Ramsey County Children's Mental Health Collaborative
Working across systems and with families to support children's mental health.
Call or Text (800) 565-2575
The Need
Mental health disorders are diagnosable, treatable and manageable. Youth with challenging emotions or behaviors may just need some extra coping tools and supports!
But, untreated mental health symptoms can impair thinking, feeling and/or behavior. This interferes with a child’s capacity to experience well-being, realize potential, be productive, enjoy fulfilling relationships, adapt to change, cope with adversity, and contribute to community.
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In 2023-2024, more families are under stress, more youth need mental health supports, less services are available, and the equity gap has widened.
In the News
Click on an article or video to learn more.
The needs listed on this page were identified by our COMMUNITY.
RCCMHC convenes hundreds of families, system partners, service providers, and community leaders through community-based listening sessions, surveys, interviews, advisory committees and task groups to identify needs and service gaps.
If YOU would like to provide feedback for this page, please contact wendy@rccmhc.org
Supporting data has also been gathered from:
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Ramsey County's Community Health Assessment
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Local census reports
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Community Health Needs Assessments conducted by local hospitals (Regions Hospital/HealthPartners, United & Abbott Hospitals/Allina Health, Children’s Minnesota-St Paul, and University of Minnesota Medical Center/MHealth Fairview),
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DHS County Reports
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Local, statewide or national reports such as the CDC's Youth Risk Behavior Survey (2011 to 2021) and Harvard's 2023 research on The Critical Link Between Parent and Teen Mental Health
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2021 Statement of National Emergency and the Surgeon General's Advisory
More Kids Are Hurting
1 in 5 high school students seriously considered suicide in 2021. 42% of all high school students, and almost 60% of girls, felt chronic sadness and hopelessness.
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Children's MN reports a 94% increase in youth mental health visits to the Emergency Department (1700 visits in 2018 and 3300 visits in 2023.) Fairview and Children's both report youth with higher acuity such as suicidal ideation, self injuring behavior and symptoms of major depression presenting to the emergency department.
Since 2020, RCCMHC has seen a 300% increase in families using our collaborative services. From July 2023 to March 2024, 464 youth received Rapid Access or Therapeutic Services through RCCMHC (a 62.8% increase compared to last year.)
Ramsey County youth ages 10-14 have the highest rate of self-inflicted injury in the 7-county metro area. 28% of Native American students in 8th, 9th, 11th grades purposely hurt themselves in the past year. (see RC Community Health Assessment: Suicide Thoughts & Behaviors , Emotional Distress , Self-Harm )
More School Problems & Chronic Absenteeism
64% of new RCCMHC clients report their child missed several school days in the last month. 15.71% had missed 10 or more school days. (RCCMHC survey 2024- does not include same-day suspensions.)
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In MN, chronic absences increased from 34% in 2017-18 to 71% during the 2021-22 school year. Students from low-income backgrounds, students with disabilities, and students of color have the highest rates of chronic absences.
Students' emotional health is closely related to learning and school success. An April 2024 University of MN report found that the single greatest challenge for K-12 school principals is student mental health. MPR interviewed a principal who said, "...we’re just seeing more students needing a more intense level of support than what we can offer within a school day." RCCMHC School District partners say there are reciprocal impacts between absent youth, reduced budgets, and available services to support youth who are struggling.
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There are disparities in suspensions and expulsions in MN (Indigenous students 10x higher, Black students 8x higher, and Students with disabilities 2X higher.)
More Caregiver Stress & Adult Mental Health Concerns
Parents are reporting higher levels of anxiety or depression. A national study shows 40% of teens report that they are worried about the mental health of a parent.
Children who have a caregiver with mental illness:
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have a higher risk for developing mental illnesses than other children
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had significantly higher rates of trauma exposure and psychosocial problems
Most RCCMHC caregivers report SPMI, mental illness, high ACE scores, trauma histories and/or chronic toxic stress.
A 2021 study showed that one in 14 children aged 0–17 years had a parent who reported poor mental health, and those children were more likely to have poor general health, to have a mental, emotional, or developmental disability, to have adverse childhood experiences such as exposure to violence or family disruptions including divorce, and to be living in poverty.
More Poverty & Less Access to "Safety Net" Supports
45% of RC youth live in lower income households as compared with 29% of children in Hennepin County or 10% of children in Carver County.
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American Indian and Black youth are more likely to live in a lower income household. (For example- 60% American Indian, 35% Black, 22% Latino, 8% Asian, 3% White)
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21% of low income children ages 6-17 have mental health problems.
