Testimony of Rachel White, Senior Youth Policy Analyst, before the Committee on Health

January 29, 2024
Person Testifying: Rachel White
Title: Senior Youth Policy Analyst, DC Action
Testimony Heard By: Committee on Health
Type of Hearing: Oversight Hearing
Topic of Testimony: Department of Behavioral Health

Good morning Committee Chair Henderson and members of the Committee on Health. Thank you for the opportunity to address the Council today by providing testimony regarding the performance of the Department of Behavioral Health. My name is Rachel White and I am DC Action’s Senior Youth Policy Analyst. At DC Action, we use research, data, and a racial equity lens to break down barriers that stand in the way of all kids reaching their full potential. Our collaborative advocacy initiatives bring the power of young people and all residents to raise their voices to create change.

Through our Youth Economic Justice and Housing Coalition, we advocate with youth and youth-serving organizations in the District of Columbia for policies, funding, and programs that expand access to comprehensive support and services that disconnected youth and youth experiencing homelessness need to successfully transition into stable and productive adulthood. We are also the home of DC KIDS COUNT, an online resource that tracks key indicators of child and youth well-being.

We know that youth experiencing or at risk of homelessness have significantly higher rates of mental health issues, including suicide, depression, anxiety, substance abuse, and conduct disorders than peers in stable homes. Specifically, 57% of homeless students reported high rates of depression compared to 43% of housed students nationally. District middle and high school students who are homeless are three times more likely to attempt suicide than students who live at home with a parent or guardian. This is layered on top of the well-documented national youth mental health crisis. Young people experiencing homelessness have an acute need for consistent, accessible, and culturally competent care.

Homelessness itself can be traumatic. The experience of living on the streets, in shelters, or in other unstable and unsafe environments can exacerbate or even cause mental health issues. Young people experiencing homelessness may face violence, sexual exploitation, and discrimination, all of which can lead to severe trauma. Many youth who experience homelessness may turn to substance abuse as a way to cope with the stresses and challenges of their situation. Substance use can contribute to or worsen mental health issues. Youth experiencing homelessness often face social isolation and stigma, which can negatively impact their mental health. The lack of a stable and supportive social network can lead to feelings of loneliness and depression. Youth experiencing homelessness are more likely to abuse substances in order to cope with their experiences. In the District, 40 to 50 percent of homeless youth have reported drug abuse, while 30% are abusing alcohol.

According to DHS 2023 Performance Oversight response, over 1,900 unaccompanied youth experiencing homelessness, including youth who are pregnant and parenting, received services through DHS. It is believed that 68% of DC youth experiencing homelessness or housing instability suffer mental health challenges, based on a 2021 Youth Count survey

Despite the number of youth experiencing homelessness and their susceptibility to impaired mental health, in FY23, DHS behavioral health services were underutilized. DBH’s Project for Assistance from Homelessness (PATH), a program designed to provide services to people experiencing homelessness impacted by a serious mental health diagnoses only served 11 youth ages 18-23. With respect to behavioral health services in general, DBH only served 112 youth under 21 who identified as homeless. These large service gaps further endanger unhoused youth, given their vulnerability and complex mental health needs.

Through discussions with youth impacted by homelessness in the District and youth homelessness service providers, we know that existing behavioral health supports are missing the mark and not meeting the mental health needs of youth experiencing homelessness. According to youth experiencing homelessness and their service providers, there is a lack of accessible, youth-friendly, and culturally competent mental health services throughout the District. This gap acts as a major barrier to youth achieving long-term stability.

For example:
The Department of Behavioral Health operates important episodic and crisis mental health services for young people but unfortunately the programs are not accessible or effective for youth experiencing homelessness.

DBH helps run school-based behavioral health counseling services, but many unhoused teens and young adults are disconnected from school. Further, not all school clinicians are trained or culturally competent in working with unhoused youth.

The Crisis Response Team, while a vital service, has consistently been unavailable when organizations call asking for their help in an emergency. Organizations are routinely told there are no team members available, or if someone does show, they are typically accompanied by police officers which can be triggering for some youth. DC can reduce the need for crisis intervention by proactively connecting youth to ongoing counseling through a mobile mental health unit.

disproportionate number of non-parenting unhoused youth identify as LGBTQ+ and their need for culturally competent care is not met by any existing DBH youth programs. Social workers’ current continuing education requirements are helpful, but fall short of guaranteeing a counselor will be fully affirming in their care. DBH and its grantees should establish an intentional goal to recruit more LGBTQ+ counselors as well as counselors with lived experiences of homelessness.

The best way to meet this need is for DBH to establish a specially trained mobile unit of counselors and mentors dedicated to meeting young people where they are, such as at youth drop-in centers or rec centers, as opposed to making youth come to a specific DBH office to access services. Mobile mental health care services should be careful not to exceed a caseload of 1 case worker per 20 youth per best-practice guidance. Too many clinicians and direct care workers in DC are overtaxed, battling burnout, and prone to high turnover. We need behavioral health workers in the District to be able to stay in it for the long haul – especially when starting up a new delivery system of care services. Continuity of care is especially important to people experiencing homelessness who often lack a feeling of stability and permanence.

DBH is aware and has acknowledged the existing access issues to their services for youth experiencing homelessness and planned last year to work with advocates and providers to fund a traveling mental health unit that would meet youth experiencing homelessness where they physically congregate. Unfortunately, those plans were put on hold indefinitely when DBH was unable to locate or secure additional funds through outside DC government sources to fund the initiative.

The Youth Economic Justice and Housing Coalition will continue our advocacy efforts for the creation of a traveling mental health model that will provide mental health services where youth physically congregate, making services more accessible. This model will be detailed in the upcoming budget hearing. Accessing services would help transition youth into DBH community services for long-term support and address youth trauma, substance abuse, and medication management, all of which will decrease the likelihood of sustained or future homelessness. Recognizing that the children, youth, and families served by the public behavioral health care system in the District are primarily individuals of color, improving our system is a matter of equity. Improved access to behavioral health services is proven to be transformative for children and families and can boost the long-term overall health and productivity of communities, as evidenced by workforce outcomes and reduced crime rates.

In addition to securing funding during budget season to create a mobile mental health unit to meet the needs of youth experiencing homelessness, we are asking the Committee on Health to ascertain the following information from DBH during the government witness performance oversight hearing:

  • Response rate and arrival timelines of DBH’s Crisis Response Team, specifically as it relates to inquiries from homeless service providers.
  • Breakdown of what type of services were used by youth experiencing homelessness up to age 25.
  • Demographic breakdown of DBH client satisfaction data of youth up to age 25 who are experiencing homelessness.

Receiving answers to these questions will paint a clearer picture of which subset of youth in the District are receiving mental health services through DBH, whether their particular needs are being fully met, and what gaps need to be filled.

Thank you for your time and consideration. I would be happy to answer any questions.