What Young People Can Do

Since many of the challenges young people face are outside of their control, we need a whole-of-society effort to support children’s mental health and wellbeing from birth to adulthood. That said, below are important steps children and young people themselves can take to protect, improve, and advocate for their mental health and that of their family, friends, and neighbors:

• Remember that mental health challenges are real, common, and treatable. Struggling with your mental health does not mean you are broken or that you did something wrong. Mental health is shaped by many factors, including biology and life experiences, and there are many ways mental health challenges can be addressed.
• Ask for help. Find trusted adults, friends, or family members to talk to about stressful situations. For example, if you or someone you know is being bullied, tell a trusted adult. If you are struggling to manage negative emotions, reach out to a school nurse or counselor, a teacher, a parent or caregiver, a coach, a faith leader, or someone else you look up to and trust. Look into therapy or counseling resources to get support when something causes distress and interferes with your life. Reaching out to others can be hard and takes courage, but it is worth the effort and reminds us we are not alone.
• Invest in healthy relationships. Social connection is a powerful buffer to stress and a source of wellbeing. But too often in our fast-paced lives, quality time with people gets crowded out. Make space in your life for the people you love. Spend time with others regularly, in-person and virtually.¹¹⁴ Find people who support and care about you and have open and honest conversations with them about your feelings. Get involved in group activities, such as recreation and outdoor activities, after-school programs, and mentorship programs.¹¹⁵
• Find ways to serve. Volunteering in your community and helping others can be a great way to connect with people, build a sense of purpose, and develop your own sense of self-worth.¹¹⁶ Helping others when you are the one struggling can seem counterintuitive. But service is a powerful antidote to isolation, and it reminds us that we have value to add to the world.
• Learn and practice techniques to manage stress and other difficult emotions. Try to recognize situations that may be emotionally challenging for you, and come up with strategies to manage those emotions. For example, if you find it stressful to look at COVID-related news, try to check the news less often, take a break for a day or a week at a time, keep notifications off throughout the day, and avoid looking at negative stories before bed.⁵¹
• Take care of your body and mind. Stick to a schedule, eat well, stay physically active, get quality sleep, stay hydrated, and spend time outside.^{117, 118, 119} And avoid substances that can ultimately make you feel tired, down, or depressed, such as alcohol, marijuana, vaping, and tobacco.¹²⁰
• Be intentional about your use of social media, video games, and other technologies. Here are some questions to help guide your technology use: How much time are you spending online? Is it taking away from healthy offline activities, like exercising, seeing friends, reading, and sleeping? What content are you consuming, and how does it make you feel? Are you online because you want to be, or because you feel like you have to be?
• Be a source of support for others. Talk to your family and friends about mental health, listen and be a source of support to them, and connect them to the right resources.¹²¹ Advocate for and contribute your ideas at the local, state, or national levels. For example, look into joining Youth Advisory Councils or mental health peer support programs in your community.¹²²

What Family Members and Caregivers Can Do

Families and caregivers play a critical role in providing the safe, stable, and nurturing environments and relationships young people need to thrive. Below are recommendations for how families and caregivers can engage with children and youth on mental health topics, help them become more resilient, and address emerging mental health challenges:

• Be the best role model you can be for young people by taking care of your own mental and physical health. Young people often learn behaviors and habits from what they see around them. You can model good habits by talking to children about the importance of mental health, seeking help when you need it, and showing positive ways you deal with stress so children learn from you. Additional ways to take care of your own mental health include taking breaks, getting enough sleep, exercising, eating balanced meals, maintaining regular routines, obtaining health insurance coverage, staying connected with family and friends, and taking time to unplug from technology or social media.¹²³
• Help children and youth develop strong, safe, and stable relationships with you and other supportive adults. Research shows that the most important thing a child needs to be resilient is a stable and committed relationship with a supportive adult.¹²⁴ Spend time with children on activities that are meaningful to them, show them love and acceptance, praise them for the things they do well, listen to them, and communicate openly about their feelings. Encourage children to ask for help and connect them with other adults who can serve as mentors.¹²⁵
• Encourage children and youth to build healthy social relationships with peers. This can be done through self-directed play and structured activities such as school, after school programs, sports, and volunteering.¹²⁶ Since peers can play a major role (both positive and negative) in children’s development, it’s important to help children learn how to deal with peer pressure. Have open conversations with your child about their values and teach them to be confident and comfortable in expressing their needs and boundaries.
• Do your best to provide children and youth with a supportive, stable, and predictable home and neighborhood environment. A lot may be outside of your control, and there will be trial and error as you figure out what works best for your child. That said, try to help children stick to a regular and predictable daily schedule, such as regular dinnertime and bedtime.^{117, 126, 127} Be thoughtful about whether and how to discuss stressful topics such as financial and marital problems. The American Psychological Association offers tips on how to talk with your child about difficult topics.¹²⁸ It’s also important to minimize children’s exposure to violence, which puts them at risk of mental health and substance use challenges.¹²⁹
• Try to minimize negative influences and behaviors in young people’s lives. Talk to children early about the risks of alcohol and other drugs, both short-term (such as car crashes and other accidents) and long-term (such as reduced cognitive abilities). The earlier a child or adolescent begins using substances, the greater their chances of developing substance use problems.¹³¹ Mental health and substance use problems can also occur at the same time. For example, some young people struggling with stress or difficult feelings turn to alcohol or drug use.¹³² And alcohol and other drugs can also affect mental health, for example by altering mood or energy levels.¹³³
• Ensure children and youth have regular check-ups with a pediatrician, family doctor, or other health care professional. Health care professionals can help you monitor your children’s health, give you advice on how to prevent problems, and diagnose and treat physical and mental illnesses. Obtaining health insurance coverage for your children can help. To learn more about enrolling in Medicaid, the Children’s Health Insurance Program (CHIP), or a Marketplace plan, go to HealthCare​.gov or InsureKidsNow​.gov.
• Look out for warning signs of distress, and seek help when needed. Signs of distress in children can show up in a number of ways, such as irritability, anger, withdrawal, and other changes in their thoughts, appearance, performance at school, sleeping or eating patterns, or other behaviors.)¹³⁴ If you notice concerning changes in your child, let them know you’re there and ready to support them however they need. Don’t be afraid to ask for help by talking to a doctor, nurse, or other professional or looking into other available resources in your community. For example, schools often have counseling services and additional accommodations (e.g., for students enrolled in special education programs).
• Minimize children’s access to means of self-harm, including firearms and prescription medications. Dispose of unused or expired prescriptions and keep medications out of reach for children and youth. If you choose to keep firearms in the home, ensure that they are stored safely: unloaded and locked up (e.g., in a lock box or safe). Having firearms in the home increases the likelihood of firearm-related death.^{135, 136} In fact, firearms are by far the most lethal means of suicide: 90% of attempted suicides with a firearm result in death, compared to less than 10% of attempted suicides overall.¹³⁷
• Be attentive to how children and youth spend time online. Digital technology can help young people connect with friends and family, learn about current events, express themselves, and access telehealth and other resources.¹³⁸ At the same time, children can have negative experiences online, such as being bullied, finding harmful information, and negatively comparing themselves to others.¹³⁹ Box 3 has a list of questions you can ask yourself about your child’s use of technology.
• Be a voice for mental health in your community. There are many ways to do this, from talking openly with friends and family about the importance of mental health, to going to school board meetings or a town hall, to volunteering with an advocacy group, to promoting greater funding and awareness of mental health programs in schools and local organizations, such as churches, libraries, parks and recreation, or sports teams.

What Educators, School Staff, and School Districts Can Do

The experiences children and young people have at school have a major impact on their mental health. At school, children can learn new knowledge and skills, develop close relationships with peers and supportive adults, and find a sense of purpose, fulfillment, and belonging. They can also find help to manage mental health challenges. On the other hand, children can also have highly negative experiences at school, such as being bullied, facing academic stress, or missing out on educational opportunities (for example, due to under-resourced schools). Mental health challenges can reveal themselves in a variety of ways at school, such as in a student having trouble concentrating in class, being withdrawn, acting out, or struggling to make friends. In light of these factors, below are recommendations for how schools, educators, and staff can support the mental health of all students:

