U.S. Surgeon General Vivek Murthy issued a public health advisory on Tuesday to address the “youth mental health crisis” exacerbated by the COVID-19 pandemic.
It is rare for the nation’s top physician to issue such an advisory, reserved for significant public health challenges that demand the nation’s immediate attention. The surgeon general’s 56-page report on the mental health of U.S. teens says it’s time to recognize and address that crisis.
The national average of weekly emergency room visits for suspected suicide attempts among teens jumped nearly 40 percent in February and March this year compared to the same months in 2019. The report attributed the recent decline in mental health to the pandemic’s high death toll, economic instability, isolation from friends and family, and a pervasive sense of fear that marked the turn of the decade.
“It would be a tragedy if we beat back one public health crisis only to allow another to grow in its place,” Murthy wrote in the report.
While the pandemic intensified the mental health issues affecting children and teens, the surgeon general makes it clear that COVID-19 did not create them. The report cites a 2020 Centers for Disease Control and Prevention study that found 1 in 3 high school students and half of female students reported “persistent feelings of sadness and loneliness” — an increase of 40 percent from 2009 to 2019.
Social media and popular culture bear responsibility, the report states, bombarding teens with messages telling them they’re “not good looking enough, popular enough, smart enough, or rich enough.” The surgeon general urges social media companies, whose business models are designed to maximize user engagement time, to prioritize the public’s health and well-being during product development, “even at the expense of engagement, scale, and profit.”
Slow progress addressing the myriad social crises — climate change, income inequality, racial injustice and inequity, gun violence and the opioid epidemic — also contributes to poor mental health among young people, the report states.
Johns Hopkins All Children’s Hospital in St. Petersburg said it has seen a 35 percent increase in referrals to mental health services between March 2020 and now compared to the previous two-year period. Meanwhile, suicide attempts and reported eating disorder symptoms among hospital patients doubled in the same period, said Jennifer Katzenstein, the hospital’s director of psychology, neuropsychology and social work.
Katzenstein said the surgeon general’s advisory is a critical opportunity to bring youth mental health to the forefront of community conversations.
“We need to not let mental health slip away as we focus so much on physical health during COVID-19,” she said.
The surgeon general’s report lists eight recommendations for how educators and school districts can help mitigate youth mental illness, such as educating staff on how to recognize behavioral changes among students that indicate mental health needs; expanding evidence-based social and emotional learning programs; and encouraging students and families to enroll in health care plans that ensure coverage of behavioral health services.
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The Pinellas County School District has already implemented those recommendations, said Donna Sicilian, executive director of student services.
“We have gone to great lengths to ensure the mental wellness of our students,” Sicilian said. “I feel confident we’re continuing on the right track.”
The report cites the American School Counselor Association’s recommendation that schools should have one counselor per 250 students, yet the national average is one counselor per 425. Sicilian said the ratio at Pinellas schools is one student services staff member, which includes counselors, psychologists, social workers, nurses with mental health training, and bullying and suicide prevention staffer, per 197 students.
The Hillsborough County School District also implemented the surgeon general’s recommendations before the advisory, said Erin Maloney, department manager of media outreach. This year, the district launched its mobile response team, she said, replacing law enforcement officers with a team of licensed mental health clinicians to help students in crisis during school hours.
“Our district has had a laser-like focus on providing mental health supports since the pandemic began,” Maloney said.
The report also has a list of recommendations for health systems to better support youth mental health, such as routinely screening children for mental health challenges and risk factors, and educating families about their role in child development.
While providers are doing their best, Katzenstein said, the ongoing shortage of behavioral health providers — a problem that especially affects Florida — has made it difficult to increase the scale of mental health programs and patients’ access to services.
Editor’s note: This story was updated with additional information from the Pinellas County School District.
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