Transcripts For CSPAN Surgeon 20240705

Chair Sanders Senate committee on health, education, labor, and pensions will come to order. And were delighted to welcome our panelists who were going to hear from in a few minutes. Let me begin by telling everybody what they already know and that is it is no great secret that in America Today we have a Mental Health crisis and that crisis has been exacerbated by the horrific covid pandemic, which we have experienced. And this is a crisis that has hit all of us, but i think especially the younger generation. In America Today, 40 of parents report being either very or extremely worried that their child is struggling with anxiety or depression. According to a recent survey by the centers for disease control, nearly one out of every three teenagers in america reported that the state of their Mental Health was poor. Two out of every five teenagers felt persistently sad or hopeless. And tragically one out of every five teenagers in our country have seriously considered suicide. How frightening is that . Tragically, suicide was the second leading cause of death for young people between the ages of 10 and 14. And it was the third leading cause of death among teenagers. All of us understand that the pandemic has had a huge and Lasting Impact on the Mental Health and wellbeing of our country and our young people. Let us never forget sometimes its easy to forget we remember the Million People who died during the pandemic, but over 200,000 children, often children of color, by the way, lost one or both of their parents to covid. And think about the impact thats that had on their lives. Further and i think were going to hear more about this later. Our kids have become less connected humanly to each other. This is kind of a new phenomenon, and dr. Murthy has written about this and im sure will be speaking about it this morning. Instead of building trustee, health trusty, healthy relationships with their friends, teachers, mentors. Increasingly, children are turning to their phones and social media to feel connected. And what kind of impact does social media have on the Mental Health of our nations youth . Thats an issue that we got to explore at Great Lengths as a nation. According to a recent study, 32 of teen girls said that when they felt bad about their bodies, instagram made them feel worse. More than 40 of instagram users who reported feeling unattractive said that the feeling began on instagram. About 25 of teenagers who reported feeling not good enough, inadequate, said it started on instagram. Im sure the same can be said about other social media platforms. And lets be clear. And something i think this committee in months ahead will get into. We are up against some of the best minds in the world who keep coming up with new ways to get teenagers addicted, addicted to their websites in order to sell them more products and make more money. And thats what we are going to have to address. But its not just social media. As dangerous as that may be. Kids in vermont and ive been around to a lot of high schools, some Community Colleges in my state. But around this country as well, worry about the kind of future that awaits them. They wonder if their political leaders in this country and around the world will address Climate Change or whether the world that they and their kids will grow up in be increasingly unhealthy and uninhabitable. And i really do wonder, walking here today through the smog and the smoke that washington, d. C. , is experiencing right now, how in new york city its a bad day but you wonder what impact it has on the kids who wonder, is this the future for they . And what that does to them psychologically. Yesterday, on another issue, i had the occasion to meet with people who came to the capitol who lost loved ones as a result of gun violence in schools. And i was stunned. In vermont where kids worry when you were young you went to school. It was a safe haven. Now they wonder if some terrible thing might happen. And when we talk about the anxieties facing young people, we cant ignore economics. Everything being equal if we dont get our act together, the young people will have a lower standard of living than their parents. Right now 60 are struggling paychecktopaycheck. All i have to say is the pandemic has exacerbated a bad situation. It is there. As political leaders in our country, its our job to address it. Senator cassidy, the mic is yours. Senator cassidy thank you, mr. Chairman. Everybody here knows a fellow american struggling with Mental Health issues. Everybody watching knows. School closures, isolation from the covid19 pandemic exacerbated, almost concentrated this among those who are younger. According to the c. D. C. From 2021 to 2022, the percent of teenagers that felt sad or hopeless increased to 42 . Those considering suicide, seriously considering suicide goes from 19 to 22 . To say its troubling is the kind of not have an adequate adjective. This is terrible. The goal of this hearing is how do we improve access to quality Mental Health care for young people. We must highlight that congress has done a lot in recent years to improve Mental Health care and access to children and all americans. We have walked this ground. We need to see what our recent work has accomplished, need to measure its effectiveness, and then to figure out what gaps remain. Now, just for context, we know this for decades the nations Mental Health system was dysfunctional, underresourced, not getting Crucial Services to americans who were facing Mental Health issues, especially those in underserved areas. I worked in a hospital for the uninsured and the underinsured for 25 years. I worked with this. Now, before i go on, let me give a shout out to senator chris murphy. He and i will 2015 led the Mental Health act, a historic bill to increase access to quality Mental Health care for all americans. And i remember chris at that time saying, bill, theres some things we agree on, a lot of, and a few we disagree. Lets focus on that which we agree and leave the other for another day. And by that we did something which lamar alexander, then the chair of this committee, said he didnt think two freshman senators could do. It was both an insult and praise in there. [laughter] but we accomplished it. And lamar went on to say it was the most profound most profound reform of Mental Health law in the previous 30 years and we were both honored. Now, we teamed up again this past year to reauthorize this and to reform it to better address the needs of americans. We increased funding for Mental Health block grants to better serve children at risk for serious Mental Illness, expanded telehealth care and increased Mental Health workforce programs, focusing on treating children in underserved populations. And i could go on. Now, additionally and again, im going to give a shout out to murphy once more. In response to the tragedy in uvalde, Congress Passed the bipartisan Safer Communities act which invested a billion dollars to children can have access to Mental Health care whether theyre in a pediatrician office, school, emergency room or Mental Health center. I had the privilege to work with him. Congress passed it. The legislation invested 8. 6 billion to expand Certified Community Behavioral Health clinics to all 50 states, offering 24 7 Crisis Intervention Services, outpatient Mental Health, and Substance Abuse services, case management, increasing access to primary care for americans, especially those who are lower income and uninsured. It provided 2 billion for schoolbased Mental Health treatment to Train School Personnel to better help students through a crisis, to increase care for children suffering from trauma, to Fund Prevention programs, to decrease bullying and violence at school and much more. Additionally, the Safer Communities act instructed the department of education and the department of health and Human Services, both represented here today, to improve guidance to schools, particularly those in local excuse me in small or Rural Communities to more easily build medicaid for schoolbased Mental Health services. And well talk and hear more about that during the first panel. Im proud of the work that congress put into this legislation and signed into law, and these achievements show there is a strong bipartisan support for addressing youth Mental Health issues. But and i say this all the time at home these grants and programs only make a difference if state and local government are aware of them and apply and show local leadership in order to participate. We need this local leadership to use these resources to make sure the assistance reaches those who need it most. What we cant do is pretend that congress hasnt done anything and that we must start anew. That, sweeping the debt clean so to speak in our minds, not acknowledging the base upon which we build, will create duplicate, inefficient programs, wasting dollars and wasting effort. By the way, the chair just echoing the chair, and i agree wholeheartedly, the resource Congress Appropriates should not be wasted. Now, congress cant solve this on its own. Throwing money at an issue without accountability is not the solution. There has to be complete buyin from the executive, from states, local government, tribal leaders and Community Organizations, among others to make sure these programs work, as congress intended. There is legislation up for reauthorization that requires attention. As i mentioned in the last weeks hearing, they have nine Health Care Authorizations awaiting for programs that expire in september. One of these is the support act, which helps individuals that is dealing with Substance Abuse disorder and increases help for those children suffering from trauma. There are 50 individual provisions in the support act that falls in this committees jurisdiction. The fact that the committee has two months left to reauthorize the programs and we have not considered bipartisan text, let alone marked them up, is concerning. I reiterate reauthorizing the support act and these other eight healthrelated bills on time, bipartisan must be the committees top priority. As Ranking Member of the committee, improving our federal programs so theyre more effective and having greater reach is crucial. So let me finish by saying i look forward to hearing from our witnesses as we can better address the Mental Health crisis to make sure more young people have access to quality Mental Health and that the resources already allocated are used effectively. Thank you. I yield. Chair sanders thank you, senator cassidy. Now were going to hear from our witnesses. Our first witness will be vice admiral vivek murthy who is the Surgeon General of the United States of america. In my view, dr. Vivek, has done an extraordinary job in talking about the Mental Health crisis and the crisis of loneliness and many, many other issues. Dr. Vivek, thanks very much for being with us. Murthy. Dr. Murthy thank you so much, chairman sanders, and thank you Ranking Member cassidy for your work on issues related to mental haegs health. Im dr. Vivek murthy. I have the pleasure of surging as serving as Surgeon General. Im most importantly here as a father of two Young Children who is concerned about their future and the future of kids across america. And im here to speak about what i believe is the defying Public Health issue of our time and thats the youth Mental Health crisis. It now threatens the health and wellbeing for millions of our children. In 2021, more than two in five High School Students, including almost 60 of girls and 70 of lgbtq youth reported feeling persistently sad or hopeless. Nearly one in five High School Students reported making a suicide plan. And this followed a 57 increase in the suicide rate among young people in the decade prior to the pandemic. In response to this crisis in december, 2021, i issued a Surgeon Generals advisory on protecting youth Mental Health. And i did this to call our nations attention to this urgent issue and for the need to act. Over the last two years, im grateful that congress in a bipartisan basis and the Biden Administration have made unprecedented investments to strengthen the Mental Health care system and to connect more youth to care. And these investments have already started to help children and families. But as all of you know, we have much more to do. Last month my Office Released two new Surgeon Generals advisories. One on our epidemic of loneliness and isolation and the other on social media and youth Mental Health. Together, they explore two important drivers of the Mental Health crisis. Regarding loneliness and isolation, we now understand that social disconnection is both exceedingly common and profoundly consequential. About one in two adults are reporting measurable levels of loneliness and social disconnection is an increased risk of not only depression, anxiety and suicide, but also heart disease, dementia, stroke, and premature death. The loneliness epidemic has hit young people particularly hard and they have the highest rates of loneliness across age groups. The time young people ages 15 through 24 spend in person with friends declined by more than 50 from 2003 to 2019. Furthermore, theres been a decline in participation over the last half century in Community Organizations that are traditionally brought us together including faith organizations and recreational leagues. Second, though, im increasingly concerned about the harmful impact that social media is having on youth Mental Health. Despite universal use theres inadequate evidence to say it is helping children. There is growing evidence to associate social media with as lessent harm. When their particularly susceptible to peer comparison, the data show youth who spend more than three hours a day on social media face double the risk of experiencing symptoms of depression and anxiety. This is deeply worrisome because on average teenagers are spending 3 1 2 hours a day on social media. Excessive social media use can disrupt activities that are essential for Healthy Development like physical activity, sleep, and inperson interactions. For example, a third of adolescents are telling us they stay up until midnight or later on week nights in front of their screens. And much of that is in fact social media use. In addition too often kids on social media are exposed to extreme, inappropriate and harmful content. Indeed nearly half of adolescents are saying social media makes them feel worse about their bodies. Two other drivers of youth Mental Health crisis that i just want to note briefly, one is trauma, which has become