Pennsylvania faces a shortage of psychiatrists that children's advocates call "alarming," and they're concerned about the impact it might have on young people whose needs become more intense and could require medication.

A June 2020 report found there aren't enough psychiatrists to meet the demand for mental-health assistance in the Commonwealth. Pittsburgh-based psychologist Dan Warner said this means the responsibility of prescribing medication for children with severe mental-health challenges often falls on pediatricians. He said the first step should be talking to a mental-health professional.

"Under significant stress, there might be a need to elevate and really looking at a biomedical intervention," he said. "Very often, the first line of that is starting with your pediatrician. Those people are not specially trained in the needs of children with mental health issues, and they don't necessarily have the time to do all the kind of work."

The most recent Pennsylvania Youth Survey found 38% of students reported feeling sad or depressed most days.

One possible solution getting the support of some health professionals is Senate Bill 25. It would allow certain nurse practitioners to have full authority to prescribe medication without requiring them to have a collaborative agreement with a physician.

State Sen. Camera Bartolotta, R-Greene County, who introduced the bill, said it would assist communities hit hardest by the shortage, both rural and urban.

"It's very specific," she said. "It would be highly regulated, but it would open the doors to incredibly good health care that is needed right now more than ever, especially mental health care. We've got hundreds of qualified nurse practitioners that could easily jump into that field and fill the void."

Terry Clark, president and chief executive of the Pennsylvania Council on Children, Youth and Family Services, which published a position statement on the state's psychiatric shortage, said this expansion can help save children's lives.

"Not every child needs a psychiatrist, but for those most vulnerable children who do, they go without the help they need," he said, "thus the reason suicide is growing amongst our adolescent age group."

Senate Bill 25 would require a qualified nurse practitioner to have 3,600 hours and three years under a physician's collaborative agreement. The bill passed out of committee in recent months and awaits a vote in the full Senate. According to Bartolotta, it has bipartisan support.

Incarcerated young people in Washington state can spend a longer time in detention if they do not have a place to go upon release.

Some of the reasons for longer stays for people under the age of 18 include youth who are experiencing homelessness or are in between homeless shelters.

Sara Zier, director of legal services for TeamChild, a Washington state based advocacy group for youth involved with the juvenile justice system, said overstaying in detention is devastating for the youth who experience it.

"They're facing layers of challenges," Zier pointed out. "Not only do they not have a safe place to sleep or to go home to or a family and supportive adults to meet their needs, but then they're held in detention where they're isolated and they don't have a chance of those things either."

Zier noted many barriers exist to ensuring young people have a place to go when they're released. She explained people do not have a right to determine where they reside until they're 18 years old. A U.S. Supreme Court decision earlier this year allows cities to pass laws punishing people experiencing homelessness, which could exacerbate the situation for young people in Washington.

Degale Cooper, CEO of YouthCare, an organization working to end youth homelessness in King County, said Black, Indigenous and people of color disproportionately experience homelessness in the county. Cooper acknowledged the city of Seattle and the state have policies in place to end youth homelessness, but funding remains an issue.

"Young people are homeless all over our state," Cooper emphasized. "If we don't have the financial resources to support organizations that can house these young people for either short periods of time or long periods of time, then the policy can't work."

State lawmakers passed a measure that went into effect in 2021 stating, "Any unaccompanied youth discharged from a publicly funded system of care will be discharged into safe and stable housing." However, the state has yet to achieve it. Zier stressed it is important to solve the issue of unaccompanied youth held in detention even though population-wise, it is a small number of people.

"From an equity perspective it's really important that our state stick to commitments we've made to house young people," Zier contended. "And also to give young people who are detained for offenses opportunities to engage in treatment, instead of being held in detention where their needs aren't met."

TeamChild offered some recommendations for addressing the issue of youth who are stuck in detention. It said the state should allow faster access to court for young people in detention and adjust the legal emancipation and minor guardianships to better serve people under age 18.

Young people in Pueblo can now avoid serious and long-lasting consequences when they are unable to pay fines or fees.

Chanell Hasty, program manager with the National League of Cities - which created the Cities Addressing Fines and Fees, or CAFFE program - said when young people cannot pay a fee, it goes into collections. That can make it much harder for them to become financially independent, contributing members of the community.

"Jobs today, they require that you have decent credit scores to get a job, so they may not be able to get a job. They may not be able to get housing because of a damaged credit score," she said. "It's just a negative economic spiral for this young person."

Unpaid fines and fees can quickly snowball, leading to increased fines, driver's license suspensions or even jail time. Through CAFFE, people can sign up for Pueblo's Financial Empowerment Center, get one-on-one financial literacy tutoring, get their court fines or fees reduced, and pay them off through community service. Pueblo is one of 14 cities selected to participate in the program, which is also open to adults.

A similar program run by the San Francisco Financial Justice Project, called AFTER, helps juvenile crime victims secure restitution costs. Struggling families are often left on the hook for these costs, which can push the entire family deeper into poverty. Without this program, Hasty said victims who have real medical bills to pay may never get the money they need.

"So a program like this allows for the victim to actually get financial restitution to pay whatever bills that result from the crime," she continued.

Researchers found that crime survivors generally receive little, if any, restitution.

One year after restitution was ordered, only 2% was paid, and more than 90% remained unpaid after five years. Municipal fines and fees also disproportionately burden low-income residents, especially residents of color.


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Indiana's youth are facing a growing mental health crisis, and officials say urgent action is needed. Nearly half of high school students in the state report experiencing depression, and suicide attempts among youth continue to increase.

Tami Silverman, president and CEO of Indiana Youth Institute highlights the struggles teens face in silence, as well as the challenges families encounter in accessing the necessary support and resources.

"Nearly half - 47% - of the students reported experiencing depression within the last year. And so, that's been pretty consistent over the past couple years, but still that's a tremendous number," she said.

In 2023, nearly one in four students planned suicide, and more than 15% attempted it. Female and LGBTQ+ students report higher rates of mental health challenges compared to their peers, reflecting significant disparities.

Barriers to accessing care worsen the situation, with two-thirds of Indiana youth who experience major depression not receiving treatment. The shortage of mental health providers across the state further limits access. Silverman called on schools and community organizations to play a pivotal role by training staff to identify mental health issues early and implementing peer mentorship programs.

"For young people dealing with stress, anxiety, depression recognizing and embracing those glimmers - those positive moments - can help provide even brief respite from some of their stress or anxiety," she continued.

Silverman also emphasized the importance of promoting mental health literacy to reduce stigma and improve access to care. By addressing challenges, Indiana can create an environment where all youth receive the support they need to thrive," she said.


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