• Create positive, safe, and affirming school environments. This could include developing and enforcing anti-bullying policies, training students and staff on how to prevent harm (e.g., implementing bystander interventions for staff and students), being proactive about talking to students and families about mental health, and using inclusive language and behaviors.^{140, 141} Where feasible, school districts should also consider structural changes, such as a later start to the school day, that support students’ wellbeing.^{142, 143}
• Expand social and emotional learning programs and other evidence-based approaches that promote healthy development. Examples of social, emotional, and behavioral learning programs include Sources of Strength, The Good Behavior Game, Life Skills Training, Check-In/Check-Out, and PATHS.^{144, 145, 146, 147} Examples of other approaches include positive behavioral interventions and supports and digital media literacy education.
• Learn how to recognize signs of changes in mental and physical health among students, including trauma and behavior changes. Take appropriate action when needed.¹⁴⁸ Educators are often the first to notice if a student is struggling or behaving differently than usual (for example, withdrawing from normal activities or acting out). And educators are well-positioned to connect students to school counselors, nurses, or administrators who can further support students, including by providing or connecting students with services.¹⁴⁹
• Provide a continuum of supports to meet student mental health needs, including evidence-based prevention practices and trauma-informed mental health care. Tiered supports should include coordination mechanisms to get students the right care at the right time.¹⁵⁰ For example, the Project AWARE (Advancing Wellness and Resilience in Education) program provides funds for state, local, and tribal governments to build school-provider partnerships and coordinate resources to support prevention, screening, early intervention, and mental health treatment for youth in school-based settings.¹⁵¹ School districts could also improve the sharing of knowledge and best practices. For example, districts could dedicate staff at the district level to implementing evidence-based programs across multiple schools). Districts could also implement mental health literacy training for school personnel (e.g., Mental Health Awareness Training, QPR training).
• Expand the school-based mental health workforce.¹⁵² This includes using federal, state, and local resources to hire and train additional staff, such as school counselors, nurses, social workers, and school psychologists, including dedicated staff to support students with disabilities. For example, a lack of school counselors makes it harder to support children experiencing mental health challenges. The American School Counselor Association (ASCA) recommends 1 counselor for every 250 students, compared to a national average of 1 counselor for every 424 students (with significant variation by state).¹⁵³ The American Rescue Plan’s Elementary and Secondary School Emergency Relief funds can be used for this purpose and for other strategies outlined in this document.¹⁵⁴
• Support the mental health of all school personnel. Opportunities include establishing realistic workloads and student-to-staff ratios, providing competitive wages and benefits (including health insurance with affordable mental health coverage), regularly assessing staff wellbeing, and integrating wellness into professional development.¹⁵⁵ In addition to directly benefitting school staff, these measures will also help school personnel maintain their own empathy, compassion, and ability to create positive environments for students.¹⁵⁶
• Promote enrolling and retaining eligible children in Medicaid, CHIP, or a Marketplace plan, so that children have health coverage that includes behavioral health services. The Connecting Kids to Coverage National Campaign also has outreach resources for schools, providers, and community-based organizations to use to encourage parents and caregivers to enroll in Medicaid and CHIP to access important mental health benefits. Families can be directed to HealthCare​.gov or InsureKidsNow​.gov. Schools can use Medicaid funds to support enrollment activities and mental health services.¹⁵⁷
• Protect and prioritize students with higher needs and those at higher risk of mental health challenges, such as students with disabilities, personal or family mental health challenges, or other risk factors (e.g., adverse childhood experiences, trauma, poverty).¹⁵⁸

What Health Care Organizations and Health Professionals Can Do

Our health care system today is not set up to optimally support the mental health and wellbeing of children and youth. In addition to changing government policy (see recommendations for Governments on page 33), we must reimagine how health care organizations and health professionals prevent, identify, and address mental health challenges. Below are some steps health care organizations and health professionals can take:

• Recognize that the best treatment is prevention of mental health challenges. Implement trauma-informed care (TIC) principles and other prevention strategies to improve care for all youth, especially those with a history of adversity. In addition to working in the clinic, for example to educate families on their role in healthy child development, health care professionals should work with other sectors (e.g., schools, child care, justice, social services, public health) on prevention strategies. For instance, health care professionals can refer patients to resources such as economic supports, school enrichment programs, and legal supports.¹²
• Routinely screen children for mental health challenges and risk factors, including adverse childhood experiences (ACEs).¹⁵⁹ Screenings can be done in primary care, schools, emergency departments, and other settings. For example, primary care providers can conduct screenings during well-visit appointments, annual physicals, or routine vaccinations using principles of trauma-informed care. Screenings should account for the diverse ways in which mental health challenges can manifest, such as changes in physical health, sleep patterns, and behaviors. It’s critical that screening services link to appropriate follow-up care. The American Academy of Pediatrics offers tools and resources for screening processes. California’s ACEs Aware initiative offers ACEs screening tools for children, adolescents, and young adults.
• Identify and address the mental health needs of parents, caregivers, and other family members. The mental health of children and youth is closely linked to the mental health and wellbeing of their families. Screening parents and caregivers for depression, intimate partner violence, substance use, and other challenges can be combined with broader assessments of food insecurity, housing instability, and other social determinants of health.¹⁶⁰
• Combine the efforts of clinical staff with those of trusted community partners and child-serving systems (e.g., child welfare, juvenile justice). For example, hospital-based violence intervention programs (HVIPs) identify patients at risk of repeat violent injury and link them to hospital- and community-based resources to address risk factors for violence.^{161, 162, 163, 164} Another example initiative is school-hospital partnerships, such as behavioral health urgent care clinics supported by schools.¹⁶⁵ New payment and delivery models, such as the Centers for Medicare & Medicaid Services Innovation Center’s Integrated Care for Kids (InCK) Model, can be used to support the mental health-related needs of children across settings.¹⁶⁶
• Build multidisciplinary teams to implement services that are tailored to the needs of children and their families. Enlist children and families as partners and engage them in all stages of decision-making, from screening to treatment.¹⁶⁷ Recognize that a variety of cultural and other factors shape whether children and families are able or willing to seek mental health services. Accordingly, services should be culturally appropriate, offered in multiple languages (including ASL), and delivered by a diverse mental health workforce. Additionally, support the wellbeing of mental health workers and community leaders, building their capacity to support youth and their families.

What Media Organizations, Entertainment Companies, and Journalists Can Do

Note: See next section for recommendations specific to technology platforms such as social media companies.

Media organizations, entertainment companies, and journalists can have a powerful impact on young people. In some cases, this impact can be positive. For example, television programs can keep children and adolescents informed about current events and teach them valuable lessons.¹⁶⁸ On the other hand, false, misleading, or exaggerated media narratives can perpetuate misconceptions and stigma against people with mental health or substance use problems.^{169, 170} In addition, media coverage of traumatic events, such as bombings and natural disasters, can contribute to psychological distress among consumers.^{171, 172, 173, 174, 175} Particularly in times of global crisis, such as the COVID-19 pandemic, people can come away from news stories feeling anxious and powerless.¹⁷⁶ Below are steps media organizations can take to protect the mental health of viewers while staying true to their role in informing the public:

• Recognize the impact media coverage of negative events can have on the public’s mental health. The solution isn’t to hide or downplay negative news, but rather to avoid misleading consumers, and to be more attentive to how stories are framed. Example best practices include:

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  Being fact-based in reporting and avoiding language that shocks, provokes, or creates a sense of panic.

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  Being more cautious about showing distressing content, particularly graphic images or video, without context or warnings for viewers. Help viewers decide whether they want to engage with the content.¹⁷⁷

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  Giving audiences context, including highlighting uncertainties and conflicting reports. When discussing preliminary research—such as papers that have not yet been peer-reviewed—outlets should be forthright about the preliminary nature of the findings, get independent experts to weigh in, and identify areas of uncertainty.

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  Offering the public ways to make a positive difference (for example, ways to donate funds or supplies to victims of a natural disaster).

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  Including positive messages and stories of hope and healing (particularly when covering pandemics, natural disasters, and incidents of mass violence).

• Normalize stories about mental health and mental illness across all forms of media, taking care to avoid harmful stereotypes, promote scientifically accurate information, and include stories of help, hope, and healing. Example best practices¹⁷⁸ include:

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  Avoiding harmful stereotypes about mental illness, such as the idea that people who have a mental illness are prone to violence or that mental illness causes violence. Research shows this is not the case.¹⁷⁹

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  Avoiding demeaning language (e.g., “crazy,” “psycho,” “looney,” “wacko”, “nut,” “junkie”). This includes using person-centered language, or language that focuses on the person rather than a disease label.¹⁸⁰ For example, instead of referring to someone as a “schizophrenic,” refer to them as a “person living with schizophrenia.”

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  Include stories of people seeking help, getting treatment, and successfully recovering. These can also include examples of people getting help from friends, family neighbors, or even strangers (not just mental health professionals).¹⁸¹

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  Direct consumers to mental health resources (as part of any mental health-related TV episode, movie, news story, podcast, or other media).