all too common in young peoples lives, particularly from violence and abuse and the loss of loved ones, incarceration, addiction and death. When they go through these childhood experiences we know it has an impact on their physical and Mental Health. Their confidence in the future has been undermined by the serious challenges they are set to inherit from economic inequality and Climate Change to racism and gun violence. This is what they say to me time and time again when i meet with young people around the country. The bottom line, our kids cant afford to wait longer for us to address the youth Mental Health crisis. We need to expand our efforts to make sure every child has access to highquality, affordable, culturally competent Mental Health care. But we must also tackle the root causes by addressing the potential harms of social media through age appropriate health and Safety Standards and data transparency requirements, by investing in schoolbased programs that equip children with the tools to manage their emotions, adversity, and Mental Health. By addressing trauma, particularly violence, and by embarking on a generational effort to rebuild social connection and community in america. Finally, we can all play a role in addressing the ongoing shame and stigma that still surrounds Mental Health and preventing young people from asking for help. Our obligation finally to act is not just medical. It is moral. Its about fulfilling our most sacred responsibility to care for our children and to secure a Better Future for them. I thank you for giving this critical issue the attention and the action it deserves. And i look forward to your questions. Chair sanders let me turn to senator cassidy who will introduce our next witness. Senator cassidy its an honor its an honor to introduce mrs. Katherine neas, Deputy Assistant secretary of the office of special education and Rehabilitative Services at the u. S. Department of education. In her role, mrs. Neas works to improve the educational and Employment Outcomes for students with disabilities. To today, she will today, she will discuss the Mental Wellbeing of all students. Mrs. Neas. Mrs. Neas chairman sanders, Ranking Member cassidy, distinguished members of the committee, thank you for letting me share the department of educations survey conveyed alarming findings of the prevalence of Mental Health or Substance Use disorder among our nations youth. The report advances the critical need for schools to expand schoolbased services and to connect youth and families to communitybased sources of care. Simply put, school is our gateway to needed services that otherwise might be inaccessible to many young people. The report also emphasizes the responsibility of schools to ensure that all learning occurs in safe and supportive environments. The departments work is focused on three top priorities. Increasing the scale and knowledge of existing School Personnel to support the Mental Health needs of students. Increasing the supply of Mental Health professionals who can work with students. And increasing funding through the Medicaid Program to support School Health services, including Mental Health services. One year ago, congress provided new funding under the bipartisan Safer Communities act that significantly bolstered federal, state, and local efforts to address student Mental Health needs. Im pleased to provide you with an update of our work to implement this law. Last september, the Department Awarded 1 billion to state educational agencies to competitively award subgrants to highneed School Districts for activities to support safe and healthy students. This Stronger Connections Grant Program will support School Districts to develop, implement, and evaluate comprehensive programs and activities that foster safe, healthy, supportive, and drugfree environments that support student academic achievement. The bipartisan Safer Communities act also provided 1 billion over five years to be equally divided across two programs, to increase the supply schoolbased Mental Health providers. The response to these two grants has been enthusiastic. Under the schoolbased Mental Health services grant, 12 states and the district of columbia and 229 School Districts across 41 states submitted applications. The department was able to fund nine states, the district of columbia, and 94 School Districts across 31 states. Under the Mental Health Services Professional demonstration grant program, 266 School Districts applied and the department was able to fund 160 grants. To support this 280 million of federal support across 264 grantees that will train 14,000 schoolbased Mental Health professionals, the department will fund a Mental Health personnel Technical Assistant center later this year. This past january, they granted grants through the promise neighborhood and the full Service Community schools program. The bipartisan Safer Communities act also directed the departments of health and Human Services in collaboration with the department of education to issue guidance to increase access to schoolbased Health Services to children enrolled in medicaid and the Childrens Health insurance program. This guidance was released on may 18 of this year. Medicaid and chip provide Health Coverage to more than half of americas children, roughly 41 million children. These programs are administered by state, according to federal requirements. Children are eligible based on Family Income or unique Health Care Needs such as having a disability or a serious Mental Illness or if they are in foster care. Under medicaids early periodic screening dodge knostics and treatment program, eligible children can receive comprehensive primary health, Mental Health and Behavioral Health services. Medicaid enrolled children who need services in school can fall into two categories. Eligible children who need General Health Care Services and students with disabilities who receive services under the individuals with disabilities education county act. In 2021, schools received nearly 6 billion in total payments for schoolbased health care to medicaid students. Schools also received about 14 billion in federal idea funding. In 2014, the centers for medicare and Medicaid Services issued a letter to state medicaid directors clarifying Reimbursable Services in a schoolbased setting. The c. M. S. Letter explained that schools can seek payment for all Medicaid Services to all students enrolled, not those with disabilities. As of may, 2023, 21 states have used this policy to expand their schoolbased Medicaid Programs. Most states use these funds to hire and sustain essential personnel who can deliver or facilitate the delivery of health and Mental Health services. As you can see, the department is actively engaging in efforts to address the Mental Health crisis facing our nations youth. Were committed to ensuring that students needs are mret, that theyre ready met, that theyre ready to learn and have the full access to learning. Thank you for the opportunity for being here and i look forward to answering your questions. Chair sanders mrs. Neas, thank you very much. Let me start off with dr. Murthy. Senator cassidy mentioned what is true, that congress has taken some action, but i will tell you as i go around vermont and talk to teachers and principals, they tell me they need more help. In your judgment, do we have at this moment the kind of Mental Health infrastructure from psychiatrists, the social workers to counselors that this country needs . Dr. Murthy well, thank you, senator. And i do appreciate the significant historic investments that have been made over the last few years. I think they have helped, but we do need more to help build the infrastructure. When we think about care, for example, Mental Health care, theres several pieces of the infrastructure that still need to be expanded. Number one is Mental Health workforce itself. And im talking here not only about psychologists and psychiatrists and others in the Traditional Health delivery model, but im also thinking about peer support models and others that can help kids and we need to think more broadly about that workforce. Chair sanders let me ask you this. We talked a lot about the problems. Talk about some of the solutions. Are there communities or schools in america that are doing something that is effective in addressing the crisis were talking about . Dr. Murthy that is the good news. That there are successful models around the country. Many of them do not know about each other and are not learning from each other and we have to invest in studying and scaling them. A few that ill mention. One is the becoming a man program, which has been a very powerful program started in chicago and now spread to some other cities which has worked in high schools with helping young people, essentially be sources of support to one another, and has been able to demonstrate actual benefits in trials that were run by the university of chicago. We also know the afterschool Matters Program has been another one which has brought Community Organizations together to be with kids and provide them mentorship, support, and safe places to play and learn after school. That has also demonstrated positive benefits. Chair sanders let me ask you this. You write about loneliness. And yet, people spend half their lives on these things. What is the difference, in your judgment, between human interactivity and activity on social media and how does that impact the wellbeing of americans . Dr. Murthy well, senator, this has been an important point of concern for me. There is no substitute for inperson interaction. As human beings, weve evolved over thousands of years to perceive not just the content of what someone says but also interpret their body language to sense nonverbal cues. We take all of that in and that contributes to a rich human interaction. When you strip a lot of that away, you lose richness. You lose quality of connection. Thats not to say theres never a place for texting or for online connection. But what i worry about is that the balance has shifted dramatically toward online connection and away from inperson connection, particularly for our kids. But the other concern, senator, is not only what kids are missing out on as a result of social media, but what theyre being exposed to on social media. And we i talk to parents all over the country who and to kids as well who say theyre exposed to content thats violent and sexual in nature, theyre often bullied and harassed online. Six out of 10 adolescent girls say they have been approached by strangers online that they feel uncomfortable. I want to say whats not happening as a result of social media in our kids lives and also the toxic effects they are being exposed to. Chair sanders mrs. Neas, you spoke about the impact medicaid is having on providing services to kids who desperately need it. We are now as a result of the end of the pandemic and the cessation of the funding, many billions of dollars we put into funds in increasing medicaid. What impact of hundreds of thousands or millions of people losing their medicaid have on Mental Health in this country . Mrs. Neas senator, thank you for that question. The work that weve done with the department of health and Human Services to make it easier for schools to access the Medicaid Program for schoolbased services is one that were very proud of because we think its going to make it easier for schools to hire and sustain necessary people. At the same time, weve been working hand in glove with the department to get word out to our School Leaders about this time of reenrollment and hoping that those children who have to reenroll in medicaid are found eligible. And that those that are found not eligible can be directed to another source of insurance. But it is something i think the administration is very concerned about and wanting to do everything we can to make sure that children who are eligible can stay on the program. Chair sanders but is it a concern that if hundreds of thousands or millions of families lose their medicaid, its going to make it harder for people to get the Mental Health services they need . Mrs. Neas without question, sir. Chair sanders senator cassidy. Senator cassidy although im tempted not to because im southerner did not wear a ill defer to senator tuberville. Senator tuberville i got two suits. I just forgot. Thank you, mr. Chairman, for having this hearing. I spent 35 years with the youth of this country as a coach, educator. This is not just a crisis that we have, Mental Health, its an emergency. We got huge problems. This is probably the biggest problem we have in this country. Its getting worse every day. I saw it change in just a short period of time. The number one commodity that we have in this country is not gold and silver. Its our young people. And were destroying them. And were sitting back and watching it happen. Ive seen prescription drugs take over our youth, especially a lot of kids that i work with. You know, we ruined the Nuclear Family and thats where a lot of this has got to come from. I counted up yesterday 32 Mental Health programs that we have in this country. 