By Stephen Gray Wallace, featured in Psychology Today.
In those six words, scribbled in his notebook next to disturbing drawings of guns and blood, 15-year-old Ethan Crumbley warned those in his world that he was not OK. Hours later, despite opportunities for intervention, Crumbley shot up his school, killing four and wounding seven more.
While some, no doubt, will see this tragedy as an opportunity to engage in arguments about gun sales regulations, others view it as yet another reminder that the state of youth mental health in America is in crisis.
So much so that the U.S. Surgeon General just released a national advisory, “Protecting Youth Mental Health.” In it, Vivek H. Murthy, M.D., M.B.A., addresses the crisis (Murthy, 2021).
Every child’s path to adulthood—reaching developmental and emotional milestones, learning healthy social skills, and dealing with problems—is different and difficult. Many face added challenges along the way, often beyond their control. There’s no map, and the road is never straight.
But the challenges today’s generation of young people face are unprecedented and uniquely hard to navigate. And the effect these challenges have had on their mental health is devastating.
Murthy goes on to note “alarming increases” in certain mental health conditions. For example, in 2019, one in three high school students (and half of all females) reported feelings of sadness or hopelessness, an increase of 40 percent from 2009.
Similar concerns were revealed by the Centers for Disease Control and Prevention’s National Center for Health Statistics (Curtin and Heron, 2019).
- After a stable period from 2000 to 2007, suicide rates for persons aged 10-24 increased from 2007 to 2017, increasing 56 percent.
- The suicide rate for persons aged 10-14 declined from 2000 (1.5) to 2007 (0.9), and then nearly tripled from 2007 to 2017.
In addition, the National Alliance on Mental Health notes the following (NAMI, 2019).
- One in six U.S. youth aged 6-17 experience a mental health disorder each year
- 50 percent of all lifetime mental illness begins by age 14, and 75 percent by age 24
- Suicide is the 2nd leading cause of death among people aged 10-34
Not surprisingly, data from the Pew Research Center mapped the rise in smartphone use against deteriorating mental health in teens, and the lines run parallel (Pew Research Center, 2021). On the contrary, the science-based Greater Good Magazine offers the following (Odgers, 2020).
Each day, we hear that smartphones and social media are making our children—particularly teenagers—lazy, addicted, lonely, uninterested in having sex, too interested in viewing sex, and unable to function in the real world.
But our fear is misplaced; there is no compelling evidence that spending time online has a deleterious effect on teens’ mental health.
Though the link between screen time and now verified effects of apps such as Instagram may make such arguments simply academic.
Yet, there is other evidence that excessive smartphone use may make teens act less responsibly for what they do and say online, spend less time with parents, face addiction, get less sleep, and limit time outdoors. This last one may be especially significant: “Time spent in nature has such incredible benefits. It builds confidence, promotes creativity, imagination, responsibility, awareness, gets them moving, and makes them think. And perhaps most important, time spent outdoors reduces stress and fatigue” (Riddle Chalos, 2021).
And then came the pandemic, with unforeseen and far-reaching effects in all facets of young people’s lives. The findings in a 2020 study sound the alarm (Total Brain, 2021).
The COVID pandemic is having a dramatic impact on U.S. students’ mental health which, in turn, is affecting precious cognitive capacities like memory, focus, and planning:
- 48 percent of high school and college students are at risk of general anxiety
- 45 percent are at risk of social anxiety
- 39 percent are at risk of PTSD
- The risk of common mental health conditions is 19 percent to 41 percent higher for females than males
Deteriorating mental health is usually linked with a decline in cognitive capacities. Expressed in percentile ranking, the standard average for any capacity is the 50th percentile ranking. However, the average percentile rank for students in this study fell well below the standard average:
- Memory: 37th percentile rank (13 percentile points below standard average)
- Focus: 37th percentile rank (13 percentile points below standard average)
- Planning: 34th percentile rank (16 percentile points below standard average)
Clearly, we need to do more to protect the emotional lives of young people. In his conclusion, Dr. Murthy offers a way forward.
Our obligation to act is not just medical—it’s moral. I believe that coming out of the COVID-19 pandemic, we have an unprecedented opportunity as a country to rebuild in a way that refocuses our identity and common values, puts people first, and strengthens our connections to each other.
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.
His report enumerates six action items to address this crisis, excerpted below.
- Recognize that mental health is an essential part of overall health.
- Empower youth and their families to recognize, manage, and learn from difficult emotions.
- Ensure that every child has access to high-quality, affordable, and culturally competent mental health care.
- Support the mental health of children and youth in educational, community, and childcare settings.
- Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers.
- Increase timely data collection and research to identify and respond to youth mental health needs more rapidly.
We do not yet know the full impact COVID-19 has had on children’s mental health, and we likely will not know until significant time has passed. This brings us back to the fact that pre-pandemic, the nation’s youth mental health was already in crisis.
Because children and teens may not clearly communicate their distress, it is important for peers, parents, and other caring adults to learn the warning signs of youth mental illness. Here, the Mayo Clinic provides some warning signs (Mayo Clinic, 2020).
- Persistent sadness — two or more weeks
- Withdrawing from or avoiding social interactions
- Hurting oneself or talking about hurting oneself
- Talking about death or suicide
- Outbursts or extreme irritability
- Out-of-control behavior that can be harmful
- Drastic changes in mood, behavior, or personality
- Changes in eating habits
- Loss of weight
- Difficulty sleeping
- Frequent headaches or stomachaches
- Difficulty concentrating
- Avoiding or missing school
They also advise, “If you’re concerned about your child’s mental health, consult your child’s doctor. Describe the behaviors that concern you. Talk to your child’s teacher, close friends, relatives, or other caregivers to see if they’ve noticed changes in your child’s behavior. Share this information with your child’s doctor.”
This is the crisis that is youth mental health. Hopefully, help is on the way.
Curtin, S. and M. Heron. (2019). Death rates due to suicide and homicide among persons aged 10-24: United States, 2000-2017. NCHS Data Brief. No. 352. October 2019. National Center for Health Statistics. https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf (15 Dec. 2021).
Mayo Clinic. (2020). Mental illness in children: know the signs. Children’s Health. February 26, 2020. https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/… (15 Dec. 2021).
Murthy, V. (2021). Protecting youth mental health: the U.S. Surgeon General’s Advisory. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-he… (15 Dec. 2021).
NAMI. (2019). Mental health by the numbers. National Alliance on Mental Illness. https://www.nami.org/learn-more/mental-health-by-the-numbers (15 Dec. 2021).
Odgers, C. (2018). Are smartphones bad for teen mental health? Greater Good Magazine. June 18, 2018. https://greatergood.berkeley.edu/article/item/are_smartphones_bad_for_t… (15 Dec. 2021).
Pew Research Center. (2021). Mobile fact sheet. April 7, 2021. https://www.pewresearch.org/internet/fact-sheet/mobile/ (15 Dec. 2021).
Riddle Chalos, M. (2021). Smartphones and anxious kids: mental health issues and the iGeneration. Lakeside Behavioral Health System. https://lakesidebhs.com/mental-health/smartphones-and-anxious-kids-ment… (15 Dec. 2021).
Total Brain. (2021). High prevalence of mental health risk amid COVID pandemic taking a serious toll on U.S. students’ cognition. February 24, 2021. https://www.totalbrain.com/high-prevalence-of-mental-health-risk-amid-c… (15 Dec. 2021).