The U.S. Surgeon General issued a rare public health advisory this week, calling on the nation to respond to the growing mental health crisis impacting young people that has worsened with the pandemic.
“Recent national surveys of young people have shown alarming increases in the prevalence of certain mental health challenges—in 2019 one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009,” wrote Vivek H. Murthy, M.D., M.B.A., in the advisory. Suicide rates among youth aged 10 to 24 years increased by 57% between 2007 and 2018, and there were more than 6,600 estimated deaths by suicide in 2020 in this age group.
“[T]oo often, young people are bombarded with messages through the media and popular culture that erode their sense of self-worth—telling them they are not good looking enough, popular enough, smart enough, or rich enough,” Murthy wrote. “That comes as progress on legitimate and distressing issues like climate change, income inequality, racial injustice, the opioid epidemic, and gun violence feels too slow.”
Various hypotheses have emerged to explain the trend, with researchers pointing to the growing use of digital media, increasing academic pressure, limited access to mental health care, alcohol and drug use, and broader stressors such as rising income inequality, racism, gun violence, and climate change. The pandemic and its disruptions to life at home and school and in the community have exacerbated these effects on youth. Tragically, more than 140,000 U.S. children have lost a parent or grandparent caregiver to COVID-19 as of June 2021.
Murthy wrote that most importantly youth mental health challenges are treatable and often preventable. “Ensuring healthy children and families will take an all-of-society effort, including policy, institutional, and individual changes in how we view and prioritize mental health,” Murthy wrote. The advisory provides recommendations for health care professionals/organizations, young people and their families, technology and media companies, schools and community organizations, and government.
Gabrielle Shapiro, M.D., chair of APA’s Council on Children, Adolescents, and Their Families and a clinical professor of psychiatry at Icahn School of Medicine at Mount Sinai, said the recent increases in suicidality among young people should serve as “a wake-up call to all of us.” She said more child and adolescent psychiatrists are needed to ensure youth with mental health challenges receive the treatment they need. She called for increased government support for those training to become child and adolescent psychiatrists, including tuition assistance and loan reimbursement.
Shapiro also said that “schools should employ a social and emotional development curriculum for all students, and because of the shortage in mental health providers, offer group therapy—for students who are deemed stable and not acutely dangerous to themselves or others—with licensed providers who are supervised by child and adolescent psychiatrists.” In addition, Shapiro advised parents to supervise their children’s use of technology and social media and place limits on the type and duration of usage, depending on their developmental stage.
The Surgeon General’s advisory gives the following specific recommendations for physicians and other health care professionals and organizations:
- Implement trauma-informed care principles and prevention strategies to improve care for all youth, especially those with a history of adversity.
- Routinely screen children, such as during well-visit appointments, for mental health challenges and risk factors, including adverse childhood experiences.
- Identify and address the mental health needs of parents, caregivers, and other family members.
- Combine the efforts of clinical staff with those of trusted community partners and child-serving systems, such as those in the child welfare system.
- Build multidisciplinary teams to implement services that are tailored to the needs of children and their families and provide culturally appropriate services in multiple languages and delivered by a diverse mental health workforce.
For more information, see the Psychiatric News article “Youth Suicide Rate Increases by Nearly 60%.”
APA Committee Overseeing Implementation of APA’s Anti-Racist Plan
Last June, the APA Board of Trustees created the Structural Racism Accountability Committee to oversee the implementation of the recommendations of the Presidential Task Force to Address Structural Racism Throughout Psychiatry and continue its work. Much progress has already been accomplished to achieve the overarching goal of ensuring that APA is a diverse, equitable, and inclusive professional organization.