32. We spent tens of billions of dollars and were not making any progress. Were going the opposite way. We have all kind of addiction. I talked to a sheriff last week in montgomery, alabama, and he said, coach, i never heard the word fentanyl until two years ago. Now thats 95 of the drugs that we have in our schools and on the streets. Biggest drug we got is this right here. We all got it. Theres not a person in here that doesnt have one of these. Im guilty like everybody else and i stay on it and i think everybody on there is true but its not. But our young kids think it is and thats a problem and we got to get control of that. A lot of it, what were talking about here today is loneliness. And we can agree on some of that. We have a program in alabama thats called the state departments running through our children hospital. It connects primary providers to operate sort of a command center out of the hospital in birmingham. Kids experiencing all the issues that they have, theyre connected with providers that are close to them. Whether its rural or inner city. Money for this particular program has tripled in the past year from the bipartisan Safer Communities act. I will tell you this. We can afford a lot of things around here but we cannot not afford to fund Mental Health. We cant. We have to be able to afford it. Through you situations like this through situations like this. So dr. Murthy, are we tracking the successes and failures of the rest of the billions of dollars that we spend . Are we tracking it . Is it where its working . Do you have people doing that in your line of work thats helping us track the money going and is that money helping to a degree where we can see success . Dr. Murthy well, thanks, senator. I wish i could circle, underscore, star so much of what you said. Youre right on. Youre right that the most important asset we have is our kids. And we got to do more to protect them. I also agree with you that when we do put funds toward a cause its important to know, is it actually working . Is it delivering the benefit . You know, while our office, the office of Surgeon General, does not conduct trials. We do have colleagues across the department of health and Human Services, at n. I. H. , samhsa, do evaluate programs so we understand whats working, who its working for and whats missing. But i think, senator, to pick up on Something Else you said here as well. I think and i like the program you mentioned in alabama in terms of the concept of building a network and an infrastructure so that primary care doctors, in particular, and others are not trying to manage this all on their own. Pediatric Mental Health access program, for example, had been very helpful in making sure those primary care doctors can get expertise, Mental Health expertise into the clinic when a patient is there and we do need more programs like that. But i dont think we will be able to keep up with the sheer, you know, Disturbing Trends that were seeing in terms of increased Mental Health concerns unless we simultaneously attack some of these root causes. And you mentioned our diadvices and particular devices and particularly for young people, social media has become, i worry for too many of them, an important contributor to their Mental Health strains. I do roundtable specifically with student athletes. Many of them tell me that not only are they having a hard time sometimes getting help. Some of them have incredibly supportive coaches and administrations. Others do not. I had one Football Player who told me after having serious thoughts of taking his own life he approached his coach and said and took a lot of courage for him. He asked for help. The response from the coach was, you know, if thats how youre feeling maybe this program is not for you. You should consider going to another university. And he was heart broken. Thankfully thats not the response that most kids get. But we still have more to do in terms of making sure kids get the help they need. If we can focus on making social media safer for our kids, if we can focus on rebuilding the social connection in community that kids need. Family is a big part of that. Faith institutions are a key part of that. Other Community Organizations like ymca, boys and girls clubs, these all play vital roles in help connect kids to each other, families to each other, but participation, senator, has been declining for half a century and its leaving people lonely, isolated and at greater risk for Mental Illness. Senator tuberville i know were over a little bit, mr. Chairman. We have unfortunately people in this country that are born with a Mental Health problem and were trying to treat them with a lot of prescription drugs. And i think thats fine to a certain degree. Sometimes were overprescribing. The problem is were creating more Mental Health problems than we had young people born with Mental Health problems and we need to understand that. If we start understanding that i think we can understand the problems that we have to overcome because we dont do this. Now were going to lose the country we all grew up in. Because Mental Health is the number one problem in this country. Number one problem. And we have to because it leads to Everything Else. It leads to so many things in this country that are negative. So thank you. Thank you for your answer. Thank you, mr. Chairman. Chair sanders senator. Thank you for convening us. I want to thank both of our witnesses for their testimony and their public service. I want to start with Deputy Assistant secretary neas to talk about bullying and harassment. One aspect of this larger challenge. I think we can all agree that children deserve to go to School Without any fear or intimidation. But as we know, far too often, bullying and harassment affect so many children and can have serious consequences for the Mental Health that stay with them for the rest of their lives and it undermines their ability to achieve academically. Senator casey we know these issues are prevalent among students with disabilities, lgbtq students, students of color and students who are either in high school or Elementary School, girls and young women. So to support the wellbeing of all students, ive introduced multiple times now the safe schools improvement act which will require School Districts to adopt codes of conduct that explicitly and transparently prohibit bullying and harassing based upon race, color, national origin, sex, disability, gender identity and religion, very much consistent with our civil rights statutes. The bill would ensure that School Districts take proactive action to support the safety and inclusion of all children. Deputy assistant secretary, whats the value of universal Prevention Strategies such as legislation like i just outlined in supporting Mental Health and academic achievement of every student . Mrs. Neas senator, thank you for that question. And thank you for is that better . Here we go. Sorry. Thank you for that question. The department has partnered with the department of health and Human Services on a website called stopbullying. Gov, which is includes resources for schools to do exactly what youre saying. I think one of the reasons we are so proud of the bipartisan Safer Communities act and the work were doing to increase the supply of Mental Health professionals who are in schools is to make those things real. Its important to have the culture of a school be conducive to learning and safe for everyone. And we want to have those resources in schools and available to schools so they can actually act on it. So i couldnt agree with you more. The need for us to address the bullying, particularly, of vulnerable kids, kids with disabilities, kids who may have uncertainty at home, we want school to be that safe place where they always know theres somebody there who has their back. Senator casey thank you. I wanted to move to a question for dr. Murthy. One of the many pieces of data that you cite in your testimony and im looking at page 1 of your written testimony. Just kind of leaps off the page. And im reading in pertinent part. In 2021, nearly one in five High School Students reported making a suicide plan. Hard to comprehend those numbers. One in five High School Students. And i wanted to not just focus on those High School Years but what happens afterwards as well. And because if thats the circumstance in high school, we can only imagine what that means down the road. This challenge that we were all talking about here predated, obviously, the pandemic. But was made much worse by it. Im citing here the Kaiser Family foundation showing that half of young adults ages 18 to 24 reported anxiety and depression symptoms this year, 2023. Half of young adults. Despite these rising needs that many institutions of Higher Education are poorly equipped to handle the Mental Health needs of students. Ive introduced the Higher Education Mental Health act along with senator kaine. It promotes collaboration among educators, students, parents, advocates, and communities to study the Mental Health concerns facing children. How can institutions of Higher Education better support students who are struggling with Mental Health today . Dr. Murthy well, thank you, senator. And i appreciate your leadership on this issue and with your proposed legislation. I think higher institutions of Higher Learning have a huge role to place. First of all, they know where young people are. They can help to change culture by starting conversation addressing stigma. They can increase access to Mental Health services on campus and through telehealth to make it easier for kids to get care. They can also invest in building the kind of connection and community we know is vital to the Mental Health of children. It doesnt happen by throwing kids in a room and say, hey, mingle and build connection. It turns out a little bit of structure along with a little bit of time can help kids actually build the relationships that they want. And finally, lets keep in mind. Many kids dont have what we might assume are just basic tools for managing emotions, building a Strong Healthy relationship. Many of them may not have gotten that. So we have to recognize that. Its why i think programs that focus on Building Social skills and Emotional Development so kids can understand their emotions and emotions of others is a life skill thats just as important as learning how to read or write. Senator casey thank you. Senator cassidy i defer to senator budd. Senator budd thank you, senator, thank you, chair. Thank you, both, for being here today. I sent a letter to n. I. H. On may 9 asking why taxpayers dollars were spent on, psychological functioning after transgender youth after two years on hormones in which two participants tragically committed suicide. Im still waiting for a response from n. I. H. On that letter and, chairman, i ask unanimous consent that i can submit my letter to the record. Chair sanders without objection. Senator budd the researchers, they concluded the study was a success but they admitted, also, they couldnt show that crosssex hormones improved the psycho social functioning for minors. So clearly it looks like this was a real waste of taxpayer dollars. Worse than that, it led or contributed to the suicide of two youth. So doctor murthy so dr. Murthy, consider what i understand your past support of crosssex hormones to transgender children, can you talk about the research will help with the mental issues were discussing today . Dr. Murthy well, thanks, senator budd, for that question. While i was not directly involved in this study and not familiar with it, what i will say, it is important for us to study what measures may help improve the Mental Health and wellbeing of transgender youth because what we see clearly in the data. As disturbing as these rates of anxiety, depression, rates of suicide are, they are disproportionately higher among lgbtq youth, particularly transgender youth. Studies that look to understand what interventions work to help those concerns is important because its a community thats struggling. Senator budd thank you. Are you worried about causing infertility and about the negative longterm impacts of these medical interventions on their Mental Health . Dr. Murthy i think, senator, whenever you have a medical intervention, its important to study the short and longer term impacts on Mental Health. And thats where an investment, resources are needed. Senator budd you said you would be concerned about the longterm and shortterm impacts of these medical interventions on their health, their Mental Health . Dr. Murthy well, i think its important for us to understand what those are through research, sir. Thats what im saying. I think this is a space this is obviously very complex area. What we need to do here we do in other areas of medicine which is to look to experts who have expertise in this area to put together the kind of guidelines that clinicians can then look at and then make the best decision for patients based on that individual circumstance just like we do in other areas of medicine. Senator budd thank you. I hope the medical community in their research would be very cautious here. Weve seen an n. I. H. Study which contributed to the suicide of two individuals. So please be careful is the message. I want to shift gears a little bit back to social media. We know children are being bombarded every day by unhealthy information on social media. Millions of children are suffering, as we talked about, from anxiety and depression, loneliness because of the addictive content on social media. Theres an advisory i think you issued, social media and youth Mental Health. And it discussed the increased use of social media by kids. To what extent, dr. Murthy, do you agree that social media is damaging to the Mental Wellbeing of children . How do you believe we should address this . Dr. Murthy well, thanks for that, senator. My concern here is not just as a Surgeon General. Its as a doctor and a patient. I have a 5 and 6yearold child children and my daughters 5. Shes in preschool. And she came home a couple weeks ago and asked my wife and me if she could post a picture on social media. She doesnt have a social media account. We never talked about social media. Yet, all of her friends are talking about this. And i do i believe that while there are some kids who get benefits from their use of social media in terms of opportunities to interact with others, in terms of an opportunity to find a Community Online where they may not have one in person, i do worry that for many children the effects are in fact harmful and are contributing to the depression and the anxiety that we see among many young people as well as issues with body image. In terms of what we can do, i think theres a lot we can do. Ultimately, this isnt all what government can do. Theres an Important Role, a Critical Role for parents here and for kids themselves. But i think what parents need some support and help and by establishing Safety Standards for social media that protect children from exposure to harmful content and harassment and bullying and from features that seek to manipulate them into excessive use, i do think we can help parents. We also need, as policymakers, theres also a role to require data transparency here. And researchers around the country, senator, tell me they had a hard time getting the data from companies to fully understand the extent of the impact of social media. I will say this, senator. When our children get old enough to drive a car or when theyre small like mine were a few years ago to get a car seat for them, we dont tell parents, you know what, go inspect the tires yourself, check out the engine, make sure the frame is adequately strong. Because we know that not all parents have the expertise to do this. They rely on us establishing standards and then enforcing those of manufacturers. These are incredibly complex platforms that are rapidly evolving fundamentally changing how our kids see themselves and how they interact with the world. Parents need to understand to interpret it and seek