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View From the Inside of the Youth Mental Health Crisis

Sara Schneider holds a picture of her son as a baby. Photo Sarah Whiting

Our mental health coverage in 2024 is made possible by the Minnesota Association for Children's Mental Health.

In 2005, Minnesota had 2,474 beds for youth who need mental health services beyond what the typical emergency room provides; in 2023, that number was down to 1,586. Yet the demand for services has increased for caregivers who are seeking medical and behavioral services for a child’s often dangerous and life-threatening mental illness symptoms. With limited places to go, youth are stuck in emergency rooms, juvenile detention centers, and county facilities — or sent out of state.

According to Aspire MN — a coalition of youth-focused mental health policy advocates — the Journal of Pediatrics reports that one in six children has a diagnosable mental health condition. More than 50 percent of kids with serious mental health issues do not receive treatment. One in 13 high school students attempted suicide in the past year; the American College of Emergency Physicians noted a 51 percent national increase in suicide attempts by teenage girls from 2019 to 2020.

One reason for the lack of beds is the lack of workforce; a recent statewide survey of mental health service providers conducted by AspireMN, the Minnesota Association of Community Mental Health Programs, and the Mental Health Providers Association of Minnesota found that 78 percent were unable to hire enough staff to meet needs.

One Parent’s Journey

Sara Schneider and her husband have three kids; the two oldest are adopted. At age four, her middle child was diagnosed with ADHD and possible fetal alcohol syndrome (FAS). “He was into things that were much more dangerous than most boys — running into the street, leaving the home,” Schneider says. “His behavior started ramping up. He was becoming more aggressive. Eventually we started locking our knives away, using locks on bedroom doors, getting cameras.”

She says it took a long time to find helpful people to educate her. “There’s no manual. I went to an ADHD specialist when he was about six. The doctor was very unkind. I started crying in the office about all the things we go through. He said, ‘Don’t you have a personal care assistant?’ I said I don’t even know what that is.”

Schneider learned that she needed to get a county caseworker. It took months to get the first appointment.

The biggest gift came, she says, when they discovered a flyer at the local YMCA promoting an upcoming discussion with members of the National Alliance on Mental Illness (NAMI). She and her husband ended up as the only attendees. “The women there listened to us. We felt heard. And then they got to work,” Schneider says. “We met with them over three weeks to learn what everything meant, how to get the paperwork for the services we deserved, and how to get a good children’s mental health case manager at the county. That next case manager was incredible.”

There was a process of discovering accommodations they could get from the school on homework to reduce incidents of frustrated anger from their son at home. “There are things you don’t know until somebody cares enough to say, ‘I think this would help him.’”

The next positive step was finding a play therapist [who tends to use toys instead of words to express feelings] to help reconnect the family members. “It was an absolutely fantastic process. My husband describes it as a stepping stone — every time we thought we were going to fall into the water, the next right thing happened.”

Her son’s elementary school had a helpful therapist — but then it closed, and the pandemic arrived. “It was extraordinarily difficult, losing access to all of your resources. Doing things on the computer fried my kid’s brain. Things really ramped up for us during Covid. That’s when he got increasingly violent, and that’s when we started pursuing residential treatment.”

Schneider adds, “When I say that our family was in crisis, I absolutely mean it. My other kids were suffering. They had parents that were scared and stressed out and putting everyone in separate rooms. When my son left for a residential center, we patched 75 holes he had made in his room.”

Though she was worried about leaving her 12-year-old son for so long living in a treatment center, hours away from home, Schneider says that access — after a three-year waiting process — was key to where the family is today. “It was through residential that he was able to get the absolute correct assessment for his needs,” she says. “He came home from that ten-month experience and was precisely where he needed to be for learning.

“The best thing about residential is the structure of the support you get. He knew the limitations, he knew what to expect, he could operate well in those boundaries,” she explains. “There aren’t any outside noises. You’re not around cell phones or your games. You’re with people like you who all have the same set of rules. One of the biggest struggles at home is the outside noise that you can’t just turn off.”

While there, “he learned to cope with his anger shooting up really fast,” Schneider says. “He can still be mad, but he has a better way to say ‘I need to take a break.’ He has much better language for his mental illness that does not embarrass him. It’s just his normal. ‘I have mental health challenges.’ That’s one of the most impressive things that I’ve seen from him.”

