Building Strong Foundations: Children's Mental Health

INTRODUCTION

Nearly 1 in 5 children have a mental, emotional, or behavioral disorder:

• Source 1: Agency for Healthcare Research and Quality, 2022 National Healthcare Quality and Disparities Report, 2022

• Source 2: Christina D. Bethell et al., Child and Adolescent Psychiatric Clinics of North America, Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes, 2022

The prevalence of mental health concerns is increasing:

• Source 1: Zara Abrams, American Psychological Association, 2023 Trends Report: Kids’ mental health is in crisis. Here’s what psychologists are doing to help, 2023

• Source 2: Jianmin Piao et al., European Child & Adolescent Psychiatry, Alarming changes in the global burden of mental disorders in children and adolescents from 1990 to 2019: a systematic analysis for the Global Burden of Disease study, 2022

Importance of addressing mental health: The US Surgeon General, US Public Health Service, Protecting Youth Mental Health: The US Surgeon General’s Advisory, 2021

RISING RATES OF MENTAL HEALTH DISORDERS & SUICIDES

Mental health issues are the leading cause of disability and poor health outcomes: US Department of Health and Human Services, Office of the US Surgeon General, Youth Mental Health, 2021

Some mental health conditions commonly occur together:

• Source 1: Centers for Disease Control and Prevention, Data & Statistics, 2023

• Source 2: Reem M. Ghandour et al., The Journal of Pediatrics, Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children, 2019

Ages at which mental health disorders develop: Ronald C. Kessler et al., JAMA Psychiatry, Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication, 2005

• Additional Resource: Martha Hostetter and Sarah Klein, The Commonwealth Fund, Transforming Care: Filling Gaps in Access to Mental Health Treatment for Teens and Young Adults, 2022

Diagnosis & Suicide Rates

Anxiety, depression, mood, and behavioral disorders are the most common mental illnesses: The American College of Obstetricians and Gynecologists, Mental Health Disorders in Adolescents, 2017

Diagnoses by 2020: Lydie A. Lebrun-Harris et al., JAMA Pediatrics, Five-Year Trends in US Children’s Health and Well-being, 2016-2020, 2022

Major depressive episodes are increasing:

• 2011 - 2020: Substance Abuse and Mental Health Services Administration, 2020 National Survey on Drug Use and Health, Section 9: Youth Mental Health Tables, Table 11.2 B - Major Depressive Episode in Past Year: Among People Aged 12 - 17; by Demographic Characteristics, Percentages, 2004 - 2020, 2020

• 2021: Substance Abuse and Mental Health Services Administration, 2021 National Survey on Drug Use and Health, Section 7: Youth Mental Health Tables, Table 7.7B – Major Depressive Episode (MDE) or MDE with Severe Impairment in Past Year: Among People Aged 12 to 17; Receipt of Treatment for Depression in Past Year: Among People Aged 12 to 17 with MDE and among People Aged 12 to 17 with MDE with Severe Impairment in Past Year; by Demographic Characteristics, Percentages, 2021

  • Additional Resource: National Institute of Mental Health, Major Depression, 2023

Suicide rates among youth and adolescents are also rising: National Center for Health Statistics, Centers for Disease Control and Prevention, Suicide and Homicide Death Rates Among Youth and Young Adults Aged 10–24: United States, 2001–2021, 2023

Suicide is the second leading cause of death: CDC Wonder, Centers for Disease Control and Prevention, About Underlying Cause of Death, 2018 - 2021, Single Race, 2023

Mental Health & Suicide Rates Vary

Mental health rates vary by race and ethnicity: Jennifer A. Hoffman et al., Pediatrics, American Academy of Pediatrics, Disparities in Pediatric Mental and Behavioral Health Conditions, 2022

Suicide rates were highest among American Indians or Alaska Natives: Nirmita Panchal, Kaiser Family Foundation, Recent Trends in Mental Health and Substance Use Concerns Among Adolescents, 2024

Rural Mental Health:

• Youth in rural health have higher levels of mental health disorders: Kelly J Kelleher and William Gardner, New England Journal of Medicine, Out of Sight, Out of Mind - Behavioral and Developmental Care for Rural Children, 2017