safety. Senator murphy thank you, mr. Chairman, for holding this very important hearing. Im so proud of this congress and many on this committee for passing the bipartisan Safer Communities act. And im glad to get an update today on how that money is being impactful to help our kids. Its part of a trend. Were spending more money today on Mental Health than ever before. Weve gone from about 155 billion in 2010 to 238 billion in 2020 and its still not enough. But i think this hearing is so important because i think weve come to the conclusion that unless you get at the root causes of unhappiness and isolation and loneliness, there is almost no amount of money that can make up for that attention. So dr. Murthy, i want to continue this conversation about social media. In part because i think its the most immediate Public Policy concern that this congress can tackle and because i think theres easy agreement between republicans and democrats. But not because i think its the whole story. I think, frankly, we probably spend more time than we should talking about this narrow but very important problem that our kids are facing. But i think we can do something about it. So lets not lose the opportunity. I know the administration hasnt endorsed any specific policy proposals. But just give us your take on which direction we should head. So senator shotts and cotton and briton and i say you have to do age verification to make sure you cant get on before 13. Cant use algorithm boosting and parents have to have a say. Other legislation says you have to have a standard that applies to social Media Companies so theyre only putting healthy content online. As you look at the sort of cornucopia of policy options that congress is looking at here, what direction would you point us in to best protect our kids . What are the tactics that the social Media Companies are using that are most disturbing to you . And ill just and ill just give you maybe the statistic that is most worrying to me. There was a recent study that shows within two minutes of establishing a tiktok account, a teenager can be fed information glorifying suicide. Within four minutes of establishing a particular t. K. O. Account tiktok account, a teenager can be sent content celebrating eating disorders. Thats how quickly really damaging, really dangerous content can get to kids who are in crisis, who are in trouble. And it just compels us in this congress to do something about it. So give us a little bit of advice. Dr. Murthy well, thanks, senator. I just want to also appreciate your leadership on the issue of loneliness and isolation. Its been an honor to Work Together with you in addressing this. I agree with you, there are multiple drivers of the Mental Health crisis. Social media is one of them. I agree its an important one to address. In terms of avenues to focus on, recognizing that social media has been around for almost two decades. During that time theres been a lot of evolution on the platforms by the different ways in which its affecting our kids lives. And so theres actually a lot to do here if we truly want to make them safe. I think one certainly is around enforcement concerning age. Many platforms established their teen as an age which they can use. Thats not health grounds, age of 13. Though many people think it is. 40 of kids 8 through 12 are on social media. Whatever rules they have in place are very poorly enforced. The second area is we need to protect the privacy, data privacy of kids. Kids to this point do not have sufficient control over their data. Neither do their parents. It is used to direct ads to them and other content thats driven by the algorithms. We need to give parents and kids control over that data. The third is around data transparency. Companies are not fully disclosing the data they have about the Health Impacts of their platforms to our kids. To kids, to parents, researchers, and to the public at large. This is what researchers tell us all the time. And without that transparency, we dont even know the full extent of the problem in which and which kids are most affected so its hard to target interventions. Finally, i will say when it comes to Safety Standards, this is a place where i think we can build models off of other products. Whether its for cars, car seats, medication, baby formula, whatever you want to consider as a parallel, but the bottom line is we need to have standards that Push Companies to assure us and to be able to demonstrate through data that theyre not exposing our kids to harmful content, that they are not in fact allowing kids to be bullied and harassed online. Particularly by strangers. And also, theyre not promoting the use of features that lead to excessive use. We know that kids are at a vulnerable stage here of development. Theyre susceptible to some of these features. We cant have Companies Taking advantage of those. These are areas which think are essential to us. Id be happy to work with you and members of this committee as you develop, you know, legislation around this. I think this can cant come this cant come soon enough. Senator murphy i appreciate your guidance to this committee. The only thing we cant afford to do is stand pat. Theres a consensus here we can find with your help. Thank you very much, mr. Chairman. Chair sanders thank you. Senator cassidy. Senator cassidy i defer to the splendid dr. Marshall. Senator marshall thank you, senator cassidy. Thank you, chairman sanders. We have to stop the hemorrhaging. When it a patient comes to the emergency room and theyre bleeding out, we dont start pumping blood into them. The first thing we have to do is to stop the bleeding. Most of our solutions today seem to be pumping more blood into people. We got to go back and start over. The greatest health care mistake the n. I. H. And c. D. C. Did was locking our kids out of schools and this launched this Mental Health pepd we had. Epidemic we have. Damage to our childrens Mental Health. Instead of talking to their chidz, their colleagues friends, their colleagues, their teachers, they talked to social media. That became their best friend. So how do we stop that hemorrhaging . I think we have to go back and think about i look at social media today worse than pornography. My young son, sons were exposed to pornography when they were very young because of social media. I think the additive pressures coming from social media today are worse than pornography. And just like we had to set parameters around pornography, we need to do the same thing with social media. I wish we didnt have to. I think we need to start over on what the solutions are. Dr. Murthy, would you support some time of an electronic Surgeon General warning on the statement of Mental Health and the impact of social media . Dr. Murthy well, thank you, senator marshall. Always good to be here with a fellow clinician as well. I know youve seen this in different angles. I worry about social media as you do. What i try to do and the advisory we issued two weeks was to put in writing clear as day what our concern was about social media and to issue that warning to the american public. I dont think its the last thing, though, that we need to do. I think its a start. Senator marshall i was growing, we had a surge general warning on tobacco. It has an impact. When you put a warn on alcohol for pregnant women, it has an impact. The biggest threat to our youth right now when it comes to our health their health. This is the number one threat to our Childrens Health right now. Its not cancer. Its its not a lot of things. This is the number one threat. Are you willing to use your pulpit and put your reputation on the line and say we need a Surgeon General warning on social media for youth . Dr. Murthy i think it would be appropriate to have a warning on social media to warn parents and kids. If congress is willing to have the legislative authority to put that label on, then i would be willing to partner. Senator marshall does it take legislation . Dr. Murthy yes. It takes legislation to do that. Senator marshall fentanyl, our drug cartels, theyre selling fake adderall that is laced with fentanyl. You are aware of that. The top buyers are children. Senator shaheen and i wrote legislation on the Judiciary Committee to hold social Media Companies accountable for illegal drug sales happening on their platforms. Does this have the support it does have the support of the white house and the d. O. J. And would love to have your continued efforts with this. Any comments on that . Dr. Murthy theres been an utter lack of accountability when it comes to how we have been addressing social media and our kids. You mentioned the use the platform is being used to expose our kids to drugs and other harmful content is one example of that. Yes, i would support measures to ensure there was more accountability for the platforms. Senator marshall the last thing we need to do is go back and study this and form committees and pray about this. We know social media is preying on our youth. We know it as surely as alcohol causes infant problems for moms as well. We know t we dont need to study this more. As black and white as you can make this what would be your recommendation to stop this from happening . If you own the social media company, why wouldnt you take the responsibility yourself . Why does it take an act of congress to do the right damn thing . What would you recommend they do . Dr. Murthy the company specifically . What i laid out in the advisory for the Tech Companies specifically, one it said, apply age appropriate design to their platforms so they are not exposing young kids to harmful content. Second, to be transparent with the Health Impacts of the data they are collecting so everybody can see how these platforms are impacting our kids health. The truth is, senator, the social media platforms have been around for nearly 20 years. If we are going to rely on them to fix this problem, i think we are waiting for something thats not going to happen. While they have made some efforts to put Safety Measures in place, its not nearly enough and its not happening fast enough. Senator marshall greed is a horrible thing. Using greed to take advantage of our youth is a horrible thing. I ask the social Media Companies to take selfaccountability and do something about 24. Dont wait for congress to do t they know what the right thing is to do. They have taken advantage of our youth. They are poisoning our youth. They are killing our youth. Dr. Murthy i would say when you and i have practiced medicine, and we prescribe medicines to people, patients, we have been able to generally tell them what the evidence is that something works or doesnt work. And what the evidence is around safety. I think its very reasonable for us to expect a company to demonstrate similar data to us so that it is apparentas parents we take that into account as we make decisions for our kids when to use social media and whether or not to use it. Chair sanders senator kaine. Senator kaine what an important hearing. My colleagues have asked a lot of good questions i was thinking about asking. I decided i would like to take my time to speak to any young person watching this hearing. Here in the room or watching it. Live or maybe watching it streamed. Young people feeling depressed about the future of the world, feeling hopeless has many causes. But to some degree you probably feel that way because you think adults have let you down. Climate change, gun violence, a couple people were killed in my hometown at a High School Graduation the other day. Both my kids graduate interested that building. My wife and i spoke in that building. Thats where we do all the graduations in richmond. Young peoples part of this sense of hopelessness is this feeling that adults have let us down. Whether on climate, guns, political polarization, or kids getting kicked around by adults for political purposes they feel marginalized. I look in my own life, i have a Social Security card. I look at my own life can i even remember what it was like to be a 5 to 18yearold . I want to tell you, i had the same feeling when i was 5 to 18 that the adults in the world were letting us down. I came home from kindergarten in november of 1963. I saw my mother crying for the first time in front of the television because j. F. K. Had been cincinnatied. You assassinated. I picked up the newspaper in 1968 and the news of m. L. K. Being assassinated. And june of 1968, r. F. K. Being assassinated. You saw protests about the vietnam war. You saw protests about civil rights issues. I was 16 when a president was forced to resign. Because of corruption. My formative life from 5 to 16 was a time of chaos. More Nuclear Weapon drills in the classroom. It was a time of chaos. There was a palpable feeling that i had and that a lot of my friends had that the adults in the world were letting us down. And that was a creator of confusion and anxiety and even depression. We werent so open about talking about Mental Health and stresses then, but i could just remember that feeling. But what i want to say to young people watching, dr. Murthy your focus on loneliness and isolation gets at something really important, young people have the power, young people have the power to change the reality if you ban together and to reduce some of the things that might make you feel hopeless or depressed right now. In all that have confusion i saw young people a little older than me, i wasnt i saw young people protesting against the war and helping lead to its end. I saw young people in the Civil Rights Movement helping battle to get Voting Rights done and civil rights laws passed. I saw young people who are now eligible to vote at age 18 becoming deeply engaged thated that led to improvements. That led congress to hold a president accountable for impeachable behavior forcing his resignation. The lessons i learned from 5 to 16 was, yeah, adults are screwing a lot of things up, and if we waited for adults to solve those things we would wait for a very long time. But when the young High Schoolers and college kids that i was looking up to as a younger person went and said we are not going to wait for adults to fix it, we are going to get engaged. When young people do that, young people change the direction of the country. I guess what i would like to say any young person watching this is you might not think you have the power to change the conditions that you find depressing. I think a lot of not even old enough to vote yet. Or what does one vote matter . The system is rigged so we dont matter. Our history shows the opposite. Things get worse when