So, Vermont's latest statewide survey of middle and high school students has intensified concerns about youth mental health.

On a special edition of Vermont this week, we sit down with expert panel to discuss what steps can be taken to best support young people in the state.

Ahead on Vermont this Week.

From the Vermont Public Studio in Winooski.

This is Vermont this Week, made possible in part by the Lintilhac Foundation and Milne Travel.

Here's moderator Mitch Wortley.

Hi, I'm Mitch.

It is Friday, January 3rd.

And joining me on the panel today, we have Vermont's Commissioner of Health, doctor Mark Levine.

Dana Kaplan, executive director of Outright Vermont, a non-for-profit that's focused on supporting and empowering LGBTQ plus youth.

And Doctor Stephen Schlozman, associate professor and chief of the Division of Child and Adolescent Psychiatry at UVM Larner College of Medicine.

Thank you all so much for being with us.

You know, and before we get started, we would just like to acknowledge that half an hour is not a lot of time to discuss a subject as consequential and complex as youth mental health.

Each of our panelists could easily cover our time individually, and no doubt still have more to say on this subject.

But it is an important topic and one that we felt deserved attention.

So let's get right into it.

As we mentioned at the top of the show, Vermont released its 2023 state wide report on the Youth Risk Behavior Survey at the end of November.

The state conducts the survey every two years, and in 2020, three polled more than 15,000 high school students, with results showing that youth mental health metrics, which plunged during the Covid 19 pandemic have yet to rebound.

So, Health Commissioner Levine, let's start with you.

This survey has been conducted every two years in Vermont since 2005.

Tell us a little bit about the survey and how the results are utilized by the state.

Yes.

This is a survey that we have a lot of experience with.

It's very valid.

We get very credible and truthful answers from students when they answer it every other year.

And, the data is directly comparable on a long term basis.

So it's very helpful and recovers such a spectrum of issues, whether it be mental health as we're addressing today, substance use, nutrition, physical activity, things that go on in schools, a whole host of topics, all connecting with the health of our population.

The fact of the matter is, many of the changes we're going to talk about today are not as short lived as people might think.

They're actually much more long standing.

Well, you know, it's a huge survey, 260 pages.

And, we're going to have links to let people know what this is all about.

You know, as we dive into some of the, subject matter here.

Starting with mental health survey results show that a third of high school students, that's nearly 35%, said their mental health was not good most of the time or always during the past 30 days.

When asked the definition of poor mental health that includes stress, anxiety and depression.

Doctor Salzman, do these numbers align with what you and your colleagues are seeing in the field and what contributing factors are you hearing about most frequently in your work with youth?

It's a great question.

How much time do we have?

I mean, this is a huge.

And now for you to answer it.

Sure.

The it's definitely in keeping with what we see in the division of child psychiatry government.

And also, I should point out, across the nation, we are not alone in the state of Vermont.

This is in a national issue going back more than two decades.

There's been reports from the CDC, from the surgeon general, from the Youth Risk Behavior Survey.

In terms of what's driving this.

I think obviously we had the pandemic, which already poured fuel onto an existing crisis.

There's a lack of folks who are willing or comfortable to take care of kids in these settings.

And then there's a lot of things going on in the world right now.

Politically, economically, in terms of climate that are freaking kids out and kids actually are actively talking about those things.

So I'm not surprised.

I'm alarmed by these numbers, but I'm not surprised.

Yeah.

It's really interesting that you say that because and Doctor Levine referred to this, too.

I like the fact that you say that the kids are giving honest answers in these surveys, because I wondered about that.

You know, Dean, a couple.

I wonder, too, if you find that, you know, LGBTQ plus youth, do they do they really speak up about these things in a way that, you know, they might otherwise be afraid to?

Yeah, I think it's a I think it's a good question, you know, do we speak up?

We speak up when we feel safe, when we feel affirmed, when we know we're in the company of people who understand us and will believe our experiences.

And I think that for LGBTQ plus youth, there is so much that they're navigating in terms of, stereotypes and misperceptions and just this widespread level of hate that, it can be unsafe for them to speak up, and there can be an incredible amount of backlash.

So you get kids into a supportive environment with, you know, even just one adult that they trust or a peer that they trust, and people can let their guard down and and share their experiences.

Yeah.

It's important to know the facts around what's happening.

