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.

Skills for reducing violence are becoming essential in schools. At the beginning of the school year, students at a Washington state high school participated in a workshop aimed at doing that. The Alternatives to Violence Project mostly works in jails and prisons around the world. This time, Evergreen High School in King County was the host.

Roger Kluck, executive director, Projects for a Civil Society, the Puget Sound area organization that offers the training locally, said the COVID-19 lockdown is still affecting kids' behavior.

"The kids have lost social graces, social skills, social emotional skills," he explained. "They don't know how to get along with each other after not being in the classroom for long periods of time."

Kluck's organization was not able to offer the workshop to all 1,000 students at the high school, so it was just for ninth graders this year. To have enough staff, Kluck added they put out an international call. Three facilitators traveled from New Zealand and three traveled from Kenya to participate.

Kluck said the ninth graders were timid at first and were reluctant to answer questions in large groups, so they broke the numbers down.

"If we put them in groups of two, three or four, they really enjoyed talking to each other," he explained, "and we'd have them share what's your favorite activity? What do you enjoy doing? What's something about yourself that nobody knows?"

Kluck said the training operates under the idea that "hurt people hurt people."

"A lot of our violence prevention works in healing people from their own psychic pain and teaching them to be empathetic and compassionate, because if I see you as being like me it's much harder for me to want to do violence to you," he continued.

Kluck said his organization plans to bring the Alternatives to Violence Project again to freshmen at Evergreen High School next year.


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Over the next couple of weeks, kids across Minnesota will head back to school. Addiction specialists say now is a good time for parents to address any concerning behavior in their child's online habits. Internet addiction is not formally recognized yet in a key reference tool from the American Psychiatric Association.

But Dr. Sara Polley, Minnesota-based child & adolescent psychiatry specialist and director of addiction psychiatry at Ellie Mental Health, feels it will eventually be considered a disorder. For adolescents, being on social media too much can be harmful to brains that are still developing, she said. So, if they have been spending a lot of time online this summer, parents need to re-establish healthy habits.

"It's really helpful to discuss with your family a media plan that applies to both the children in the family and the parents in the family, with potentially specific times set aside for use of social media or use of the internet not related to completing school assignments," she explained.

She also recommended "tech-free zones" in places like the kitchen, in hopes of sparking more family conversations. If your teen becomes combative when asked to limit screen time or is becoming socially withdrawn and only prefers to be online, Polley said it is time to seek advice from a family doctor or mental health professional.

Polley added pushing above the "three-hours-a-day" mark of social media use can put adolescents at greater risk for depression and anxiety. It can also prevent them from getting a good night's sleep, making the back-to-school transition problematic.

"And when I ask young people, 'What are you doing when you're up late at night?' - nearly 100% of the time, they say that they're on their computer, they're using social media, they're watching videos on YouTube." she continued. "And that can make it really difficult for them to do what they need to do during their usual full-time job, which is going to school."

Other experts worry the effects could result in disruptive behavior in the classroom. Middle school and high school students are often sent home with tablets and laptops for school use. They might come with settings limiting what can be done online, but Polley said it is still good for parents to set their own boundaries. Those could include only allowing the devices to be used in the living room, or making sure they are placed in backpacks when homework is completed.


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Mental-health coverage and using digital devices to communicate with doctors' offices are among the health-care priorities of Generation Z. Providers are urged to make note of the needs of patients born between the late 1990s and the early 2010s. Industry researchers say like a lot of other age groups, Gen Z embraces telemedicine. But as these individuals begin to navigate adulthood, they also value apps that make it easier to schedule appointments, manage conditions and look up data.

Richelle Andrae, government relations specialist with the Wisconsin Primary Health Care Association, said more importantly, this generation wants to feel empowered when receiving care.

"I don't think a Gen Z individual is really likely to just be directed to what to do with their health care," she said. "They need that buy-in and options so that they can have a voice in the process of providing care."

She said Gen Z deserves praise for normalizing conversations regarding behavioral health amid nationwide calls to expand mental-health care and insurance plans to cover those expenses. According to Y-Pulse data, 71% of consumers in this age group say they value brands that incorporate mental health as part of their marketing.

Dr. Donald Tavakoli, national medical director for behavioral health with United Healthcare, said Z is just starting to enter the workforce. Because they report higher rates of depression, eating disorders and even suicidal behaviors, he said it is important they understand terms such as deductibles, co-insurance and out-of-pocket when signing up for plans.

"They have significant rates of mental illness, so we think it's really important that they first have their health insurance lingo down - really understanding the common terms of how to navigate health insurance," he said.

Industry experts say because they prioritize their mental health, these individuals are likely to seek out employers who offer packages with quality behavioral health coverage.

Health equity is another priority for Gen Z. Andrae said her organization, which is the member association for community health centers around Wisconsin, is trying to reduce access barriers for underserved populations, including young adults and adolescents.

"They may not have a parent or a family member or a guardian who can take them to a clinic after work," Andrae said. Maybe that parent or guardian is working multiple jobs."