young people dont engage. Things get better when young people do engage. And not only do they get better in society, but the therapeutic value of linking arms with colleagues 20 bat to battle for improvements in violence or gun violence, that very act of forming Community Among young people has a positive impact not only on society but on ones sense of wellbeing. You have a purpose on the table right before you. If you look at us and you think we are not responsive to you, you can link arms and you can change the world and feel a lot better about the world that you are living in. With that, mr. Chair, i kwroeld back. Chair sanders thank you, senator kaine. Senator cassidy. Senator cassidy thank you, mr. Chair. In senator sanders opening questions, dr. Murthy, you suggested we have done a lot but need to do more. But mrs. Neas you made it clear we are on a trajectory to do more. Yes we put on these programs, you mentioned your Testimony School in louisiana thats very successfully instituted a medicaidbased clinic for those with Mental Health. And another one opening. And presumably another and another and another. Sometimes its the potential of that which is being realized which is more important to allow it to be realized than creating a whole new program. I say that, though, my question is, the programs we have put in place for example to help schools use medicaid to pay for services is that increasing in terms of implementation, do you suspect it will continue to increase . Secretar neas senator, thank you so much for that question. And we certainly hope that with this medicaid guide and new Technical Assistance center that will be announced shortly that we are going to make it easier for more and more School Districts to figure out how to access medicaid so they can do just the things that you are talking about. We have seen a number of great examples across the country of partnerships. We were just in delaware mr. Cassidy let me stop. I understand you have to use examples. What im asking is do you have the interest being shown to expand upon these examples to make this evan more widely useed . Secretar neas absolutely. Mr. Cassidy its being realized. Something which is not being realized and maybe you cant speak to it. But the bipartisan act passing because of republican support there is 1 billion for funding physical safety of schools. In one sense we are trying to address the front end. How do we keep kids from having a problem. We are also trying to address the back end. The kid does have a problem and comes in and tries to commit violence or someone else does. As far as i know the rules have districts how to implement physical hardening of their schools has only been promulgated in three different states. Why have those rules not been promulgated . This is what is allowed, to physically harden your school in case there is somebody who comes to commit violence. Why have they not been promulgated to all 50 states . Secretar neas thank you for that connection. The stronger connections grant that we at least the funds released in september and we are doing listening session was Key Stakeholders on what kinds of things they wanted to use those funds for. Our guidance that was put out in november and again revised this past march does help schools understand what are allowable activities. What we are hearing from mr. Cassidy being specific with my question. I called my superintendent that they are being told they could not use the money to physically harden the school. I spoke with the secretary and he said you correct that. Im told, maybe im wrong, that the direction kr ebgs that schools may use the money as congress intended, by the way, physically harden, was only promulgated in three states. Louisiana being one of them. Am i correct in that or wrong . Secretar neas start, im not aware my understanding from what we have heard from states that they have used these funds for things to increase the physical security of schools. Senator cassidy thats different from hardening. If i can ask can you get back with me on the ticks on the most updated information . Secretar neas. Senator cassidy its been suggested several times subject children to ridicule that can otherwise make them prone to these episodes of depression, etc. Im very concerned about the issue of dyslexia. Anyone that has a child stands up cant read in front of the class and ridiculed because she cant read understands that pain. There is a lot of money put out in these bills to help School Districts do catch up learning. I mentioned dyslexia because they are particularly vulnerable. Heres an article from the times from three days ago, schools receive billions in stimulus funds that may not be doing enough. Pandemic aid was supposed to help students recover from learning loss. Results have been mixed. It points out there is little guidance given to schools beyond you shall spend 20 of it. There are schools that have put in very good programs. Small, focused learning. Others that apparently have not. Any comments on that . And specifically whatwhat can we do now to get schools to use best practices as opposed to forfeitering dollars away . Secretar neas one of the key elements the federal special education lie is child find. One of the things that states have struggled with that we are working very closely with to address is making sure they are identifying and serving any eligible child. Certainly students who have dyslexia are among those kids that we want senator cassidy it does not appear they were universally adopted. Secretar neas correct. We are working on specific guidance on these specific issues so that states can fully understand what their responsibilities are so they can make that we can have a different situation. Chair sanders senator hassan. Senator hassan thanks to our witnesses not only for being here today but the work that you do. I just want to start by following up a little bit on what senator kaine was talking about. I think we all have been hearing from constituents about concerns about Mental Health and childrens Mental Health. I will tell you that in the spring of 2021 when schools in New Hampshire began to reopen more fully i went and visited in one of my local School Districts with a mix of students and teachers and administrators, students from first grade all the way through high school. I was struck towards the end of the discussion when we had been talking about how kids were doing, how their families were doing, what the schedule in school felt like, did they feel they were keeping up with their learning, how the year had been when a girl who must have been 10 turned to me and said senator, what are you doing about Mental Health . And i had been dancing around it. Im from a generation where we didnt talk about Mental Health in the same way we talked about socalled physical health. Then recently another one of my constituents, an 18yearold, raised a question about Mental Health. She was driving with a friend one day and the friend had a panic attack. And she didnt know what to do. So now shes working to help students get that kind of understanding for Mental Health first aid what can kids do to help each other in these moments where they need to be supported and until they can get professional help. I also want to encourage young people to know that when you speak up, your representatives hear it and we are doing our best to listen. We are trying to make progress. I want to ask a couple of questions to our witnesses about some of the progress we have made. Sometimes it doesnt seem enough, fast enough. But it is really important to understand the Building Blocks that maybe are in place. Let me start with a question to dr. Murthy. I enjoyed our discussion in our Office Yesterday and my team appreciated it very much, too. Last year my colleague, senator earnsth ernst and i had the standup act passed into law. Its law that helps ensure schools are using Suicide Prevention policies that are evidencebased. Dr. Murthy, why is it important for schools to adopt policies that are evidencebased. Senator cassidy was talking about our schools using the resources we are giving them in the right way. Why is it important that they are evidencebased especially given the increase in Mental Health our youths face from social media . Dr. Murthy thank you, senator. That story will remain with me. Specifically to your question. Having evidencebased process is important because sometimes even with the best of intentions our programs do not have the desired effect. Either in terms of extended impact or in terms of who who they are impacting. The other piece is that sometimes when we Study Programs we realize there may be unintended consequences of those programs t may help in some areas. Harm in others. That point of studying these programs and making sure people know what the evidence tells us the program where they invest resources, time, and effort they can do it. And programs have greater consequence will actually help. Senator hassan let me ask a question to you mrs. Neas. This is another example out of New Hampshire. Our university of New Hampshire at manchester, our Biggest School district in New Hampshire, they are leveraging funds from the bipartisan Safer Communities act to train and place 80 graduate students study social work in high school in high needs schools. High schools and elementary and middle schools. These graduate students will benefit from a yearlong internship with on the job training while you public School Students receive needed services. Mrs. Neas, in addition to this example from my state, what other innovative local solutions are you seeing School Districts deploy to address the Health Personnel shortage . Mrs. Neas one of my favorite questions. We have seen some really innovative things across the country. We were just in a school in delaware where the Childrens Hospital runs a clinic thats on the campus of the school. The majority of these children in this Elementary School are homeless and live in nearby shelters. The year before this they had more than 1,000 incidences of disruptive behavior that resulted in suspenses. Now there are virtually none. Its a great partnership. The hospital staff does all the billing. And the School Provides the physical space. What the principal said to me what keeps you up at night . He said learning loss. He say we have the support for kids and the teachers dont have to be both therapist and teacher. And that the staff there help teachers figure out how to get through the day to support kids so that they are emotionally ok and learning. I think thats one of the greatest things that we are seeing that partnership between educators and Mental Health providers on behalf of children where children are. Senator hassan thank you, mr. Chair. I have some other questions, too, including the importance of providing services in summer programs and camps which is something i think ill follow up with our witnesses on. Lastly again, young people watching, this hearing probably wouldnt be happening if young people hadnt been speaking up. Thank you all very much for that. Chair sanders senator. Thank you, chair sanders, Ranking Member cassidy. Thanks so much to both of you for being here. When i was in a sophomore in college, i was really struggling. And i, thanks to my roommate, who recognized some of the signals and signs of somebody dealing with depression, she suggested that i go to a School Counselor at my university. Man, that made a huge difference. I dont think i would have done that on my own. Can i see now that i was struggling also in high school. But having access to that care in my School Setting made a huge difference. The barriers and stigma i would have experienced were stripped away. And i share this story often, especially with young people, because i can see them kind of go, finally, somebody is being real about this with me. Senator smith this is one of the reasons why i have been so focused on expanding access to schoolbased care. Mrs. Neas im really excited about the support that we have put behind schoolbased servicings. I have heard from places in minnesota where we are doing this. Especially in places,ing this something i have been working on, helping schools partner with communitybased organizations to get those services in schools. It makes a huge difference. But heres the thing, in minnesota, we are gogetters. All of this money, three Higher Education institutions focus on training. One School District has pursued this so far. So can you talk to us a little bit about i have the feeling we are constantly putting grant opportunities in front of School Districts. Some, especially rural districts, do not have the capacity to even know about these opportunities, let alone act on them. Could you talk a little bit about that issue and how we are putting resources out there that is actually not that accessible to a lot of schools. Mrs. Neas thank you for that question. We hear that all the time about capacity. This especially small districts not able to write for these opportunities. Its one of the many motivators to our medicaid work where we are really trying hard to make it possible for people that are in schools to work with their Medicaid Agency so that we literally have lots of kids, half the kids in our Public Schools are eligible for medicaid. If we can help schools figure out how to recoup some of those payments they can sustain things. They dont have to write a grant. Again we know the 21 states that have access to the rule thats resulting in almost 6 billion of revenue to schools for services they want to provide. And that, to me, how do we we need the more people. The people who need to train more people. Thats something that you can do with grants. I want this to be sustainable. Long term. For small School Districts to not be left out of that. Thats really what we hope the guidance and our efforts to shine a light on this opportunity that we can have more of that happen. Senator smith how many states did you say are participating . Mrs. Neas 21. Senator smith less than half. Thats the governor and legislature. Thats another problem we have. In someplaces there is opportunity and someplaces there are not based on the calculations that state leaders have. Vice admiral im used to calling you you and i have had terrific conversations. Im so grateful for your leadership on issues of social isolation both for our elders as well as for young people. I have had people say to me, tina, you cant legislate away loneliness. You have done research that really shows how we can think about this as a social determinant of Peoples Health