NYC Brings Online Therapy to Teenagers

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Brian Lehrer: Brian Lehrer on WNYC. The New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan is going to join us now. He'll speak mostly about a new free mental health resource available to all New York City teenagers, that is all New York City residents ages 13 to 17. If you need a reminder about the state of teen mental health nationwide, we've reported on the show that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association collectively declared child and adolescent mental health to be a national emergency.

In March, the CDC published findings that the mental health of children and teenagers has been on a decline over the last decade, not just during the pandemic. Right now there are new teen mental health stressors including for the many new teens here in the city experiencing the trauma of being asylum seekers uprooted from their old homes, and often feeling unwelcome in their new. The war in the Middle East with the big Jewish and Israeli, and Arab and Muslim populations here, feeling it somewhat personally or just getting moved and challenged by just seeing it in the media.

It's all-important context as the city announces a partnership with the telehealth company Talkspace to launch Teenspace, a $26 million pilot program aimed at providing counseling support for teens with signs of depression, anxiety, or other mental health struggles. Again, this is for New York City residents ages 13 through 17. Let's talk about this and more with Dr. Ashwin Vasan, New York City Commissioner of Health and Mental Hygiene. Dr. Vasan, always great to have you on. Welcome back to WNYC.

Dr. Ashwin Vasan: Thanks for having me, Brian. Happy holidays.

Brian Lehrer: Happy holidays to you. What do you want listeners to know right off the bat about Teenspace?

Dr. Ashwin Vasan: Well, I think you're lead-in was correct. We're in a teen mental health crisis. If you really look at the data, it started about a decade ago, but then the pandemic made things measurably worse. In 2019 over a third of New York City high schoolers reported that they felt so sad or hopeless almost every day for the last two weeks that they stopped doing their usual activities. That figure rose to 38% in 2021, after being much, much lower a decade ago. We're seeing the same sorts of trends with suicidal thoughts and even attempted suicides over the past year or two.

Objectively speaking the data is telling us a story that our teens are hurting, our young people are hurting. I'm sure everyone listening who's a parent or who's in the life of a young person can relate to this. We created NYC Teenspace, which is a digital front door to our mental health system that really puts the power of asking for help and receiving that help in the hands of young people. Over 400,000 New York City teens aged 13 to 17 are now going to have access to online therapy, psychotherapy, counseling, psychosocial supports.

Also, self-help tools that will not only get their immediate needs met. They can build a relationship online through telehealth as you described. It's also setting them up for a lifetime of skills to be able to ask for help, receive help, which will prepare them for a lifetime of navigating the ups and downs of mental health challenges. In a mental health system that for too long has been really complicated to navigate, and where there is at times a supply-demand mismatch really.

Not enough therapists to go around, especially for vulnerable kids, we wanted to make sure that every single young person had access to this without the intermediary of an adult or a school or another place mediating that relationship. We're very proud of this. Already we've had hundreds of signups in just a little over 10 days since we launched it, and so we're excited to see this rollout over the coming months and years.

Brian Lehrer: Have people actually been going on it, teens 13 to 17 years old, and encountering a particular experience when they get there? Maybe tell people who are listening who may be in that age group themselves. Ears perking up because, oh, maybe this is something that can help me in some way, or their loved ones who may be listening, is it online right now for the experience, and what happens when you get there?

Dr. Ashwin Vasan: Absolutely. All you need is a digital device, a handheld device, a phone, an iPad, or a computer of some kind. You go to nyc.gov/teenspace, or you can go to talkspace.com/nyc and sign up right away. If you are 13 to 17, you are eligible as long as you live in a New York City zip code. You do need parental consent, but that's a one-off. You just need your parental permission, and then your parent is no longer involved in the relationship between you and a therapist.

Once you fill out a questionnaire about what your needs are, all done online. You can do it on your smartphone or your tablet, and then we match you with a New York State-licensed psychotherapist. Within minutes to hours, you will have an intake appointment, and you'll begin your journey. You can either get your needs met right away, you can build a long-term relationship online with a therapist, or if your needs are longer-term, or more complex. Or maybe you're a young person they're feeling like they might be in crisis, we can get you through this platform to where you need to go, which is maybe in-person kit.

This is truly a digital front door to the system. For all the young people listening, if you are listening, although you should all be in school at the moment, please sign up and don't feel ashamed, don't feel afraid. The city's here to support you with all of your needs and never feel like you can't ask for help. I didn't know about the parental consent requirement until you just said it. Why have that? Wouldn't some of the teens who most need something like Teenspace not be comfortable asking their parents for that consent, and would want this to be completely confidential from their parents?

