent of Dallas County children don’t have health insurance, which is nearly triple the national average, and over 22 percent live in poverty, the report notes. But the focus of the discussion was the 27 percent increase in adolescent suicide since 2016. Suicide is now the second leading cause of death for adolescents aged 15-24, and 130,000 children in North Texas suffer from an emotional disturbance or addictive disorder.

The panel, moderated by Children’s Health Foundation President Brent Christopher, focused on mental health and how authentic sharing of these issues can reduce stigma and avoid catastrophic events. “When we talk about mental health, it begins with teens,” said Dr. Madhukar Trivedi, who is a Professor and Chief of the Division of Mood Disorders at UT Southwestern.”It is very much an illness of teens, but it gets ignored and we wait for a crisis or major problem. There is a lot of ignorance, and that is what actually perpetuates this problem.”

Part of the process of removing the stigma involves sharing of mental health struggles rather than pushing them under the rug. “There is an incredible ache to be transparent and open,” Christopher said. “But how do we have that conversation in light of the fear that is out there?”

While individual conversations can make an impact on the personal level, Momentous Institute Executive Director Jessica Trudeau discussed the need for system level changes. The Momentous Institute offers training and services to improve children’s social emotional health, while Children’s Health is meeting part of the need for expanded services with it’s Suicide Prevention and Resilience in Children Program, which provides therapy and and targets risk factors associated with teen suicide. Children’s Health also works with local schools to provide telebehavioral health services for schools without enough providers. “How do we help shift school climates so that they are more healthy and secure places?” asked Marcelina Melvin, Director of Program Implementation for Child and Family Policy at The Meadows Institute for Mental Health Policy.

The panelists discussed the need for universal screening in schools, similar to the vision and hearing screenings that are done already, as a way to decrease stigma and increase coverage. Reimbursement issues persist, and often times primary care physicians and pediatricians want to refer mental health issues to specialists, which makes expanding coverage more difficult and expensive.

There has been some progress. This year, the Texas Legislature made investments in mental health policy, created guidelines for school districts, and created a child mental health care consortium, but being comfortable with addressing and talking about mental health are still problems from providers to parents and teachers. “We have created a health system and societal system of don’t ask don’t tell,” Trivedi said.


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