The Surgeon General’s Call to Action on Child Mental Health

The Surgeon General of the United States, Dr. Vivek Murthy, recently released an advisory report on the current state of youth mental health along with recommendations to improve well-being. This publication follows on the heels of a number of hospital systems and healthcare professional organizations, such as the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Academy of Pediatrics (AAP), issuing dire statements about worsening mental health and declaring the problem a national emergency.

These reports can be quite useful. Not only can they outline potential solutions but they also provide needed validation that certain problems have indeed escalated to the point of needing massive and concentrated interventions. Many mental health professionals still frequently reference the 1999 report from then Surgeon General Dr. David Satcher which at the time offered a number surprising and alarming statistics regarding the prevalence of mental health conditions and the amount of disability associated with them.

Sadly, this report indicates that many of these statistics have grown worse in the past 22 years. For example, the advisory notes that, even before COVID, half of adolescent females reported persistent feelings of sadness or hopelessness (up 40% from 2009). Since the pandemic began, there have been even further increases in levels of anxiety, depression, and other mental health challenges.

Most of the advisory, however, is divided into sections that outline actions that can be taken by various groups, including young people themselves, parents, educators, the government, and even social media and video game companies, to support mental health and well-being. At the end of each section there are multiple online resources that can provide further information and support.

Topline Recommendations

· Take care of your own mental and physical health

· Nurture strong, safe relationships with your kids

· Help children develop good peer relations

· Provide a supportive and stable home environment to the best of your ability

· Try to prevent substance use in youth

· Get regular healthcare as much as possible

· Look for warning signs of emerging mental health problems

· Minimize access to means of self-harm, particularly more lethal ones like firearms and medications

· Monitor and limit media and online use, as appropriate

· Advocate for mental health in your community

The current report is downloadable for free (see reference below) and it is certainly worthwhile a look at the whole thing. Dr. Murthy writes, regarding the current state of mental health, that “it would be a tragedy if we beat back one public health crisis only to allow another to grow in its place.”

Since its release on Dec 7, the report has generally been well received. The Child Mind Institute in New York tweeted that “this document is a wake-up call for the country and a long-overdue statement of leadership from the federal government.”

Some Surprises in the Recommendations

One recommendation to youth themselves is to serve others – something that may first come across as a bit strange but can in fact help children and adolescence develop a sense of purpose and self-worth.

There’s also a call for pediatric healthcare professionals to screen the parents’ mental health in addition to children themselves, which will likely result in some further discussion. The recommendation to reduce access to lethal means, including the specific mentioning of firearms, is also a welcome addition but will likely spur some controversy. Finally, this report also rightly shines a light on the role of social and societal factors such as racism and poverty in both the development of mental health problems and when it comes to getting access to quality treatment.

Also worth noting is how much of the advisory was devoted to the role of media and technology (both as potential problems and solutions). While recognizing that things like smartphones, video games, and social media are here to stay, the report offers a number of suggestions to parents, media organizations, journalists and entertainment companies on how to reduce the negative impacts these things can have. In the closest things to an actual call-out, the report states that “there can be tension between what’s best for the technology company and what’s best for the individual user or society” while still acknowledging that much additional research is needed on the link between media of various types and mental health.

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A Personal Perspective

Yet while there is much to like about the advisory, some areas unfortunately are a little weak. My biggest complaint is how surprisingly little airtime was devoted to an enormous issue that underlies so many other challenges related to mental health care – namely an inadequate and ever-dwindling workforce that remains undervalued in so many ways. This topic was treated much too superficially, in my view, with lots of vague calls to “expand” the workforce that lacked any substance or detail of how to do that during a time in which people are burning out and moving to other professions that pay better and offer a much less stressful working environment.

Overall, however, the new Surgeon General’s Advisory is a welcome document that offers updated knowledge of our current challenges and provides practical responses that truly could make a difference. Of course, now all we actually have to implement these recommendations.