Surgeon General’s Advisory: Youth Mental Health in 2021

On Tuesday, December 7^th, 2021, the Surgeon General issued an advisory regarding the mental health of children and teens in the U.S.

Here’s the short version:

Our youth are in trouble – but there are things we can do to help.

The rest of this article is the long version.

Why a Surgeon General’s Advisory Is Important

A Surgeon General’s Advisory (SGA) carries more weight than a report from the Centers for Disease Control (CDC), a special study published by the Substance Abuse and Mental Health Services Administration (SAMHSA), or a position statement from independent organizations like the American Psychological Association (APA) or the American Academy of Child and Adolescent Psychiatry (AACAP).

The Surgeon General issues advisories only after a careful consideration of the verifiable facts and evidence around a public health issue. An SGA is:

“…a public statement that calls attention to an urgent public health issue and provides recommendations for how it should be addressed. Advisories are reserved for significant public health challenges that need the nation’s immediate awareness and action.”

In the beginning of the coronavirus pandemic, scores of independent entities – including our organization – wrote articles and issued statements warning of a potential youth mental health related to the pandemic. A year into the pandemic, data appeared confirming what experts predicted: a nascent mental health crisis. Now, nearly two years in, we have sufficient data to confirm the crisis in not imminent or in the process of developing.

It’s here.

We’ll share the data that forms the basis of the advisory, and then offer the action steps the Surgeon General recommends that we, as a nation, should take to support our youth during this time of significant and elevated need.

Youth Mental Health in 2021: The Facts

To understand where we are now, we need to understand where we were.

Here’s a summary of relevant mental health facts and trends identified by experts over the past 14 years.

Youth Mental Health 2007-2019

• Suicide:
  • Suicide rates among youth ages 10-24 in the US increased by 57% between 2007 and 2018
  • The percentage of high school students seriously considering suicide increase by 36% between 2009 and 2019
  • The percentage of high school students with a suicide plan increased by 44% between 2009 and 2019
• General Mental Health:
  • In 2019, 20% of children between age 3 and 17 reported an emotional, behavioral, developmental, or mental health disorder.
  • In 2016, only 50% of the children with a treatable mental health disorder received the treatment they needed.
  • The percentage of high school students with persistent feelings of sadness or hopelessness increased by 40% between 2009 and 2019
• Psychiatric Emergencies:
  • From 2011 to 2015, overall visits to hospital emergency rooms increased by 28% for:
    • Depression
    • Anxiety
    • Behavioral disorders

That’s where we were before the pandemic. Which, to be honest, was not the greatest place. However, mental health experts did not describe our youth as in crisis for various reasons. Increasing awareness of mental health issues, increasing advocacy for reducing stigma around treatment and support, and increased access to surveillance technology such as online/text/social media surveys may all have contributed to the increase in reported mental health issues among youth. That all makes sense – but that’s all speculation.

In addition, one way to interpret that speculation is that the problems were already there – which does not make them any less real. In fact, it might mean we weren’t paying enough attention to youth mental health before we began to reduce stigma, record good data, and recognize nationwide trends.

The numbers now tell us a story that doesn’t require retrospective speculation. The Surgeon General cites research that includes data from over 80,000 youth around the world.

Here’s what that research indicates.

Worldwide Youth Mental Health: 2021 Compared to 2019

• General Mental Health:
  • Symptoms of anxiety and depression doubled
    • 20% of youth reported depressive symptoms
    • 25% of youth reported anxiety symptoms
  • Symptoms related to behavioral disorders such as ADHD increased moderately
• Psychiatric Emergencies (United States):
  • Visits to hospital emergency rooms for mental health issues for adolescents 12–17 increased 31%
  • Visits to hospital emergency rooms for suspected suicide attempts increased:
    • 51% for adolescent girls
    • 4% for adolescent boys

The SGA tempers this data by reminding us that symptoms of distress typically increase during natural disasters – including health emergencies like a global pandemic – and that over time, a majority of people process the stress in healthy ways and do not develop mental health disorders as a direct result of the disasters. The report also indicates that preliminary data that some measures of mental health distress that increased in early 2020 returned to pre-pandemic levels by late summer 2020.

Despite those reassurances, the SGA included content that described the risk factors associated with pandemic-related youth mental health and identified specific groups of youth most at-risk for pandemic related mental health issues.

We’ll share that information now.

