In a new advisory warning that US children, adolescents, and young adults are experiencing a mental health crisis that has worsened during the COVID-19 pandemic, US Surgeon General Vivek H. Murthy calls for a swift and coordinated response to the problem.
Today’s generation of young people faces “unprecedented” challenges that exact a toll on their mental health, Murthy notes in the advisory.
Mental health challenges were the top cause of disability and poor life outcomes in young people before the COVID-19 pandemic, with up to 1 in 5 US children aged 3 to 17 years having a mental, emotional, developmental, or behavioral disorder. And since the emergence of the pandemic, young people have exhibited increased rates of psychological distress, including symptoms of depression, anxiety, and other mental health disorders, the advisory says.
“The COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating,” Murthy said in a statement. The report cites “concerning” clinical data indicating that in early 2021, US emergency department visits for suspected suicide attempts were nearly 51% higher for adolescent girls and nearly 4% higher for adolescent boys compared with the same period in early 2019.
The advisory “shows us how we can all work together to step up for our children during this dual crisis,” Murthy noted.
The 53-page document makes numerous recommendations about addressing the problem, with advice aimed at a wide range of stakeholders, including young people and their family members and caregivers, educators and schools, health care organizations and health professionals, media and technology companies, community organizations, employers, and governments at all levels (federal, state, local, and tribal).
For example, for the health care sector, the advisory recommends that clinicians routinely screen children for mental health challenges and risk factors, including adverse childhood experiences. Such screenings can be performed in primary care settings, schools, and emergency departments and should link with appropriate follow-up care.
In addition, efforts of clinical staff to address the issue can be combined with those of community partners and “child-serving systems,” such as child welfare and juvenile justice. Examples of such initiatives cited in the report include hospital-based violence intervention programs that identify patients at risk of repeat episodes of violence-related injury and connect them with resources in the community, and school-hospital partnerships, such as behavioral health urgent care clinics supported by schools.
“New payment and delivery models, such as the Centers for Medicare & Medicaid Services Innovation Center’s Integrated Care for Kids (InCK) Model, can be used to support the mental health-related needs of children across settings,” the advisory notes.
The report also calls on media organizations and entertainment companies to recognize the effect that media coverage can have on the mental health of consumers and urges them to follow best practices to avoid misleading the public and to take care in how stories are framed. This includes giving context (including identifying uncertainties, such as those arising from preliminary research; presenting conflicting reports; and interviewing independent experts), avoiding language that “shocks, provokes, or creates a sense of panic,” and exercising caution in presenting distressing content such as graphic images without context or warning for viewers.
Media organizations should also normalize stories about mental health and mental illness, avoiding harmful stereotypes and demeaning language and promoting accurate, science-based information, the report says. It also recommends including stories of people seeking help and successfully recovering, as well as directing the public to mental health resources.
Noting the growing concern in recent years about the effect of digital technologies—especially social media—on the mental health of youth, the advisory urges social media, video gaming, and other technology companies to prioritize user health and well-being during product development and share with the public the products’ effects on users.
The companies also should be “transparent and allow for independent researchers and the public to study the impact of company products” on users, the advisory says. The document also recommends that such companies design “hospitable” online spaces for young people—for example, by partnering with civil society groups to support the creation of industry-wide safety standards to foster online engagement that supports the health and well-being of children and teens.
Federal, state, local, and tribal governments also have a role to play in addressing youth mental health challenges through a variety of actions, the advisory says, such as initiatives in the United Kingdom and Australia aimed at ensuring safe online experiences for youth. Governments can also address regulatory barriers, ensure appropriate payment, and expand broadband access for initiatives that make telehealth more widely available for mental health challenges, such as a Colorado program called I matter, which offers 3 free behavioral health sessions for the state’s youth, primarily through telehealth.
In addition, the advisory called on governments to work toward comprehensive and affordable coverage for mental health care for all children and teens, through such actions as ensuring adequate payment for pediatric mental health services and compliance with mental health parity laws. It notes that local, state, and tribal governments “can access outreach and enrollment resources to help enroll and retain eligible children in Medicaid and CHIP at InsureKidsNow.gov.”
To bolster the number of mental health professionals available to treat children and teens, the advisory recommends expanding and supporting the mental health workforce through a number of actions. These include accelerating training and loan repayment programs; recruiting a diverse workforce that reflects local communities; investing in training and hiring of community health workers, family counselors, care coordinators, and others from a broader range of disciplines; and fostering a pipeline of school counselors, nurses, social workers, and school psychologists to provide mental health services to young people in school settings, among other measures.
The surgeon general’s advisory is among other urgent calls to address the mental health challenges of young people in the US. In October, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association declared a national emergency in child and adolescent mental health.
Published: December 14, 2021. doi:10.1001/jamahealthforum.2021.4995
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.
Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).
Conflict of Interest Disclosures: None reported.