The state of youth mental health

Brandy Galloway first noticed something was amiss with her daughter, Aurora, shortly after her girl turned three years old. The toddler was fixated with death, especially the death of her own mother. “There was one time she punched me in the throat and ran away, telling — what we thought at the time was her imaginary friend — that she believed she had killed me,” Galloway explained they later learned the imaginary friend was a hallucination, and her behavior was more than just an over-active imagination.

Over the next decade, Galloway and her family actively sought treatment and a diagnosis for Aurora, becoming frequent visitors to Colorado Children’s Health. It took many years and bouts of institutionalization to discover that Aurora had a rare genetic mutation that caused her to exhibit bipolar I disorder at an early age. She was also not receptive to medication.

While Aurora’s diagnosis was genetic, social environmental factors also play into how young people navigate the world, especially those who might not be neurotypical.

Over the past decade, CDC data and statistics on children’s mental health have shown that instances of diagnosed depression, anxiety, behavioral issues, and co-occurring mental health disorders have been on the rise in individuals between the ages of 3 and 17. For many individuals, these years are when individuals start to show the first signs of a mental health disorder, making awareness during this time crucial.

Rosie Gellman is a psychiatrist who initially started in pediatrics and switched to adolescent psychiatry when she realized that young people were underserved in the mental health space. “It is a crazy and difficult world for kids, we have never dealt with some of these issues before,” she explained, speaking to the rise of social media and technology. Gellman discussed the pressures that young people face in the world, especially post-pandemic, with more isolation and pressures than ever before. A decline in mental health is often attributed to a combination of both the environment and the genetic makeup of the child.

Dr. Rosie Gellman

Biology

Chemical imbalances and genetic predisposition are the most significant indicators of mental illness. However, there is still a lot to learn about the brain. For that reason, diagnosing mental illness is not as simple as diagnosis for other parts of the body. Achieving an accurate diagnosis can be challenging and complex but is necessary to find the proper treatment of medications and support.

Galloway, discusses their struggle to find treatment during the pandemic. “Finally, we got her in at Children’s Hospital in 2020, but we were turned away many times. They believed us, but they needed to see her in psychosis. They wanted us to upset her on the way in so they could report her being unsafe. The reason is that so many kids needed help in 2020, so they could not admit her. There was just no room.”

Galloway went on to retell that it took another three years of off-and-on partial hospitalization to figure out a treatment plan for her daughter while she was actively hallucinating, fixated on violence and death, and trying to escape school.

Galloway’s case, which, due to the nature of the violence in the home, was more extreme and required advocacy on the part of therapists and the parents. Other students with mental health concerns can fly under the radar for years. Chelsea Newton, a licensed clinical social worker who works both in schools and with individual clients in her practice, Phases of the Mind Therapy, discussed the problem of diagnosing younger clients. She explained that while those with behavioral issues in the classroom might be more noticeable, that is not always the best indicator of an issue. “There are kids who are anxious, having intrusive thoughts, or having trouble with executive functioning. They often look like the quiet student, and they are trying to get by despite the internal chaos.” She explained that, as a school social worker, she relies heavily on reports from the teachers and parents, though for a quieter kid, that system has its flaws.

Environment

While the social environment does not cause mental illness, it can impact the wellness of young people and exacerbate those who are sensitive to the world around them. Newton stated, “What is happening with a kid is from the home, community, and world impacts their mental health. Even with an individual student coming forward with a concern, there might be an organic cause, but it is rare. It is likely pressure or stress coming from somewhere else. We need to look at the systems: school, home, the community, and the world. A lot of those things really affect kids.”

While the environment has an impact on mental health, it is more navigatable through therapy and perception. That said, there are many aspects of the current world that have a deep hold on how children see and live in the world

Post-pandemic world

For many, the coronavirus pandemic brought a sense of instability and uncertainty. For those dealing with mental illness, the results were more dire. In a report by the CDC, there has been a gradual increase of suicide and homicide since 2001. The report states that between 2007 and 2021, suicide rates for individuals ages 10 to 24 went from 6.8 to 11 deaths per 100,000 people with the suicide rates nearly tripling for those between the ages of 10 to 14.

The impact of the pandemic can be seen in a local parent who watched her child decline with rapid changes and feelings of instability. Molly Johnson, who has asked to use a pseudonym for this article to protect the privacy of her family, found herself dealing with a sudden change in her family during the pandemic. While her daughter had exhibited traits of mental illness, recently being diagnosed with obsessive-compulsive disorder at the age of 3, things made a shift in 2020.