Mental Health Post-Pandemic: Risk Factors and At-Risk Groups

All our youth are at risk of mental health issues as a result of the pandemic. The numbers before 2020 predicted this situation, the pandemic exacerbated it, and the post-pandemic numbers confirm it. With that in mind, please read and understand the following factors that apply to any school-age and high school children you know. We encourage you to pay close attention to whether you’re a parent, a teacher, a coach, or an involved friend or family member.

Pandemic Related Mental Health Risk Factors

1. Presence of mental health disorder before the pandemic
2. Living in an urban area
3. Living in an area with severe COVID-19 outbreaks (rural or urban)
4. Having parents or family members who are frontline workers of any sort:
   • Health workers
   • Service industry workers (restaurants, grocery stores, etc.)
   • Delivery drivers
5. Experiencing significant disruptions in daily life, including:
   • Virtual school
   • Lack of social contact with peers
6. Presence of adverse childhood experiences (ACEs), which include:
   • Abuse
   • Neglect
   • Witnessing or directly experiencing community violence
   • Discrimination
   • Experiencing financial instability, food insecurity, and/or housing instability
   • Experiencing trauma, such as losing a family member, friend, or caregiver to COVID-19

Those are the factors that increase risk of mental health issues among children and teens. Now we’ll list the various groups of children and teens at increased risk of developing mental health issues related to the pandemic.

Increased Pandemic Related Risk: Specific Groups

1. Children and teens with developmental disabilities:
   • The pandemic impacted targeted support through public schools and community programs that offered important assistance to these children. Types of support that became inaccessible for many children includes:
     • Special education classes
     • School counseling
     • Occupational therapy
     • Speech therapy
2. Racial and ethnic minority groups:
   • American Indian and Alaska Native youth
   • African American youth
   • Latino youth
   • Asian American youth
   • Native Hawaiian, and Pacific Islander youth
   • LGBTQ+ youth
   • Low-income youth
   • Youth living in rural areas
   • Youth in immigrant households
   • Populations with circumstances such as:
     • Living in juvenile detention
     • Homeless youth
     • Runaway youth
     • Youth in the child welfare system
3. Additional At-Risk Groups
   • Youth with more than one risk factor:
     • Children with developmental disabilities who lost a parent or caregiver to COVID-19
     • Youth vulnerable to discrimination in the healthcare system, including:
     • People of color
     • LGBTQI+ youth/youth with LGBTQI+ parents
     • Youth in immigrant households
4. Groups of youth with mental health disorders are at increased risk of contracting severe COVID-19. This includes youth with:
   1. • Depression
      • Bipolar disorder
      • Schizophrenia

Those are the groups the SGA – based on evidence collected from around the U.S. and the world – identify as at increased risk of developing negative mental health issues as a result of the pandemic. To close this article, we’ll share the actions steps the Surgeon General recommends that we, as a society, can take to help support these at-risk groups.

What We Can Do to Help

There are two foundational factors that inform all the information we’re about to share: awareness and education. Those two factors may appear synonymous, but we need to distinguish between the two. Awareness is knowing something exists, while education is learning about that something. The former gets the ball rolling. The latter helps it keep rolling in the right direction.

With that in mind, let’s look at the things the Surgeon General says we can all do to help our youth during this time of need.

Supporting Youth Mental Health: First Steps

We can:

• Recognize mental health is an integral part of overall health
• Understand mental health conditions are real, common, and treatable
• Realize people with mental health conditions need support, compassion, and care, as opposed to stigma, shame, or blame.
• Recognize mental health is as important as physical health
• Empower youth to recognize and learn the skills required to manage difficult emotions.
• Help youth develop the building blocks of positive mental health, which include:
  • Supportive relationships with parents, peers, and adults like teachers, coaches, and counselors
  • Techniques to cope with stress
  • The skills required to taking care of their bodies and minds
  • Mindful use of social media and technology
  • Knowing how to ask for help
  • Knowing who to ask for help
• Ensure all youth have access to high-quality, affordable, and culturally competent mental health care.

That’s an abbreviated list, but it’s a good place to understand how we can support our youth in this pandemic and post-pandemic era. The last bullet point implies a wide range of structural changes many mental health experts – and the Surgeon General – believe will have a positive impact on youth mental health. Systemic renovations that will ultimately redound to the benefit or our youth in general, and therefore support their positive mental health specifically, include reducing child poverty, increasing access to early childhood education and childcare, expanding access to healthy food, and increasing the availability of safe and stable housing for all children and their families.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, 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. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.