Understanding the Youth Mental Health Crisis

From structural racism to pandemic isolation, stressors on young people are contributing to a mental health crisis that has exploded in recent years. Multiple U.S. health agencies and groups have issued a call to address youth mental health.

The 2022 Adolescent Behaviors and Experiences Survey (ABES) conducted by the U.S. Centers for Disease Control and Prevention (CDC) revealed that more than a third of high school students experienced poor mental health as COVID-19 took hold in 2020.

The disruptions of the global pandemic exacerbated an existing problem that had been growing for years, as a result of systemic inequities in American society. The situation became so dire that youth healthcare-focused groups like the American Academy of Pediatrics (AAP) declared a national emergency in child and adolescent mental health in 2021.

How are the challenges facing today’s young people contributing to a youth mental health crisis? And what can the mental health care community — and others responsible for protecting the health of children and teens — do to address the problem?

What Is the Youth Mental Health Crisis?

Children and adolescents who experience mental health issues often face a host of challenges within their families, in school, and in the justice system. A 2021 U.S. surgeon general’s report cites mental health problems as the leading cause of disability and poor life outcomes for children ages 3 to 17.

When young people are facing mental health challenges, they may exhibit behaviors such as:

• Expressing extreme anger or worry
• Using alcohol or drugs
• Exercising or dieting obsessively
• Binge eating
• Struggling in school
• Engaging in self-harm

In their 2021 emergency declaration regarding youth mental health, the AAP, American Academy of Child and Adolescent Psychiatry (AACAP), and Children’s Hospital Association (CHA) noted skyrocketing rates of mental health challenges.

CDC data confirms this observation. In 2021, the CDC reported that, when compared with data from 10 years prior, mental health issues and suicidal thoughts and behaviors had shown a significant increase. In 2011, the agency’s report showed that 28% of high school students had experienced long-term feelings of sadness or hopelessness. After consistently increasing over the decade, that figure was 42% in 2021.

Factors Affecting Mental Health

The systemic inequities and pandemic disruptions cited as the drivers of growing mental health concerns in recent years are part of a broad range of factors that can influence people’s mental and emotional well-being.

Biological factors, such as genetics and brain chemistry, can affect mental health. Experiences and environment also can be contributors. The World Health Organization (WHO) has established a list of social determinants of health (SDOH) that can significantly influence people’s overall well-being — including their mental health. SDOH includes variables like the location of birth and quality of available health care.

The following categories of social, political, environmental, and economic influences can affect the health of individuals and families:

• Economic stability: A family’s inability to afford healthy food, quality housing, and consistent health care can put children at a disadvantage when they are seeking support for mental health issues.
• Health care access: The lack of mental health professionals — and insurance and funding to cover their care — can hinder efforts to diagnose and treat mental disorders.
• Neighborhood and environment: People who live in areas with high rates of violence and compromised air or water quality face greater risks to their health.
• Education access: Children who have access to high-quality education, with little incidence of discrimination or bullying, are more likely to be healthy and live longer.
• Social and community interactions: Family, friends, and people in the community can influence whether people seek help for mental health issues. When people face discrimination or bullying, they may hesitate to speak up about their concerns.

Youth Mental Health Statistics

A host of data, including the previously noted youth mental health statistics, reveals troubling trends in the emotional well-being of the nation’s children and teens. The following findings indicate a growing crisis in youth mental health — and in the care provided for it — in the United States:

• A 2020 report from the National Center for Health Statistics (NCHS) showed a 57% rise in the suicide rate for 10- to 24-year-olds in 2018 compared with 2007.
• By 2020, suicide was the second leading cause of death among youth ages 10 to 14, according to the CDC, and it was the third leading cause of death among people ages 15 to 24.
• One in 5 youths between the ages of 12 and 17 experienced a major depressive episode (MDE), or sadness and loss of interest, in 2020, according to a 2021 report from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
• Nearly a third, or 29%, of high school students, experienced poor mental health in 2021, according to the CDC’s “Youth Risk Behavior Survey” that year.
• A 2023 Mental Health America (MHA) report shows that, in 2019-2020, more than 1 in 10 youths experienced depression so severe that they had trouble functioning at work or home.
• More than 1 in 5 high school students seriously thought about suicide in 2021, compared with 16% in 2011, the CDC reports.
• One in 10 high school students attempted suicide in 2021, according to the CDC.
• About 60% of young people who had severe depression in 2019-2020 did not receive any treatment for the condition, according to the MHA 2023 report.
• A 2022 survey in the Annals of Family Medicine found that 85% of primary care medical practices found it difficult to access pediatric mental health resources like medication advice and psychotherapy.
• One in 10 youths with private health insurance, approximately 1.2 million young people, did not have mental health coverage as part of their policies in 2019-2020, according to MHA’s 2023 report.

