The Status-Quo Will Never Solve the Youth Mental Health Crisis

As a clinical psychologist, professor, and intervention scientist, I’ve spent over a decade studying and delivering mental healthcare for children and teens—and growing convinced that current treatment systems are built to fail.

The gap between need and access to youth mental health care is incontestable. Between 50-80 percent of youth who need support access no treatment at all. And this gap is a feature, not a bug, of how care is delivered. Most mental health treatment happens in brick-and-mortar, hard-to-access clinics; it’s carried out by highly trained professionals, over long periods—often, months to years. If the number of licensed child therapists magically doubled overnight, provider shortages would still be insurmountable. Treatment would still be unaffordable, clinics out of reach, and insurance coverage unreliable. The process of finding a therapist would still resemble a maze of pointless, unfunny riddles, with answers that shift by the day—perfectly constructed to deter people most desperate for help.

Perhaps most damningly: Even among youth who do access therapy, the most common number of sessions they receive is just one. The average is fewer than four. Yet, most science-backed therapies for child depression, anxiety, and behavior problems are meant to last between 12 sessions and 20.

Existing mental health treatments are structurally incompatible with how people access treatment. The youth mental health crisis will keep getting worse without radical changes to where, when, and how mental health support can be delivered.

But here’s what most people don’t know, including most people in my own profession. A science-backed solution to increasing access to youth mental health support has existed for decades. We’ve just failed to integrate it into systems of support.

Now is the time to realize the promise of single-session interventions as a force for youth mental health.

What are single-session interventions? SSIs are backed by decades of international research and practice and 70 clinical trials, including the work of my research team, the Lab for Scalable Mental Health at Northwestern University. SSIs are structured programs that intentionally involve only one encounter with a provider or program; they may serve as stand-alone or adjunctive services. Importantly, SSIs are a one-at-a-time mode of support: Although they may be accessed on many occasions, any one session is designed to yield positive change. That is, SSIs acknowledge the dual realities that any therapeutic experience might well be someone’s last, and that it can be genuinely helpful anyway. That any moment can serve as a turning point, spurring upward spirals toward meaningful emotional change.

SSIs are also effective in improving youth mental health. Building on research dating back to the early 1990s, my team has developed a suite of effective, digital (self-guided) SSIs—based on bite-sized principles of cognitive-behavioral therapy—that have reached 50,000 youth to date. Crucially, 40 percent of these youth have identified as racial and or ethnic minorities, 50 percent as sexual or gender minorities, and 12 percent live in rural counties, showing that SSIs can promote equity in access to support—which status-quo therapies notoriously do not. Across our studies, 80 percent of youth who used an SSI reported improvements in their hope for the future and ability to solve problems in their lives.

In our trials of youth with more severe distress, levels of depression, anxiety, trauma symptoms, and disordered eating have declined even three to nine months after completing a digital SSI, compared to completing a brief online activity that mimics supportive therapy (nonspecific support that doesn’t teach practical coping skills). SSIs can and have helped youth on waitlists for therapy, offering support when youth first reach out for help, and online, where most teens first seek mental health information and support. SSIs developed by our team have even been embedded within social media platforms, where they are offered to young people immediately after they search for terms like “suicide” or “depression.” That is, they offer “just-in-time” support, at precise moments of need, regardless of access to traditional forms of care. In these ways, SSIs can fill gaps in treatment systems—quite literally, by being embedded into spaces where no other supports exist.

Of course, SSIs are not a silver bullet for the youth mental health crisis. They cannot replace existing forms of higher-intensity care, which many will still need. But they can help millions of young people who would otherwise access no support at all. They can reduce wait times for needed support. They can lessen the strain on emergency, primary, and outpatient care. They can deliver bite-sized, evidence-based care at precise moments of need. By complementing and extending supports that already exist, they could move the needle on youth mental health.

Ultimately, embedding SSIs into existing mental health support systems will require changes in how insurers reimburse treatment (currently, there is no Medicaid reimbursement code for single-session therapies); major shifts in how therapists are trained (most are never exposed to single-session approaches at all); and multi-sector partnerships to offer SSIs widely and sustainably. Here are three necessary next steps to making brief, in-the-moment support the new normal in mental healthcare:

1. Therapists can offer SSIs to people stuck on waiting lists, right when they reach out for help. My lab hosts several 20-minute, digital SSIs, and anonymously, for teens and caregivers to try wherever and whenever they want. All have been tested in clinical trials with 300-2,500 people across the United States. Each SSI teaches a concrete, evidence-based coping skill, and helps people build an action plan to put that skill to use—including while they wait for longer-term care. Therapists interested in delivering SSIs themselves may use my lab’s open-access single-session consultation protocol, or complete an online, self-paced training in "single-session thinking”—like this one, created by the Bouverie Centre in Australia, which has maintained a single-session therapy service for decades.

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2. Schools can embrace SSIs as a resource for students. Evidence-based, digital SSIs could be offered to students nationwide, at little to no cost to school districts. Students could try SSIs anywhere, anytime, and anonymously, when and where needs arise. Creating options for students to seek support independently is especially crucial for teens who feel uncomfortable or unable to ask adults for help.

3. Pediatricians can offer SSIs in conjunction with routine mental health screening at annual check-ups. The American Academy of Pediatrics recommends universal screening for adolescent depression. For teens who report severe symptoms, SSIs could be offered right away, to bridge the gap between identifying needs and connecting with longer-term care.

In all these contexts, SSIs have and can help people feel more capable, hopeful, and motivated than they felt before. They can remind people that any big change is just a series of small changes. And while much about our world is uncontrollable, taking a small, meaningful step toward a better future is always within reach.

For some youth and caregivers, an SSI is enough to spur lasting benefits. For others, it opens doors to further help-seeking (if change is possible, maybe other forms of treatment could help, too). In both cases, SSIs expand the tapestry of options for support in a system where the status quo will never be enough.

A more accessible, inclusive, hopeful approach to mental healthcare will stay impossible until people can imagine an alternative. Hopefully, the well-tested reality of single-session interventions can make this approach not just imaginable, but actionable.