As kids head back to school, advocates are calling for expanded access to school-based mental health services in Maryland and nationwide.

The National Association of School Psychologists recommends a ratio of 500 students to each school-based psychologist. Most states are not meeting the standard. Maryland's current ratio is more than 1,000 students per school psychologist.

Sen. Malcolm Augustine, D-Prince George's County, said the legislature has taken steps to expand access.

"In the last few years, we've had a real emphasis on mental health, behavioral health in our school system, and we've passed different pieces of legislation in support of that," Augustine pointed out. "The biggest one was the Blueprint for Maryland's Future, which we passed in 2021, which expanded school-based health centers and increased the number of mental-health professionals in our schools."

The state has been operating school-based health centers since 1985 when the first one opened in Baltimore City. The program has grown to 89 school-based health centers in 16 jurisdictions across the state.

The Centers for Disease Control and Prevention estimated 20% of children have a mental, emotional or behavioral disorder and of those, only about 20% have access to specialized mental health care.

Caitlin Hochul, vice president of public policy for the mental health advocacy organization Inseparable, said school-based professionals can help bridge the coverage gap.

"Sadly, we know that most kids who have a mental health condition aren't receiving the care they need and that's really why school based mental health services are so important," Hochul emphasized. "They help improve access to care. And are really one of the most effective tools we have to help improve children's mental health well-being, because we are reaching kids where they spend most of their time and that is in schools."

Inseparable has published a checklist to promote mental health in schools. They advocate annual wellness checks for all students, regular staff training around mental health and school engagement with families and the community.

The mental healthcare landscape in Nebraska is being upended by policies for reimbursing providers who see patients covered by both Medicare and Medicaid. Systems say they're losing money, resulting in access gaps for older low-income clients.

Providers say the key concern has to do with serving patients considered dual-eligible, meaning they're enrolled in Medicare and Medicaid. This year, the federal government expanded the scope of professionals who can see Medicare patients for therapy and be reimbursed.

But Jon Day, executive director of Blue Valley Behavioral Health, said because of how Nebraska policy aligns with dual-eligible situations, practitioners are now seeing rates cut in half.

"More providers are coming out and saying, 'Oh my gosh, we can't see these people cause we're losing money.' So, we either refer them out, or they're not taking on people as well," he explained.

Day estimates a $200,000 revenue loss for his system and added that it's not easy to refer clients elsewhere because of provider "deserts" in some areas. Those working with the Nebraska Assocation of Behavioral Health Organizations have been meeting with state Medicaid leaders, noting the state can cover the difference without taking on extra costs. But progress on a final solution has been slow.

Providers say they understand the federal government's desire to bring more mental health professionals to the table in seeing patients. But they add unintended consequences at the state level almost defeat the purpose.

Chase Francl, CEO and president of the Mid-Plains Center for Behavioral Healthcare Services, said this is a heartbreaking situation.

"There's such a low margin on any behavioral health services, and any small disruption really can have catastrophic effects," he said.

Even though fixes offered by these providers are described as solutions without extra costs, they acknowledge the challenging environment given the appetite among elected officials to reduce the state's budget. As for the federal change that brought this situation to light, Licensed Independent Mental Health Practitioners can now be reimbursed under Medicare, and not just those with Masters or doctoral degrees in Social Work.

'Tis the season for celebration and good cheer. However, for many Michiganders, the absence of a loved one - whether through death, divorce or another painful separation - can make this time of year feel almost unbearable. According to the National Alliance on Mental Illness, 64% of people with depression report the holidays just make them feel worse.

Dr. Ibrahim Sablaban, a psychiatrist and addiction medicine physician at Corewell Health, offers a surprising insight: he says sadness is one of the most universal human emotions, and should be embraced.

"The worst thing somebody can do is really try to suppress feeling human - really suppress feeling lonely, feeling sad, feeling a sense of loss," he explained. "It's very easy to say, 'Oh, I need to get my mind off of so-and-so who passed away,' but that's not the healthy way forward."

If you or someone you know is struggling with a mental health crisis, help is available 24/7 - call or text 988, the Suicide and Crisis Lifeline, to connect with someone for free and confidential support.

While many enjoy Michigan's snowy holiday scenes, the state's long winters and reduced daylight can also worsen depression, especially for those with Seasonal Affective Disorder, the aptly-named "SAD." Dr. Sablaban advises sharing emotions with trusted family and friends, and reflecting on happy memories of loved ones.

"To be able to embrace the traditions and the things that you shared with that individual, even if they're not in your presence. To be able to keep those things alive," he continued.

Mental health professionals also emphasize that while family traditions can provide comfort and remembrance, it's okay to let go if they become too painful. Explore new ways to celebrate, and over time, new traditions will naturally evolve.


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On this Election Day, Indiana residents may be feeling the effects of what some are calling election stress disorder, but there are several ways to cope.

If you're suffering with anxiety related to the biggest day of the year for politics, Dr. Jennifer Embree - chief wellness officer and clinical professor at the Indiana University School of Nursing in Indianapolis - encourages taking a moment to pause before reacting to election-related news, especially on social media, and focusing on what you can control.

"When we pause, it's easier to take the emotion out of that situation and then really thinking about what exactly are you afraid of," said Embree. "What's the worst thing that can happen? And then, what issue impacts you the most?"

Deep breathing exercises can lower heart rates and reduce anxiety. One popular technique is known as box breathing: inhale for four seconds, hold for four, exhale for four, and hold again for four.

Medical experts caution against using alcohol or drugs to cope, noting the substances often disrupt sleep and ultimately do little to alleviate stress.

Instead, clinicians prescribe seeking professional help if stress becomes unmanageable.

Embree suggested connecting with supportive people who help keep them calm. For those greatly stressed, she recommended meditation, exercise, or even dancing to manage emotions.

"Think about the people that keep you calm and really are your support peope," said Embree. "Those are the people you need to be connecting with - not people that are going to make you more anxious, more upset, that's one thing - is to keep the calm around you."

While election outcomes are beyond individual control, Embree said maintaining personal well-being is key to victory in navigating this high-stress period and future events.