and could make a difference. Could you speak briefly to that. Dr. Murthy absolutely. I agree you cant legislate away loneliness. I dont think thats the solution here. Government can take steps to help Community Organizations. We are we also need Community Organizations, families, individuals to recognize that this is an important priority for all of us. I worry that we have become a lonely and disconnected nation. That has massive consequences for our Mental Health, physical health, for economic prosperity, for our ability to pull together in the face of adversity whether thats the pandemic or another hardship. And for all of those reasons i believe that addressing loneliness is a strategic and critical priority for our country. Its something i think we can do. People that give me the most faith we can do that are young people. When i talk to them around the country they are not waiting for others to step in. They are building programs at their schools to help connect one another. They are reaching out to support each other. They are talking more openly about Mental Health and issues like loneliness than any prior generation. I think their leadership will be vital in us addressing this challenge. Senator smith thank you, mr. Chair. Chair sanders senator murkowski. Senator murkowski thank you for the hearing. Its somewhat telling that with everything that is happening this morning there is a significant overflow room just down the hall. I have been back and forth between a couple Different Committee hearings this morning. And there continues to be a line of young people, of young people trying to get into this committee hearing. So i stop and talk to them. Why are you standing in this line today . Why is it important to you . And one of the young men said its personally important to me. Im curious to know as a young immigrant, the intersection services that are available for those in from other areas. Another one indicated that she was interested in education, she wanted to understand more how people who had had adverse incidents in their lives as young kids, as she had, what more support could be provided in schools. Young people are paying attention to this as an issue. They are paying attention to what we as legislators do. I listened to some of my colleagues, yeah, we cant legislate loneliness going away. Its hard enough. How do you legislate against bullying. How do we do the reach out. I appreciated your comments to senator tuberville when he mentioned as a coach he interacted directly with these young people. Your comment that you sat down at round tables with students, particularly student athletes. What more are we doing to ask young people what the solutions are . We had a hearing in this Committee Last year on youth Mental Health. We invited an extraordinary Young Alaskan by the name of claire. I think claire at the time was 19. She gave testimony and presented the youth perspective and what she had done as one individual that had gone through a real crisis what she had done within her School Community to engage more. And i remember claires story and how strong she was in sharing that with us. What are we doing to ask the young people what we can do to help . Ill throw that to you, Surgeon General. Dr. Murthy thanks so much. I am looking forward to coming to alaska. I first came to alaska when you and i met there in 2016. That was an opportunity. We did a lot of round tables, including with young people. The goal was to understand how they are being impacted by Substance Abuse disorders and broadly by the Mental Health concerns to involve young people, there are a few things we have to do and doing more and more of. We have to bring young people to the table to understand and hear their concerns and go to where they are. So part of what my office has been doing is having round tables with young people in committees across the country. The second thing we have to do senator murkowski can i step you there. It takes extraordinary strength for a young person to say i want to be part of this public engagement. The ones that are really hurting are the one that is are just struggling to get up out of bed that morning much less go to a round table. How do we get them . Dr. Murthy thats right. Thats why we are also is recognizing that its not easy for them to come to the tables to be opened. Its easier often when they are doing that with folks they know, they trust, trust an institution and organization. We are also working with faith organizations, with universities, and others to help them pull round table listening sessions together with young people to create opportunities for them to get in they dont necessarily get involved in a round table and may comment on a survey and share their input atphopl mustily. We want to give as many chances as possible for young people. We are encouraging mayors and institutions i mentioned to formulate their plans. My believe is we want to do something that will help young people here, we need them at the table throughout the process. Before we develop the solution, as we work on execution, and when we do evaluation to understand whether its working or not. That is what we are encouraging localities to do, mayors, to nongovernmental organizations like ymcas, educational institutions and others. Senator, its not its not easy. It takes time, effort, and focus and continued attention. The easiest thing is to go into a closed room and come up with your own solutions and implement them. I dont think thats whats going to get us the best results. Senator murkowski agreed. Recognize we need to be doing more to be inclusive of these young people. Ill have a question for the record for you, mrs. Neas. This is relating to the fact that of the bipartisan communities act funding through the Mental Health services grant, professional demonstration Grant Programs apparently only 17 of these grants were awarded to rural districts. Im trying to understand what more we can be doing to make sure that these grant resources are going out to all areas of the country, including rural. Thank you. Chair sanders thank you very much. Thank you, mr. Chairman. In june we celebrate pride. Its a time for folks to gather and lift up and celebrate lgbtq americans, the movement for the fight for equality. And we also reflect upon the challenges. There is an intersection of our conversation here. Its already come up a little bit. With the Mental Health crisis that kids are facing, from data last year, 45 of lgbtq youth reported that they had considered attempting suicide. Senator baldwin 45 . Youth who live in communities that are not particularly accepting, or families that arent particularly accepting report higher rates of attempting suicide. Im going to note and maybe we can introduce it for the record, there was an article last weekend in the New York Times about death investigations. And the fact we dont have complete after suicides we dont have complete information because oftentimes they dont ask the questions about Sexual Orientation or gender identity. But in utah they are. It was a fascinating piece that we should have as part of the record. Thats data we are lacking. At the same time we are celebrating pride month, we are witnessing in america a Staggering Number of pieces of legislation at the state level that are described as antilgbtq bills. 491 reported so far this year. At the state and local level, school board level, we see a lot of additional activity. I dont have numbers on that. Its rampant. I wonder, again, what the impact of that is on Mental Health of members of the lgbtq community. I want to get to a question. We are talking about offering support in schools, but i want to also think of other gateways where people come in and get help. I was proud to cosponsor the bill that brought us the 988 Suicide Prevention hotline. It was made it became operational last summer. The ability was that with that technology to provide more customized service. I know first thing people are asked are you a veteran. If so youll get your Mental Health services you choose from the v. A. But we along with Susan Collins we have provided funding for a Pilot Program in 988 for offering specialized support for people who call and text or chat on 988 who are identifying as lgbtq. How do we use we have School Boards schoolbased Mental Health in some cases, but how do we use a gateway like 988 to provide better support for, in particular, our lgbtq population . Dr. Murthy senator, thank you for your leadership on 988. Its a topic that i talk about often when i travel around the country. I cant tell you how many faces i have seen turn from worry to look of relief when they know there is some help available immediately when they or their child are in a crisis. Its already making a difference. Do i want to say to the lgbtq, i agree we need to look for more ways to ensure that they know help is available for them. School is a natural place. 988 is a place where early on if we can signal to young people that this is a place where you can get assistance, where people will understand how your you unique circumstance and background, i think is essential. I also think that, i say this as a doctor, father, i believe that every child deserves to know they matter, regardless of what their background is. The reason my parents came to america many years ago was because they wanted my sister and me to grow up in a country where we knew that just because we had a different color of our skin or name spoupbded funny or background is different it didnt mean we mattered any less than any other child. Thats what we aspire to as a country. We may not have always gotten there, will you but thats a place where need to do more to make them feel mattered and valued. Too many tell me they often dont feel that way. They often feel left out or bullied or attacked. I would urge leader, whether elected leaders, whether they are leaders in the community to include lgbtq youth at the table where they are listening to what communities have to say and physically reach out to them to understand their perspective and life experience. I just learned as a doctor of the year sitting with patients, very different backgrounds, and listening and learning to them there is nothing that replaces facetoface contact with people. Listening to someones story. And it shifts how we think about issues. That could not be more important now because too many of our lgbtq youth are struggling. You see in the suicide rates. To me that is a five alarm fire we are dealing with. Senator baldwin i have several questions for the record. Since i have run out of time. I thank our witnesses. Chair sanders thank you very much, snarled baldwin senator baldwin. Let me thank the panelists for what i think is an extraordinarily interesting hearing on the subject that i think everybody here recognizes is of enormous consequence to this country. I just want to take a few seconds to make this point. I think we are all proud of the accomplishments that we have made. We want to tout them. But there is another reality and i want you to tell me what im missing here if anything. If 85 million americans are uninsured or underinsured, and if we have the scarcity of Mental Health providers in this country, am i missing something in suggesting that the tens of millions of people, people call my office, aim sure they call other offices, by husband my husbands in desperate shape. I cant find the help. We cant afford the help. And on top of that, correct me film wrong, i think as a result of the ending of the Public Health emergency, some 17 Million People are going to be dropped there the medicaid rolee medicaid roles s that correct . Mrs. Neas i know its a large number. Chair sanders yes. We want to take pride in what we have accomplished. Lets not kid ourselves. We have to move dramatically if we are serious about protecting the Mental Health and helping people in this country. There is a lot of work that has to be done. With that, give mike to senator cassidy. Senator cassidy my closing 30 seconds i want to emphasize three things. Senator kaine speaking about how young people can be the drivers of change. Senator murkowski speaking about how folks are lined up and are young. Looking at the audience here, you are young. I suspect those watching on tv are young. Dr. Murthy saying we cant leave it up to government, but we also need individual action. My appeal is all the young people who rightly have a concern about this, you are the ones who can introduce people to this hotline set up by senator baldwin. You are the one that can advise as senators were advised to seek help. We can only do so much. You all can do more than we. I just finish by echoing wonderful comments from my colleagues. Chair sanders for the witnesses, thank you very, very much. Its the end of our first panel. Well begin the second panel in a moment. Thank you. [captions Copyright National cable satellite corp. 2023] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy visit ncicap. Org] chair sanders thank you very much for being here. We are going to continue this discussion on this issue of enormous concern to the american people. Senator murphy was going to introduce russell tucker, unfortunately he is detained. Let me begin by introducing her. Mrs. Russelltucker was appointed commissioner of the Connecticut Department of education in 2021. Previously she served as chief operating officer, division chief for the Departments Office of student supports and organizational effectiveness. Mrs. Russelltucker thanks for being with us. Mrs. Russelltucker thank you. Good morning, chairman sanders, Ranking Member cassidy, and members of the Senate Committee on health, education, labor, and pension. I am charlene russelltucker commissioner of education in connecticut. I give you information on youth Mental Health crisis and connecticuts response to support the needs for students. My big goal is to ensure every Connecticut School has a coordinated and sustainable system of care to provide comprehensive Mental Health supports and services to all students and school staff. The Surgeon General mentioned in a survey of connecticut High School Students confirmed our students face unprecedented Mental Health challenges. Too many for students reported having felt sad or hopeless. And that their Mental Health was not good. Most or all of the time. Most concerning is that 14 said they seriously considered suicide. And 6 actually attempted suicide. These data highlight the immense needs for Student Wellness and urgency for action at federal, state, and local levels. Effective solutions require teams of stakeholders khrg policymakers, community leaders, parents, families, educators and students. I would like to say it cant be about them without them. The commissioners round table for family and Community Engagement in education, the diverse constituent group of stakeholders representing school staff, advocates, parents, and guardians, community leaders, and students to advise me on policy and priorities. Connecticut Student Voice for change Program Allows High School Students to propose projects utilizing state funds. Notably 80 of student proposals focused on Mental Health. Using their voice to advocate for Mental Health support for their peers. They spoke and we are listening. Our Behavior Health pilot established a system of coordinated care for schools in seven districts. One pilot School District identified 250 students at risk of suicide that was able to provide kreutal and Immediate Responses. Our states mobile Crisis Intervention Services delivers a range of Crisis Response and Stabilization Services to youth and families. Simply calling 911 or 988 immediately dispatched clinicians to schools or 234 eu where a child is in crisis. The Surgeon General report of loneliness underscores the importance of engagement. Our government learning engagement and Attendance Program is a researchbased Home Visit Initiative that improves attendance, feelings of belonging and familyschool relationships. Additionally we invested 33 billion in funding in a multiyear summer enraeufpment grant program. Prioritizing communities, disproportionately impacted by the pandemic. Programs place a strong focus on peer relationship. Run an academic acceleration during the summer. In the first year this program connected more than 108,000 students with enrichment opportunities. The department invested 2. 