Dr. Ashwin Vasan: Well, the fact of asking for help and getting parental consent is state law, it's federal law, and so we have to comply with the law because these are minors. Only in certain cases are minors allowed to access care without parental consent. That's true for general health care, it's true for mental health care, it's true for all interactions with care providers. That's the one-off. Part of the process here is normalizing mental health and normalizing the act of asking for help. There isn't a problem that's too small or too big to go on to Teenspace.

You could be someone who really feels like they're in extreme need and crisis, or you could feel like I'm just having some relationship trouble, or some issues with a family, a friend, or what have you. The kinds of information you have to share with your parent or adult caregiver in order to get that consent doesn't reveal any of those details. Then going forward, every single thing that the young person speaks about with the therapist is governed under privacy laws, HIPAA, and complete confidentiality between patient and provider.

Brian Lehrer: It sounds like the parental consent requirement is something you can't change as a matter of policy because it's in the law. Just to button up this line of questioning, is there anything else that you would recommend for any teen who may not feel safe telling their parents that they want mental health counseling? Maybe the parent is being abusive.

Dr. Ashwin Vasan: Totally understand. We do have 988. That is our mental health crisis hotline. That is completely anonymous. It's completely free. All of this is free of charge, including Teenspace, and doesn't require a parental consent. If there is a very specific scenario where there's issues of safety, issues of potential violence or threats, that information can be shared confidentially over 988. We can get you to the right place, whether it's child protective services or some other entity, or getting the law enforcement authorities involved.

Brian Lehrer: Good to remind people of that option. With respect to Teenspace, are services on the platform available in languages other than English? I mentioned in the intro, for example, the mental health needs of many recently arrived asylum-seeking teens.

Dr. Ashwin Vasan: Yes, 100%. We have therapists on the platform that speak 30 languages, and then we have simultaneous translation for upward of 120 different languages. Language access is a huge issue. You rightfully point out that, in this most diverse city, with people arriving every day it's important that we meet people where they are in the language that is most comfortable for them.

Brian Lehrer: Listeners we can take some phone calls for the New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan talking about this new free mental health resource available to New York City residents aged 13 to 17 called Teenspace. You can also ask Dr. Vasan about anything else related to his work as Health and Mental Hygiene Commissioner of New York City. I'll bring up a couple of things that are not this before we run out of time, like if he's expecting any new COVID spikes after Thanksgiving gatherings or particular mental health services for teen migrants.

With respect to the stresses that people are feeling relating to the war between Israel and Hamas or other things. We also have other viruses kicking around right now as you know, 212-433-WNYC. If you have a question for Commissioner Dr. Vasan 212-433-96 92, call or text. We talked on the show way back in June of last year. One of our topics was how a robust school nurse workforce was a key part of your agenda with respect to children's mental health. I wonder if NYC Teenspace helps remove schools as intermediaries in addressing youth mental health when maybe that's not the best venue for it. How do you see those two things working together?

Dr. Ashwin Vasan: It's a great question. I think it's not a either-or choice. We need to meet young people wherever they are, however, they want to be met. Obviously, young people are spending most of their time in school, and so I know the chancellor and myself are committed to ensuring that public schools are equipped with not just school nurses but with school mental health resources. We're working on that issue on a number of fronts, whether it's the expansion of school-based mental health centers that the governor announced in her budget last year.

Whether it's programs that we're building onsite at New York City Public Schools. There's also plenty of independent school students that need access to this care as well. We also listen to school administrators when we built this. What they are facing is a set of challenges where more administrative burden. If they were left in charge of navigating this entire platform or it being the intermediary as you say, that's just more work on an already stretched workforce. This was all about empowerment, putting the power and the choice in the hands of the young person to go and reach out and ask for help.

Which is why if you are using the platform if you're one of those early adopters those hundreds that have already reached out for help, tell your friends about it. Tell them and tell us about your experiences. We want to improve this platform. It will only get better through user testing and data, and I know that our partners at Talkspace are committed to collecting that data. They do that everywhere they work. We wanted to ensure that the burden of this wasn't placed on schools and rather it's more about empowerment of the young person, him or herself or themselves.

Brian Lehrer: Eddie in Brooklyn, you're on WNYC. Hi Eddie.

Eddie: Hey, doc. Hey, Brian. Good question about the age here. Younger kids, younger than 13 are also having a lot of trouble, and I think they were the ones that were heavily influenced by COVID and the lockdown. My son who's not quite 12 is struggling a lot. We're having a lot of challenges trying to figure out how to get him some help just to cope in school and with friends and family and everything, school work. Just functioning, understanding the world. He's not 13 yet. Is there something for a younger kid?

