Article Spotlight

The current state of youth mental health warrants a transformation in how to invest in and deliver mental health services. Even before the COVID-19 pandemic, youth mental illness was a pressing concern that often went underestimated and
under addressed, despite approximately one in five children ages 3 to 17 years inthe United States experiencing a mental, emotional, developmental, or behavioral disorder (1). Rates of youth suicide were climbing (2), and many children and adolescents struggled with conditions such as anxiety and depression (3). Historically underserved populations, including racially and ethnically

The pandemic highlighted and increased youths’ mental health challenges.

minoritized and lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youths, were disproportionately affected, with rates of suicide among Black youths rising faster than those of any other racial-ethnic group (4) and LGBTQ+ adolescents attempting suicide four times more often than non-LGBTQ+ youths (5). However, access to mental health resources and support was limited for numerous reasons, including stigma, financial barriers, and a scarcity of mental health professionals specializing in pediatric care (6, 7). Before the pandemic, the underinvestment in and fragmentation of the U.S. youth mental health system left a significant portion of the youth population grappling with their mental health in silence or unsupported.

The pandemic highlighted and increased youths’ mental health challenges. Prolonged periods of lockdowns, economic instability, social isolation, increased use of digital devices and exposure to social media, disrupted education, and uncertainty about the future took a toll on the mental well-being of children and adolescents. Many reported feelings of anxiety, depression, and loneliness as they faced the sudden loss of routine and social connections and the strain of remote learning (8). The inability to engage in typical social activities and rites of passage, such as proms, graduation ceremonies, and extracurricular activities, further exacerbated the sense of loss and isolation experienced by young people. In addition, >140,000 children in the United States lost a primary or secondary caregiver because of COVID-19 (9).

Furthermore, the strong impact of the pandemic on marginalized and minoritized communities revealed significant disparities in mental health and education systems and worsened existing inequities (10, 11). In addition to increased rates of psychiatric illness among children and adolescents, rates of suicide during the pandemic were higher than before the pandemic (12). In early 2021, U.S. children’s hospitals recorded a 45% increase in self-injury and suicide among 5- to 17-year-olds compared with the same period in 2019 (13). In recognition of this trend, U.S. primary health care leaders, including the Surgeon General and the American Academy of Pediatrics, declared a national emergency and made an urgent call for new and comprehensive approaches to ensuring the well-being and resilience of the younger generation (14).