The survey found that female students and LGBT plus students are more than two times as likely as male students and heterosexual, cisgender students to report poor mental health.

So, Dana, this is a trend we saw throughout the data, with rates for LGBTQ plus youth often 15 to 25% higher than their fellow students on questions about mental health, self-harm and even suicide plans.

What unique challenges are these students facing that contributes to this disproportionate impact?

And I think that it's pretty clear to see right now the ways that LGBTQ youth, and specifically trans youth are being targeted for their identities across the country and here in Vermont.

I think it's really hard when you don't feel a sense of belonging, when you don't see yourself reflected in curriculum, when you are constantly harassed or tormented for just trying to go to the bathroom.

I mean, these are the daily experiences of young people in Vermont.

Schools are rife with, a level of negativity.

And and a lot of young people are not feeling safe.

Bottom line, I mean, briefly, you know, it's it's adults that are driving this, right, that are making these youth, outcomes come up for youth like this.

I have to set a better example, as I guess what I'm trying to say 100%.

Okay.

Yeah, yeah.

No, I mean, like you said a couple things.

First, like, yes, adults, we lead the way here.

We actually have to instill some hope to.

We can we can agree that things are bad, but we also have to give kids actionable things that can make stuff better.

Like, we got it.

We got to meet them.

The worst thing on earth is to be a teenager, to be told things are really bad.

There's nothing you can do about it.

You're exactly at the age where you're starting to have autonomy and agency.

You can you can fix things.

So we got to give them ways to fix things.

The other thing you brought up this brought a sense of belonging.

A lot of the data in the labs suggests that middle school kids are suffering even more than high school kids, which is interesting because epidemiologically, a lot of the psychiatric syndromes, they have their onset during during high school and later, later adolescence.

But middle school is all about belonging.

It's all about what groups will have you, what groups won't have you.

It's been talked about among developmental specialists for a long time.

To the extent that we can make kids feel like they belong, help them to feel like they have a place that's safe.

We're actually going to go a long ways towards making this better.

Yeah, middle school kind of sets the stage for high school, too, in a lot of ways.

Also, the statewide report also shows that nearly a quarter of those surveyed said that they had engaged in self-harm.

That's doing things like cutting or burning themselves on purpose without wanting to die.

That percentage has risen from 16% in 2013 to 23% in 2023.

We've got the graphic up there, and in 1 in 7 high school students reported that they had made a plan about how they would kill themselves in the past year.

That's up from 11% in 2013 to 14% in 2023, with LGBTQ plus students again being nearly three times as likely as heterosexual, cisgender students.

To answer yes to both, I'd like to open this up to the group.

A lot of the data coming out of this report shows that students are, by and large, still stuck at the levels that we saw during Covid.

Why do you think these numbers have not rebounded yet the way we might have hoped?

Dina, let's start with you.

But I do want to open this up to everyone.

Sure.

I think that we're talking about a population of folks who already were disproportion impacted across the board in terms of health risks.

Right.

We know that minority stress theory points to the fact that there's nothing inherently wrong with being who you are with your sexuality or your gender in and of itself.

It's the harm that comes from navigating systems that were not designed for you to succeed.

It's the harm that comes from harassment and bullying.

And so, you know, to to Steve's point, there is so much that we need to do around creating community, creating sense of belonging and instilling hope.

That's part of our our mission is about hope, equity and power, and you've got to work on each of those levels to believe that there is something for you to look forward to, that you can experience joy.

And I just think that across the board, across the state, we don't have the resources, we don't have the attention to be able to say, here's what we're doing to streamline this level of care.

And so it's hard for people to to climb back up.

And then you introduce new challenges like, am I going to be able to have access to my medicine that I need in order to feel like myself and go out into the world?

So it's just, there's not been there's not been a chance for a rebound.

Doctor Levine, were you surprised that the numbers have not bounced back from Covid?

I really wasn't, as I said in my earlier comments over the last ten years, we've been seeing these increases on a steady basis.

So these problems are not new because we had a pandemic.

Are they much worse because we had a pandemic?

Absolutely.

Certainly social isolation is one of the big byproducts of a pandemic.

And unfortunately, social isolation and the public health world is really the causative mechanism for so many of the public health problems that we see, like the kind we're discussing today, very, very challenging to, expect those to vanish within a year or two of a pandemic ending, especially when the modus operandi for most people was that the support systems they tended to rely on actually weren't there.

