Findings from multiple organizations highlight the severity of the youth mental health crisis in America.
- According to Centers for Disease Control and Prevention data, in 2020, suicide was the second-leading cause of death for ages 10-14 and the third-leading cause for ages 15-24.
- A December 2021 U.S. surgeon general’s advisory on youth mental health reported that in early 2021, emergency department visits for suspected suicide attempts were 51% higher for adolescent girls and 4% higher for adolescent boys compared to early 2019.
- A 2022 Mental Health America report shared that 15.1% of youth ages 12-17 experienced a major depressive episode in the past year; 10.6% have severe major depression that affects how they function; and over 60% with major depression don’t receive mental health treatment.
How did this crisis develop, and how can the mental health community tackle it? Alex Stavros, chief executive officer of Embark Behavioral Health, a leading network of outpatient centers and residential treatment programs offering premier mental health treatment for teens and young adults, shared his insights.
Why There’s a Crisis
Stavros said a variety of factors have contributed to the teen mental health crisis, including:
- The amount of information teens consume: Because the human brain isn’t fully developed until the mid 20s, teenagers have difficulty managing stress — and they face it regularly. “When you think about exposure to social media or news in general and everything going on in the world, be it war, violence, struggles, or pain, it puts a lot of stress on a vulnerable, developing brain,” Stavros said. This “always on” life also affects sleep, which is a significant driver of healthy development. Lack of sleep, in turn, is a key contributor to depression and anxiety.
- The need to keep up with everybody else: Social media, reality TV shows, and the Internet have made teens all too aware of what people around the world are doing and achieving. “It used to be keeping up with the Joneses meant keeping up with your next-door neighbor. Now, it’s quite literally about keeping up with the Kardashians. And as teens start to see — because of how social media is represented — that everybody else appears to be doing well and is happy, they start to feel shame that they’re not good enough,” Stavros said.
- The pressure to do more: “It used to be that you didn’t really know how good colleges were, nor did you know what sort of activities people were involved in, but now with the Internet, everyone knows whose college is better and what activities you’re involved in,” Stavros said. “And parents feel this subconscious pressure, and they feel inadequate, and it creates a vicious cycle of pressure and a feeling of shame and stress.”
- Fewer deep relationships: Teens spend hours on their phones or laptops interacting with people instead of connecting in person. Stavros said they’re missing out on the deep relationships with friends, boyfriends, and girlfriends that can help them develop not only a sense of self but also resiliency, which comes from experiencing normal ups and downs with those closest to them. Relationships with caregivers are also suffering. “The parents are working longer hours and bringing their laptops home instead of being present with their child, having dinner with them, and listening to them,” Stavros said. “Meanwhile, the kids get lost in their devices and spend less time in nature, playing, and in relationship. There’s a lack of connection, which is critical for healthy identity development.”
- A focus on happiness vs. joy: Teens can get too caught up in pursuing happiness, which depends on external circumstances, instead of joy, which can be found within. “One of the big things we need to do as a society is to refocus on joy and on finding purpose and meaning in pain and suffering. We need to embrace struggles and failure and not ‘just do whatever makes them happy,’” Stavros said. Doing so, he explained, will help teens grow, develop, and nurture grit and resiliency.
Barriers To Solving the Crisis
Stavros cited three key barriers to solving the teen mental health crisis:
- Stigma: There’s a stigma around talking about — and getting help for — mental health conditions. Parents feel shame, so they keep it under wraps.
- Awareness: Teens and parents may struggle with acknowledging and identifying what, exactly, is wrong as well as where — and how — to get help.
- Access to high-quality services: Mental health providers don’t always accept insurance, may not be taking new clients, or could have long waitlists. In addition, there’s a whole segment of care missing from the health care system.
Stavros said Embark is dedicated to knocking down these barriers, a task that’s key to the company accomplishing its big goal to lead the way in taking teen and young adult anxiety, depression, and suicide from the all-time highs of today to all-time lows by 2028.
The Continuum of Care
When it comes to helping teens feel better, Stavros said mental health providers need to offer a true continuum of care. To illustrate that approach, he shared a quick analogy. If you have a toothache, you don’t jump straight to a root canal. Treatment could be as simple as getting a cavity filled or just watching the tooth for a few months. That approach is possible because dentistry has a continuum of care where distinct levels of services are available depending on the issue being treated.
“We don’t want to go overboard with interventions from a health care perspective,” Stavros said. “It’s the same exact thing for mental health. We want to intervene at the right level at the right time.”
That’s the approach Embark Behavioral Health takes to treating families.
“There’s this whole spectrum of services — from virtual to intensive outpatient programming, in-home services, and day treatment programs — that allows us to ensure that the teenager or young adult can stay at home, with their community, and in school as long as possible to address the issue versus jumping to an inpatient setting,” Stavros said.
Partnering With Insurance Companies
As providers strive to address the teen mental health crisis, Stavros said they’ll need to partner closely with insurance companies.
“An insurance company wants to partner with organizations that offer a robust continuum of services so that the level of care delivered is the lowest and least invasive — yet still effective,” he said.
Over time, Stavros expects that insurers should pay for results, not services.
“What we want to move toward is a model where insurance companies have a relationship with providers where they’re able to say, ‘We have a complex situation with a 14-year-old boy, and we’re not exactly sure what he needs. We trust you to help figure that out, and we’ll pay you a certain amount per day to come up with a treatment plan and deliver treatment and therapy. And we expect a particular result, as defined this way,’” he said.
The Right Therapy for Teens
When it comes to treating teens, Stavros said family therapy is critical.
“We really believe that you don’t fix a kid,” he said. “If you want to change a kid, you need to change their environment. You need to focus on the system.”
He explained that parents need to be consistent and predictable caregivers who provide clear boundaries that create a safe environment for the teen to develop.
“We’re supposed to be in vertical relationships so that we don’t get enmeshed — where, as a parent, we feel ‘If my child is OK, I’m OK. If my child is in pain, I’m not doing well,’ and we go up and down with them,” Stavros said. “That ends up becoming a burden for the child. Subconsciously, they start to carry that burden of knowing that they’re dependent on you and you on them. That creates co-dependency.”
Stavros also recommended going beyond traditional talk therapy where teens meet with therapists to get advice and coping mechanisms, as their prefrontal cortex — the part of the brain that can learn and apply that information — is not fully developed. Instead, he said, teenagers need experiences, activities, and movement.
“We want to use evidence-based treatments, but we don’t need to do that sitting down, per se,” Stavros said. “And we want to do that in a group aspect with peers. We want to do that with other trusted caregivers. We want to create multiple experiences of connection and relationship, facilitated by trained clinicians.”
What’s Ahead for Teen Mental Health Care
Looking to the future, Stavros believes wearables such as health-monitoring watches and rings and continuous glucose monitors can help teens — as well as young adults and parents — understand and address their mental health conditions. These devices can track everything from heart rate variability to sleep patterns, and providers can use that information to create individualized treatment plans and set goals for a healthier life, with the full treatment team monitoring how the teen is doing.
“For example, if a teen has a couple days of materially less or more sleep or excessive sugar intake, one could assume there’s a higher risk of depressive feelings and anxiety,” Stavros said.
He also believes a better understanding of how physical and mental health interact will be key. For example, a treatment plan should include goals related to sleep and a focus on nutrition and cutting down on ingredients that can negatively affect mood, such as gluten or meat.
Overall, Stavros said, using data to blend nutrition, fitness, medication, and therapy can have terrific benefits.
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