There is a crisis in children and youth mental health in Vermont. At the national level, the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry declared a crisis in youth mental health in 2021. The Surgeon General of the United States also described the state of children’s mental health as a national crisis.
Several factors contribute to the current crisis including the dramatic increase in the acuity of mental health stress in the community. Many of the issues contributing to stress for youth include their experiences during the COVID pandemic, increased family stress, systemic racism and homophobia, social isolation, the pandemic of substance use, death of family and friends, food and housing shortages, societal instability, and the climate crisis. Thankfully there is less stigma about discussing mental health and greater willingness to seek assistance. However, to be treated, these needs require greater federal and state funding.
Complexity and Acuity
Not only are many more youth needing crisis stabilization, but youth are also often experiencing more intense levels of symptoms. Young people frequently present with higher levels of depression and anxiety, than before. Many of these youth have thought about dying by suicide. Many have acted on those thoughts.
Transitional-aged Youth
Transitional-aged Youth (TAY) are uniquely affected by many of the stressors of children and youth. Transitional-age Youth have recently been identified as between the ages of 18 and 29 according to recent research. This group until recently has been largely overlooked but now they are understood to have specific developmental challenges which may, as a result, lead to specific mental health needs. In addition to the stressors all young people have experienced, Transitional-aged Youth experience unique stressors related to their developmental tasks.
Young people are moving into adulthood, which these days takes much longer than for previous generations. As their personality develops into adulthood, they are experimenting with relationships including different peer groups and potential partners, while redefining their roles in their families of origin, now that they are adults. In addition, they are examining the world of work to identify their life’s passion.
All these areas of fundamental life choices have been going on for them, while the world was shut down during the pandemic and going through intense social and political strife. Even well supported Transitional-aged Youth, we all know, struggle with consistently making good decisions in all these areas of life. Some, like Alex, find additional support helpful.
Alex is 23 and has been dealing with anxiety for a few years but it got more intense during the pandemic. Sitting in the hospital emergency department, they were really anxious and desperate. After high school they had lost track of most of their friends. But they got a Computer Degree at the community college and worked at a few different short-term jobs for a couple of years. After the isolation of the pandemic everything felt off. Their friends weren’t around much. Relationships with bosses and even coworkers at jobs were often stressed and Alex struggled to keep a job. They moved back in with their parents. Alex’s mom was stressed a lot, and their stepdad was mostly critical.
Alex spent more and more time alone drinking and using cannabis and even some pills. It felt better for a little while, but afterward the stress was still there and somehow things seemed even worse. They didn’t even go to some job interviews. Alex thought about suicide and even wrote a note but then decided to tell their therapist. They agreed to go to a hospital for a week to help with the suicidal thoughts and urges. They hoped it might help them to feel better and it did while they were there. But after leaving the hospital they felt miserable again.
The doctor at the emergency department, Alex’s therapist, and primary care physician all recommended doing something called an Intensive Outpatient Program (IOP). Alex had no idea what all those letters actually meant, but everyone kept saying it would be helpful. They hoped the program could help them to finally start to feel better, but after years of therapy and hospitals, it was hard to imagine anything could actually work.
The NFI Crossroads Transitional-aged Youth (TAY) IOP in South Burlington provides comprehensive mental health treatment for young adults between ages 18 and 24. It consists of three hours of treatment per day, three to four days per week. The IOP meets Tuesday – Friday from 9am – 12pm. The IOP is a six to seven-week program for a total of 22-24 treatment days.
The program provides comprehensive Dialectical Behavioral Therapy (DBT) treatment including individual therapy, supportive/expressive counseling, DBT skills group, psychiatric evaluation & medication management, and DBT phone coaching. These therapeutic modalities support the learning, practicing, and generalization of DBT skills. There is also an opportunity to discuss family therapy support as an option as clinically indicated.
NFI Crossroads TAY accepts referrals from the public, hospital emergency departments, inpatient units, and residential programs. The IOP is a step between once-a-week outpatient therapy and 24/7 inpatient care. The IOP helps people who have tried outpatient treatment or inpatient care but have not found the lasting improvements they need.
For treatment to be most successful, it is critical that the individual is motivated and interested in making positive changes. For this reason, the individual must call the program directly to schedule an intake. Referrals must come directly from the transitional-aged youth. Community providers or family members are welcome to reach out for more information, with questions, or to share relevant clinical information.
NFI Crossroads has groups for other ages as well, including for adults over age 24 and groups for adolescents as young as 13. Even the youngest have often been doing therapy for years, and the adults, sometimes for decades. Many have met with several therapists and tried several types of therapy. They have often spent time in hospitals. The pain they have endured is hard to describe and harder to imagine. Many experience levels of depression and anxiety that are so severe they struggle to live their lives.
Tasks like getting out of bed, working, and getting to school can seem impossible. Many have seriously contemplated or even tried to end their own lives because they don’t know how else to end the pain. There is a deep sense of hopelessness when someone has tried so hard to feel better and continues to feel pain. Most who come through the door don’t really believe that this treatment could help them feel better. And how could anyone believe that this experience will be different, when their entire lived experience says otherwise?
For many, something sounds different about DBT from the very beginning. When DBT is the right fit, the explanation of the model – referred to as the biosocial theory – communicates empathy, understanding and a glimmer of hope. Often, the person lets out a slow exhale as they quietly reflect, they begin nodding or their eyes well up with tears. Many ask how a therapeutic framework could possibly understand and accurately articulate their entire existence so well.