“During the pandemic, things got harder. When we [Johnson and her husband] had to return back to work, she started showing behaviors that were associated with OCD. Maybe she always had it, but the pandemic flipped the switch to her, to have full-blown OCD.” Johnson’s experience, while stressful, was not unique. According to a study published in the Journal of Behavioral Research and Therapy in 2022, the number of youth reported as either suffering from anxiety or depression had gone from 31.7% to 56.7% from 2018 to 2020, indicating that the pandemic might have been a catalyst for many young people experiencing a mental health disorder.

Cyberbullying

The concept of bullying is not necessarily new, though the medium in which children and teens are facing harassment is more uncharted. According to a 2022 study by the Pew Institute, 53% of teens stated that they had been the victim of online harassment. While all young people are at risk, this form of bullying is skewed more towards affecting female-identifying students than males. Categories of bullying included offensive name calling, spreading false rumors, receiving, explicit and unwanted images, being stalked, physical threats, and having explicit photos of themselves shared without their permission.

Newton discussed the importance of conversing with children about conducting themselves on the Internet. “Kids can be terrible with each other. It impacts how they engage in class. We must create kindness and community in school when social media sees people in an exclusive social hierarchy. We have conversations around how to be good digital citizens.” Newton explained that young people do not always understand how their actions impact their peers when they interact through a screen rather than face to face. Unfortunately, while they may feel disconnected, the impacts are profound.

In a 2023 study published in the Journal of Environmental Research, cyberbullying had a direct impact on a young person’s mental health, causing a decrease in self-esteem and a rise in anxiety, depression, and suicidal ideation. While cyberbullying often occurs among acquaintances and friends, social media, at large, also has a deep impact on mental wellness.

Social media

In May 2023, the Office of the U.S. Surgeon General issued an advisory regarding social media’s impact on the youth mental health crisis. The advisory cited problems such as body dissatisfaction leading to eating disorders, harmful content leading to self-harm or accidental death, exposure to hate-based content, and giving a space for predatory behavior. The advisory also goes on to explain the risks of excessive use, citing that one in four teenagers spends over five hours a day on social media, and one in seven spends over seven hours online. This behavior has been linked to attention deficit hyperactivity disorder as well as depression.

In Gellman’s experience, excessive use starts at a younger age and can extend to online games. “Social media is a huge issue. Same with video games. They are limiting time outdoors and being active. Kids are supposed to be active and playing for their development, but they are not doing that as much, especially with the homework they are already assigned.”

Academic pressures

Another major impact on young people’s mental health is academic pressure and worries about college acceptance. In an article published in the Journal of Affect Disorder, academic pressures are related to depressive symptoms in 48 out of 52 studies. Furthermore, academic stress has been connected to isolation, anxiety, and poor parental and child relationships. However, there are changes on the horizon.

Newton explained that there has been less push towards standard college than in previous years. “There are more job training colleges and more work programs. While there is still a lot of pressure to have good grades and extracurriculars, making a resume, there is still pressure to do a lot, but it looks different than it has been previously.” Newton added that parents who have not changed their mindset that going into a trade is as important as a four-year university can still pressure teenagers who do not feel like college is for them.

Current events and school shootings

It is undeniable that surviving a traumatic event, such as a school shooting, would impact the mental wellness of the average student. However, students who have not experienced these events firsthand are also experiencing stress and fear.

Newton discussed the impact that any sort of drill can have on students. “There are different protocols for everything from a student or community at risk, and they all have different levels of severity. We practice all situations, and on those days, we have to have additional support in schools. After those drills, the kids are feeling triggered because they have experienced or heard of similar experiences. Kids worry about these drills because they think the adults are lying to them about what is going on.” Newton explained the fear and anxiety that exists in the students and the constant worry about gun violence due to nationwide news.

During our 2023 election coverage, YS made sure to ask every school board candidate running for election how to reduce the stress and trauma that can be inflicted by running school shooting drills.