Dr. Ashwin Vasan: Thanks, Eddie. I totally empathize with your situation. I've got three kids, 10 and younger. At least the older two were really hit by the pandemic in its early phases, and so I totally empathize with you here. We built this platform because we look at rates of smartphone usage and adoption and independence, and also the best data is around teen mental health. You're absolutely right that younger and younger children are being affected and continue to be impacted. I'm seeing that certainly in my own life.

There isn't one simple answer, but I would say a couple of things. Number one, both the governor, the president, and we as a city are doing quite a bit to ensure that people with health insurance coverage, with commercial insurance. Meaning insurance that you get through your employer are providing adequate networks of care. Meaning that pediatric mental healthcare inclusive of that is more accessible than it has been. That the networks are not only large enough to manage the demand, but that they are culturally competent for people who English is not their first language.

That's one piece there. Going the conventional healthcare route and seeking an appointment with a mental health care provider is a good step to do. We can help with that. We can certainly help you and your family through hotlines like 988. We can help you get access to services through that. Please reach out to 988. You don't have to be in crisis to reach out to 988. If you have any mental health questions or issues, you can certainly call. I think the other piece of this is technology.

Do we want youngest kids to be accessing this care through a digital device? I think there isn't really good data to say that telehealth is effective for very young kids. I think we saw that with schools, moving very young kids to online school and virtual environments wasn't most effective in terms of learning. I think it's a new area of work and we're going to be pushing more and more into this space to address the needs of younger kids.

Brian Lehrer: Let's take a phone call from a therapist. Sarah in Teaneck, you're on WNYC with Dr. Vasan. Hi, Sarah.

Sarah: Hi, you talked about there being complete confidentiality once sessions begin, and then it occurred to me that there are, I think, parameters for that. I know in my practice and maybe it's New Jersey state law, if a child is expressing at-risk behaviors such as of harm, suicidal ideation, I believe that one might be obligated to inform their caregiver. That even at the outset of therapy when you contract with the teen, you let them know that there is no such thing as a 100% foolproof confidentiality. That there may be issues that need to be where their caregiver need to be born into. You'll talk about that, that's something you'll work out, is that accurate?

Dr. Ashwin Vasan: Yes, thanks for raising that. This care, Telehealth Care, Telemental Health Care is subject to the same mandatory reporting guidance that under state law and federal law that every kind of care of a minor is subject to. Any concerns of violence, either self-harm, abuse, neglect and so forth, the provider is a mandatory reporter. You're absolutely right, that's built into the contract, that's built into the consent. That is certainly discussed at the time of consent.

Brian Lehrer: Thank you for helping us to clarify that Sarah. Question from a listener in a text message. Listener asks, is it true that Dr. Vasan has shut down NYC Well, and in its place put the National 988 program potentially creating a situation? This listener says, where a young New Yorker considering an abortion can be routed via a 988 to a state like Texas where the call operator cannot give any pro-choice information.

Dr. Ashwin Vasan: We did not shut down NYC Well, we transitioned from NYC Well to 988, and we're still using the infrastructure underneath NYC Well to ensure that New York City is an exemplar in implementation of mental health crisis and mental health support hotlines. I'm not sure how to answer the second question because I think it's not correct. It's just misinformation. 988 is a mental health hotline. The only other place that we send people out of 988 aside from more acute care or law enforcement for something urgent is not related to abortion.

We have a separate hotline for anyone seeking reproductive healthcare. It is our Abortion Access Hub, and so there's a separate hotline for that, and so that 1-877-NYC-AHUB or 1-877-692-2482, and that's where anyone from all 50 states can call that hotline and seek access to illegal abortion here in New York City.

Brian Lehrer: That's another good one for people to know about. 877-NYC-AHUB is what you said, right?

Dr. Ashwin Vasan: Correct. 877-NYC-AHUB or 877-692-2482.

Brian Lehrer: Just to clarify on the rules governing people who answer the 988 mental health hotline, do you know if what the caller is suggesting or the texter is suggesting is even a thing. Does that go to a national group of 911-ish or 988 in the case of mental health 988 operators? If somebody's having issues that lead them to call 988 around a crisis pregnancy, is it possible that they're going to get a 988 operator in Texas or another state where that person may not even refer them to NYC-AHUB, for example?

Dr. Ashwin Vasan: If there's an immediate life-threatening concern, our 988 operators are trained to route people to 911 if that sounds like a life-threatening-

Brian Lehrer: The question isn't about a life-threatening concern, the question is about a crisis pregnancy.