Dialectical Behavior Therapy (DBT) is a form of therapy created by Marsha Linehan, PhD in the late 1980’s/early 1990’s specifically for people who have difficulty tolerating and regulating challenging emotions. These individuals often develop strategies for coping with intense emotions that help them feel better in the short term but end up causing more suffering in the long term. These individuals often make impulsive, emotionally driven decisions and struggle with risky coping behaviors such as self-injury, suicidal thoughts, substance use and chronic avoidance. The treatment integrates strategies for creating change that is necessary for a person to live a more fulfilling life, ultimately to support the motto of DBT, which is to “find a life worth living.”
The idea that profound change can happen in six weeks, after years of debilitating suffering, seems impossible unless you’ve witnessed it or experienced it yourself. The change can start small, with very subtle shifts that could be missed if you weren’t watching carefully. There’s a slight shift in body language. A head tilts up a little bit more. Eyes make direct contact for a moment. Shoulders lift as the enormous weight starts to lighten. The face starts to soften and becomes more animated. The glimmer of hope in the eyes starts to grow.
DBT IOP treatment is very intense and challenging. Most who come with intense symptoms leave with low levels. By the end there is more control over risky and often life-threatening behaviors. People begin to connect with others differently, and most importantly, they start to envision their lives with hope and without suffering.
Alex was highly skeptical that this IOP thing would work. But they needed to do something to change things. They were extremely anxious when they came in for their initial meeting. Alex was very quiet and mostly nodded in response to questions. Their upper body remained very tight and still, while their left leg bounced up and down throughout the meeting. When the DBT model was explained they nodded more frequently.
At the start, Alex thought six weeks of treatment would drag on forever, but they actually enjoyed some parts of the program. They liked connecting with other people and realized that they weren’t alone. They started to understand more about why they felt the way they did, but making changes was also very difficult.
Alex was shocked when they were told three weeks had passed and the program was halfway done. They had been working hard to understand their own emotional experience and articulate that clearly to others. Alex was discovering that their anxiety was often secondary to their sadness, hurt, and disappointment about losing touch with their father. They had also been working hard to act opposite to their depression urges. They felt a little bit better but worried that they would never feel completely better.
Alex’s mother Heather came to some of the optional family groups. She learned to validate Alex’s experience and to tolerate her own emotions when she could see Alex was hurting. She started to notice small changes in how Alex interacted with her. Alex started to tell her more about their struggles finding a job and spent time helping to make and share meals together. Discussions didn’t become arguments as often.
During Alex’s fifth week in the program, they noticed a big shift. They had more energy and enjoyed interacting with people more. Their quirky sense of humor started to reemerge. They became more animated when talking with peers. They even reached out to a friend to go hiking.
Alex became more aware of their emotions in the moment and more readily communicated their experience to others. Alex began to integrate the skills they learned into more areas of their life. They got a part-time job and moved in with a co-worker. They reached out for phone coaching when they had the urge to leave work part way through the day.
Alex hasn’t self-harmed or thought about suicide since the second week of program. They are tracking how long they have gone without self-harming on a phone app. They check the app daily and feel a deep sense of pride when they see the time ticking up. They’ve only had a couple of drinks while out with co-workers after work. They’re still working on managing stress at the workplace.
After their sixth week of program, Alex graduated from Crossroads with a clear plan and was looking forward to life. During graduation, Alex reflected that at the start of the program they had been convinced it wouldn’t work. They told their peers who were just starting the program that they couldn’t believe how quickly the time went and how much had actually changed during that time. “I honestly didn’t think this program could help and I’m telling you it did,” they said. “It can be really hard at times. Put the effort in. Do the work. It’s worth it because it actually works!”
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Surgeon General of the United States all declared the state of children’s mental health a national crisis in 2021. That’s because a great many young people and their families in the US and in Vermont are experiencing issues in life like those described in this article. Families have never before been in such distress as they are these days. This description of Alex is not one person but a composite of people who typically use Crossroads. In addition to the experiences described here, Transitional-aged Youth of color, those who are gay or are questioning gender identity and in other traditionally marginalized groups often get bullied or made to feel less than. We can all be kinder to and examine our assumptions about others.
More mental health treatment resources for children and families are desperately needed across the country and Vermont, The Department of Mental Health and the Designated Agency/Specialized Services Agency Network are working hard to offer enough services because of the staffing shortage crisis affecting all employment sectors.
Washington County Mental Health Services (WCMHS) was one of the first mental health centers in the nation to use DBT in the early 1990’s. About 10 years later, Matrix started and ran Crossroads for nearly 20 years. In 2019, NFI took over and collaborated with WCMHS to develop DBT treatment for adolescents and now NFI has opened the Transitional-aged Youth Program (TAY) at Crossroads.
For more information about other NFI trauma responsive mental health and special education programs please visit www.NFIVermont.org.
NFI Vermont, Inc.
Providing trauma responsive, innovative mental health and education services to Vermont children and families.
This article is part of a collaboration produced by members of Vermont Care Partners. Vermont Care Partners is a statewide network of sixteen non-profit, community-based agencies providing mental health, substance use and intellectual and developmental disability support
