In the two years since the start of the pandemic, America’s mental health has taken a nosedive. A combination of economic struggles, isolation, and fear has rendered the majority of people vulnerable to emotional difficulties and the onset of new or recurring psychiatric illness. While this downturn in mental health and wellbeing has affected everyone, vulnerable populations have suffered most, including veterans, the elderly, people with lower income, and young people – with teens displaying some of the most dramatic declines in mental health.
The way that teens have experienced the pandemic – not to mention the previous ten years of increasing social pressures and the rise of Instagram – has been especially difficult as they navigate the inherent uncertainty of their teen years. Imagine having to skip your homecoming, participate in classes from a possibly inhospitable home environment, struggle to feel connected to your peers, and deal with your parents or caregivers all day, often without the ability to escape because you live in a rural area and don’t have a car or a license. In a word, being a teenager in the pandemic has sucked.
Unfortunately, these mental health struggles due to the pandemic and many other global stressors facing young people today can be detrimental to the health of teens and in some cases, fatal. These high stakes make it critical to address the current crisis in teen mental health.
Is there really a crisis in teen mental health?
In December, in a rare public advisory, the U.S. surgeon general warned of a “devastating” mental health crisis among adolescents. This statement reflects countless studies and data sources showing that mental illness is currently rising at an alarming rate in teenagers. In 2019, 15.7% of teens reported having a major depressive episode, a 74% increase from 2004. Emergency room visits also rose sharply for anxiety, mood disorders and self harm. Problematic substance use is also a significant issue, with The National Center for Drug Abuse reporting that an estimated 863,000 adolescents are currently in need of substance abuse or addiction treatment, but are not receiving it. Further, suicide rates for people ages 10-24, which were stable from 2000-2007, jumped by nearly 60% by 2018 according to the CDC, and U.S. suicide rate in 2020 was the highest among wealthy nations. These rising rates of untreated psychiatric disorders and emergency-room visits for suicide attempts and self-harm leave little doubt that the extent and nature of the threat has changed significantly. Numerous hospital and doctor groups have called it a national emergency, citing not only these rising levels of mental illness, but also a severe shortage of therapists and treatment options, and insufficient research to explain the trend.
How did we get here?
Thirty years ago, American teens were at greatest risk for injury and death from risky behaviors such as smoking, drunk driving, teen pregnancy, and binge drinking. While rates of these behaviors have fallen dramatically due to various public health initiatives, a new threat to adolescent health has emerged – rising rates of psychiatric illness. Are these mental health struggles that are inherent to adolescence and merely went undiagnosed before — or are they being overdiagnosed now (read more about mental health diagnostic failure here)? Historical comparisons are difficult, as consistent and comprehensive data on psychiatric disorders in teens has been collected for a relatively short period of time. Research has shown that many mood and anxiety disorders emerge during adolescence, when risk for mental illness is heightened due to dynamic brain and behavioral development as well as major biological changes such as the onset of puberty. However, the pandemic and other aforementioned stressors unique to the world we currently live in are exacerbating this vulnerability.
One source of stress that is frequently blamed for the current mental health crisis is the rise of social media, but research on this issue is limited. The existing findings are nuanced and often contradictory, which is further complicated by the fact that some adolescents appear to be more vulnerable to the effects of screen time than others.
Federal research shows that teenagers as a group are also getting less sleep and exercise and spending less in-person time with friends — all crucial for healthy development — at a period in life when it is typical to test boundaries and explore one’s identity. The combined result for some adolescents leads to mental health struggles such as anxiety, depression, compulsive behaviors, self-harm and even suicide.
What do we do about it?
Antelope Recovery fills an existing mental healthcare gap by focusing on 5 problems that we can easily address.
1. Uneven distribution of workers
There is a large geographic disparity in available mental health services and a highly variable distribution of therapists and psychiatrists across the United States. Even within a single state, mental health providers are typically concentrated in urban, more liberal areas, leaving many rural populations without access to care. A 2017 study found that more than 60% of counties in the US (80% of rural counties) do not even have a psychiatrist. Patients in rural parts of the country are routinely forced to drive 45 minutes to three hours for needed mental health care.
- The creation and uptake of telehealth services is a huge step forward in improving health care access for people living in rural areas. Innovative uses of technology to deliver and augment mental healthcare are providing novel possibilities for treatment that were previously unavailable to rural populations.
2. Lack of adequate training for therapists
Most therapists are not equipped to work with severe mental illnesses, e.g. bipolar disorder, schizophrenia, or addiction. Many graduate programs for Masters-level therapists do not provide adequate education on the diagnosis and treatment of these illnesses, or even how to engage with these patients in a way that is not counterproductive to their recovery. 60% of schools that train students to become licensed professional counselors require no supervised training in evidence-based psychotherapy modalities, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT). In addition, 40% of therapists do not work with people who have a psychiatric diagnosis – those who most desperately need help. Instead, the majority of therapists work exclusively with high-functioning clients who simply want to expand their potential and increase their self-awareness. It is a therapist’s own prerogative to choose which clients they choose to accept, and the choice of many therapists to avoid treating mentally ill patients exacerbates an already dire situation.