• Youth in rural health have higher levels of suicide: Jennifer A. Hoffman et al., Pediatrics, American Academy of Pediatrics, Disparities in Pediatric Mental and Behavioral Health Conditions, 2022

• Youth in rural areas have less access to mental health services: National Institutes of Health, NIH Research Matters, Rural youth often lack access to suicide prevention services, 2020

• Youth in rural areas have to travel further to receive mental health services: Blake Berryhill et al., Rural Mental Health, Adolescent Depression and Anxiety Treatment in Rural Schools: A Systematic Review, 2022

Females were more likely to have suicide attempts but males were more likely to die by suicide:

• Source 1: Nirmita Panchal, Kaiser Family Foundation, Recent Trends in Mental Health and Substance Use Concerns Among Adolescents, 2024

• Source 2: WISQARS Explore Fatal and Nonfatal Data, Centers for Disease Control and Prevention, Explore Fatal Injury Data Visualization, 2024

LGBTQ+ Mental Health:

• LGBTQ+ youth are also at an increased risk of mental health issues: Juliann Garey, Child Mind Institute, Mental Health Challenges of LGBTQ+ Kids, 2023

• Higher rates of mental health may stem from various factors: The Trevor Project, Facts About Suicide Among LGBTQ+ Young People, 2024

Teenagers with disabilities are more likely to have mental, emotional, or behavioral health disorders:

• Source 1: Shalini Lal et al., Frontiers in Rehabilitation Sciences, Mental health problems among adolescents and young adults with childhood-onset physical disabilities: A scoping review, 2022

• Source 2: Jackie Carey, Applied Health Sciences, Helping teens with disabilities prevent and treat depression, anxiety, 2021

BIOLOGY & SOCIAL DETERMINANTS SHAPE YOUTH MENTAL HEALTH

Several factors shaping youth mental health: The US Surgeon General, US Public Health Service, Protecting Youth Mental Health: The US Surgeon General’s Advisory, 2021

Life Experiences: COVID-19’s Impact on Mental Health

COVID-19 worsened children’s mental health:

• Source 1: Sherry Everett Jones et al., Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, Mental Health, Suicidality, and Connectedness Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021, 2022

• Source 2: Zara Abrams, American Psychological Association, 2023 Trends Report: Kids’ mental health is in crisis. Here’s what psychologists are doing to help, 2023

• Source 3: Nicole Racine et al., JAMA Pediatrics, Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19, 2021

The pandemic added to pre-existing mental health challenges, especially for vulnerable populations: US Department of Health and Human Services, Office of the US Surgeon General, Youth Mental Health, 2021

Emergency department visits increased: Rebecca T. Leeb et al., Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020, 2020d

UNDERTREATMENT OF MENTAL HEALTH DISORDERS

Mental health disorders are often underdiagnosed and undertreated: Margarita Alegria, Melissa Vallas, and Andres Pumariega, Child and Adolescent Psychiatric Clinics of North America, Racial and Ethnic Disparities in Pediatric Mental Health, 2010

Over 50% of youth under the age of 18 did not receive mental health treatment in the past year: Daniel G. Whitney and Mark D. Peterson, JAMA Pediatrics, US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children, 2019

The unmet need is greater among racial and ethnic minorities: Tracey L. Henry et al., Journal of Primary Care & Community Health, Taking a Closer Look at Mental Health Treatment Differences: Effectiveness of Mental Health Treatment by Provider Type in Racial and Ethnic Minorities, 2020

State-Level Differences

The rates of children and adolescents who do not receive mental health treatment vary by state: Daniel G. Whitney and Mark D. Peterson, JAMA Pediatrics, US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children, 2019

Causes of Treatment Disruptions

Undiagnosed, untreated, or inadequately treated mental health concerns can disrupt everyday life:

• Source 1: Centers for Disease Control and Prevention, Children’s Mental Health, What Is Children’s Mental Health?, 2023

• Source 2: Mental Health America, Recognizing Mental Health Problems in Children, 2024

Cost of care: National Council for Mental Wellbeing, Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America, 2018

Mental health professional shortages: Hemangi Modi, Kendal Orgera, Atul Grover, Association of American Medical Colleges Research Institute, Exploring Barriers to Mental Health Care in the US, 2022

