About a quarter of Tennessee’s children suffer from mental, emotional, developmental or behavioral disorders, according to a new report. 

The Tennessee Commission on Children and Youth on Tuesday, Feb. 21, presented the report to the Tennessee General Assembly. It details the mental health challenges and access to treatment the state’s youngest residents face. 

“We have a very lofty mission for the agency and that’s to lead systems improvement for all children, youth and families through data-driven advocacy, education and collaboration,” Richard Kennedy, executive director of the commission, told legislators. 

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The 2022 State of the Child Report analyzes indicators of children’s well-being using social, educational, economic and health data. 

When it comes to ensuring youth who are struggling have access to treatment, Tennessee ranks 40th nationwide in access to care.

The state ranks 41st in youth mental health and 47th for youth with major depressive episodes who did not receive mental health services. 

“Youth in Tennessee have similar rates of prevalence of anxiety and depression as their counterparts across the nation,” said Kylie Graves, policy specialist with the commission. “But where we struggle is when those kids are struggling, getting them the help and services that they need to mitigate those negative impacts.”

Although youth mental health challenges were increasing prior to the pandemic, COVID exacerbated numerous issues. 

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The percentage of Tennessee’s adults ages 18-24 who experienced extended periods of poor mental health has increased over the last three years.

And although almost 90% of Tennessee’s young adults report having some form of health insurance, one in six reported delaying care because they could not afford to see a health care provider. 

Between March and October of 2020, emergency department visits for mental health concerns in Tennessee increased 24% for children aged 5-11 and 31% for children ages 12-17. 

A study comparing weekly ER visits in 2020, 2021 and January 2022 to 2019 found the pandemic appeared to be especially hard on girls’ mental health. 

Researchers found increased visits in 2020 for eating disorders and tic disorders among girls ages 12-17. In 2021, visits increased for depression, eating disorders, OCD and tic disorders. 

By 2022, visits for anxiety, trauma, stress, eating disorders, OCD and tic disorders had increased. 

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The study found the number of ER visits for eating disorders among adolescent girls doubled during the pandemic while visits for tic disorders tripled. 

In addition, the report shows dating violence increased. One in six Tennessee high school girls reported experiencing physical dating violence in the last year — nearly twice as high as the national rate. 

The report found violence was prevalent for Tennessee’s children, who were more likely to have been a victim of or a witness to violence than their peers in other states. 

Adverse Childhood Experiences, or ACEs, include being the victim of violence or witnessing violence, as well as experiencing the death of a parent, having a parent who spent time in jail, living with someone who suffers from mental illness, severe depression or substance use disorder and experiencing housing or food insecurity. 

Childhood adversity can significantly impact future health, social development, academic success and economic prosperity. 

“What we saw was that children in Tennessee reported a higher level of adversity than their counterparts across the nation, with 41% of Tennessee children having at least one adverse experience,” Graves said. “And we see a huge differential when you look at it through household income as well.”

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The report said one in three children below the poverty line had two or more adverse experiences. 

And Black children in Tennessee are nearly twice as likely as their white peers to have at least two adverse experiences. 

Graves said building resilience is key to mitigating some of the negative impacts of adverse experiences. One way to do that is by providing neighborhood amenities — such as parks, recreation centers and libraries — that allow children space to play, engage and feel supported by the community. 

“And what we found is that the largest group of Tennessee kids, 25%, did not have any of those amenities in their neighborhood,” she said. 

In addition, many children are dealing with the loss of parents and caregivers to COVID. 

Nationwide, 215,700 children lost a caregiver to the virus, according to the report. 

Besides the trauma stemming from the loss, Tennessee children may be placed in the state’s foster care system, which has the nation’s highest rate of foster care instability. 

They may also be separated from other family ties, experience less stable housing, endure economic distress, and be at an increased risk of being victims of abuse or violence or developing mental health challenges. 

Older children face the additional challenges of caring for younger siblings and forfeiting educational opportunities to instead provide for their family. 

“Looking at the unique situation of those who are older youth, they may have lost a caregiver and then been thrown into needing to provide for their family and becoming the adult in the household,” Graves said. “Taking care of siblings or finding a job during such a challenging, tumultuous time is going to have a lot of long-term implications.”

Aside from their homes, kids spend more time at school than anywhere else, and behavioral, emotional and physical health conditions are often first identified in schools. 

Students are six times more likely to receive evidence-based mental health treatment when it’s offered in schools compared to other community settings, but 56% of Tennessee’s school districts had zero or only one psychological professional on staff. 

Addressing Tennessee’s youth mental health crisis will require getting children access to the support services they need, the report said. 

The full State of the Child report is available here.