Rethinking Our Approach to Youth Mental Health Care

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As the new year begins, we find ourselves in the midst of a youth mental health crisis, the likes of which we have not seen in the last half-century or more. I am afraid the ripple effects will be felt for generations. The lasting impact of the chronic stress and trauma of the pandemic has exacerbated what were already dangerously high levels of mental health challenges in youth, especially in marginalized communities.

Necessity breeds innovation. During the pandemic, our reliance on videoconference technology to connect with each other facilitated easier access to remote treatment, which helped lower the barriers to accessing mental health care for many youth and families. However, sadly, no matter how many more psychologists, psychiatrists, and social workers we train and how easy we make it to see them, it is clear that there is no way that we can possibly meet the overwhelming needs of our youth using traditional models of mental health care delivery. Access to these traditional delivery models are also inherently biased against many historically marginalized kids and families from underserved communities. We have to think outside the box.

The good news? As we continue to learn more about the brain, we realize that traditional mental health care delivery models may have left a lot to be desired anyway because they often violate some basic principles of neuroplasticity (how to change the brain). For example, new connections in the brain are formed by the repetition of many small doses of what neurobiologists call “good stress.” To be successful, those doses would need to occur many times throughout the day, rather than, for example, from 4:00 to 4:50 p.m. during a session in an office. Skills learned in one context often don’t generalize or transfer to other contexts because of the “specificity principle” of neuroplasticity, which simply suggests that to change a neural network, you need to activate that specific neural network. Artificially created circumstances do not activate the same neural networks.

Recognizing these limitations of traditional mental health care delivery models, there are now many attempts to think outside the box with innovative digital tools to reach youth struggling with mental health. However, many of these ideas fly in the face of perhaps the most crucial principle of neuroplasticity: that our brains develop best in a rich relational context, which is hard to recreate in the digital world.

So, what does this all amount to? A need for interventions that can be delivered by people who already spend most of their time with the youth in their natural environments and can therefore provide enough doses in a real relational context. Who are those people who can help address this youth mental health crisis? Parents and teachers, for starters.

Our work has focused on helping youth with social, emotional, and behavioral challenges by teaching the adults around them an evidence-based approach. As I have written previously, behavioral challenges are the canary in the coal mine of mental health issues. They rarely occur in isolation and instead reflect a broad range of co-occurring difficulties in what clinicians call externalizing and internalizing domains. Behavioral challenges reflect underlying skills deficits implicated in a wide range of mood, anxiety, and even autism spectrum disorders, not just disruptive behavior disorders like ADHD.

We have shown that parents, teachers, and other adult caretakers can learn and practice an evidence-based approach to solving problems collaboratively with youth that can be applied in the flow of everyday living. Our research has proven that when adults practice the approach called Collaborative Problem Solving, youth with a wide range of diagnoses, clinical symptoms, and general functioning improve—not just behavioral difficulties. What is the mechanism by which this occurs? The approach builds relationships, decreases conflict and stress, and builds neurocognitive skills, which, not surprisingly, improves mental health functioning broadly.

There is no one or simple solution to the current youth mental health crisis. But the answer cannot be simply training more clinicians or deploying digital tools. We must rethink the very methods by which we deliver mental healthcare. Teaching evidence-based approaches to parents and teachers is a powerful way to reduce clinical symptoms and improve general functioning.