The CDC found that pandemic pressures exacerbated existing mental health issues among youth in the U.S. Among high school students in 2021: 37% reported poor mental health, 44% persistently felt sad or hopeless, 29% reported that an adult in their home lost a job, 55% experienced emotional abuse at home, and 11% experienced physical abuse at home.

Causes of the Youth Mental Health Crisis

The mental health challenges that children and teens have reported in recent years are the result of a combination of factors, many of which worsened during the COVID-19 pandemic. Following are some key causes of the youth mental health crisis:

The Impact of Social Media on Youth Mental Health

While the aim of social media is to make people feel more connected, it can lead to mental health concerns ranging from loneliness to addiction in people of all ages — and children and teens are the most vulnerable to its impacts.

Starting at around age 10, children’s brains begin changing to focus on social rewards such as peer approval and attention. Through their teen years, they are more sensitive to feedback they receive from others, like comments posted on social media.

Compounding social media’s impact on youth mental health is young people’s widespread and frequent use of its many platforms. A 2022 Pew Research Center report, for example, notes that nearly 1 in 5 teens (19%) said that they were “almost constantly” on YouTube. Among those surveyed, 16% reported this level of use of TikTok, and 15% indicated they were almost constantly on Snapchat.

Cyberbullying

Negative comments online can become extreme, rising to the level of bullying. Cyberbullying can have an even more detrimental impact on mental health than in-person bullying because it can occur anytime and come from a wide variety of sources from anywhere in the world.

The negative effects of cyberbullying are evident in study results published in the Journal of the American Medical Association (JAMA) Network Open in 2022: Cyberbullying victims between the ages of 10 and 13 were four times more likely to report thinking about or attempting suicide than those who were not cyberbullied.

Comparison Culture

Children’s and teens’ social media consumption leaves them vulnerable to comparing themselves unfavorably to the images they see there. The results can range from depression to eating disorders.

In 2021, data reportedly from the company then called Facebook regarding its Instagram app showed that comparison culture is particularly damaging for teenage girls. The company’s research revealed that nearly a third of teenage girls who used Instagram indicated that, when they felt bad about their bodies, the app made them feel worse.

The Effects of Homophobia and Transphobia on LGBTQ Mental Health

Homophobia and transphobia can leave young people who identify as LGBTQ vulnerable to a host of mental health problems. These children and teens often face challenges ranging from harassment to violence, and the stress that accompanies these experiences — and fears related to them — can lead to negative impacts on their emotional health.

LGBTQ mental health issues can have devastating consequences. A 2022 report from The Trevor Project, an organization focused on suicide prevention among LGBTQ youth, showed that among 13- to 24-year-olds in this population, 3 out of 5 felt scared about the future. Discussion of laws that could affect the rights of the LGBTQ population had a negative impact on the mental health of two-thirds of survey respondents.

These fears can lead to devastating outcomes. According to the 2021 CDC report, 45% of high school students who identified as LGBTQ had seriously considered attempting suicide in the past year, compared with 15% of heterosexual students. The report also indicates that 22% of LGBTQ students attempted suicide during that time, compared with 6% of heterosexual students who did so.

Climate Change and Youth Mental Health

Concerns about climate change and its real-world effects are also contributing to the youth mental health crisis. A 2022 report from the WHO cited a potential connection between hazards such as extreme heat and storms and mental health concerns like stress and depression. Youths involved in activism related to climate change face additional mental health risks.

Climate Despair

Whether they’re dealing with its effects or simply concerned about its impact, many individuals are experiencing climate change-related mental health problems.

Extreme weather events linked to climate change can lead to anger and depression. Some individuals have even committed violent acts because of the effects of extreme heat and storms. For many young people, concerns about such events are affecting their mental health.

A 2021 report in The Lancet showed that more than half of 16- to 25-year-olds surveyed said climate change made them feel “afraid, sad, anxious, angry, powerless, helpless and/or guilty.” More than 45% said these concerns affected their day-to-day lives.

Climate Activism and Burnout

Young people who are involved in climate change activism often deal with another challenge that can affect their mental health: burnout.

Those working to advance eco-friendly policies often grapple not only with concerns regarding the planet’s ecology but also with grief about areas already affected by climate change. To make matters worse, young people actively working on climate change issues can face debilitating doubts about the effectiveness of their efforts.

The Role of Economic Instability in the Youth Mental Health Crisis

Nearly 12% of the U.S. population, 37.9 million people, lived in poverty in 2021, according to the U.S. Census Bureau. This includes approximately 1 in 6 children who were living in poverty.