Children in low-income families have the greatest rate of mental health disorders but have the highest underutilization of services.
Caregivers report long waitlists for basic needs "safety net" supports such as eviction prevention, shelter, MA renewals, and financial supports (e.g., Since July 2023, Financial Assistance has had an average backlog of 1,000+ applications.)
More Loneliness & Isolation
Social isolation and loneliness puts people at higher risk for mental illness.
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A 2024 poll from the American Psychiatric Association finds that 30% of adults say they have experienced feelings of loneliness at least once a week, while 10% say they are lonely every day.
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Social relationships are important to healthy identity formation and mental wellbeing. But 3/4 youth are experiencing high rates of loneliness and isolation. (See VIDEO with Surgeon General.)
"One of the most important things we can do for other people is simply to check on them, to show up for them in their moments of need and to listen." (US Surgeon General.)
Many RCCMHC parents report that they have "burned bridges" with family or friends who might be able to provide a break or support because they don't understand their child's mental health challenges or the family's situation. When parents first start working with RCCMHC, most report feeling scared, frustrated and alone.
Cultural Disparities
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BIPOC youth in Minnesota are about 1/3 to 1/2 less likely to receive community based mental health services as white youth.
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Systemic inequalities contribute to poor mental health. For example, "Black youth in Minnesota are at risk of experiencing toxic stress that contributes to depression and anxiety due to long-standing structural racism."
Ramsey County is the most densely populated county in the state, as well as one of the most diverse. In Ramsey County, 57% of the youth population are children of color. 23.4% families speak a language other than English at home. But we lack interpreters and providers who speak the same languages as our families. RCCMHC families say that they want to work with helping professionals who understand and are sensitive to their ethnic and cultural values, customs, and practices. But nationally, 83% of psychologists are White.
MN has the largest gap in graduation rates for youth of color in the country.
Staff Shortages & Long Waitlists
Before 2020, OVER HALF of RC residents who needed mental health services were not receiving them or were receiving delayed treatment.
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In 2024, increased needs combined with mental health workforce shortages have resulted in 7-12 month waitlists for youth therapy (< age 11), skills work, neuropsych testing, and MN Choice Assessments as well as delayed access for youth mental health case management services.
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RC’s ratio of mental health providers to population is the LOWEST among counties in the metro area.
A national survey shows that 90% behavioral health workers are concerned about the ability for those not currently receiving care to gain access to the treatment they need. 93% behavioral health workers have experienced burnout. 83% worry that workforce shortages in the mental health and substance use industry will negatively impact society.
In 2024, Ramsey County is designated as a mental health professional shortage area (HPSA) with a particular shortage for low income individuals. Many mental health agencies have reduced services or closed due to poor reimbursement rates.
Poor Service Coordination
Navigating the Children's Mental Health System is very hard. Caregivers don't know about service options. They don't know when or where to find care.
Many RCCMHC families report that they have 15+ "workers" per family that they need to juggle. Other families say they don't have ANY ​services because they can't figure out where to start!
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Getting a diagnosis often involves working with primary care, child therapist, family therapist, and psychiatrist.
Patients often experience an escalation of symptoms in the emergency department and a lack of transition support and coordination with community providers (see Children's Crisis Residential Services Study) Of the RCCMHC families who have taken their child to the Emergency Department for a mental health crisis, most report feeling unsupported and sent home the same day. Most youth in crisis returned to school the next day.
Unlike providers of adult therapy, child therapists often have to work with caregivers, school, courts, county, primary care, and other mental health providers. Providers have large caseloads and many report using their own time to coordinate with others or to support a family with needs that cannot be categorized as a health need for insurance reimbursement. (This issue is most frequently reported by culturally-specific providers in Ramsey County.)
Fear and Distrust
Many RCCMHC families report distrust in health care, county, and school systems.
77% of people with disabilities, 69% of people from ethnic minority groups, and 70% of LGBTQ+ people say they have had experiences that damaged their trust in the healthcare system.
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Institutional distrust is shaped by individual and collective experiences of injustice; ultimately, it is injustice that exacerbates health inequities.
There is typically an 11 year delay between onset of mental health symptoms and treatment. There could be many reasons for delay (capacity issues such as waitlists, challenges with system navigation, eligibility hurdles.) However, it is also likely that caregivers' individual and generational experiences with unfair treatment, blame, prejudice or stigma impact treatment delays. Parents without proper legal documentation may also fear that their legal status will be discovered if they access services for their children.