They were isolating.

They didn't have the same peer, conversations.

They didn't have the interactions with their educators.

They didn't have the interactions with the professional community.

Now they have the opportunity to have all of those.

But these problems, as Steve will attest to, do not resolve overnight.

These are very, entrenched problems in many ways.

Yeah.

And I think by being human, we can all attest to it.

Like these are those are very key developmental times.

Your brain is going through massive changes during that time, those massive changes that are reflected in your behavior, your ability to be with other people, to negotiate conflict, to understand that if someone's being cruel, it's it's about them.

It's not about you.

It's not as if it's okay for folks to be cruel, but the ability to be resilient to that, that was put very dangerously at risk during understandable precautions that we had to take during the pandemic.

Now, what we're busy thinking about.

So to give us a little bit of hope here is what do we do now?

We can't.

What we're learning is we can put kids back in the regular classroom.

We can teach them.

But in terms of the other job of schools, which is the social, the developmental and psychiatric development of kids that we're actually figuring out as we go along.

So in terms of the resources you were talking about, to the extent that we can get more involved with the schools, to the extent that we can get more involved with the homeschool community.

Also, chronic absenteeism is a huge issue in the schools.

Those are kids who aren't there.

So how do we how do we reach those kids as well?

Finally, I just want to stress it might be that we're hearing more about this because we've destigmatize this is a good thing.

People are more willing to bring up their issues.

The problem is we don't have the resources to meet this now, declared greater need.

That's really interesting.

I want to quickly follow up on that.

First of all, psychologically, how do you get to that realization?

I was struck by what you said about somebody who's bullying someone else, that person having to realize that it's the person doing the bullying that has the problem that is so hard when you're being attacked, how do you how do you reach that?

It's right on the road, right?

When someone cuts you off.

Yeah, yeah.

Think it's a great example.

Yeah.

So this is the one of the ways you do is to say that exactly to yourself because you can say, oh, come on, Billy, it's not about you.

You feel like you when they cut you off on the road.

So understanding getting yourself into Billy shoes at that point.

Super helpful.

Teachers do this all the time.

Adults do this all the time.

We got to do it more.

We have to do it more mindfully.

We have to be aware of when it's happening and help this kid to know, get the kid out of harm's way, but help them to know that it's not them.

And it's a really sometimes I think we we sort of think that, but we don't actually explicitly say it.

And right now, I think maybe more than ever, we need to explicitly make those things clear.

And not all kids are getting the same messages.

Right.

So it's one thing for Billy to have that happen.

Wants to be caught up, you know, or you're driving in, you're cut off once, but if you happen every time you get in your car to be cut off right, then it is harder and it is harder to come back.

And you talk about resilience and I think it's true, you know, these are young people who are navigating these daily interactions of people coming at them.

And and it yeah, it's hard.

You don't have someone to be able to say, hey, you know what?

I know that this is happening.

I see you, I believe you, you're okay.

Come over here.

Let's have a different experience.

It it it's tough.

What do you think the resources are doing?

And just to quickly follow up on that, that that LGBTQ plus youth needs to have in order to to feel that sense of this.

Why is this always happening to me?

Because that must be the experience they have.

Sure.

I think that, you know, when we look at schools, the the majority of young people are spending the majority of their days in schools.

There are things that we know help to support safe school environments.

So we need to have ongoing training for teachers.

We need to have curriculum that is inclusive of all people and all identities and their experiences.

We need to have good social policies, and we need to be able to have social spaces for young people to connect with others that are like them, so they see themselves reflected.

Can these be things like afterschool clubs or things like that, or does it have to be within the classroom itself?

Because devil's advocate question here, you're going to get pushback from parents, some parents on that, on what you were just saying.

Absolutely.

And the bottom line is, I would hope that all parents and caregivers want for their young people to be safe, want for them to be their best selves.

You know, we've got to do education with teachers, with administrators, with folks in positions of power, with parents as well, because there's so much misinformation out there.

At the end of the day, we all just want to be able to be ourselves and be safe.

And so, yeah, I think third spaces are critically important because for some kids it's true.

Regardless of what you do, harm has happened in the hallways.

Those hallways are not going to feel safe for you.

Right?

But but third spaces are critically important.

Spaces like camp spaces like gender and sexuality Alliance clubs.

Some sometimes folks are meeting after school, outside of school, in community centers.

