Improving Adolescent Mental Health: A National Challenge

Three years ago, the office of the Surgeon General of the United States published a report about adolescent mental health with a title that got our attention:

Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory (SGA) 2021

The advisory outlined the current state of mental health among youth and teens, citing increases in rates of depression, anxiety, behavioral disorders, and – the most alarming trend – increases in suicidal behavior among youth, adolescents, and young adults over the past twenty years. After reviewing the available data, the Surgeon General concluded:

“Mental health challenges in children, adolescents, and young adults are real, and they are widespread. But most importantly, they are treatable, and often preventable. Our obligation to act is not just medical – it’s moral. If we seize this moment, step up for our children and their families in their moment of need, and lead with inclusion, kindness, and respect, we can lay the foundation for a healthier, more resilient, and more fulfilled nation.”

That was in early 2021, when we were still reeling from the impact of the COVID-19 pandemic, months before the first vaccines became available, and before most youth and teens returned to a typical school and family schedule that resembled life before the pandemic.

That raises a series of questions, based on the Surgeon General’s statement above:

Did we seize the moment?

Did we step up for our children and families in their moment of need?

And did we lay the foundation for a healthier, more resilient, and more fulfilled nation?

While specific answers to those questions may be impossible to provide, we can address the real facts behind the advisory with reliable data from reputable sources. First, we’ll review the facts and figures that led to the advisory in 2021, then compare them to the latest available data, three years later.

Adolescent Mental Health Before the Pandemic

The authors of the SGA collected information from a wide range of sources, including government sponsored programs and independent peer-reviewed research. Data from the Centers for Disease Control (CDC), the National Institutes of Health (NIH), and the U.S. Department of Health and Human Services (HHS) make up a bulk of the source material for the advisory, which highlighted the following data points.

Mental Health Among Youth and Adolescents (2019)

General Mental Health

 

• • 2019: 20% of children 3 – 17 had a mental health or behavioral disorder

• • 2016: 50% of youth with a mental health disorder received treatment

• • 2009-2019: Persistent feelings of sadness or hopelessness increased by 40% among high school students

Psychiatric Emergencies

 

• • 2011 to 2015: Emergency rooms visits for depression, anxiety, and behavioral disorders increased 28% among high school students

Suicide

 

• • 2007-2018: Suicide fatalities increased 57% for young people 10-24

• • 2009-2019: Serious thoughts of suicide increased 36% among high school students

• • 2009-2019: Making a suicide plan increased by 44% among high school students

We’ll also include data from the 2019 National Survey on Drug Use and Health (2019 NSDUH) to assess rates of depression and treatment for depression, as measured by the presence of a major depressive episode (MDE), which is a proxy metric for major depressive disorder. We include this data in order to make an apples-to-apples comparison with data from the same categories in the 2022 NSDUH.

Major Depressive Episode Among Adolescents 12-17 (2019)

Major depressive episode (MDE) in past year:

 

• • Total: 15.7%

• • By gender:
    • Female: 15.9%

     

    • • Male: 7.7%

• • By age:
    • 12-14: 8.4%
    • 14-15: 12.6%

     

    • • 16-17: 15.4%

MDE with severe impairment in past year ages 12-17:

 

• • Total: 11.1%

• • By gender:
    • Female: 16.5%

     

    • • Male: 6.0%

• • By age:
    • 12-13: 6.8%
    • 14-15: 11.9%

     

    • • 16-17: 14.5%

Next, the data on suicide among adolescents in 2019, retrieved from the 2019 Youth Risk Behavior Survey (2019 YRBS).

Suicidal Behavior Among Adolescents 12-17 (2019)

 

• • Had serious thoughts of suicide in the past year: 18.8%

• • Made a suicide plan in the past year: 15.7%

• • Attempted suicide in the past year: 8.9%

Now let’s look at the data on mental health treatment among adolescents in 2019, again with data from the 2019 NSDUH.

Mental Health Treatment Among Adolescents Who Needed Treatment (12-17) 2019

 

• • Overall: 16.7%
    • With MDE: 43.3%

     

    • • MDE with severe impairment: 49.7%

• • Inpatient: 2.9%

• • Outpatient: 15.3.0%

When we look at these statistics as a whole, it’s easy to see why the Surgeon General issued a mental health advisory in 2019. A significant percentage of our adolescents – across detailed age categories – had a major depressive episode or a major depressive episode with severe impairment – and did not get the treatment they needed.

The difference between the number of people who need treatment for a specific disorder and the number of people who receive treatment for that disorder is called a treatment gap. We’ll now review data from the most recent NSDUH in order learn whether we closed the treatment gap or allowed it to increase.

Comparing Data: Mental Health Among Adolescents After the Pandemic

The 2022 National Survey on Drug Use and Health (2022 NSDUH) offers our first real glimpse into mental health among adolescents after the disruption of the pandemic eased. By 2022, we’d achieved a new normal. Kids and teens were back in school, everyone who wanted a vaccination had one, and parents had re-established a consistent work routine.

Major Depressive Episode Among Adolescents 12-17 (2022)

Major depressive episode (MDE) in past year:

 

• • Total: 19.5%

• • By gender:
    • Female: 28.0%

     

    • • Male: 11.5%

• • By age:
    • 12-13: 13.0%
    • 14-15: 21.4%

     

    • • 16-17: 23.8%

MDE with severe impairment in past year ages 12-17:

 

• • Total: 14.6%

• • By gender:
    • Female: 21.7%

     

    • • Male: 7.9%

• • By age:
    • 12-13: 9.1%
    • 14-15: 16.2%

     

    • • 16-17: 18.2%

This data offers shows us that rates of MDE among teens have increased by close to 4 percent since the pandemic, while MDE with severe impairment increased by 3.5 percent. It’s important to note that MDE among adolescent females almost doubled – from 15.9 percent to 28.0 percent – while MDE with severe impairment among adolescent females increased by 5.2 percent.

