WASHINGTON — When Elmo asked “How is everybody doing?” back in January, he was not expecting the onslaught of stress, despair, and anxiety that hit his replies.
“I’m just looking for somebody to talk to and show me some love if you know what I mean,” famous singer T-Pain wrote back to the red Muppet.
“Elmo I’m gonna be real I am at my f—ing limit,” wrote another user. Elmo’s tweet racked up more than 100,000 responses.
The perennially 3 1/2-year-old Muppet was a bit overwhelmed, but characteristically supportive, Sesame Workshop’s Jeanette Betancourt, senior vice president for U.S. social impact, told educators and therapists during a May presentation on mental health awareness at the Rockville, Md., headquarters of the Substance Abuse and Mental Health Services Administration.
The “It’s Okay to Not Be Okay” symposium was one of the latest in a storm of Biden administration events, proposals, and funding programs aimed at tackling the nation’s mental health crisis and child welfare. Sesame Street was a familiar setting for both federal officials and experts attending the talk: The Health and Human Services Department has long partnered with the Sesame Workshop to distribute mental health care resources to parents, kids, and even military families specifically.
Sesame Workshop told STAT this week that it is developing new resources on talking with kids about parental substance use, including a digital course for providers. The organization is working on the resources with the Foundation for Opioid Response Efforts, and they aim to make them available early next year.
Elmo — and other Muppets, such as Cookie Monster and even Oscar the Grouch — have long been asking their young audiences about feelings, and sharing their own. It’s part of a yearslong effort by Sesame Street to foster conversations about mental well-being, and makes Sesame a logical partner for others with similar aims.
“We generally call them big feelings…there’s joyful big feelings, and there’s also ones that may be more challenging,” Betancourt told STAT after her presentation.
Over the past four years, Congress allotted billions in new funding to federal and state mental health resources. President Biden asked for billions more in his next budget.
But the onslaught of efforts and funds have not panned out in tangible results. Roughly 20% of American adults report living with mental illness; more than half are not receiving treatments. Childhood mental well-being is actually worsening, according to federal data.
Psychology experts, government officials, and lawmakers have attributed the trends, particularly among children and teens, to a litany of factors: Covid-19 shutdowns, economic challenges, and substance use among family members, and all the stressors those factors put on young children. Experts, including Surgeon General Vivek Murthy, also blame social media (but not Elmo, who he was quick to remind people is a longtime friend).
“Our friend Elmo is right: We have to be there for each other, offer our help to a neighbor in need, and above all else, ask for help when we need it,” President Biden wrote after the Muppet thanked people for sharing their feelings and promised to check back in soon.
Federal officials are sharply aware that mental health trends are not turning around just yet.
“What we don’t know is whether that’s going to diminish. So far, it seems like it’s not diminishing,” Anita Everett, director of SAMHSA’s Center for Mental Health Services, told STAT in May during a conversation alongside Betancourt.
Sesame Workshop has experience helping very young children with difficult topics. In 2019, the company introduced a green, moppy-haired Muppet, Karli, who was in foster care because of her mother’s substance use issues. Elmo, who befriended the new arrival, of course, had a conversation with his father Louie about what addiction means.
“Karli’s mommy has a disease called addiction,” Louie explains. “Addiction makes people feel like they need a grown-up drink like alcohol or another kind of drug to feel OK. That can make a person act strange, in ways they can’t control.”
Karli’s story came about as Sesame looked at trends around foster care and the substance use crisis, Betancourt said.
“[We] try to make sure that we use our Muppets in a way that is not scary, but at the same time, provides a scenario that’s comforting,” Betancourt said.
“We do a lot of research on what is happening, where are the gaps? How is media presenting different topics?” she said. Over the years prior to Karli’s arrival, there had been a steady increase in children under 6 entering the child welfare system, with parental substance use cited as a significant factor in their placement.
“We realized that in order to tell the full story and acknowledge these transitions, we really need to put [out] what was a reality for many young children,” said Betancourt.
But while Karli and Elmo’s conversations about their big feelings are important to bring words to young children navigating similar experiences, Sesame Workshop and childhood psychologists agree that they are only the first step in ensuring mental well-being — and having at least one stable caregiver at home to have those conversations is the next.
“The content is great, but it’s all in the context of relationships,” Meghan Schmelzer, senior manager of infant and early childhood mental health policy at the advocacy organization Zero to Three, said.
And while the pandemic brought turmoil, the government response also brought billions of dollars to the effort to support caregivers and boost childcare resources, psychologists and advocates said.
“That was a time that we have never really seen in our history, in terms of recognizing that families need these resources and support,” said Schmelzer. “States had this amazing amount of money — and had to use it in a short amount of time.”
Those funds — largely dispatched from the American Rescue Plan through block grants — are drying up now, just as other programs such as the child tax credit are set to expire, Schmelzer and others said. And issues federal officials pledged to tackle, such as workforce shortages and bottlenecks for psychiatric care, still persist.
“The problem is a lot of kids who did the worst, developmentally, during the pandemic are the kids who also are resource challenged in so many different ways,” said Dipesh Navsaria, a professor of pediatrics at the University of Wisconsin, and medical director of Reach Out and Read Wisconsin, an initiative to help foster caregiver-child relationships through storytelling. “That didn’t magically go away with the end of the pandemic.”