You know, the survey that we've been talking about is actually very helpful in helping us answer some of these questions.

So when you talk to students who have experienced some form of mental health distress, about 30 or 33% of them say that they've actually been able to get help and feel that they've been able to connect with someone to get the help that they need.

However, when you start looking into the survey questions, we have questions about, do you have an adult that you can talk to about things that bother you?

And this is beyond your parents, but some responsible adult, whether it's in the education community or outside of that, and very small percentages, say yes to that question.

Okay, so there you asked youth how they feel connected to their community.

Like do they do I matter as a member of my community, you can look at it as the glass half full or glass half empty.

A little over 50% say yes.

I actually feel like I matter to my community, but that means just shy of 50%.

Don't think so.

And that's a lot of us.

So how do you counter that the after school activities are prime mechanism for connecting youth with adults, adults who are committed to what the youth want to get out of that after school time, because hopefully when it's designed, they have a voice in saying, what are the activities that would be very useful to them?

Yeah, I mean, thank you so much for saying that.

It's not it's the afterschool community, but it's not the summertime.

Right?

There's it's the town itself.

It's Vermont.

I've been here a year and just a little bit more.

So I'm really getting to know the state just barely now.

It's taken a while and I love it here.

And what strikes me about Vermont is it's unique for its individual communities that that function, with their with their own specific identities.

You have to help kids to feel like they're parts of those communities.

And when I asked kids, do you feel like you have a sense of place?

And there's this whole literature and sense of place, many of them kind of like, I don't I don't phrase it that way.

So, like, what does it mean for you to be from Newport, for example?

And they'll say, I don't know.

It's like, what is it like for you?

And I'm like, no, that's not the point.

Like you grew up here, what do you what do you think of it here?

To the extent that we can help kids to feel like they belong in their communities, in their schools and every place that they interact, actually everybody does better.

So if we can have welcoming places for folks who are LGBTQ, plus everybody does better, not just people in that group.

And that's what we forget about.

So when we get pushback saying, oh, we don't want budget money, we don't want that we it's not just for this group.

It actually the literature is really clear.

Everybody supports the entire community.

Yeah.

Doctor, let me stick with you for a moment here.

We hear a lot about things like social media use when discussing youth mental health.

Parents I speak to are always talking about this, with survey results showing less than 1 in 10 high school students.

That's about 8% reporting they don't use social media.

How much of an impact is social media actually have, and what can we do to mitigate the potential harmful effects?

The really important topic, obviously, I've got two kids, they're 18 or 19 and 24.

They and a wife who enjoy social media and I enjoy social media.

So I think one of the mistakes we can make is to completely demonize it.

It doesn't make sense just in terms of the science, and also doesn't make some sense in terms of practicality.

If the numbers are as high as the wire BBS survey says, and it's probably even underreported there, it is very likely that we're not going to be able to just stop it.

So what we need to do is teach better social media hygiene.

And this has to happen in the classrooms, in the home.

This has to happen in terms of how much time you spend on social media, what your response is to other people are remembering that it's not really an an anonymous response.

It's like these things last forever once you put it online, but I don't.

I want to point out that it's also the lifeline for a lot of people who are otherwise marginalized.

They can find people who agree with them, who believe the things that they believe, who want to do the things they want to do.

I don't want to take that away.

Yeah.

Also a potential outlet for those who feel socially isolated.

Absolutely.

The problem is many individuals don't understand that they are still socially socially isolated, even when they are using social media, because they're looking at a very select group of material.

They're hearing other people's experiences and taking that as the gospel, and they're not actually individually connecting with people one on one, which is very challenging for them.

We also know from the survey there are unhealthy numbers of hours per day that many of our high school students are actually connected on social media, and the number of times they check it per day.

And we can believe that data.

We need to hear that data and put it in juxtaposition to the data that we also know that you can teach that hygiene that Doctor Schlozman is talking about.

You can show that there are benefits to social media, and it can be very instrumental and positive feature in your life, but don't let it become a negative feature in your life.

Dina, I want to ask you this question, and I want to be careful about asking it because I don't want to play into stereotypes here.

But as we're talking about social media, use the things that that, Doctor Schlozman and Doctor Levine were just talking about, the way to use it correctly.

Are there particular challenges for LGBTQ plus youth when it comes to social media?

Did they talk to you about that?

Have you heard things like that?