Perceived Social Stigma

• Source 1: Nirmita Panchal, Kaiser Family Foundation, Recent Trends in Mental Health and Substance Use Concerns Among Adolescents, 2024

• Source 2: Amelia Gulliver, Kathleen M Griffiths, and Helen Christensen, BMC Psychiatry, Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review, 2010

Long wait times: Stella McLaughlin et al., BMJ Open, Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol, 2023

Lack of Knowledge

• Source 1: Nirmita Panchal, Kaiser Family Foundation, Recent Trends in Mental Health and Substance Use Concerns Among Adolescents, 2024

• Source 2: National Council for Mental Wellbeing, Study Reveals Lack of Access as Root Cause for Mental Health Crisis in America, 2018

Lack of Culturally Competent Care: Alana N. Rice and Suzanne C. Harris, Journal of the American Pharmacists Association, Issues of cultural competence in mental health care, 2021

STRATEGIES TO ADDRESS CHILDREN’S MENTAL HEALTH

Create a Framework to Promote Mental Health

Address Disparities in Youth Mental Health: National Institute of Mental Health, Strategic Framework for Addressing Youth Mental Health Disparities: Fiscal Years 2022 - 2031, 2022

Promote Mental Health Awareness:

• Source 1: Centers for Disease Control and Prevention, Promote Social, Emotional, and Behavioral Learning, 2023

• Source 2: Collaborative for Academic, Social, and Emotional Learning, SEL and Mental Health, 2023

Identify Mental Health Needs Early-On: Office of the Surgeon General, US Department of Health and Human Services, Youth Mental Health, 2024

Invest in Stakeholder Engagement

• Expand Stakeholder Engagement and Research: National Institute of Mental Health, Strategic Framework for Addressing Youth Mental Health Disparities: Fiscal Years 2022 - 2031, 2022

• Expand Funding Opportunities to Increase Access: Jessica Dym Bartlett and Brandon Stratford, Child Trends, A National Agenda for Children’s Mental Health, 2021

Incorporate Strategies to Prevent Suicide:

• Source 1: Centers for Disease Control and Prevention, Prevention Strategies, 2022

• Source 2: Eric J. Sigel and Mara H. Rahmandar, Healthy Children, American Academy of Pediatrics, Suicide Prevention: 12 Things Parents Can Do, 2023

Improve Mental Health Support

Expand Workforce Capacity:

• Engage Families and Caregivers in Mental Health Care: The National Child Traumatic Stress Network, Family Engagement and Involvement in Trauma Mental Health, 2017

• Improve Workforce Capacity and Access to Treatment: Jessica Dym Bartlett and Brandon Stratford, Child Trends, A National Agenda for Children’s Mental Health, 2021

Implement Evidence-Based Programs: Office of the Surgeon General, US Department of Health and Human Services, Youth Mental Health, 2024

Provide a Continuum of Support:

• Source 1: Office of the Surgeon General, US Department of Health and Human Services, Youth Mental Health, 2024

• Source 2: Resources for Integrated Care, Resources for Plans & Providers for Medicare-Medicaid Integration, Disability Competent Care, 2024

Utilize Non-Traditional Sites of Care

• Source 1: Vikki Wachino, The Brookings Institution, Moving mental health care out of the office, 2023

• Source 2: Sydney Daniello et al., Mental Health Alliance, Addressing The Youth Mental Health Crisis: The Urgent Need For More Education, Services, And Supports, 2021

• Source 3: Centers for Disease Control and Prevention, Mental Health Services for Children Policy Brief, 2023

Explore Complementary Approaches to Mental Health

• Source 1: Brad Bowins, MD, National Alliance on Mental Illness, 7 Behaviors for Improving Mental Health

• Source 2: National Alliance on Mental Illness, Complementary Health Approaches, 2023

• Source 3: Aksha M Memon et al., Indian Journal of Psychiatry, The role of online social networking on deliberate self-harm and suicidality in adolescents: A systematized review of literature, 2018

• Source 4: Matteo Briguglio et al., Neuropsychiatric Disease and Treatment, Healthy Eating, Physical Activity, and Sleep Hygiene (HEPAS) as the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk for or with Neuropsychiatric Disorders: Considerations for Clinical Practice, 2020