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Poor care access leaves youth mental health crisis in limbo

Limited workforce, challenges balancing care access with school, and stigma are exacerbating the youth mental health crisis.

Only around half the kids displaying symptoms of anxiety or depression are getting a clinical diagnosis for the disorders, and even fewer are able to access care, according to a new United Hospital Fund report that paints a picture of the youth mental health crisis in America.

In 2021, only 39 percent of adolescents experiencing a major depressive episode (MDE) were actually able to access care for it. Meanwhile, only nine in every 20 teens displaying symptoms of anxiety and 10 in every 20 displaying symptoms of depression were able to get a clinical diagnosis for the disorders.

These findings, gleaned from multiple surveys of kids in the US plus New York State and New York City, indicate a still-glaring youth mental health problem.

“Over the past decade, the number of adolescents suffering from behavioral health conditions has increased, and the toll is especially profound for communities of color,” Oxiris Barbot, MD, United Hospital Fund president and CEO, stated publicly. “Solutions won’t be easy or quick, but this report sheds light on potential ways to make a disjointed and under-resourced child behavioral health system more responsive, effective, and equitable.”

Millions of teens in the US had a mental health condition in 2022, with symptoms and diagnoses ranging from disordered eating to ADD/ADHD, depression, anxiety, substance use disorder (SUD), and behavior problems. Of the 6.7 million adolescents who have depression, anxiety, ADD/ADHD, or behavior problems, more than half said they have multiple mental health conditions.

These numbers represent a growing trend in America’s youth, with MDE, clinically diagnosed depression, clinically diagnosed anxiety, and overall feelings of sadness and hopelessness reaching all-time highs across the country. Girls, kids who identify as lesbian, gay, or bisexual (LGB), and some racial/ethnic minorities are more likely to report mental health symptoms, the report added.

These rising rates of mental health conditions come with serious consequences for teens; kids with co-occurring mental health symptoms are three times more likely to use illicit drugs, 2.3 times more likely to binge drink, 1.5 times more likely to drink and drive, and 1.3 times more likely to have sex without using any birth control or contraception.

But despite this growing youth mental health crisis, few teens are able to access the healthcare resources they need.

As noted above, only around half of adolescents reporting symptoms of common mental health diagnoses (anxiety and depression) are getting a clinical diagnosis. A clinical diagnosis means a clinician determined the individual met the criteria for a mental illness based on the DSM-5.

Meanwhile, only about 65 percent of kids experiencing MDE get treatment for it, and there are steep racial disparities at play here.

American Indian/Alaska Native (AI/AN), Hispanic, and multi-racial teens are significantly less likely to get MDE treatment than other racial/ethnic groups. Black and Asian kids are among the most likely to get treatment for MDE, while White kids are slightly less likely to access MDE care.

There are numerous barriers keeping kids from getting the mental healthcare they need, the report added in qualitative detail. Balancing mental health needs with social determinants of health can get in the way, while some pediatric experts say it’s hard for families to balance missing school for mental health appointments.

Moreover, care siloes and lack of care coordination can stymie efforts to tailor care, while the mental health workforce shortage also plays a big role. In fact, the national average of behavioral health prescribers in the US comes out to 207 prescribers per 100,000 youths. Nevada and Texas have the lowest rates, at 147 and 152 prescribers per 100,000 youths, respectively.

The growing youth mental health crisis needs attention, not just for ethical and compassionate reasons, but because there are big costs associated. The report noted 94 million missed days of school due to behavioral health conditions, with the typical kid with one or more behavioral health conditions missing an average of 14 school days per year.

The entire family unit is affected, the report added, with the researchers calculating between $5.7 and $11.5 billion in lost wages to parents caring for adolescents with behavioral health conditions. That’s between $6,300 and $12,500 for each family affected.

But there are some ways healthcare professionals can begin to move the needle on this issue, the report authors said.

Foremost, empowering non-clinical staff for early behavioral health intervention can help manage conditions before they escalate. Supporting programming that supports youth in telling their own mental and behavioral health stories could also help break down the stigma linked to accessing care, the report authors advised.

Finally, they recommended better communication between families, schools, and communities. School-based mental health can be effective because it meets adolescents where they are and can serve as a conduit between kids and their families.

“Ultimately, an all-hands-on-deck approach is critical to paving the way for a more coordinated behavioral health ecosystem for adolescents— all disciplines and fields must come together to help adolescents caught in the grip of this crisis,” the report authors concluded.

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