Sure.

I mean, I think I think, for any marginalized identity, there are particular challenges.

And, you know, it strikes me that for so many young people especially, we're talking about a rural state like Vermont, when you don't see yourself reflected in the people around you and you're and only the power of being mirrored, the power of knowing that there's other people out there, or you're in a small town and you can't be anonymous.

And there's something really important about discovering who you are and having some level of anonymity.

I think, of course it's important to think about safety and, and the vulnerability of young people online.

But I think that that's true for, for any, any young person, regardless of identity.

And I'm really glad that all three of you were saying, this is not about just shutting down social media, just saying like, no, you can't be on your phone.

It's just not a reality these days.

This is a new world.

It's not the world I grew up in, but it's certainly different.

You know, I want to open this up to everybody as we kind of wrap up here.

What?

We aren't, talking about feeling sorry.

Let me take that again.

What we're not talking about here feels important.

What do kids need?

What kind of you know, what can they do to improve the numbers we've been talking about in this survey?

What do state officials need to do?

What you folks in the state of Vermont, what would you like to see come about to help bring these numbers back to a level that we're not so concerned about?

We'll start with you.

Okay?

Know.

I'm sorry.

Go ahead.

I think that on a basic, basic human to human level, there is a need to be believed.

There is a need to belong.

There is a sense that who I am is possible, that I can see a future for myself.

Right?

So on, on a social level, as individuals, we can act up.

We can make sure that we are speaking out on behalf of safety and belonging for all kids.

Right.

When it comes to finances, I think we need to make sure that we have the funding that we need in order to, do things like support the agency of education, rolling out best practices guidance.

Right.

There's there's school districts that really need support and training out there.

The the number of increased calls that we've gotten from administrators and youth and families alike, what's 2025 going to look like?

Are we going to be safe?

Are we going to have access to our medicine?

That sort of stuff is is really, really intensified right now.

So making sure that there's funding, that is secure and stable.

And then we need to continue to look at policies.

You know, there's still a real gap between Vermont's progressive policies and the lived experiences of young people, as we've been talking about over this time.

So we need to pay attention.

Wyoming lawmakers need to pay attention.

And we need to really take this issue very, very seriously.

All of us talk to you within your thoughts on what's needed.

Yeah.

First of all, we have to listen.

And our youth are telling us the truth.

Our youth are telling us things we often don't want to hear, but we have to listen.

And we have to let them participate in the process of analyzing what information we have, because they understand some of the solutions.

And if we're only asked them to gather together and articulate them, that's important.

Second, we need to understand we live in very, potentially disruptive times.

Everyone's talking about all kinds of disruptions that could occur and things that we've taken for granted.

And we need to understand that the adults in the room have to react in ways that are healthy, so that our youth can respect that.

I think thirdly, we need to really, do things like what we call, mental health first aid, which practitioners as well as, adults and students can learn and really understand how to cope better with the trying times we're in and with the emotions that they're feeling.

And I think the after school programs are a good example of ways to really answer youth needs and help them connect with their communities better and connect with the adults in the world who can help them better.

Doctor Schlozman, your final thoughts on that?

Everything they said, I mean, like, I'm so delighted that you guys got to speak before me because I get to sort of do a broad stroke here.

What?

We we definitely need primary prevention.

Mental health hasn't been so good at that.

At least at the hospital level.

At the clinic level.

So we it would be great to get upstream enough through some of the community interventions that we just talked about so that these problems don't happen in the first place, or that these problems are at least are mitigated in the first place at a at a higher altitude.

I think a general attitude of instilling hope of of it sounds silly, but I think as we worry about all the disruptions you just talked about, we forget to tell people that they still get to be kids.

It's really great to be a kid.

We want to help them to enjoy this coming of age that that all of us hopefully got to enjoy.

That's a super important piece of any intervention that we do.

I am happy to end on a hopeful note, and that is where we will have to leave it for today.

I want to thank our panel so very much for boards.

Commissioner of health, doctor Mark Levine, Dena Kaplan, executive director of Outright Vermont, and Doctor Steven Schlozman, associate professor and chief of the Division of Child and Adolescent Psychiatry at UVM Larner College of Medicine.

Thank you all so much for your expertise today, your compassion and your hope for the future.

I really do appreciate you being here in Vermont this week.

I'm Mitch Wertlieb, thanks for watching.