Building a Resilient Future: Addressing Youth Mental Health

COMMENTARY

As part of President Biden’s first State of the Union Address, he announced a strategy to address the national mental health crisis, which critically includes expanding focus on youth mental health.¹ Additionally, in December 2021, the United States Surgeon General Vivek Murthy, MD, MBA, issued a Surgeon General’s Advisory on the urgent need to address the nation’s youth mental health crisis.² Advisories are reserved for significant public health challenges and have priorly included advisories on opiates and smoking. The recent Surgeon General’s Advisory calls for immediate and coordinated responses to prevent youth mental health from becoming a second pandemic.

While youth have been relatively protected from the lethality of the COVID-19 virus itself, they have been more vulnerable to the psychological impact. Additionally, unlike other physical health conditions, three-quarters of mental health disorders manifest before age 25.³ The combination of these dynamics has created conditions ripe for a secondary pandemic for youth. Similar to the lack of preparedness for the COVID-19 pandemic, we are not prepared to face this second threat. In fact, we were failing, as suicide, depression, and addiction among American youth were at all-time highs before the pandemic worsened them further. For example, at least 4.1 million adolescents—1 in 5—had at least 1 major depressive episode in 2020.⁴

Mental health challenges have been particularly hard on young women and youth of color. The pandemic has directly correlated with an over 50% increase in emergency room visits by adolescent girls and young women for suicide, rates of need have grown faster for Black and Hispanic youth, and Black and Hispanic children have experienced grief due to the loss of a parent at rates many times higher than White children.⁵

However, unlike in the early days of COVID-19, there is existing guidance on what to do for youth mental health—guidance that we have too long failed to invest in commensurate with the need. Treatments—including psychotherapy, medication, and care coordination—have been robustly validated and proven safe. Prevention across development phases has also been found to be effective. Youth can also help each other, as social support is an especially beneficial intervention. Additionally, as 7-year-old Molly Wright, one of the youngest-ever TED speakers, clearly articulated, we must likewise prioritize young children’s healthy brain development during the 0- to 5-years-old period, preventing further mental and brain health disorders across the lifespan.⁶

Improving access to screening, detection, and early intervention for children and adolescents is key. Signed into law in mid-2019, the Texas Child Mental Health Care Consortium (TCMHCC) was formed with the state’s 12 publicly funded medical schools.⁷ TCMHCC is funded with $118.5 million in state funds to provide universal access to child psychiatry consultation in primary care through the Child Psychiatry Access Network (CPAN), urgent access to psychiatric telehealth care and referrals in Texas schools through the Texas Child Health Access Through Telemedicine (TCHATT) program, and expansion of workforce training and the public psychiatry workforce more broadly. Launched in May 2020, TCMHCC engaged 5000 pediatric primary care providers in CPAN and reached nearly 1.7 million Texas students through TCHATT in less than a year, including 12.5% Black and 34% Latino students—numbers proportionate to the broader child population of Texas. TCMHC provides an infrastructure that can be scaled up or down as needs change. The Texas legislature just took advantage of this by adding $113 million in American Rescue Act funds to ramp up all these programs in response to the ongoing mental health surge.

California has committed $4.4 billion over a 5-year period to youth mental health to build capacity for prevention and treatment, help schools cope with the demand, and support families.⁸ Scaling up investments and sharing best practices between states are key to addressing this national issue.

All the programs mentioned are helping children, young adults, families, and schools across the country cope with the growing youth mental health pandemic. As these initiatives demonstrate, youth mental health is more than health care. Just like all health conditions, mental health is shaped by a variety of factors, including genetics, brain chemistry, trauma and violence, social connections, neighborhood safety, access to food, larger social and economic policies, and more. As such, the recent Surgeon General’s Advisory provides recommendations on how to improve youth mental health to a variety of stakeholders including families, educators, health professionals, entertainment organizations, technology companies, governments, communities, funders, and others.

Students’ ability to engage and connect with their schools is critical to improving emotional well-being and enhancing learning outcomes. Young people must also be directly involved with designing solutions to address the youth mental health crisis. Already, youth are speaking up about their mental health challenges and leading change. Youth-led initiatives, ranging from starting nonprofits to campaigning for policies to developing apps, have led to reduced stigma and increased access to care for mental health. It is imperative that government policies, technological solutions, and other initiatives that address youth mental health are designed with young people—not for them.

The youth mental health crisis is a public health imperative with enormous implications for America’s future. Our actions now will determine the future trajectory of our nation and have the potential to prevent a second pandemic. Investing in our youth by building our nation’s human capital, or rather Brain Capital, is an ongoing process. Addressing the youth mental health crisis is not only a medical and moral imperative, but it is also key to ensuring we have the next generation of leaders needed to build a prosperous future for our nation and world. As Murthy urges in the recent Advisory, by addressing the youth mental health crisis, we have an opportunity to “step up for our children and their families” and “lay the foundation for a healthier, more resilient, and more fulfilled nation.”² It is this future that we must build together.

Ms Smith is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute. Dr Beck is president of the healthcare division of Higher Ed International. Dr Keller is president and chief executive officer of the Meadows Mental Health Policy Institute. Dr Hynes is head of the OECD New Approaches to Economic Challenges Unit. Dr Eyre is co-lead of the OECD-PRODEO Institute Neuroscience-inspired Policy Initiative supported by Meadows Institute.

References

1. Remarks of President Joe Biden – State of the Union Address as prepared for delivery. March 1, 2022. Accessed April 12, 2022. https://www.whitehouse.gov/briefing-room/speeches-remarks/2022/03/01/remarks-of-president-joe-biden-state-of-the-union-address-as-delivered/

2. Protecting youth mental health: the U.S. Surgeon General’s Advisory. 2021. Accessed April 12, 2022. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

3. Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359-64.

4. Major depression. National Institute of Mental Health. January 2022. Accessed April 12, 2022. https://www.nimh.nih.gov/health/statistics/major-depression

5. Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency department visits for suspected suicide attempts among persons aged 12-25 years before and during the COVID-19 pandemic - United States, January 2019-May 2021. MMWR Morb Mortal Wkly Rep. 2021;70(24):888-894.

6. Wright M, TED and Minderoo Foundation. How every child can thrive by five. July 2021. Accessed Arpil 12, 2022. https://www.ted.com/talks/molly_wright_how_every_child_can_thrive_by_five?language=en

7. Texas Child Mental Health Care Consortium. 2022. Accessed April 12, 2022. https://tcmhcc.utsystem.edu/

8. Wiener J. When children suffer: California to funnel billions into mental health overhaul. March 17, 2022. Accessed April 12, 2022. https://calmatters.org/health/2022/03/california-children-mental-health-crisis/