The Kids Aren’t Alright

To see data describing the mental health challenges of Gen Z (born between the mid-1990s to around 2012) is to realize that these young people are living childhoods and adolescences unlike any, ever. Growing up inevitably has its trials and tribulations, but there has never been anything like what we’re seeing now. Approximately 30% of teens currently suffer from an anxiety disorder, and 20% suffer from a depressive disorder. 

There was already a steadily growing mental health crisis among young people in the United States, due in part to the rise of social media and the resulting exposure to constant comparisons with peers, cyberbullying, unrealistic beauty standards and other deleterious factors. 

Exacerbating this situation, the U.S. has been experiencing a shortage of pediatric mental healthcare providers, including child and adolescent psychiatrists, clinical and school psychologists, counselors and therapists. The American Academy of Child and Adolescent Psychiatry reports that there are just 14 child and adolescent psychiatrists for every 100,000 children in the U.S. — at least three times fewer than needed. 

Then came COVID-19: Lockdowns, social isolation, disruptions in education and fears of the virus itself all amplified preexisting mental health issues and led to a surge in demand for mental health services among children and adolescents. Further, the pandemic has made shortages and turnover even worse due to provider burnout and trauma. 

A REVERBERATING CRISIS

Beyond the profound and at times tragic impact that pediatric mental health challenges can have on young people’s emotional well-being, the long-term effects have ramifications that reverberate throughout society and well into the future: 

Economic impact: Mental health issues in childhood and adolescence can lead to decreased productivity, higher rates of absenteeism, increased healthcare costs and potential loss of income in adulthood. This strains healthcare systems, decreases workforce participation and impacts economic growth. 

Social impact: Individuals who experience mental health issues in their formative years may struggle to form and maintain relationships, leading to social isolation. Educational impact: Mental health issues can impair cognitive functioning, academic performance and educational achievement. This can lead to reduced employment prospects, poverty and inequality. 

Healthcare burden: Untreated mental health conditions can lead to longer hospital stays and increase demand for mental health services, limiting access to care for those with severe conditions. 

Criminal justice impact: Individuals with untreated mental health issues are more likely to break laws, due to behavioral issues, substance abuse or an inability to access appropriate mental health services. 

Relationship issues: Mental health conditions can impact family dynamics, sometimes leading to strained relationships, increased stress and conflict within households. 

Public perceptions: Stigma surrounding mental illness perpetuates discrimination and social exclusion, hindering individuals from seeking help, accessing treatment and integrating fully into society. 

Understandably, the children and adolescents in families experiencing socioeconomic disparities are even more prone to mental health challenges, as marginalized communities often lack access to mental health resources and face additional stressors related to poverty, discrimination and unstable home environments. 

SUICIDE ON THE RISE

Over the past decade, the proportion of pediatric visits for mental health reasons doubled, including an astonishing fivefold increase in the proportion of visits for suicide-related symptoms. 

“Teen suicide fluctuates between the third- and fourth-leading cause of death in teenagers,” says Joseph Austerman, DO, Department Chair of Behavioral Health and Neurological Sciences at Cleveland Clinic Children’s. 

“While there has been a slight improvement post-COVID, studies show that 13% to 17% of kids in the United States have either self-injured or seriously considered suicide,” Dr. Austerman says, “and there’s a concerning trend of self-injury beginning in younger children, now as young as 11 years old.” 

In fact, more teenagers and young adults now die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease combined. Most heartbreaking of all, according to a recent study among 9- to 10-year-olds, 1 in 12 reported having had suicidal thoughts. 

The tragic gravity of these statistics serves as a clarion call for prioritizing mental health awareness, destigmatizing the search for help and implementing effective interventions to safeguard the well-being of our young people. 

“Another concern is the impact of state and national regulations on the mental health of kids, especially those identifying as LGBTQ, with 45% of this group seriously considering suicide,” Dr. Austerman says. “Any legislation that hinders a provider’s ability to offer care is detrimental to the patient.” 

MENTAL HEALTH GOES TO SCHOOL 

Navigating the turbulent waters of adolescence is challenging enough without the added pressures of the high school environment, where academic demands and intricate social dynamics can significantly intensify stress. 

The complex web of high school social life — where peer acceptance can hinge on fleeting trends and social media presence — creates an undercurrent of stress. These factors can transform high school hallways into a gauntlet of emotional and mental challenges that leave lasting impacts on young adults’ well-being. 

It is important to remember that even the most caring teachers and administrators don’t often have the skill set to support students with mental illness, especially when it isn’t outwardly apparent. 

