The Need for an Upstream Approach to Addressing the Youth Mental Health Crisis

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The Need for an Upstream Approach to Addressing the Youth Mental Health Crisis

This generation of young people is facing a lot of stress. Beyond school life, social pressure, navigating relationships with family and friends, and all the basic challenges of growing up, they also worry about political uncertainty, climate change, the violence of the gun, and the chaos of the world, which they are constantly exposed to. thanks to the internet. And they have recently endured a global pandemic that has upended many of their norms and sense of place and belonging. We owe it to young people to help them build psychological flexibility to support lifelong mental wellbeing. In doing so, we not only build a strong generation, but we also ease the overburdened health care system and reduce the rising costs of acute mental healthcare.

As the fog of the pandemic lifts, we are left to define the public health crisis of our time: mental health.

The statistics paint a frightening and heartbreaking picture. Forty-two percent of high school students felt so sad or hopeless that they couldn’t do their regular activities for at least two weeks in 2021, an increase of 50% from 2011, according to the CDC. The number seriously considering suicide rose to more than one in five, a 38% increase over the decade, and one in 10 who attempted suicide, a 25% increase over the decade. That means an average classroom of 30 has three students who attempt to end their lives each year.

Youth anxiety, depression, and suicide are at unprecedented levels, yet 60% of youth with severe depression do not receive any mental health treatment, according to Mental Health America. This can be largely attributed to the current health care system’s “downstream” approach, which only addresses mental health issues proactively after they have become major illnesses that require serious treatment. Despite approximately 50% of lifetime mental health problems being established by age 14 and 75% being established by age 24, health care systems spend 90% of those mental health care investments in acute mental healthcare treatment for adults, such as inpatient psychiatric care, hospitals, and emergency services. This “downstream” approach is inefficient and expensive, and the only solutions it provides are reactive, condition-centric, and episodic.

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Mental health tools and resources for the “left of center”

To make meaningful progress in changing the devastating youth mental health crisis, we must shift our focus “upstream” to early intervention and prevention. We need to proactively deal with the root of the problem and provide mental health support before people reach a breaking point, which does not require a diagnosis of mental illness. We need to support young people throughout, not after, the 11 years on average it takes for the first symptoms of mental illness to reach the point of receiving traditional treatment. And we need to support all young people whose mental issues never escalate to that point or whose issues are not considered serious enough for treatment.

While health care systems are overwhelmed with treating sick people and failing to address mental health issues until they become severe and urgent, a large neglected population of those youth emerged who did not receive help but needed it: the “missing middle.” It is approximately 60%–80% of young people who struggle a bit with their mental health but do not get any support because they do not have a diagnosis, do not think that their issues are serious or persistent enough to ensure a diagnosis and therapy. , and are not facing a serious, urgent crisis. Often, these people don’t recognize the severity of their issues, don’t think therapy or medication will help, or don’t feel comfortable discussing the topic with parents or counselors.

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Mental health tools can be very helpful in this population. 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 do not require a diagnosis. A solution like this can 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 connectivity is an essential part of a successful upstream approach. Young people appreciate the feeling of being surrounded by like-minded peers and seeing rather than just being told that they are not alone in their struggles and that there is a path forward. They know that the older generation does not face the exact same issues and situations, so advice from even licensed professionals is not always necessary to hear, as is advice from peers who have similar experiences. Peer forums and stories allow young people to connect, gather advice from, and experiment with different coping strategies that have worked for their peers in similar situations.

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Upstream mental health support is critical because if stress, anxiety, depression, and other mental health problems are not managed—because they are in the “missing middle” of our current healthcare system—they often escalate to more serious and expensive problems. This risk is especially raised 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 toughness, emotional intelligence, and psychological resilience in their early years to create a generation that is healthier and lives longer. functioning adults.

Moving the health care system to an upstream approach will require a lot of work, but young people need it very much, and the health care system needs it too. Emergency departments across the country are overwhelmed, gridlocked, and unable to handle the surge in mental health emergencies, especially among young people. And the entry point for mental health services for youth is often the emergency department.

Reaching people earlier with preventive support is also more cost-effective. Every $1 invested in prevention and early intervention for mental illness yields $2 to $10 in savings in health care costs, criminal and juvenile justice costs, and lower productivity, according to the National Academies of Sciences, Engineering, and Medicine. It’s time for society to come together and provide the “missing middle” with access to upstream behavioral health support before it’s too late and tragedy strikes.