The Urgent Need to Address Youth Mental Health


In this two-part special report, we highlight the urgency of addressing child and youth mental health. The impact of the COVID-19 pandemic in recent years has exacerbated the silent youth mental health pandemic that had worsened in previous decades. With 1 in 5 children and adolescents living with behavioral and/or developmental disabilities and less than half having received treatment in the last decade, young people are at high risk of poor outcomes.1

To focus on the youth experience, Paul Weigle, MD’s cover story on social media and self-diagnosis addresses the virtual and real world in which our youth are growing up. Understanding the risks and benefits offered by social media – along with the reality that 95% of young people have access to a smart phone – highlights the importance of technology’s role in mental health.

Substance abuse continues to be a challenge, with teen overdose deaths increasing by 65% ​​from 2019 to 2021. In their article on continuing medical education, Aaron R. Quiggle, MD; Colin W. Burke, MD; and Timothy E. Wilens, MD, give us a warning about how our young people are at increasing risk for addictive disorders.

The article by Lisa M. Horowitz, PhD, MPH; Patrick C. Ryan; and Maryland Pao, MD, on partnerships with pediatricians, provides an important strategy for addressing the mental health crisis: leveraging the trusted relationships of primary care providers. Expanding the mental health treatment team will be key to increasing our workforce and mitigating the risk of suicide, which continues to be the second leading cause of death among people aged 10-24. Additionally, among teenage girls, there was a 51% increase in suspected suicidal behavior compared to before the pandemic. Young people arriving in emergency departments have increased severity, complexity and comorbidities of behavioral health disorders.2

The article by Pravesh Sharma, MD; and Justine Larson, MD, MPH, highlight the importance of a systems of care approach to the youth mental health emergency that creates more effective safety nets for youth and families. The COVID-19 pandemic has exacerbated the social determinants of mental health, including family mental health, substance use issues, negative childhood experiences, racial disparities, social isolation, trauma, food and housing insecurity, economic stress and poverty. Not all children and adolescents were affected in the same way; children of color and other minority youth are disproportionately affected by systemic and structural racism and the inequalities inherent in the systems of care meant to serve them. Disparities in access to quality and culturally competent care disadvantage these young people and their families. Other marginalized youth groups include sexual minority youth; those of the justice and child protection systems; and those affected by poverty, discrimination, violence, trauma and dislocation. The humanitarian crisis for young people is significant because untreated and undiagnosed mental illnesses are associated with family dysfunction, poor school performance, juvenile incarceration, substance use disorders and suicide. The combination of racism, COVID-19 and mental health adversity created the perfect storm.

We hope that this special report, and its counterpart in the following issue, will help you provide the best possible care for your child and adolescent patients.

Dr. Ng is president of the American Academy of Child and Adolescent Psychiatry.

The references

1. Benton T, Njoroge WFM, Ng WYK. Sounding the alarm for children’s mental health during the COVID-19 pandemic. JAMA Pediatrician. 2022;176(4):e216295.

2. Leeb RT, Bitsko RH, Radhakrishnan L, et al. Mental health-related ED visits in children under age 18 during the COVID-19 pandemic – United States, January 1 to October 17, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(45):1675-1680.

3. Fortuna LR, Tolou-Shams M, Robles-Ramamurthy B, Porche MV. The Inequity and Disproportionate Impact of COVID-19 on Communities of Color in the United States: The Need for a Trauma-Informed Social Justice Response. Psychological trauma. 2020;12(5):443-445.

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