In addition to concerns like hunger and homelessness, poverty can lead to mental health issues, including those affecting children and teens. Not only can it be emotionally draining to worry about the availability of basic necessities like food or clothing, but it can also have physical effects that are detrimental to children. For example, the American Psychological Association (APA) cites a connection between extreme hunger and stunted brain growth, which can lead to long-term negative impacts on emotional development.

COVID-19 and Youth Mental Health

From coping with isolation to navigating family dynamics, a range of issues have affected children and teens since the start of the COVID-19 pandemic. These challenges have further fueled the youth mental health crisis.

The negative impact of COVID-19 on youth mental health has been even more prevalent for young people who are from marginalized populations.

Educational Changes

School closures and disruptions at the start of the pandemic left children without the structure and socialization that comes with in-person attendance at school. A 2022 study in JAMA Pediatrics found that this scenario affected children’s physical and mental health.

Researchers examined the outcomes of studies involving nearly 80,000 children from around the world during lockdowns and school closures. They found that disruptions in children’s educational activities led to mental health issues such as stress, anxiety, and depression.

Family Upheaval

Adverse childhood experiences (ACEs) are potentially traumatic events that occur in youth, ranging from experiencing abuse to having a family member commit or attempt suicide. These experiences place young people at greater risk of mental health challenges and other negative outcomes. The CDC noted in 2022 that eliminating these experiences could lower the number of depression cases by 21 million.

Lockdown conditions during the pandemic left many children and teens vulnerable to ACEs while they were with their families. For example, the CDC’s ABES report shows that more than half of high school students experienced emotional abuse in their homes in 2021.

The rate of experiences that can lead to mental health problems was especially concerning for LGBTQ students, 20% of whom reported they had been physically abused by an adult in their home.

Hunger, another experience that can have a negative effect on youth mental health, was most pronounced for Black students, according to the ABES report. Nearly a third reported there was not enough food in their home during the pandemic.

How Racism Affects Youth Mental Health

A variety of events in the United States in recent years have led to a racial justice reckoning. The impact of these occurrences — from the death of Black men in police custody to hate crimes against Asian Americans and Pacific Islanders — can include mental health problems.

The CDC reports that more than a third of all U.S. students believed they had received poor or unfair treatment at school because of their race or ethnicity in 2021. Among these high school students, those who reported racism were more likely to have poor mental health.

Youth Responses to Racial Injustice

The APA called the rash of racial bigotry-fueled incidents in the United States in 2020 “a racism pandemic.” Young people have played a critical role in fighting racial injustice, with students credited for the growth of the Black Lives Matter (BLM) movement following George Floyd’s murder by Minneapolis police in 2020.

The APA warns that events rooted in racial injustice can lead to mental health concerns such as depression and anxiety or substance abuse disorders. The organization notes that members of the Black community experience trauma after hearing frequent reports of racist incidents.

Racial Justice Activist Burnout

Like activists for climate change, those working to champion racial justice can experience burnout.

In a 2021 study, the International Journal for the Advancement of Counselling explored the physical and emotional exhaustion that can accompany this work, and the toll it can take on the mental health of those involved. Protesters can experience emotions ranging from fear of violence during protests to harassment from the public.

Additionally, while protesters may feel energized as they begin their work, perceptions that public interest is fading can lead to hopelessness and depression.

The State of Youth Mental Health Care

According to a historical review in the Psychiatric Times, medical treatment of youth mental health issues dates from the end of the 19th century, when the focus of these services was  .

Building from those origins, today’s mental health care for young people takes an approach that examines a variety of symptoms and causes. As the nation grapples with a youth mental health crisis, the focus of this work has shifted to include prevention as well as treatment — and to incorporate the efforts of everyone from health care providers to friends and family members.

History of Youth Mental Health Care

Around the time that Illinois established the nation’s first juvenile court in 1899, psychiatric professionals were beginning to recognize that the violence that led many youths into that system was a public health problem.

During the early 20th century, the importance of people’s childhood experiences in their long-term mental health became clear, eventually leading to a movement in the 1990s to provide youth-focused mental health care.

Yet according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), too often the services aimed at addressing these issues have taken place in locations that can be harmful to the young people they aim to serve:

• Emergency care facilities, where surroundings may be overwhelming and frightening
• Justice system venues, where police may not have the training required to effectively address individuals with mental health issues, and where young people of color and LGBTQ youths historically have struggled with discrimination

In fact, a 2020 Pediatrics article argues that, as a result of barriers like racism and inadequate mental health care, children and teens involved in the justice system often fail to reach their full potential in life.