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  Craft more authentic stories by consulting with subject matter experts and people with personal experience of mental illness or mental health challenges.

• Whenever depicting suicide or suicidal ideation, adhere to best practices such as the National Recommendations for Depicting Suicide.¹⁸² For example:

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  Convey that suicide is complex and often caused by multiple factors, not a single event.

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  Show that help is available. For example, in TV shows or movies, show characters reaching out to health professionals, talking to supportive peers, friends, or family, or calling or texting a crisis hotline.

What Social Media, Video Gaming, and Other Technology Companies Can Do

Over the past two decades, more and more of our lives have moved onto social media platforms and other digital public spaces. The COVID-19 pandemic has rapidly accelerated this trend. During the pandemic, the time teenagers spent in front of screens for activities not related to school more than doubled, from 3.8 to 7.7 hours per day.¹⁸³ In 2020, 81% of 14- to 22-year-olds said they used social media either “daily” or “almost constantly.”¹³⁸

In these digital public spaces, which privately owned and tend to be run for profit, there can be tension between what’s best for the technology company and what’s best for the individual user or for society. Business models are often built around maximizing user engagement as opposed to safeguarding users’ health and ensuring that users engage with one another in safe and healthy ways.^{184, 185} This translates to technology companies focusing on maximizing time spent, not time well spent.

In recent years, there has been growing concern about the impact of digital technologies, particularly social media, on the mental health and wellbeing of children and young people.^{186, 187, 188} Part of the challenge with research on this topic is that digital technology involves a vast range of devices, platforms, products, and activities, so it’s hard to generalize. Researchers also have limited access to data to inform potential research.

Many researchers argue that digital technologies can expose children to bullying, contribute to obesity and eating disorders, trade off with sleep, encourage children to negatively compare themselves to others, and lead to depression, anxiety, and self-harm.^{139, 187, 189, 190, 191, 192} Several studies have linked time spent on social media to mental health challenges such as anxiety and depression.^{26, 193, 194, 195, 196, 197} Meanwhile, others have cast doubt on the idea that technology or social media use is a major factor in youth wellbeing.^{198, 199, 200, 201, 202, 203}

Importantly, the impact of technology almost certainly varies from person to person, and it also matters what technology is being used and how.²⁰⁴ So, even if technology doesn’t harm young people on average, certain kinds of online activities likely do harm some young people. For example, some research has linked “passive” social media use (such as scrolling through posts and auto-play video) to declines in wellbeing (versus more “active” use such as commenting on posts or recording videos).²⁰⁵

There can also be benefits to certain online activities, such as connecting meaningfully with friends and family, learning a new skill, or accessing health care, and these also vary from person to person.²⁰⁶ For example, LGBTQ+ young people may be more vulnerable than other young people to cyberbullying but also more likely to consider social media important for feeling less alone, expressing themselves, finding inspiration, and getting support.^{138, 207}

There is a clear need to better understand the impact of technologies such as social media on different kinds of users, and to address the harms to users most at risk. We need more research using strong data and research methods, such as longitudinal and experimental designs, behavioral (as opposed to self-reported) measures of time spent online and types of content engaged with, as well as data on subgroups of users (e.g., boys vs. girls).^{208, 209}

Most importantly, technology companies must step up and take responsibility for creating a safe digital environment for children and youth. Today, most companies are not transparent about the impact of their products, which prevents parents and young people from making informed decisions and researchers from identifying problems and solutions. At a minimum, the public and researchers deserve much more transparency. More broadly, below are specific recommendations for how these companies can prioritize the wellbeing of users above monetizing those users for profit:

• Prioritize user health and wellbeing at all stages of product development.²¹⁰

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  Elevate user safety, health, and wellbeing in the culture and leadership of technology companies. Senior technology executives should acknowledge that their products can harm some young people and take material and measurable steps to prevent and mitigate these harms, even at the expense of engagement, scale, and profit. Leaders should be accountable for creating a safe, accessible, and inclusive digital environment for their users and designing safe products.

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  Assess and address risks to users at the front end of product development. Build products and services using a precautionary approach that focuses on making them safe for youth before they are deployed. Company employees at all levels, especially those involved in product development, should be expected to prioritize user health and wellbeing in their day-to-day work. For example, consider how to align performance incentives for product developers to measures of user wellbeing. Develop consistent procedures for receiving input on proposed products from youth, parents, health and youth development professionals, and civil society, for example through advisory groups. Create ways for employees to voice concerns about products without fear of retaliation.

