- We are currently dealing with a national emergency involving child and adolescent mental health.
- Access to mental health services has been made more difficult because of a severe shortage of mental health providers.
- One way to improve accessibility to mental health services is to encourage their use through telehealth.
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national emergency in child and adolescent mental health in the fall of 2021. It was suggested that the mental health crisis was exacerbated by COVID-related stress.
One consequence of worsening mental health may be the rising rates of youth suicides (Ruch et al, 2019). At this time, nearly 20% of high school students have seriously contemplated suicide, and 9% have attempted suicide, as reported by the National Alliance of Mental Illness.
Unfortunately, the efficacy of our current mental healthcare delivery system appears to be insufficient to address the crisis. This may be a contributing factor to the increase in school shooting incidents across the country. According to the Washington Post, during the past two decades more than 85% of school shootings in the United States have been committed by people younger than 25, and the majority by children under 18.
As a counselor for young people, I want to offer some possible reasons for worsening youth mental health in this century, review some difficulties in providing adequate mental healthcare at this time, and discuss how we might improve provision of mental healthcare in the United States.
Reasons for Worsening Mental Health
Worsening mental health may be related to the lack of accessibility of extended family. In the past, it was common for three generations of a family to live together or very near each other. Thus, teens who were not keen on interacting with their parents were still able to easily talk to a trusted adult, who could help guide them through turbulent times. However, such access is no longer possible for many young people.
Further, interactions between neighbors have become less common, rendering another potential source of support largely unavailable. Teens may have less access to their teachers or school counselors because of the increased professional workload in schools. Clergy also are less accessible because teens no longer participate as much in religious activities.
Another reason for poorer adolescent mental health may be related to earlier onset of puberty among contemporary youth (Brix et al., 2019). This may have led to a mismatch between puberty-related emotional intensification and young adolescents’ relatively immature cognitive abilities (Arain, 2013).
Overuse of social media is another modern stressor associated with increased rates of anxiety and depression. Engagement in negative interactions through social media (such as cyberbullying) can lead to mood disturbances, and teens often develop feelings of inadequacy when they compare themselves to idealized versions of their peers as presented through social media.
The use of electronics for gaming, social media interactions, and reading online news has been associated with decreased sleep in adolescents. In turn, increased fatigue can be associated with the development of mental health issues.
Many children are no longer afforded ample opportunities to develop resilience. When children are faced with an obstacle, e.g., an academic or social challenge, parents often step in preemptively to help ease their children’s struggles. Further, many parents and children now typically blame the “system” for children’s difficulties. As a result, children are less apt to develop a sense of responsibility for their behavior. Thus, when teens are confronted with challenges, their repertoire for dealing effectively with them likely is limited.
In a culture that has grown increasingly secular over the past few decades, religious ideas about the sanctity of life have become less influential as well, perhaps leading to a more callous attitude toward life among young people.
Difficulties in Providing Mental Healthcare
Access to mental health services has been made more difficult because of the perceived stigma around seeking mental healthcare, a severe shortage of mental healthcare providers and mental healthcare facilities, and the expense of mental healthcare, which often is not covered adequately by insurance.
Because of the shortage in providers, in many communities primary care clinicians currently are the first line practitioners who diagnose mental health issues, provide initial counseling, and prescribe medications for depression and anxiety. However, often these providers have not been given access to adequate educational resources regarding provision of optimal mental healthcare at the primary care level.
Steps to Consider for Improvement in Mental Health
While we cannot recreate the extended family, we can educate parents regarding the importance of encouraging teens to take time to introspect or interact with mentors, appropriate use of social media, allowing more time for sleep, and how to help their children develop a better sense of personal responsibility.
Such education can be provided through schools and the efforts of child advocacy groups including by publicizing more widely the ongoing public education offerings of the American Academy of Pediatrics.
As a society, we ought to consider whether we want to change how life and violence are portrayed in entertainment venues, including at the level of advocacy groups and perhaps government. Also, we ought to consider teaching in our schools that learning how to achieve a peaceful attitude and identifying constructive solutions leads to greater happiness than expression of anger and sadness.
I believe that all good clinicians use effective psychological approaches to help treat their patients. Thus, many primary care providers should be receptive to being taught how to provide basic psychotherapy, including through the use of cognitive behavioral techniques and hypnosis.
Additionally, they can be provided with ample opportunities to consult with psychiatrists in an ongoing fashion regarding the prescribing of medications for psychiatric conditions that can be treated safely at a primary-care level.
Increasing the number of school counselors and clinical social workers who provide counseling are yet other venues though which we can improve availability of mental healthcare.
Another way to improve accessibility to mental health services is to encourage their use through telehealth, as we have done during the COVID pandemic. During the pandemic many states waived their requirement that treating providers must be licensed in the states in which the patients reside. Permanent waivers of such requirements would be very helpful, especially in states with smaller populations that do not support many mental healthcare professionals.
Insurance companies should be educated about how poor mental health adversely affects most people with chronic disease, and how this causes increased healthcare costs. In fact, when patients receive mental health therapy their symptoms, and the costs associated with their treatment, can decrease dramatically (Anbar, 2021).
Once companies recognize that mental healthcare leads to decreased overall costs, they should be happy to provide ample funding for such care, and may actively encourage patients to seek it.
I propose that once mental healthcare becomes easily accessible, many would take advantage of receiving therapy, including people who are not in extreme crisis. Thus, people would realize that seeking mental healthcare does not mean that something is terribly wrong, and associated stigma should decrease. In turn, this would allow even more people to receive mental healthcare, which should help reduce the risk for development of severe psychological pathology.
Call to Action
Improved mental healthcare should help decrease destructive behavior and the many other sequelae of poor mental health. However, our society and mental healthcare industry will need to undergo significant changes to enhance such care. I believe that we should embark on this process of change immediately in view of our current challenges.
Copyright Ran D. Anbar
Anbar, Ran D. (2021). “Changing Children’s Lives with Hypnosis: A Journey to the Center.” Lanham, MD: Rowman & Littlefield.
Arain, Mariam et al. (2013). “Maturation of the adolescent brain.” Neuropsychiatr Dis Treat. 9, 449–461.
Brix, Nis et al. (2019). “Timing of puberty in boys and girls: A population‐based study.” Paediatr Perinat Epidemiol. 33, 70–78.
Ruch, Donna, A. et al. (2019). "Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016." JAMA Netw Open. 2:e193886.