Today’s Mental Health Care for Youth

The standards of youth mental health care today recognize the importance of addressing the ACEs that can lead to emotional problems. In its 2022 guidelines for assisting youths who have experienced this type of traumatic incident, SAMHSA recommends a comprehensive approach that provides:

• Someone to talk to, such as staff members at a crisis center who can offer assessment, de-escalation assistance, and connections to ongoing care options
• Someone to respond, with mobile crisis teams that are available to offer support for mental health-related incidents involving children and teens in homes and schools and in the community
• Safety, through in-home services, or in crisis care or hospital settings as needed

Trauma-informed care is essential for promoting youth empowerment and safety. SAMHSA defines the “four Rs” of a trauma-informed approach in crisis response: recognize the signs of trauma, especially those that are specific to adolescents and children; respond to the realities of trauma by applying a trauma-informed approach; realize that trauma is a major contributor to mental and behavioral health crises; and resist re-traumatization of those youth receiving services and those providing services.

SAMHSA encourages those assisting young people who have mental health issues to focus on the following goals:

• Keeping young people in their homes when possible
• Providing services that focus on the needs of youths, not adults
• Integrating family and other loved ones into treatment
• Offering services that take into account differences in culture and language

Addressing the Youth Mental Health Crisis

Treatments such as medication and therapy can effectively treat young people’s mental health problems. Today’s efforts to address the youth mental health crisis, however, take an approach that is more comprehensive and aims to mitigate problems before they start. They include working with children and teens to help them practice mindfulness and regulate their emotions.

But the CDC points out that encouraging positive behaviors and choices is just one way to tackle youth mental health challenges. To get at the root of the issues that can cause these problems, the agency encourages health care providers to also partner with those in the public sector — such as professionals in education, transportation, and housing — to address the social and environmental issues that can lead to mental health problems.

The Importance of Protecting Youth Mental Health

From academic difficulties to self-harm, mental health challenges can lead to a number of negative outcomes for children and adolescents. And these outcomes can in turn worsen the underlying mental health disorder. Substance abuse is an example of a potential outcome of mental health issues that can make those problems more severe.

Considering the potential harm that can arise from emotional challenges, it’s imperative that the nation work to protect youth mental health. Resources are available to help children and teens handle the many pressures they face.

Resources for Youth Mental Health Services

Young people and those who care for them can turn to a host of youth mental health services. Resources for connecting to services for treating and protecting youth mental health include:

• Anxiety & Depression Association of America (ADAA) — Includes a list with links to mental health resources for the Black community as well as children and teens and their loved ones
• Boys Town National Hotline — Serves teen boys and girls and their families, helping them through issues such as abuse, anger, and bullying
• CDC School Connectedness — Includes resources for educational professionals and families to strengthen youth mental health through schools
• SAMHSA’s National Helpline — Provides phone-in assistance that’s always available, in English and Spanish, for individuals and families facing mental health or substance abuse concerns
• The Trevor Project — Offers online and over-the-phone options for mental health crisis help for LGBTQ youth, as well as information resources and opportunities to connect with others for support
• The Youth Alliance — Lists crisis hotlines and websites for young people in need of information, support, and referrals to organizations that can assist them
• YouthLine — Connects teens to a crisis support and help line, with options to find assistance through call, text, chat, or email

Tips for Youth Leaders and Organizers

For individuals who want to help combat the youth mental health crisis, following some key best practices can help. Among the beneficial actions to take are:

• Encouraging teens and young people to share their feelings to discover how they may be struggling
• Learning about mental health disorders to better understand the young person’s problems and how they can cope
• Setting limits for children’s and teens’ social media use to ensure that it doesn’t interfere with activities like homework, meals, and sleep
• Explaining the hazards of social media, including telling children and teens that images they view there often aren’t realistic and that cyberbullying is dangerous
• Modeling positive behavior, such as refraining from racist, homophobic, and transphobic language and from excessive use of social media
• Joining advocacy groups to help protect against dangers that can contribute to youth mental health challenges, such as climate change and systemic racism
• Partnering with young people to find ways to work together to help them overcome their problems
• Staying positive and praising each step the young person takes to overcome their mental health challenges

Mental Health: Critical to Ensuring a Successful Future

Since the COVID-19 pandemic worsened the already challenging conditions for children and teens, prominent medical organizations have made the severity of the problem clear: The United States is facing a youth mental health crisis.

The causes of this mental health emergency are complex and include both biological and environmental factors, making it critical that everyone — from loved ones, to health care providers, to school personnel — work together to address these issues. Doing so can help ensure that today’s youth have the opportunity to grow into healthy, successful adults.

Infographic Sources:

CDC, “New CDC Data Illuminate Youth Mental Health Threats During the COVID-19 Pandemic”

SAMHSA, “National Guidelines for Child and Youth Behavioral Health Crisis Care”