In 2018, at Lakewood High School in a Cleveland suburb, Cleveland Clinic Children’s School Mental Health Program began a collaborative care clinic, adding mental health care to the school’s primary care. The demand for mental health services was immediately apparent; the program quickly went from one counselor to four, and two psychiatry residents were also added. 

At the Lakewood High School clinic, students have to complete a registration packet at the beginning of the year. Once registered, they can access services ranging from general healthcare to mental health support. There’s a separate entrance to the clinic, which looks like a typical medical office with exam rooms and a waiting area. Students can come in for things like a sore throat or vaccines, but if needed they can also see a mental health counselor. 

“There is a national movement toward school-based health clinics, but the level of integration we’ve achieved is still somewhat rare,” says Molly Wimbiscus, MD, Child and Adolescent Psychiatry Fellowship Training Director at Cleveland Clinic’s Children’s. “Many clinics focus on either general healthcare or mental health, but we’ve managed to blend both. This kind of collaborative care requires a lot of investment and training, and not every health system is set up to support it. But when it works, it can really reduce wait times for services like psychiatric evaluations, which often take months.” 

Cleveland Clinic Children’s plans to expand the School Mental Health Program to three additional districts in the Cleveland area, focusing on inner-ring suburbs, with the goal of replicating the success of the Lakewood High School clinic. 

SERVING THE UNDERSERVED

“Be the Boss of Your Stress” is a school-based program created by Cleveland Clinic pediatric psychologist Gerard Banez, PhD, to help children in underserved communities learn how to manage stress effectively. The initiative, which has garnered positive feedback from teachers and principals alike, teaches kids practical mind-body skills such as belly breathing, imagery, relaxation techniques and positive self-talk. It works with students from first to eighth grade, providing age-appropriate strategies to cope with stress. 

The program promotes overall healthy habits, including good sleep, nutrition and physical activity. It also engages teachers and parents to ensure that these skills are reinforced in the classroom and at home. 

“My goal is early intervention to prevent more serious problems,” says Dr. Banez, Clinical Director of the Integrated Behavioral Health/School-Based Health Program and Training Director for Cleveland Clinic Children’s Pediatric Behavioral Health. 

“We’re currently in two schools, and we’re adding a third, all in the Fairfax neighborhood of Cleveland,” he says. “Our focus has always been on kids and families in low-income, underserved communities, where the need for mental health services is critical. We work with whole classrooms, meeting with about 20 to 25 kids at a time for eight weeks, one hour per session. Teachers sit in to learn the strategies we teach so they can coach the kids. We also try to engage parents to help generalize what the kids learn from the classroom to their home lives.” 

MEETING THE CRISIS HEAD-ON

Already Northeast Ohio’s largest option for pediatric patients in crisis, Cleveland Clinic is positioned to build the most comprehensive pediatric mental health program in the country. Tom Mihaljevic, MD, CEO and President and holder of the Morton L. Mandel CEO Chair, has prioritized this issue and assembled a task force to address the various levels of need. 

To address pediatric mental health needs, current and planned Cleveland Clinic initiatives include: 

Mobile Intensive Intervention Team: This specially trained multidisciplinary intervention team of professionals provides therapeutic, educational and medical management to children struggling with acute behaviors. These services are provided at home and in hospital settings, and are uniquely designed to provide intensive mental health services and community care connection for more long-term management. 

Partial Hospitalization Program: There is a significant dearth of acute psychiatric hospitalization beds for the pediatric population in Northeast Ohio. The purpose of this intensive outpatient program will be to keep patients ages 12 to 18 out of inpatient treatment or transition them back to a less acute level of mental healthcare. This approach has been proven to reduce psychiatric hospitalization. 

Suicide Prevention Center: This initiative will allow for rapid assessment and provide a clear path for more long-term care for patients in need. The intensive outpatient service will focus on acute assessment, triage, care coordination, hospitalization prevention and research, and will mitigate suicidal and self-harm ideation. 

Behavioral Health Unit in Emergency Department: An extension of Cleveland Clinic’s current Pediatric Emergency Department, this locked unit will be set up for assessment, de-escalation and the initiation of treatment for children experiencing acute behavioral episodes, self-harm or decompensation. 

The mental health challenges faced by our youth are unprecedented, and any delay or failure to effectively address them will adversely affect our nation’s social fabric, productivity and overall health for decades to come. Cleveland Clinic is committed to providing the resources, expertise and innovative programs necessary to address the critical gaps in pediatric mental health care and to lay the foundation for a healthier, more resilient generation. 

“Our vision,” Dr. Austerman says, “is to address this crisis head-on.” ◼