Sunday, April 14, 2024

Youth Mental Health Crisis Quietly Continues in Rural New Jersey

Note: this article adapts material from a piece written for NJ Decides, a collaborative news project of the Center for Cooperative Media.

While the issue of parental rights attracts the most attention in educational policy, the ongoing youth mental health crisis continues to impact millions of students across New Jersey and the nation. Research shows that rural areas may be particularly vulnerable to both poor mental health as well as an acute shortage of the mental health professionals who can treat it.

Statewide, rates of youth in-patient hospitalizations for mental health have risen every year. According to data from the New Jersey Hospital Association, anxiety-related in-patient hospitalizations in adolescents grew 23% between 2017 and 2019, followed by a 54% spike from 2019 to 2021. Depression-related in-patient hospitalizations grew by 6% between 2017 and 2019 and again by 26% between 2019 and 2021. 

The crisis continues quietly – and acutely – in rural areas like Warren County, where existing vulnerabilities to mental health have only worsened.

Mental health: the rural context

Rural mental health troubles predate the pandemic. In the 2017 Behavioral Risk Factor Surveillance System Survey, Warren County residents reported a higher rate of depression: 19.2% vs. 14.8% for New Jersey overall. This held steady during the pandemic. In a 2020 New Jersey Behavioral Risk Factor Survey, 19% of Warren County residents reported mental distress for 14 or more days over a 30-day period vs. 13% for New Jersey overall.

The same mental health struggles appear in youth. In a 2022 survey conducted by the Warren County Stigma-Free Communities Initiative, about 20% of students in grades seven through 12 reported feeling so sad and hopeless almost every day for two or more consecutive weeks that they stopped their usual activities. 

That question asked about pre-pandemic behavior. After COVID, about 37% of students reported debilitating hopelessness– a staggering percentage.

Gregor Thomas, the associate vice president of community outreach at the Center for Family Services, sees three common struggles for children with mental illness in Warren County: overloaded outpatient therapy centers, a lack of public transportation services in rural areas and limited entertainment possibilities for adolescents, which means fewer positive outlets.

Warren County has tried to expand its mental health care services, said Laura Richter, the county’s associate director of human services. Families with children and adolescents in distress can reach out to Performcare, a behavioral health service organization that includes a mobile unit. Families in need can also call on the crisis intervention unit at the Center for Family Services, the Warren County Education Association with its network of community partners and Atlantic Health’s psychiatric hub at Hackettstown Medical Center. 

But a survey in the 2020 Warren County Needs Assessment speaks to holes in this network of services, with more than half the respondents complaining that services are little known or advertised, overloaded with long wait lists or likely to give out-of-county referrals that are difficult to reach. 

NJ4S: attempts so far

To address the mental health crisis, the Department of Children and Families implemented the New Jersey Statewide Student Support Services Network, or NJ4S, this fall. The model aims to connect schools to their surrounding mental health and social support infrastructure, with 15 regional hubs acting as coordinating centers. 

NJ4s defines three tiers of student support, depending on need. Tier 1 strategies are preventative measures offered to all students, including social-emotional learning and anti-bullying initiatives. Tier 2 strategies include early identification and more individualized services, including classroom support, mentoring and small-group interventions. Students in crisis or with stronger support needs are candidates for Tier 3 services, which generally include a mental health professional for clinical interventions, counseling or referrals. 

The Center for Family Services is the regional NJ4S hub for Somerset, Hunterdon and Warren Counties. The hub “is actively providing Tier 1 presentations across the community and Tier 2 services to schools,” Thomas said, with Tier 3 services planned to roll out as soon as enough clinicians are hired.

It’s a step in the right direction, said Olivia Montuore, vice president of the youth-led mental health nonprofit Reach Out based in Long Valley, but it’s not enough.

“More long-term solutions for students who need more than just assemblies on mental wellness need to be considered,” she said, “and that is where NJ4S is falling short.”

The mental health provider shortage

Mandating referrals, health screening and intervention from mental health professionals won’t help if those professionals don’t exist. Nationwide, a critical shortage of child and adolescent psychiatrists, school psychologists and school counselors delays treatment for millions.

