Understanding the Barriers – and Solutions – to America’s Youth Mental Health Crisis

While the COVID-19 public health threat has diminished in recent months, a corresponding mental health crisis exacerbated by the pandemic shows no signs of waning.

Last year, more New Jersey teenagers sought emergency medical care for anxiety and depression than in prior years, with Hackensack University Medical Center reporting a nearly 50 percent increase in pediatric emergency room psychiatry consultations.

Joshua Langberg, director of the Center for Youth Social Emotional Wellness at the Rutgers Graduate School of Applied and Professional Psychology, is working directly with young people to develop solutions. One of those young people, 18-year-old Nez Venturelli, is sharing their experience to help strengthen the state’s youth mental health services.

Put the youth mental health crisis into perspective: What kind of numbers are we talking about?

Langberg: The Center for Disease Control and Prevention estimates between 30 and 40 percent of youth post-pandemic are experiencing anxiety or depression or endorsing that they feel hopeless. Too often we simply repeat numbers and forget to think about what they really mean.

So, let’s think about it. Take the average American high school, say, with around 1,000 students. Assuming 30 to 40 percent, that means there are 300 to 400 kids in a typical U.S. high school who are feeling significantly anxious or depressed and hopeless and in need of our understanding, caring and support. Each one of these schools might, if they are well-resourced, have three or four counselors and a school psychologist. In other words, we have a system that cannot handle the numbers that we’re talking about.

Nez, you were, until recently, one of those students. What was your experience like?

Venturelli: From kindergarten to 6th grade, I had no one to help. In 7th grade I sought therapy and spoke with someone once or twice a week. But I wasn’t getting “better,” so I met with a psychiatrist, who then had me take medication and I would only see her three times a year. It felt as though I was stuck.

High school was different. I got a guidance counselor who made me comfortable and allowed me to be myself. She would take walks with me and even helped my mom and I have a better relationship. In my senior year, she went to a different school, but my team of counselors grew into every adult figure in the school. I was coming out of my shell, and they saw me – the real me.

Unfortunately, most young people don’t know where to turn when they need help. They’re not taught how to ask for a “hero” – someone to help navigate the challenges. Heroes don’t just appear; they must be found. But not everyone finds them.

We were already facing a youth mental health crisis before COVID-related lockdowns. What did the pandemic do to these trends?

Langberg: All human beings at times feel worried or sad, and we all have a certain level of risk for those feelings becoming frequent and impairing, which is essentially what a diagnosis of anxiety or depression represents. Stress is one of the main factors that can cause occasional worries or sadness to become chronic and impairing. The pandemic rapidly changed our routines, increased uncertainty and caused many youth to live in a constant state of fearfulness.

The pandemic also isolated people and forced us to rely largely on the internet and social media for connections. In some studies, 70 to  90 percent of respondents said their social media use significantly increased. Social media and the internet can be helpful from an information and social connections standpoint but can also be harmful. Think about the messages we are exposed to through media, such as political divides, natural disasters, health crises, violence in schools. Seeing that information day in, day out, has a real impact on how our youth see the world. It can leave them feeling hopeless.

Understanding how to balance internet and social media use in children and adolescents is difficult. That is why organizations such as the American Psychological Association (APA) have recently published a social media health advisory and set of recommendations. These factors all combined to lead to high levels of individual and family stress, which understandably led to higher rates of significant mental health problems in children and adolescents.

One might have expected that after the pandemic ended, youth mental health concerns would subside. Have they?

Langberg: We don’t know the long-term implications of removing two years of typical development from a young person’s life because we don’t have many examples to look at for reference. That said, if you consider the developmental difference between a three-year-old and a five-year-old in terms of social skills and academic knowledge, or if you think about someone missing their last two years of high school and then transitioning to college, you will likely conclude that the implications will be long-lasting.

Youth missed key developmental and skills building opportunities. It is also important to remember that the pandemic exacerbated an existing underlying trend. It didn’t cause a mental health crisis. It was already there. From that perspective, there is no reason to expect that the end of the health crisis part to the pandemic would result in improvements in youth mental health and wellness.

Venturelli: COVID-19 had such an impact on young people. Look at any classroom: Every single student in that room is dealing with something in their head. Even if they tell you they’re fine, they’re not. Lives were interrupted and it isn’t easy to fix that and move on.

You recently hosted a summit at Rutgers to help find solutions to this crisis. Explain what you did.

Langberg: Individuals cannot solve this challenge. We need to come together to collaborate to develop new innovative programs and to work towards systemic and structural change. The question is: How do we get parents, together with mental health providers, together with pediatricians and schools, together with youth, together with researchers? That is what the Youth Mental Health Equity Summit was meant to do.

The summit was held in April for the first time. We had about 135 people come together, including representatives from major state agencies and mental health associations of New Jersey, nine different school districts, pediatric practices, mental health practices and hospitals, and many youth mental health and wellness focused community-based organizations. We provided the community with the space and opportunity to share information, collaborate, innovate and listen.

We started the program with a panel of youth from all different socioeconomic backgrounds who have struggled with mental health. These young people talked about their experiences and what they felt was missing in their community that would have helped them. That guided the rest of the activities.

One outcome of the summit was a list of barriers and solutions. In the weeks that followed we have begun to provide funding for some of these ideas through small grants. Our goal is to partner with community and state agencies to grow the summit and to make it an annual event. Everyone is so busy. We need a reason and a structure to come together and collaborate. Only when we do that will we begin to develop more effective systems of care.

It is wonderful to see many others prioritizing youth mental health and proposing real actionable solutions. For example, the National Governors Association led by Gov. Phil Murphy recently proposed a comprehensive national response to the youth mental health crisis (plan). If you read the plan you will see remarkable similarities with the solutions identified at the CYSEW summit. Now it is time to come together, to move beyond focusing on the negatives and crises and to turn our collective attention towards implementing solutions. 

Venturelli: The summit was a wonderful experience as we were simply able to speak and be heard. Participants were all well-educated in their field, but the school doesn’t have all the answers to this crisis. For that reason, it was awesome to see how my words were translated into notes that helped summit participants better understand things from a young person’s perspective.