“After he got home from the treatment center, he was playing basketball at a neighbor’s. A new kid came to play with them who was [exhibiting signs of mental illness]. I heard my son simply say, ‘You got mental health?’ That was awesome.”

Insights From a Mental Health Nurse

Margie Bailey, a former mental health nurse at PrairieCare, worked for several years with children and adolescents coming into the inpatient hospital for mental and behavioral health challenges. They ranged in age from 5 to 18. The challenges that brought the youth to the inpatient unit ranged from debilitating anxiety, to severe depression that manifested in self-harm or suicidal ideation, to undiagnosed ADHD, and emotional dysregulation and behavioral problems that posed dangerous situations for family and others.

“Sometimes we had kids that would come because there was nowhere else to go — they were a ward of the state or county. We became kind of a holding spot for them. Those were very sad cases,” says Bailey.

PrairieCare also works with teens experiencing a first episode of psychosis or drug-induced psychosis.

The floor staff works with patients to build trust, and to help set them up for success: how to talk to the doctor, how to have difficult conversations with legal guardians, how to advocate for their needs, and how to learn skills in group activities. Bailey advised guardians and the kids that they had the opportunity, in working on themselves, to gain lifelong adult skills that some adults never learn.

Now working as a nurse on a college campus mental health clinic, Bailey says a challenge is that there is so much demand that a student might not see a therapist more than once a month. “As accessible as we want to be, we’re not able to meet all the needs,” she says. “Students are teetering on how to hold it all together. At 18, this is the first time you’re handling all of your medical needs by yourself, unless you’ve given permission for parental involvement. They have to schedule follow-up appointments and get medications filled on time while navigating college.”

The good news, Bailey noted, is that young people are more aware of the importance of mental health. “Even our high schoolers are so much more aware of what their friends struggle with, and talk about it openly in a way that previous generations never did.”

Despite all the challenges, Bailey said, “Somebody comes out of the womb, and we can’t guess how they’re going to be resilience-wise, so I don’t ever want to give up on anybody.”

Limited Access

One parent, who prefers to remain anonymous, ended up needing to call the police after her nearly 18-year-old became increasingly depressed and emotionally dysregulated. “I don’t have great experiences with police, but these officers were so well trained on how to deal with the situation. You could tell they had been through a lot of training. They absolutely knew how to talk to a teenager, and were able to get him to leave the house with them. They took him to the ER.”

From there, it took a few days before a bed opened up in adolescent inpatient care — which was uncomfortable for him because the group was filled with 11-, 12-, and 13-year- old children. Daily family therapy became a turning point.

Schneider says their first case manager was not great. “We’re working in a system that is overworked and underpaid. Some people do it from their heart; they want to help children, they want to help parents succeed. And then you have the people who see this as just a job. Or they get frustrated with the walls they run into that [mean] they can’t push for you.”

Schneider also talked about the limited access to youth treatment in Minnesota. “We were told there are a couple of crisis centers where you can go for a day or two, maybe a week at a time, but those were always full.”

She is not a fan of her particular county’s crisis line. “One of my biggest complaints about our state is that you can call a crisis line and get immediate help — only it’s not immediate. You have to talk to someone on the phone while you might be in the middle of a really terrible situation. They arrived at my home after my kid had already de-escalated. That’s the thing with kids — they move on and you’re still paralyzed. This crisis counselor shows up and it becomes a mountain of paperwork. I had to sit there and retell my story to a stranger and do paperwork that did nothing. I only called the crisis line twice before I decided this was not a useful resource for us.”

Schneider also says that she was told of three possible places in Minnesota for residential treatment. “In one case, we were packing him a day before he was supposed to go and learned our funding wasn’t coming in. He was not able to go. That was devastating. It was one full year later before there was an opening.”

She also said, “Unfortunately, in the system it often feels like you have to get hurt before anything is taken seriously. You have to show proof of bruises and cuts. It’s a sad, broken way to go. And requires lots of documentation. ‘Did you call the cops 17 times? Did you do this, did you do that?’

“When we had our post-placement with the county, the head of the department we talked to was astounded at the success we had with the treatment center, saying it doesn’t happen that way to everyone who goes. I said, ‘It could, if you stepped in earlier, if you didn’t let it get so bad. It definitely could. It doesn’t have to be like that.’”