Tom Mauser, an advocate with Colorado Ceasefire, is also well aware of the issue. Mauser lost his son Daniel in the 1999 Columbine High School shooting. He explained that he is a part of the program that helps parents and students become more aware of gun control while allowing them to feel empowered rather than fearful. He stated, “Colorado Ceasefire offers programming for students and parents around gun violence and how it is impacting them. Usually, half the students have been impacted. There is a lot of fear, anxiety, and depression as communities feel unsafe. Adults can change their habits when things happen, but you can’t stop students from going to school.” Mauser explained that helping students learn how to report potential threats to safety and to speak openly about concerns can prevent tragic events from occurring.

Chelsea Newton, LCWS

Solutions

Schools: Support and screenings

Many schools are instituting a mental health screening test to become aware of potential obstacles. “We use a universal screener, so every kid is getting screened for mental illness unless the family opts out. They provide a self-report, and professionals, principals, and teachers evaluate it. This, combined with a teacher report looking at behaviors in class, helps to support students earlier,” Newton explained. He added that the problem comes when the parents have preconceived ideas about mental health and choose not to have their children evaluated, even if it is likely needed.

Parents also have mixed experiences in schools when it comes to their children’s mental health. Galloway, whose daughter was recently relocated to a group living situation for the family’s safety, discussed her experience with the St. Vrain Valley School District. Galloway explained that she was accused of Munchausen by proxy, now known as factitious disorder imposed on another, and was not taken seriously for several years, “St. Vrain has not been on our side since we have been doing this. She [her daughter] has run away from her school several times over the past three years. They have concocted many versions of a plan, none of which have worked.” Galloway continued that this inspired her to join the Parent Teacher Organization in order to help not only her daughter but other students in need of support.

On the other side of the coin, Johnson, whose daughter attends a Boulder Valley School District school, discussed her experience as primarily positive with a counselor who has advocated for her daughter to find support in the classroom. Johnson believes that while schools are a compassionate place, too much is being required of them. “We are asking too much of schools, especially with this mental health crisis post-pandemic and Marshall Fire. We are also asking them to deal with student hunger and provide mental health care in a way that a school simply can’t. I see so many parents asking for schools to accommodate our children rather than navigating discomfort.” Johnson explained that part of the responsibility falls to mental health availability and parental advocacy.

Mental health funding

As schools are stretched to their capacity, it is increasingly important that the state find ways to support mental health funding. Mauser explained the issue: “One call is more mental health counselors in schools, which is probably true. In my mind, here is a cautionary note: Counselors are important, but they won’t be doing hourly sessions with a student who needs that kind of support. They can evaluate the importance of mental health if they need it. It is up to the parent to find that support.” Mental Health Colorado is working on legislation to help access support that is out of network, so individuals are not waiting months or years to find and afford treatment in their insurance network.

Community involvement

Another responsibility falls on practitioners, who are screening young people, not feel uncomfortable around having difficult conversations. “Most kids are more comfortable talking about mental health than their parents are. I have been working with doctors and other professionals to talk about more dark and sensitive issues, reminding them that asking questions does not cause bad thoughts to pop up. If a patient had diabetes, the doctor would ask about it; suicide and mental health should be the same,” Gellman explained.

Gun control

Between suicide and violence prevention, legislation around gun control can make a major difference in safety. The issue of gun violence is unique to the United States. Mauser stated, “America is so based on individualism. Partially, the lack of violence elsewhere is due to fewer guns, but other places are also more holistic and community oriented.” Mauser explained that while mental health awareness and support are extremely important in prevention, the isolation seen in the United States can make it hard for people to find resources. For that reason, legislation can be the difference between life and death.

In 2021, gun deaths among U.S. kids rose 50%, which include homicide, suicide, and accidents. Making it harder to not only obtain guns but also access them in the home has been shown to limit the potential for disaster. “We now have a three-day waiting period, which is significant for suicide. It is often an impulsive act; they can think about their plan over three days and get help,” Mauser said. For many young people, three days of waiting could help remove the risk of impulsive violence as well.

Mauser has also worked to institute the Colorado’s “red flag” law, which helps teachers alert attention to a student or adult who could be at risk, making them unable to purchase a firearm until investigated. In association, Safe2Tell Colorado is a tip line for any adult or young person to report potentially unsafe people or situations anonymously.

With more screenings and conversations around mental health, the number of reported cases is likely to rise since many young people have been historically overlooked or misdiagnosed. However, the increase in awareness in tandem with more public policy and advocacy to support the needs of children and adolescents could be the key to decreasing the rate of mental health-related deaths in our youth.