The State of Mental Health in America 2022: Youth Prevalence and Access to Care

Part Two in a Series

On October 19th, 2021, a variety of leading pediatric organizations including the Children’s Hospital Association and the American Academy of Pediatrics declared a national emergency in children’s mental health. This emergency was brought on by challenges related to the COVID-19 pandemic, as well as other related factors like physical isolation, fear, and loss.

Hearing about the current challenges in youth mental health from these pediatric experts is helpful, but many people need to see the actual numbers before a problem as significant as this becomes actionable.

Thankfully, Mental Health America (MHA), one of our nation’s leading nonprofits dedicated to mental health, offers a valuable resource to help further this discussion. Their annual survey, the State of Mental Health in America Report was recently released, and it contains a vast amount of valuable data collected from all 50 states and the District of Columbia.   

This is the 8th year in a row this survey has been published, and it offers a helpful snapshot of how many people in the United States are affected by mental health challenges, and how many can access proper care. In addition to offering plenty of data on the adult population, the survey also answers those same questions about America’s youth.

The focus of this particular article will look at the mental health challenges and access to care in the youth population. A separate blog that focuses exclusively on the results of the study for the adult population can be found here. Let’s take a deeper look into this year’s findings as they relate to children and adolescents.  

An Important Note about COVID-19 and the Survey Data

While COVID-19 has undoubtedly had a significant impact on the mental health of youth in America, it’s important to note that factors related to the COVID-19 pandemic will not be reflected in this survey. Despite it being labeled as the 2022 survey, all of the data was collected in 2019.

As a result, the report writers note that it’s very likely the current mental health prevalence displayed in the survey is being under-reported. Next year, expect to see a meaningful change as data and insights from 2020 are reported.

 Key Takeaways

    • Just over 15% of youth have experienced a major depressive episode this year.
    • More than 60% of youth with major depression do not receive any mental health treatment. Even in states with exemplary mental health access, that’s nearly 1 in 3 youth who do not receive care.
    • In states with the least access to mental health care, only 12% of youth with severe depression receive consistent care.
    • Youth who identify as more than one race had the highest rates of severe major depression.
    • 8.1% of children have private insurance that does not cover mental healthcare services.

The Prevalence of Youth Mental Health Concerns

Even though data for the COVID-19 pandemic has not been calculated into this report, there are still concerning trends to be aware of when it comes to the prevalence of youth mental health concerns in America.

15.08% of youth (ages 12-17) reported at least one major depressive episode in 2019. That’s a 1.24% increase from 2018. This may not seem like a large percentage, but that represents more than 300,000 additional youth who report these symptoms.

Despite not being of legal age, many children and adolescents turn to substances like drugs and alcohol to cope with their mental health challenges, especially if they aren’t able to access professional care. Just over 4% of youth surveyed reported a substance use disorder this year. Some of the most problematic states with the largest numbers of youth substance use disorders include Oregon, Montana, and Nevada.  

Youth Access to Care

Research has shown that childhood depression tends to persist into adulthood, if left untreated. If mental health access for children and adolescents remains a challenge, we can expect to see overall prevalence numbers for both youth and adults rise correspondingly over time.

Currently, many youth are not able to access mental health care when they need it most. Nationwide, more than 60% of youth who have experienced at least one major depressive episode received no mental health treatment.

Even in Maine, the state with the highest access to care for children and adolescents, 30% of youth surveyed were unable to access mental healthcare. In Texas, that number is a shocking 73.1%, which represents more than 255,000 youth in that state alone who aren’t getting the care they need.

Nationwide, youth of color are significantly less likely to receive an accurate diagnosis and subsequent treatment for depression than their white peers. This trend continues when considering access to specialty mental healthcare, which includes everything from in-patient treatment facilities to at-home therapists.

Overall, youth of color were more likely to access mental health services at school. Investments in better school-based mental health resources like dedicated counselors, improved mental health education, and more comprehensive screenings could offer school boards, districts, and states an opportunity to meaningfully improve access to care and balance mental health equity for all students.   

Variations by State

Depending on where they live, youth in the United States have very different opportunities to access mental health care. In many cases, emotional and mental health concerns are only identified when a child begins their education.

Throughout the US, less than 1% of children with IEPs (Individual Education Plans) have been identified as having an emotional disturbance (ED), a statistic that is completely at odds with the fact that 10.69% of children with major depressive episodes reported that their mental health concerns interfered with their education.

With so few students given dedicated resources for their emotional and mental health concerns, this will continue to be an issue, especially in areas like Arkansas and Alabama where rates of emotional disturbance-based IEPs are the lowest.

Coincidentally, Alabama was one state where mental health outcomes for youth worsened between 2018 and 2019, dropping from #36 to #45. Other states that noticeably declined in the national rankings include Nebraska, Texas, and Delaware. States that made meaningful improvements include Colorado, Illinois, and Oklahoma.

Final Thoughts

With most COVID vaccines approved, or on the verge of approval for children and teens aged 5-17, we are reaching a turning point in the COVID-19 pandemic. While vaccinating our youth is important, we must also ensure that we continue to treat their mental health needs, which are worsening in most parts of the country, especially for youth of color.

There are many ways to put these insights into action in your own practice. With diligence and thoughtful work, you can help improve the mental health outcomes of children and adolescents in your community by making your practice more accessible to youth, and especially youth of color, who may need mental health services but are currently being left behind.

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