Call to Action: The Surgeon General’s Advisory on Protecting Youth Mental Health

Attorney General Youth Mental Health Crisis

On December 7, 2021, the U.S. Surgeon General released a 53-page Advisory paper on youth mental health. The Advisory is an extraordinary document that draws attention to and elevates the youth mental health crisis that has long existed and has been exacerbated by the lingering pandemic and its social isolation. The Advisory provides a comprehensive overview of the many reasons why the mental health of our children, teens, and young adults has deteriorated so rapidly over the past two years. Importantly, it lays out specific calls to action for every stakeholder who has the power to change the trajectory of mental health for our nation’s young people.

Children, teens, and young adults are perceptive. As parents and caregivers, we celebrate how quickly our children learn language and absorb the world around them. Unfortunately, our perceptive children now recognize that we adults do not have all the tools to help them navigate the increasing complexity of our society. They are doing their best to come of age in a tumultuous and unpredictable world.

Through our work educating families and facilitating support groups for parents, we hear devastating stories from caregivers with children as young as nine years old who have been hospitalized because they no longer want to live. We hear from parents whose young adult children have disappeared into the fog of serious, life-threatening mental health crises and substance use disorder – two conditions that often occur together. We hear from mothers who email, writing “My son is suicidal. I’ve tried everything and no one will help.” When these cries for help reach us, our hearts break. These stories aren’t statistics. These experiences belong to real people living every parent’s worst nightmare.

While the Surgeon General’s Advisory lays out a whole-of-society effort that includes steps every stakeholder can take to mitigate this crisis, the reality for many parents and caregivers is that crisis intervention resources are simply unavailable. Decades of underinvestment by federal, state, and local governments in social services and supports means that the demand for mental health services far exceeds the supply and many fall through the cracks, with disastrous consequences for their families and communities.

Like with access to physical health care services, there is a two-tier mental healthcare system. Families with financial resources can afford to take their children to the 56 percent of therapists and child psychiatrists who only accept cash payments. Families without means are subject to long wait times, unending paperwork, and frequent conversations with insurance companies and local bureaucracies for a very limited number of available appointments. Crisis services, including inpatient psychiatric care, partial hospitalization, and other step-down services, are in short supply. By the time these services become available, for many individuals it is too late. This shortage is particularly acute for the 112 million Americans who live in rural areas of states like Arizona, South Dakota, Montana, and Idaho.

Our overburdened state and local government workers, psychiatric hospitals, and mental health professionals are on the front lines of this crisis with limited time and resources. They are engaged in extremely difficult and emotionally challenging work, often criticized for “not doing enough.” Our mental health care system is understaffed and underfunded. It is a systemic failure.

This failure can be corrected, but we must address the lack of financial incentives to care for the mental health of our youth. Recent history provides one example. The steep cost of a medical education led many medical students to choose high-paying specialties over less well compensated primary care practice, creating a shortage of primary and geriatric practitioners. The Affordable Care Act of 2010 not only included provisions to incentivize these practice areas, but also included provisions to support the training of more physician assistants, nurses, and other health care professionals who are so important to our healthcare workforce. These public investments are beginning to bear fruit, creating greater access to primary care in shortage areas. The U.S. Congress and state governments must do better for mental health. They should begin by expanding current mental health parity laws, increasing the behavioral health workforce, and permanently increasing funding for crisis services for youth. These initial steps are necessary, but legislators must continue to prioritize efforts targeted to the specific mental health needs of youth. Their future – and ours – depend on it.