According to their professional organizations, the ratio of student counselors to students in New Jersey is 337 to 1 vs. a recommendation of 250 to 1. It’s a similar situation for school psychologists, with a ratio of 659 to 1 vs. a recommendation of 500 to 1. 

But the situation is most dire for children and adolescent psychiatrists (CAPs). A total of 341 CAPs work in New Jersey, according to the American Academy of Child and Adolescent Psychiatry’s Workforce Maps posted in May 2022. There are two in Sussex County and three in Hunterdon. In Warren County, the map gives a CAP count of zero for 21,178 children. 

This is particularly critical because mental health treatment relies on accurate diagnoses. Without a child psychiatrist to administer those formal diagnoses, youth in crisis will struggle to have their illness recognized, much less treated. 

Since the Workforce Map’s publication, two CAPs have begun practicing in Warren County: Dr. Jean Ying-Chang, medical director at the Center for Family Services, and  Dr. Adam Silberman, a newly hired child and adolescent psychiatrist at Hackettstown Medical Center. 

With few CAPs available to provide formal diagnoses and sustained treatment, it’s difficult to assess how many children need mental health care in Warren County. According to 2016-19 CDC data, about 9.4% of children ages 3 to 17 will have received an anxiety diagnosis at some point in their lives, and 4.4% will have received a diagnosis of depression. If these percentages are applied to Warren County’s under-18 population, that would imply an estimate of about 1,990 children with anxiety and 930 with depression. That’s almost 3,000 children for two psychiatrists.

According to Joshua Langberg, director of the Rutgers GSAPP Center for Youth Social Emotional Wellness (CYSEW), the provider shortage is driven by two factors: extensive schooling that leads to equally extensive student debt, and a long clinical training process that requires a large corps of supervisors.

The CYSEW has developed models to rapidly scale up paid clinical training opportunities for would-be CAPs, defraying costs and simultaneously allowing trainees to serve their communities. Implementing those models on a mass scale would require funding and coordinated action from state and county officials, on par with efforts to address the shortage of healthcare workers and teachers. So far, these efforts have yet to manifest. 

The road ahead

The mental health crisis did not occur in a vacuum, Langberg said. The issues that drive it – increased social isolation, bullying, school shootings and performance pressure – seem to have staying power. 

“We need our legislators, families, and schools talking about mental health regularly, openly and encouraging regular scheduled yearly assessments and appointments, just like we do for health checkups and vaccines,” Langberg said.

What would count as a mental health “vaccine”? For Montuore with Reach Out, one specific support would have helped her as a struggling high school student.

“More mental health professionals that can work one on one with students who are struggling would be the thing that schools could do best,” she said. 

In the ongoing shortage of mental health professionals, the state’s efforts to coordinate services may amount to building a doctor’s office with nobody inside. 

Local mental health resources

If you or someone else you know is struggling, here are some resources that can help:

Warren County Division of Administration’s programs from the Mental Health Board, including Warren County’s Stigma-Free Initiative: 

Atlantic Health System – Behavioral Health

653 Willow Grove Street

Hackettstown, NJ 07840




A mission-based behavioral health administrative services organization partnered with the State of New Jersey’s Department of Children and Families. Includes a mobile unit. 

988 Suicide and Crisis Prevention Lifeline

988 (call or text)

This free helpline provides free and confidential emotional support to individuals in suicidal crisis or emotional distress 24 hours a day, 7 days a week. Accepts text messages, chats, and calls. 

Center for Family Services

(908) 689-1000

Outpatient mental health, sexual abuse treatment, and suicide prevention treatment. Includes a Family Crisis Intervention Unit.

Chip O'Chang
Chip O'Chang, Contributing Writer
Contributing Writer

Chip O'Chang is an educator, fiction writer, and lifelong resident of New Jersey. He has also written for My Life Publications and NJ Indy. He lives in the NJ Skylands with his partner, two cats, and and a bearded dragon.