Few Whole-Family Supports
In a recent summit with 200 Black Twin Cities middle and high school students, young people spoke out about the need for family therapy. “What we’ve learned is that young people don’t exist outside of the context of supportive adults and family" Rachel Warren, coordinator of the Reimagine Black Youth Mental Health.)
Family engagement and "whole-family" services are rarely billable to insurance/Medicaid so local family service providers have to use grant funding or do the work for free.
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Most RCCMHC families say they prefer 2-Gen/ whole-family support but they are rarely offered this option.
“Addressing the complex needs of families living with parental mental illnesses and the emotional and/or behavioral problems of their children requires a comprehensive, coordinated approach… but comprehensive, “whole family” services, resources, and supports are generally not available... Specialized services and systems that support adults are separated from child and youth services, and each service is often targeted by specific agencies with differing expectations and funding requirements.”
More Substance Use
A 2024 study by University of MN Medical School and Masonic Institute for the Developing Brain has found that high school students who report using drugs, alcohol or nicotine are at higher risk for suicidal thoughts and other mental health disorders.
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Drug overdoses are now the No. 1 cause of death for young people in the United States.
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In 2022, Minnesota saw a 49% increase in fatal teen overdoses.
Youth in our community are using meth and fentanyl- rates are especially concerning among Karen and Hmong youth. RC Crisis Team reports increased calls to support Karen and Hmong families with youth who are using fentanyl/meth and have run away.
Many RCCMHC families report knowing someone who has overdosed, died from an overdose, or has lost custody of their children due to drug use. Caretaker drug abuse is the #1 reason for youth to be removed from the home in Minnesota.
Too Many Justice-Involved
Approx. 70% of youth in the Corrections System have a mental health disorder that has been unaddressed or under addressed.
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Over 90% of youth in the Corrections System have experienced trauma.
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Youth felony cases in RC have increased 24% since 2018.
Lack of accessible and appropriate mental health care can lead worn out and frustrated parents/caregivers to the juvenile justice system. Many RCCMHC parents report that they have called the police on their children in hopes that they would be placed in detention and finally get the help they need.
Black youth comprise 20% of the RC youth population (ages 10-19) but accounted for 60% of detention admissions in and 59% of youth on probation in 2022.
More Child Maltreatment
"Maltreatment during infancy and early childhood has been shown to negatively affect early brain development and can have repercussions into adolescence and adulthood.
The immediate emotional effects of abuse and neglect—isolation, fear, and an inability to trust—can translate into lifelong consequences including low self-esteem, depression, and relationship difficulties."
Research shows that family violence, child abuse and neglect can increase during times of caregiver stress.
In MN, Emotional Disturbance is the #1 disability reported by child welfare agencies who completed assessments/investigations. (Emotional Disturbance 7.6%, Developmental Disability 1.7%, Physical Disability 0.3%, Chemical Dependency 0.3%)
Respite & Out of Home Placement
In Ramsey County, youth are placed in out-of-home care when a child protective services worker and a court have determined that it is not safe for the child to remain at home because of a risk of maltreatment, including neglect and physical or sexual abuse.
Youth may also be placed out of the home temporarily to receive mental health or chemical health treatment or because of involvement with the correctional system.
Youth with mental health disorders are more likely to be placed out of the home. In Ramsey County, behavioral health was cited as the primary reason for placement for 24% of youth who were placed out of the home. Youth behavioral health was cited more often than alleged abuse, domestic violence, caretaker health or caretaker drug abuse. This rate is almost equal in number to alleged neglect. In comparison, ALL other metro counties cited caretaker alcohol/drug abuse as the #1 reason (in Hennepin, 40% caregiver alcohol/drug abuse and 11% youth behavior.)
We have very few options for temporary respite- especially for youth with developmental disorders or aggressive and challenging behaviors.
Too Problem-Based
Youth and their families have strengths, resources and the ability to recover from adversity. But RCCMHC youth and families say they want services to be strengths-based but they feel as if most service providers focus on the "problems."
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Many people who seek mental health care drop out. 70% who drop out do so after their 1st or 2nd visit. Families who do not feel respected or engaged in the process will not get the mental health treatment they need.
Strengths- based work takes time and it's is not always easy. In order to share power, we have to give up some of our own. We need to let go of stereotypes and be open to new ways of thinking.
We need to see youth and families as the HEROES of their own stories. Learn more about youth mental health needs and the strength based approach in our film, Children's Mental Health: The Whole Story.
Interventions that address only one factor at a time often fail.
Because the pathways leading to health are complex, effective solutions are likely to be complex as well …
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and will require COLLABORATION
(Braveman & Egerter, 2013)