The Urgent Need to Address Youth Mental Health

SPECIAL REPORT: CHILD AND ADOLESCENT PSYCHIATRY

In this 2-part Special Report, we highlight the urgency of addressing child and adolescent mental health. The impact of the COVID-19 pandemic over the past few years exacerbated the silent pandemic of youth mental health that had been worsening over previous decades. With 1 out of 5 children and adolescents living with behavioral and/or developmental disorders and fewer than half receiving any treatment in the past decade, youth are at high risk for poor outcomes.¹

To focus on the experience of youth, the cover article by Paul Weigle, MD, on social media and self-diagnosis addresses the virtual and real world in which our youth are growing up. Understanding the risks and advantages offered by social media—with the reality that 95% of youth have access to a smartphone—underscores the importance of technology’s role in mental health.

Substance use continues to be a challenge, with overdose deaths for adolescents increasing by 65% from 2019 to 2021. In their continuing medical education article, Aaron R. Quiggle, MD; Colin W. Burke, MD; and Timothy E. Wilens, MD, give us a wake-up call for how our youth are at growing risk for addictive disorders.

The article by Lisa M. Horowitz, PhD, MPH; Patrick C. Ryan; and Maryland Pao, MD, on partnerships with pediatricians provides an important strategy in addressing the mental health crisis: leveraging the trusted relationships of primary care providers. Expanding the mental health treatment team will be critical to increasing our workforce and mitigating the risk of suicide, which continues to be the second leading cause of death for those aged 10 to 24 years. Furthermore, in adolescent girls, there was a 51% increase of suspected suicidal behaviors compared with before the pandemic. Youth arriving to emergency departments present with increased behavioral health disorder severity, complexity, and comorbidities.²

The article by Pravesh Sharma, MD; and Justine Larson, MD, MPH, highlights the importance of a systems of care approach to the youth mental health emergency, which creates more effective safety nets for youth and families. The COVID-19 pandemic exacerbated social determinants of mental health, including family mental health, substance use issues, adverse childhood experiences, racial disparities, social isolation, trauma, food and housing insecurity, economic stress, and poverty. Not all children and adolescents were equally impacted; children of color and other minoritized youth are disproportionately affected by the systemic and structural racism and inequities embedded within the systems of care meant to serve them.3 The disparities in accessing quality and culturally competent care disadvantage these youth and families. Other groups of marginalized youth include sexual minority youth; those in the justice and child welfare systems; and those impacted by poverty, discrimination, violence, trauma, and dislocation. The humanitarian crisis for youth is significant, as untreated and undiagnosed mental illnesses are associated with family dysfunction, poor school performance, juvenile incarceration, substance use disorder, and suicide. The combination of racism, COVID-19, and mental health adversity created the perfect storm.

We hope this Special Report, and its counterpart in the subsequent issue, will help you provide the best possible care for your child and adolescent patients.

Dr Ng is the president of the American Academy of Child and Adolescent Psychiatry.

References

1. Benton T, Njoroge WFM, Ng WYK. Sounding the alarm for children’s mental health during the COVID-19 pandemic. JAMA Pediatr. 2022;176(4):e216295.

2. Leeb RT, Bitsko RH, Radhakrishnan L, et al. Mental health-related emergency department visits among children aged <18 years during the COVID-19 pandemic - United States, January 1-October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(45):1675-1680.

3. Fortuna LR, Tolou-Shams M, Robles-Ramamurthy B, Porche MV. Inequity and the disproportionate impact of COVID-19 on communities of color in the United States: the need for a trauma-informed social justice response. Psychol Trauma. 2020;12(5):443-445.