That’s a clear indication that we need to redouble our efforts to support all adolescents with depression, with a specific focus on adolescent girls.

Next, we’ll transition to another critical metric: suicidality. We’ll look at the most recent data on suicide among adolescents, retrieved from the 2023 Youth Risk Behavior Survey (2023 YRBS).

Suicidal Behavior Among Adolescents 12-17 (2021)

 

• • Had serious thoughts of suicide in the past year: 22.2%

• • Made a suicide plan in the past year: 17.6%

• • Attempted suicide in the past year: 10.2%

This data also shows an increase from pre-pandemic to post-pandemic levels, mirroring increases in depression. Between 2019 and 2021 among adolescents, thoughts of suicide increased by 3.5 percent, suicide plans increased by 1.9 percent, and suicide attempts increased by 1.3 percent. Suicidality increased most significantly among adolescent females, a trend we’ll address in-depth in a separate article.

Finally, let’s look at mental health treatment post-pandemic, in order to learn whether we did, indeed, close the treatment gap. One consequence of the Surgeon General’s Advisory was an increase in the quality and detail of our data collection on youth and adolescent mental health. We have more comprehensive data for 2022 than for 2019, as we see below.

Mental Health Treatment Among Adolescents Who Needed Treatment (12-17) 2022

 

• • Overall: 29.8%
    • With MDE: 56.8%

     

    • • MDE with severe impairment: 62.3%

• • Inpatient: 3.0%
    • With MDE: 7.7%

     

    • • MDE with severe impairment: 9.3%

• • Outpatient: 23.0%
    • With MDE: 48.0%

     

    • • MDE with severe impairment: 53.6%

• • Prescription Medication: 12.8%
    • With MDE: 28.1%

     

    • • MDE with severe impairment: 32.2%

• • Telehealth: 13.8%
    • With MDE: 34.4%

     

    • • MDE with severe impairment: 39.1%

This is where we can report good news: treatment rates increased between 2019 and 2022. Overall mental health treatment increased by 13.1 percent, treatment for adolescents with MDE increased by 13.5 percent, and treatment for adolescents with MDE with severe impairment increased by 12.6 percent.  Inpatient treatment increased by 0.1 percent, and outpatient treatment increased by almost 8 percent.

We’d like to see the inpatient numbers increase of course, but this data answers the question on the treatment gap we posed above. Between 2019 and 2022, we began to close the treatment gap. This is a significant development: it means we took the SGA seriously and redoubled our efforts to support the mental health of our adolescents.

We should add that this increase in treatment occurred in context of an overall increase in rates of mental health disorders among adolescents. The fact that the treatment percentages increased is encouraging, but we need to keep our eye on the ball, and focus on increasing our efforts to support our children and teens, year over year.

What We Can Do to Help

We asked and answered a question regarding the treatment gap above, in the affirmative: that’s good news. We also asked a series of questions in the introduction, which we haven’t answered yet. These questions were based on insight from the Surgeon General, directly addressing the actions he thought we needed to take in a time of need.

Let’s revisit them:

Did we seize the moment?

Did we step up for our children and families in their moment of need?

And did we lay the foundation for a healthier, more resilient, and more fulfilled nation?

For our part, we can also answer in the affirmative: we worked every day to seize the moment, step up and serve youth and families, and lay the foundation for a better future. We understand the challenges ahead: rates of mental health disorders among children and teens are increasing, especially among females. We support families every day in our treatment centers with the highest quality mental health care available.

To address the challenges of the youth mental health crisis, it will take a collective effort from everyone in the country. From families of youth with mental health challenges to federal, local, and state policymakers to community advocates and regular people going about their lives, there’s an active role we can all take in creating a healthy future for our youth.

These are suggestions for all of us, as presented by the Surgeon General:

How to Support Adolescent Mental Health

 

1. 1. Understand emotional, psychological, and behavioral health are core components of overall health and wellness.

1. 1. Recognize mental health disorders are treatable medical conditions that can improve with evidence-based treatment delivered by qualified professionals.

1. 1. Offer teens with mental health disorders, behavioral disorders, or emotional challenges the empathy, compassion, and support they need to heal.

1. 1. Work to reduce stigma and shame attached to mental health disorders by modeling openness, awareness, and understanding.

1. 1. Value adolescent mental health as much as we value adolescent physical health.

1. 1. Teach teens the skills they need to tolerate distress and manage/process difficult emotions.

1. 1. Collaborate with teens to build a solid foundation for psychological and emotional resilience, which means helping them develop:
      • Positive, healthy, protective relationships with the adults in their lives
      • Stress tolerance skills to cope with stress
      • The basics of self-care
      • Positive, healthy, productive use of the internet and social media

       

      • • The ability to know when and how to ask for psychological and/or emotional support

1. 1. Increase access to evidence-based, affordable, and culturally competent, high-quality mental health care.

If we can all get on board with these eight points, we can create the future our youth deserve: one where they have the support they need, when they need it, without stigma, shame, or unnecessary barrier to care. With our collective awareness, wisdom, energy, and commitment, we know this future is attainable.

How to Find Support: Online Resources for Families

To find help, call or email us here at BACA, or consult one of these online resources:

 

• • The American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Their treatment finder is convenient and easy to use.

• • The National Institute of Mental Health (NIMH) maintains a page for youth, adolescent, and family mental health

• • The National Alliance on Mental Illness maintains excellent resources for families