By David Willis, MD, FAAP & Jennifer Oppenheim, PsyD
“Our children need help.” This lament is increasingly vocalized by parents, child health providers, and local and national public health leaders. Across our nation, behavioral health experts are sounding the alarm of rising rates of child and youth loneliness, mental health disorders, and suicide. A recent CDC survey noted that the percent of teen girls who reported feeling persistently sad or hopeless rose from 36% in 2011 to 57% in 2021. Shockingly, nearly 1 in 3 (30%) seriously considered suicide.
Three major child health organizations — American Academy of Pediatrics, Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association — have joined together to declare a National State of Emergency in Children’s Mental Health. And just this month, the U.S. surgeon general, Vivek Murthy, MD, released a new Surgeon General Advisory calling attention to the health crisis of loneliness, isolation, and lack of connection in our nation. Surgeon General Murthy notes that, in addition to impacting our physical health, loneliness and isolation contribute substantially to mental health challenges, with childhood loneliness and social isolation increasing the risk of depression and anxiety, both immediately and well into the future.
As we highlight the importance of emotional well-being of children and youth this month, we should also celebrate the growing openness in our society and the healthcare system to talking about the importance of mental health and what we must do to support the mental health of each child, family, and community in our nation. This is one potential silver lining of the pandemic: Its universality seems to have resulted in unprecedented numbers of people candidly sharing their experiences of anxiety, loss, sadness, grief, loneliness, and trauma. This has led to a growing recognition that mental health is something that is relevant to each of us — something that we need to attend to with the same attention we place on our physical health.
Yet at this moment of increased need and openness to seeking mental health supports, nearly half of Americans live in behavioral health workforce shortage areas. Even where supports exist, barriers still persist. A lack of trauma-informed, racially and ethnically congruent, and culturally responsive treatment options and practitioners is one issue. The hesitation by communities — particularly communities of color — to seek help because of past unjust and discriminatory experiences with systems of care is another. As we recognize the need to increase the number and diversity of highly trained behavioral health clinicians equipped to treat serious mental illness and addiction, might this also be a moment to build a relational health workforce that is trained to offer support and connection for those who are getting by but struggling to move to a place of greater health and well-being?
Several examples illustrate the impact of centering relationships and connection as part of supporting emotional and mental well-being:
The Friendship Bench is an evidence-based intervention that trains volunteer grandmothers to offer a brief problem-solving therapy to community members struggling with anxiety and depression on designated wooden benches. The model was developed in Zimbabwe, and its founder, Dixon Chibanda, PhD, describes connection as the most therapeutic feature of the work, with storytelling, reflective listening, and problem-solving as key ingredients.
Facilitating Attuned Interactions (FAN), a communications framework and practical tool for building trust and connection, is helping practitioners across disciplines to develop stronger, more respectful and trusting relationships with families. FAN is based on the understanding that careful attunement facilitates a sense of connection and being understood, which in turn creates openings for change.
The Confess Project, which has a mission to build awareness around mental health within the Black community, trains barbers and hairstylists to become mental health advocates to reduce mental health stigma, build connection, prevent suicide, and provide links to treatment. The project started in 2016 with a goal of “equipping marginalized Black men and boys with mental health strategies and coping skills to help them move past their pain.”
Whole Hearts, Minds & Bodies is a therapeutic mentoring program based in Tahoe, California, that provides clinically supervised, one-on-one, nature-based therapeutic mentoring for youth experiencing serious mental or behavioral health challenges. By centering relational well-being, the intervention provides the container, support, connection, and opportunities for young people to start their healing journeys and thrive.
While these examples provide some exciting potential ways to address the current mental health crisis by focusing on the healing power of human connection, we can do even more. Promoting Early Relational Health (ERH) offers a path for ensuring that families have the supports they need during the first years of their child’s life so that they both can thrive and experience the joys and health benefits that come from emotional connection. If communities can grow and strengthen their own relational health workforces to partner with and support young children, youth, and families (including ERH-trained doulas, pediatricians, home visitors, teachers, mentors, and others), we can ensure that future generations are mentally healthy from the start.
The Nurture Connection network is working toward this goal of creating a foundation for flourishing by advancing Early Relational Health (ERH) for babies, toddlers, their families, and communities. Below are some examples for building healthier, more connected communities. We’re partnering with:
Hope springs eternal for growing these and other ERH initiatives as a means to promote flourishing and prevent future child mental health challenges. We also need to advocate for policies that cultivate strong, positive, and nurturing relationships as a foundation for health and well-being. By strengthening our ERH efforts, we are responding to the surgeon general’s call to strengthen social infrastructures, enact pro-connection public policies, mobilize the health sector, deepen our knowledge, and cultivate a culture of connection. We invite you to join Nurture Connection, the growing movement to promote Early Relational Health.
David Willis, MD, FAAP, and Senior Fellow at the Center for the Study of Social Policy, is a pediatrician, an Early Relational Health leader, and part of the Nurture Connection leadership. Jennifer Oppenheim, PsyD, Founder, Oppenheim Consulting, is a clinical child psychologist with more than 30 years of experience in the fields of infant and early childhood mental health, maternal mental health, and large-scale systems change efforts.