2 million funds for grants to support new partners in underserved communities in designing innovative, high quality afterschool programs to address students academic and Mental Health needs. Mental health is a bipartisan priority. Including addressing work force shortages. The governor and our General Assembly directed 100 million for multiagency Mental Health initiatives. Including 28 million for Mental Health professionals in schools. Multistate agencies are working together to expand the razorbacks of ranks of chloroquine nichials to increase Mental Health needs. Additionally when School Districts have leveraged over 183 million of local funds for students and staff. We are committed to funding and sustaining what works. We also invested funds to establish a groundbreaking collaborative that brings together University Researchers to conduct rick russ evaluations of the many new programs and initiatives thats on the way in our states to ensure programs and investments are achieving results. Thank you for modeling bipartisan National Discourse that will need to enhance access to needed services and ultimately improved academic access supports and outcomes for young people. Thank you very much. Im happy to take your questions. Chair sanders thank you very much. We are going to jump over dr. Garcia for a second. We are going to dr. Joy osofsky who will be introduced by senator cassidy. Senator cassidy its a joy to introduce dr. Joy. A developmental psychologist and National Leader in Early Childhood development. I learned a lot from her. Shes who taught me you can ob gyn picking up separation disorder from day zero, which is amazing. She was very the Mental Health reform bill of 2016. I owe a lot to her. She has expertise in trauma informed care. Helped many louisiana families recover from Hurricane Katrina. And apply that expertise during the covid19 pandemic. She received numerous awards and recognition for her work. Dr. Osofsky, thank you for being here. Dr. Osofsky thank you very much, senator cassidy, for the invitation and senator sanders. I very much appreciate being here. One of the things i want to say in introducing my testimony is how important the opportunity has been for me. Actually together with my husband who is a psychiatrist, to be able to consult with senator cassidy on Mental Health issues. To identify and support community and state agencies that work individually and collaboratively in supporting the Mental Health needs of children and families, including cross state efforts. We started this in 2016. We have been pleased to support his efforts to increase Mental Health support in schools and in communities. And we didnt talk about communities and i think we need to integrate that in the conversation we have now. It would expand communitybased Mental Health services and meltal Health Care Services in schools and communities both raourlt and urban areas. We know in rural areas its much harder to access Mental Health services in general. The efforts of funding also for the National Child Traumatic Stress network to improve training, treatment, and services for children, adolescence, and families who experienced trauma. I have been fortunate enough to work with the National Network being funded since 2003 to develop Mental Health collaboration with schools and communities. And our latest effort, and i think one that is very much reflective of the direction of the National Network has been to not just work in one community but develop Regional Coalition sews that we scrub the work that we do. The efforts each of us make in working with children who have been traumatized in different ways and experienced trauma to be able to share that knowledge with other communities. For example, and it actually happened to be quite fortunate during the covid pandemic, we a fellow in the network that just ended, Disaster Coalition for child and family resilience. Through that coalition we felt we built regional relationships across states. One in the gulf south where we already had relationships due to the disasters, Hurricane Katrina and the gulf oil spill. In the northeast region of the United States across five states. AntiRegional Coalitions are and the Regional Coalitions are composed of people of all different backgrounds, state agencies, education agencies, stakeholders in the community, people who are involved in policy. We had some politicians involved. So that we are able to share information across the different groups for much better preparedness as we share information response and then recovery when a disaster of any type occurs, not just a natural or psychological disaster, but also a terrorist attack or shooting that has occurred in a community or shooting thats occurred in schools. That we can share information. Have Immediate Response to those situations. I really feel that the work of the National Child network speaks to some of the issues that has already come up in terms of integrating across community, innovative ways to provide Mental Health services in way that is would be quite acceptable. The other thing i want to bring up that has not been discussed is the importance of how to support resilience. How to support resilience in children and how to support resilience in families. Certainly we have seen families being pressed immeasurably during the covid pandemic. Indefinite information, everything changed all the time. Indefinite uncertainty. We didnt know what was going to happen from one day to the next. How the family come together and how can a School System or Community Come together when you dont know how things are going to change from daytoday. The issue came up how to communicate. Thats why theres been excellent exit interviews of social media as a way to connect. We were told we couldnt be around people. How can children relate to their friends . How can one have a sense of family if you cant see people and relate to them . I think that its really very important for us to think about how to establish connections across families and connections across communities. One of them, i see im about to time, i was going to give you a brief example how we brought together families and children after Hurricane Katrina on some of the cruiseships that housed people that did not have housing and how we worked together. Including Mental Health as way of just being there. Thats something we have to think about also as supporting parents to be able to be there and listen to their children and give support to their parents. Thank you very much. Chair sanders thank you. Our next witness is dr. Joshua garcia. Dr. Garcia is the superintendent of the tacoma, washington, School District. He previously served as deputy superintendent, assistant superintendent, high school principal, assistant principal, as well as director and teacher. Other than that not much. Thank you for being with us. Dr. Garcia chairman sanders, Ranking Member cass tkeurbgs members of the committee. I am proud superintendent tacoma School District and honored to share the viewpoint of superintendents for this important hearing focused on Mental Health of our nations youth and speak with you about what we observed, doing, what what we might do together to curb the meant at health crisis. Tacoma is fully committed to each of our students being safe, engaged, supported, healthy and challenged. We recognize mental hell impacts us all Mental Health impacts us all. It affects how we think and act t helps us determine how we handle stress, relate to others, and make healthy choices. During highly critical phase of development the lack of support and comprehensive approaches are significantly impacting our students ability to go socially, emotionally, and academic development. Tacoma Public Schools more than 28,000 students represent 170 tribes and ethnicities. Over 2,000 of our students qualify as homeless. Over 55 qualify as low income. 15 qualify for special education students. In the 20112012 school year each 6 our high schools was labeled as a dropout tpabgtory we were in a dire state. We started the tacoma hield initiative. An action plan that recognizes students are learning 24 hours a day, seven days a week. Fast forward to 2022, 90. 2 of our students graduate in four years. 86. 7 of our high schools take collegelevel classes this year alone over 12,000 participants in kindergarten to eighth grade have engaged in after school activity. A Record Number of High School Students are participating a in page opportunity experience. We know the challenges that our students are facing are only growing. In the last year our students, tony, angel, marko, and others have been shot in our community. Our students have to survive human trafficking, battle homelessness, drug abuse, physical and mental abuse, and social media harassment and bullying. While these may not be new to us as a nation, the speed of the incidences antiTraumatic Stress are and the Traumatic Stress are increasing. Like you and i they are being bombarded with experiences. Unlike us, they are doing this without fully developed brains. Coping skills or access to preventive and therapeutic services. In 2021, 13,239 of our 10th grade yours in our states made a plan for suicide. As you heard, Washington State is not unique. Our students are facing tremendous challenges, and schools cant do this work alone. We have moved away from episodic events to Sustainable Practices across our buildings and communities. They are focused on three elements, Prevention Strategies, response strategies, and therapeutic services. Our Prevention Strategies, each of our schools develop an intentional plan to support emotional learning. They contextualize each plan at each site. Our students are engaged in physical and Mental Wellness supports during the day and after school ecosystem. We do a shared business model. Community assets, business supports, and funding with over 70 partners. Our system of positive behavioral supports ensure students understand school expectation, fostering stable and reinforcingsing reenforcing Mental Health habits. Our responsive strategies we have invested in professional development. We support and train, facilitate practice with intentional hearing and understanding. We provide peer support. And intensive supports for student at risks. The department of Education Credits we were able to invest in therapeutic supports. T. P. S. Is not able alone to meet the needs. To meet this challenge we are implementing a plan to increase the ratio of students to Mental Health providers. Heres a fuhr things i encourage us to think about doing together. Expand on the bipartisan Safer Communities task. I now budget decisions are tough. With the message students are telling us we have to listen to. Pay for Health Care Services with Health Care Dollars to ensure medicaid access. Incentivize the Health Care Industry to partner with schools. Prioritizing youths first. Build on categorical funding opportunities. Increase flexibility. With the support for the carl perkins and department of labor grants to build hope. Require states to match your investment. Has tacoma done everything we do . Not yet. We are making a difference. We have evidence. We know through engage. Our students are being more successful dealing with individual emotions and stresses. Developing their social awareness and working academically at all times. Finally, america schools and individual communities cant do this alone. We must work through partnership. We know its not easy. There are egos. However we are in this together. We may not be united on everything, but our future is with us now and we must be united in our commitment to senator sanders let me begin the questioning. Ms. Russell tucker, you mentioned summer programs and after school programs. One of the things that we have to give young people a lot of positive communitybased activity. Can you talk about the impact increased funding for after school and summer programs has had in connecticut . Ms. Russelltucker i appreciate that question because it is an important piece of the work that we have been doing. Under our funding, we received 11 million summer enrichment and added more funding for the subsequent summers now up to 33 million around summer enrichment. We try to get students back together back with their peers and work while they are having a good time with each other. Enrichment is so important. We have evaluated the impact of that, 1088,000 students. We are in summer number 3 and we are making sure we know what happens. Senator sanders you would Like Congress to continue that funding . It is important we are funding what works and evaluating the impact of those. E want to treat the millions of young people who are struggling and challenge them and bring them together and have proactive activities. You are challenging young