This generation of young people is dealing with extreme stress. On top of school life, social pressure, navigating relationships with family and friends, and all the standard challenges of growing up, they’re also worried about political uncertainty, climate change, gun violence and global turmoil – which they’re exposed to constantly thanks to the internet. And they recently endured a global pandemic that upended many of their routines and sense of place and belonging. We owe it to young people to help them build psychological flexibility to support mental well-being for life. In doing so, we not only build a resilient generation, but we also alleviate the overburdened healthcare system and reduce the mounting cost of acute mental healthcare.
The crisis at hand
As the fog of the pandemic lifts, we’re left with the defining public health crisis of our time: Mental health.
The statistics paint a harrowing and heartbreaking picture. Forty-two percent of high school students felt so sad or hopeless that they could not engage in their regular activities for at least two weeks in 2021, an increase of 50% from 2011, according to the CDC. The amount who seriously considered suicide soared to more than one in five, a 38% increase over the decade, and one-in-10 attempted suicide, a 25% increase over the decade. That means an average classroom of 30 has three students who attempt to end their lives every year.
Youth anxiety, depression, and suicide are at unprecedented levels, yet 60% of young people with major depression do not receive any mental health treatment, according to Mental Health America. This can be largely attributed to the current healthcare system’s “downstream” approach that only addresses mental health issues reactively after they’ve evolved into major disorders requiring acute treatment. Despite approximately 50% of lifetime mental health problems being established by age 14 and 75% being established by age 24, healthcare systems spend 90% of mental healthcare investments on acute mental healthcare treatment for adults, such as inpatient psychiatric care, hospital and emergency services. This “downstream” approach is inefficient and expensive, and the only solutions it provides are reactive, condition-centric, and episodic.
Mental health well-being tools and resources for “the missing middle”
To make meaningful progress in reversing the devastating youth mental health crisis, we need to shift our focus “upstream” to early intervention and prevention. We need to proactively tackle the root of the problem and provide mental health support before people reach a breaking point, without requiring a mental illness diagnosis. We need to support young people throughout, not after, the 11 years it takes on average for initial mental illness symptoms to reach the point of receiving traditional treatment. And we need to support all the youth whose mental issues never deteriorate to that point, or don’t perceive their issues as being severe enough for treatment.
While healthcare systems are overwhelmed with treating critically ill people and failing to address mental health issues until they become severe and urgent, an enormous overlooked population of youth has emerged that isn’t receiving help but should be: the “missing middle.” This is the roughly 60%-80% of youth who are struggling somewhat with their mental health but not getting any support because they don’t have a diagnosis, don’t think their issues are serious or ongoing enough to warrant a diagnosis and therapy, and aren’t facing a severe, urgent crisis. Often, these people don’t recognize the severity of their issues, or don’t think therapy or medication would help, or don’t feel comfortable addressing the topic with parents or counselors.
Upstream mental health-well being tools can help this population tremendously. They should be equipped and encouraged to access mental health support whenever and wherever they want, and at their own pace. They should have 24/7 access to solutions that don’t require a diagnosis. A solution like this could offer useful mental health resources such as therapeutic content, articles, peer stories, asynchronous messaging with licensed clinicians, and forums moderated by mental health professionals.
Peer-to-peer connection is a key component of a successful upstream approach. Young people value feeling like they are surrounded by like-minded peers, and being able to see rather than just be told that they’re not alone in their struggles and there is a way forward. They know that older generations didn’t face the exact same issues and situations, so advice from even licensed professionals doesn’t always necessarily resonate as well as advice from peers who share more similar experiences. The forums and peer stories allow young people to connect with, gather advice from, and experiment with different coping techniques that have worked for their peers in similar situations.
Upstream mental health support is critical because when stress, anxiety, depression and other mental health problems are left unchecked – as they are for the “missing middle” in our current healthcare system – they often escalate into more serious, and more costly, problems. This risk is especially heightened for youth, who are in the golden window of time when environmental exposures have a pronounced impact on brain development. We need to give young people the tools and resources to build mental resilience, emotional intelligence, and psychological strength during their early years in order to create a generation of healthier and higher-functioning adults.
Shifting the healthcare system to an upstream approach will take a lot of work, but young people desperately need it, and the healthcare system direly needs it as well. Emergency departments across the country are overwhelmed, gridlocked, and unable to handle the influx of mental health emergencies, particularly among youth. And the entry point for mental health services for young people is often the emergency department.
Reaching people earlier with preventive support is also far more cost effective. Every $1 investment in prevention and early intervention for mental illness yields $2 to $10 in savings in healthcare costs, criminal and juvenile justice costs, and low productivity, per the National Academies of Sciences, Engineering, and Medicine. It’s time for society to unite and provide the “missing middle” with access to upstream behavioral health support before it’s too late and tragedy ensues.
Photo: SDI Productions, Getty Images