- Closure of the implementation gap: When researchers discover life-changing treatments, they are not implemented into standard clinical training for 20 years, on average. Academics and professionals actively working together to close that gap could significantly improve treatment options and outcomes for individuals struggling with psychiatric illness.
- Supervision and training requirements: Comprehensive supervised training in evidence-based therapy and severe mental illness needs to be a requirement to ensure successful outcomes for both therapists and their clients. There are dozens of therapeutic modalities, with varying degrees of efficacy. Learning effective treatment models that are well-supported by research and seeing actual results will increase therapists’ confidence, reduce stress and burnout, and ultimately lead to higher treatment success rates.
3. Fragmented care
Currently, patients can go to nine different therapists with the same symptoms and walk out of each of their offices with nine different diagnoses and nine different treatment recommendations. Mental health diagnostics are extremely imprecise and depending on the type of mental health professional seen, wildly different treatment plans may be prescribed for the same patient. To a certain degree, this is unavoidable considering the many different types of mental health professionals that exist, including psychiatrists, clinical psychologists, marriage and family counselors, psychiatric nurse practitioners, addiction counselors, art therapists, equine therapists, social workers, and more. However, because of the vast differences in training across these fields and the lack of an overarching system delineating a role for each, it is not always obvious which clinician is most relevant to see. This is a major issue for those who acutely need treatment, especially if they do not have the money or time to see multiple professionals and find the right fit. Further, even if seeing multiple professionals or being admitted into a psychiatric care facility is an option, mental health providers often fail to share vital health records with each other, leading to a loss of valuable information and a waste of time for patients who are forced to repeat the same information and complete the same diagnostic procedures multiple times. Not only does this disorganization negatively impact the mental and financial health of those who need help the most, it leads to an estimated yearly loss of one billion dollars in our healthcare system.
This fragmentation in the field is confusing and burdensome for clients and caregivers alike and puts an undue burden on the patient and their families as they navigate the complexity of conflicting diagnoses and treatment plans, as well as the fickle world of health insurance.
- Standardized electronic health records that are easily shareable between providers, even across different health care organizations.
- A focus on diagnostic discrepancies and how to reduce their frequency in the future.
- Tracking of treatment outcomes using validated measures so that recommendations for treatment can be made in a data-driven manner.
- Follow up within 7 days after being discharged from care: The first week post-discharge is when risk of relapse and suicide are highest. Programs often end care without any plans for follow-up. Relapse prevention should be included as an integral part of all treatment plans.
- Stepped care. Step-by-step access to different programs and small incremental shifts in care allow for a refined treatment tailored to the acute needs of patients.
4. Prohibitive costs and lack of insurance coverage
Currently, 30% of therapists do not accept insurance. Additionally, even when providers do accept insurance, individual insurance companies may not choose to cover essential mental health treatment. Currently, insurance companies decide when mental health treatment should end without considering the expertise of a patient’s care providers. Often, inpatient treatment ends after 30 days when long-term care (4-9 months) is required for safe and lasting recovery. Private facilities usually run 15% below capacity due to insurance complications, further reducing access to treatment for those who need it.
- Mental health care should be comprehensively reimbursed by public and private insurance plans on par with other forms of acute care. Repairing psychological damage incurred after an acute psychiatric episode takes time and money, however, it is possible with the right resources. When people do not receive the care they need, they often develop a chronic disability, leading to a significantly reduced lifespan and many years of lost productivity. Investing in appropriate care is effective and beneficial to individuals and society.
5. Not enough long-term care centers
Long-term care centers are at capacity with long waitlists. In the 1950s, there were an average of 340 inpatient beds available per 100,000 people, while now, only 17 beds are available per 100,000 people. Currently, it takes an average of 48 days for people with a mental illness to find and receive the care that they need, which is often too late when dealing with severe addiction, suicidality, or psychosis. Usually, during that long waiting period, families, communities, and care workers, who are unequipped to support the patient, end up expending large amounts of energy and money to prevent the worst from occurring, draining themselves and those around them. This can lead to feelings of helplessness from the caseworkers, overwhelm and fear in families, and typically, increased symptoms in the patient.
In addition, existing long-term care centers are often mismanaged. Currently, 22% of patients in long-term care centers do not actually have a mental health diagnosis. This is troubling because an estimated 34.5% of people with a severe mental illness are not receiving care for their condition. We must find a way to get the right people to the right places for treatment.
- Long-term care centers accept inappropriate clients to meet their financial needs and provide inadequate alternatives for those clients. By fixing the aforementioned insurance issues, long-term care centers will have the financial flexibility to triage clients based on need, rather than ability to pay.
- Because insurance will not pay for long-term mental health care and long-term care centers are fairly expensive to run, it is extremely challenging for these centers to stay open. Insurance policies should be adjusted to cover long-term mental health rehabilitation to increase the availability of these treatment options.
Together, we can help our teens heal.
There are numerous factors contributing to the declining mental health of American teenagers. Antelope Recovery aims to mitigate the current bottlenecks in our country’s mental healthcare for teens by addressing these five problems in mental healthcare.