people and providing Job Opportunities among other things. Talk about the importance of treating young people with respect and allowing them to use their energies in productive ways . Dr. Garcia its important that each community has the opportunity to see what responsible looks like and thats what our plans doing. Giving Student Voice to that conversation and they bring family voice. Each of our plans is published. Senator Sanders Young people are involved in the development of their plans . Dr. Garcia it looks different in a classroom than in the lunch room. And we have to build community through a common language. We bring respect and what does that look like in the afterschool world and what are the activities they want to participate in. It is an intentional effort to Bring Community together. But that is across. Empeurm t of people. Has an impact. Dr. Garcia students have asked me and said josh stop asking us opinions and bringing others asking our opinion if the adults arent going to do anything. We bring data around. Student voice at our board meetings. Students will vote with their feet, if you will. Extra curricular, not what the adults wants to offer but what they want to participate in. They want to know the activity. We survey their interests regularly. Senator sanders let me ask dr. Osofsky a question, what impact, you walked through the streets of washington this morning and breathed the air, young people worry about Climate Change, gun violence, they worry about gun violence. Louisiana, vermont. What impact does all of that and more have in indefinite uncertainty about worrying about the future, from an environmental, climate point of view. Dr. Osofsky i struggle with this in the Mental Health world. What children need of all ages growing up, they need to have schedules and have routines and know whats expected. Having a schedule of knowing when they get up in the morning and go to school and who is going to pick them up and what their activity might be. With the covid pandemic that changed continually. One of the things we recommended is set a new schedule, have the children involved in setting the schedule is so there is something predictable and went on in that way and tried to support the parents, too. Parents didnt have a schedule either. Instead of getting up and going to work and doing whatever, they were having to balance that with educating their children if they were fortunate to have internet and every day that changed as well for them. The other thing that is important for the young people is their peers. For the younger children to play with them to the older children, it gets more complicated, as i mentioned contributes but its very, very important, for school is open again and for there to be a schedule and things that children can count on to be able to move forward. I wanted to make a comment about involvement of youth. After there was so much destruction with Hurricane Katrina there were a lot of teenagers on the streets because there was nothing there. There were no activities. We solved them with recovery and the teachers who didnt have classrooms in schools, they involved with recovery. The teenagers instead of being in trouble were able to contribute in positive ways. Senator sanders senator cassidy. Senator cassidy do schools share information between parents and teachers cutting parents out of their childs life. What do you say about the role students who are going through traumatic experiences . Dr. Osofsky that is an important issue because we know the Important Role that parents play, to be there for them, to listen, advise them and be a part of their life. One of the studies done by covid sent out information to families, different backgrounds, racial groups and asked them to have their children talk about what is important during covid and whats going to help them. Number one was the parent was the hero and keep them safe and that was so important to them. From the Mental Health point of view, if the parents can be emotionally available not just being there and being involved with their activities, that is important and will know when things are happening before the school will know. But that collaboration is very important. But parents play a key role in supporting Mental Health of their children. Signifi cant dollars were put forward for teleMental Health. Is there a role to be in School Settings . Dr. Osofsky it does work well for adolescents. They are more used to that. And it is a way to stay in contact, we are very pleased they allowed Mental Health to be done during the pandemic. For younger children it can be challenging. But we found it to be very successful in working with teenagers and hope that will continue. Senator cassidy here you speak today that suddenly occurred to me the people that decided to lock down our economy had the nobel call but ended up in increasing isolation. Did they have children psychologists to do a cost benefit ratio, if we lock down we are going to have x amount available . Dr. Osofsky i dont know about that process. Certainly we were communicating, a number of us and talking about it and i recall almost every time i did an interview i recall an interview with n. P. R. Reporter who had two children and he talked to me how can i support my children under this circumstance . They cant see their grandparents. The holiday was coming and very important. Telecommunication was really helpful. But im not sure whether they did consult. Senator cassidy it wasnt it was predictable that when children were isolated they would have some of the problems that we now see, is it a fair statement . Dr. Osofsky it is. It is clear in families where they had more resources and work remotely and get help and separate learning areas. They wouldnt have to be afraid from covid. Many families with resources were able to do that. For fewer resources, including learning over time and catching up where many of these children have problem. Senator cassidy face time with my eight years old. You mentioned teleMental Health works and younger child wants to hit a button. We will be asked to support these programs in school. At what point just a little boy who has a. D. D. . Dr. Osofsky what we call children about eight years old and older, we found earlier, they were able to Pay Attention earlier. Senator cassidy boy and girls . Dr. Osofsky we didnt see differences. That age and older were going pretty well. But we provided Mental Health services. I think are the ones, we work with with very Young Children under the age of five. If the parents are working with them and thats a combination, not just the Mental Health person, its working with the parent together and then the parent learns how to support the child. We are finding now even in person certainly virtual involving parents even with teenagers and older children its very important to support them. Senator sanders senator markey. Senator markey i want to make a comment about transyouth what mentioned senator baldin. State legislatures have passed 75 bills and blocking transgender care. Drag shows have been attacked and local clinics are installing security systems. Declare it a National State of emergency for lgbtq americans and discriminatory actions and statements by elected officials at every level of government up to the fire and making the youth Mental Health crisis worse. Passing bills into law is a tough process but what is easy to give people the freedom to be themselves. Do not use hatefilled rhetoric to score political points and we need to do it during pride week and i see this as a huge problem in our country. I want to turn to issues that obviously the Surgeon General was addressing but you are on the front lines. One in three teenaged girls. Contemplated. Suicide. Lgbtq one in five lgbtq attempted suicide. We know exacerbated by the tech and the role they are playing in the lives of these children in our country because its just unregulated in terms of what it can do to teenagers. No protections, no safeguards. They collect an avalanche of personal information and use it up to send back an endless stream of toxic content into the minds of young people in our society and the results are clear, more money for big tech, more pain for kids and teenagers. We know that instagram, facebook, tiktok. So we have to take action. We know they are collecting information and sending it back that puts forward financial interests of these companies. My question as Ranking Member castedy and i introduced a piece of legislation to create an Online Privacy bill of rights. There is a law on the books for 12 and under. But no law for 13 girls who have bolemia. I want to get your comments. The bill would ban targeted ads to children and teens. Two, it would establish a youth marketing and Privacy Division at the federal trade commission and three, it would limit the collection of children and teens personal information and it would actually say to parents you have the right to the companies erase this stuff you have gathered about my child. Would you support that legislation so the parents and kids have protections against big tech . Than k you for the background and information and it is important recognizing the impacts. I believe hearing the voices and youth voices are a part of what is proposed and hear from the voices including families. And ultimately the he proposal being made. I will be looking at that very closely to get a sense of all that being proposed. Senator markey do you believe children and teens need an online bill of rights . Dr. Garcia yes, i do. I was struck by the comments this morning and that we require companies to give them suicide information. We could require to push that information to them as well. Senator markey what about up front putting the preventative action in place. So if the child is targeted, and do we need protections put in place . Dr. Garcia i would say yes. Dr. Osofsky i would agree with my two other panelists here. One of the things i was thinking about it doesnt in any way mitigate what i just said. We know for many of these youth thats how they make relationships, too. So if there was a way to be able to help support them at the same time we are protecting them i hope would be very important. Senator markey we know the big tech plays a big role. So we are urgently in need of passing comprehensive legislation. A. I. That we are discussing right now is on steroids. Big Companies Target children. We have to put the protections in place and if we dont do that, we wont be able to protect children. Senator. Parents role. Im going to turn to mrs. Russelltucker. I served on a School Board Many years ago. Didnt have the issues that we now contend with. Its a lot different now than then. Parents were the primary stakeholder on any issue and disciplinary one. In your testimony you list in terms on the Mental Health issue, the stakeholders, the office of the governor, state board of agencies. And families, students, advocates, policy patriotickers, local Health Officials and more. I tried to get out of the secretary who the main stakeholder should be and could not get parents out of his mouth the first time. After the Virginia Election and was made an issue there. He did say that parents should be a stakeholder, not the primary. When we are talking about Mental Health, there is a list and but i would think in any of these issues, the parents ought to be the primary and Everything Else ancillary. Would you agree with parents being the primary and all these other ancillary or do you have a different way of saying what you are meaning what you said there . Ms. Russelltucker i have long recognized the value and parent voice in everything we do in education. It is important that they are at the table and they are a stakeholder and Family Engagements round table that i mentioned is doing just that. They worked together through their voices to define what Family Engagement means in connecticut. They are important. Every time we have a policy that their voices are there at the table so we can hear their perspective. So they are mr. Braun are they consulted with getting them first or just part of the group . Ms. Russelltucker i know for a lot of the initiatives they have in this state they are consulted and provide consent for services. So in that case of health, they are very much key and there to make decisions around chair. Dr. Garcia in Washington State, students can Access Services without family consent. Would you say they are the primary and not just part of it . Dr. Garcia what i have experienced is family in different spots. Recognition is that families are not in a place where they are able to be at the table for work, a variety of issues. Its not the luxury. You consider them the primary. Another question, over the years we spent billions on the issue and then like each panelist we have a minute and a half here, do you think we have implemented what we have already put into law and the money we devoted to it properly . Do you think that has been done in a way that would justify more . Do we need to do better at that and what is at stake with maybe being able to do that better. Give it 30, 40 seconds and move on down the panel. Ms. Russelltucker we know what works. We implement we must know the results and impact and state level you can see in my testimony. Yes or no and federal programs, you think we have implemented as good as it needs to be . Ther e is always room for improvement. Dr. Garcia i would require states to match your investment and Funding Direct streams are important and competing for grants are oftentimes problematic. I would encourage us how to direct to build on sustainability. Dr. Osofsky i believe very strongly that the investment at least one program that i am involved with and National Child Traumatic Stress network. We focus on trauma and how to help children and there has been creative ways to spread what we learn and address the issues that we are concerned about with children. So that money has been very well spent. Senator sanders that concludes our hearing today and i thank all three of our witnesses for their excellent presentations. Questions for the record will be due in 10 business days. I ask unanimous consent to enter into the record five statements from stakeholders outlining youth Mental Health priorities. That will take place and the committee stands adjourned. [captions Copyright National cable satellite corp. 2023] captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org. Brightish Prime Minister is meeting with President Biden to discuss u. S. U. K. 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