Dr. Ashwin Vasan: Yes. I don't know the answer to that question, Brian. I think if there is a person who's got a high-risk or a crisis pregnancy who calls for mental health support to 988 and ends up needing abortion care or reproductive healthcare. We can certainly refer them and we have trained our providers to refer to the AHUB, to the Abortion Access Hub. We haven't seen that specific case arise in almost a year and a half that the Abortion Access Hub has been up and running, but it's certainly something we can look into.

Brian Lehrer: Are you seeing a Teenspace or anywhere else mental health issues being expressed by young people around the war between Israel and Hamas? So many people have strong feelings about it on one side or another, whether they're directly connected or not.

Dr. Ashwin Vasan: Yes. Whether it's on Teenspace or not it's a little early for data on Teenspace itself, but we're seeing people of all ages really hurting during this most difficult moment in our world. Certainly, it's casting appal on what was already a challenging time. I think people are still unpacking the detritus of the pandemic and the impact the pandemic has had on them and their physical and mental health. We're seeing that play out in our data.

Life expectancy has experienced a historic drop for the first time in a century. That's the product of COVID, but it's a product of a lot of cumulative impacts that some of which are driven by mental health, whether that's rising overdoses, suicides, violence. That's why we recently launched Healthy NYC, which is the city's strategy to address falling life expectancy as a unified health agenda. Certainly, mental health and teen mental health is a big piece of that.

Because the sooner we get to young people experiencing mental health concerns, especially in this moment where the war in the Middle East and other wars frankly, which are not getting as much coverage around the world are impacting people's wellbeing. The sooner we get to people and equip them with the care and the tools for a lifetime, the better hope we have that they'll be able to navigate the ups and downs of mental health for a lifetime. Live a healthier, longer life, which should be the civic objective of advancing democracy like ours.

Brian Lehrer: All right. Last thing, I will launch it with a text message from a listener who writes, I'd like to know if this cold season/flu season is especially bad. I know a lot of people, including myself, they write who have had bad colds, that just won't go away. I'll tack onto that. The question that I teased at the beginning of the segment which is with Thanksgiving just a few days ago, are you expecting any COVID spikes in the city in the aftermath of people gathering, or do you think that's now a relic of the past?

Dr. Ashwin Vasan: No, this is respiratory viral season. We're in the midst of it. We're in the first couple of months of it. The good news is that-- let's just take COVID, for example. Our cases are significantly down from, if you even look at September, and that's not altogether atypical. We've seen over the three years of the pandemic that during the summer where large gatherings and travel is more frequent that cases rise actually, paradoxically, you would think outdoors. It would be lower, but we've actually seen over the three years, every summer cases have risen.

I would not be surprised if we start to see an increase in COVID cases, and along with that flu and RSV in the coming weeks and months, especially through the holiday season as we have for the past now three years. The good news is that we are really better equipped than we've been in any of those three years. We have an updated COVID-19 vaccine, which everyone should go get if they haven't already. Especially if you're in a high-risk group, above 65 underlying conditions, if you're a member of the disabled community you should be getting vaccinated right away.

We have a flu shot that looks to be effective against this year's circulating flu, and for the first time we have an RSV vaccine. If you're a parent of a very young child, an infant, talk to your pediatrician about whether the RSV antibody is right for you. If you're over 65, talk to your doctor about whether the RSV vaccine is right for you. I think we're better prepared than ever, but don't be surprised if we see the sniffles and the colds and the flu rise. The good news is we're not seeing any significant uptick in cases yet. We're definitely not seeing any significant uptick in hospitalizations nor severe or mortal COVID.

The death rate has remained extremely low for many weeks now. This is part of living with COVID, this is part of living with circulating respiratory viruses. The good news is we've got more tools than ever. Of course, if you do have to gather, we are all gathering during this holiday season and we want everyone to gather safely and healthy. You aren't feeling well and you cannot stay home, then wearing a mask works, wearing a mask even if others around you are not wearing masks, wearing a high-grade mask works. We've got the information, It's about making smart and healthy choices,

Brian Lehrer: Good reminders from the New York City Health and Mental Hygiene Commissioner, Dr. Ashwin Vasan. We always learn a lot when you come on. Good luck with Teenspace, the mental health resource that the city has just launched for New York City residents age 13 to 17 that they can access online with parental consent. Thanks for coming on to introduce it.

Dr. Ashwin Vasan: Thanks so much, Brian. Always a pleasure. Happy holidays.

Brian Lehrer: You too.

 

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