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  Continually measure the impact of products on user health and wellbeing and share data with the public. Supplement traditional product success metrics, such as monthly active users, with dedicated metrics for user health and wellbeing. In addition to relying on user-reported data (e.g., surveys), consider using behavioral data (e.g., analysis of user inputs such as typed keywords). Make results publicly available. Take corrective action to address harms.

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  Recognize that the impact of platforms and products can vary from user to user, and proactively ensure that products designed for adults are also safe for children and adolescents. Consider many kinds of users, including users of different ages and developmental stages, when developing new products and features. Talk to those users and collect data to identify subgroups who may be harmed by certain products or ways of engaging. Use this data to inform product design and research.

• Be transparent and allow for independent researchers and the public to study the impact of company products on user health and wellbeing.

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  Allow users to provide informative data about their online experience to independent researchers. This should be a fully consented process that allows users to individually request personal data about their use to transfer to researchers (e.g., timestamps of when and how long use takes place; type of content seen and engaged with; whether, when, and how interactions with others took place). Companies should also allow third-party researchers to request data on behalf of users if evidence of full user consent is provided and facilitate the automated transfer of data to third-party researchers (e.g., through application programming interfaces or APIs).

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  Directly provide researchers with data to enable understanding of (a) subgroups of users most at risk of harm and (b) algorithmic design and operation. Data on algorithmic design and operation should be of sufficient granularity to allow researchers to understand when, why, and how users are shown different types of content.

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  Partner with researchers and experts to analyze the mental health impacts of new products and features in advance of rollout. Regularly publish findings. Where possible, design evaluations in ways that enable causal inference (for example, using randomized interventions).

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  Allow a broad range of researchers to access data and previous research instead of providing access to a privileged few. Make research results publicly available and do not bind researchers to non-disclosure agreements. Avoid conflicts of interest that cast doubt on researchers’ independence.

• Build user-friendly tools that help children and adolescents engage online in healthy ways.

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  Take a holistic approach to designing online spaces hospitable to young people. For example, support the creation of industry-wide safety standards for online health and wellbeing, in partnership with civil society groups. Just as we have safety standards for offline activities, such as driving, we should also consider standards for online activities.^{211, 212} Private organizations, such as video game companies, have already begun sharing best practices and developing a common framework for protecting users.²¹³

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  Limit children’s exposure to harmful online content. This can involve a mix of limiting access for younger users, reducing content amplification, prohibiting data collection of and targeted advertising to children, ensuring privacy settings are maximized by default, removing content quickly if it violates company policies, tightening age verification requirements and audits, enabling independent algorithm audits, and imposing consequences for users found to be circumventing age restrictions or other policies.²²⁷ Companies should conduct research to evaluate whether these measures work. For example, children today can easily get around age limits by claiming to be older than they really are. To address this, some companies have required users to upload an ID and a selfie to verify identity and age (without storing the underlying ID or selfie data).²¹⁴

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  Give users opportunities to control their online activity, including by opting out of content they may find harmful. For example, some companies have built in “frictions,” such as notifications that remind people to take breaks and limit screen time.²¹⁵ Other examples of frictions could include banning “auto-play” functions on videos or limiting scrolling capabilities for youth users. Also consider allowing users to opt out of content they believe may harm their mental health, such as ads involving violence, alcohol, or gambling, or content related to eating disorders.²¹⁶

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  Develop products that actively safeguard and promote mental health and wellbeing. New technologies create opportunities to reach large numbers of youth with educational interventions, such as directing youth to mental health tips and resources.²¹⁷ There are also emerging digital technologies—often referred to as “digital therapeutics”—that prevent, manage, and treat health conditions. More and more of these technologies are gaining clinical validation and regulatory approval.^{218, 219}

• Promote equitable access to technology that supports the wellbeing of children and youth. For example, donate digital technology and remote services (e.g., internet access) to under-resourced populations.

What Community Organizations Can Do

Thousands of community organizations are doing heroic work every day to support the mental health of children and young people. While different groups address different parts of the problem, serve different youth populations, and implement different solutions, all community organizations can keep the following recommendations in mind as they continue their work:

• Educate the public about the importance of mental health, and reduce negative stereotypes, bias, and stigma around mental illness. Community groups can play a key role in fostering open dialogue about mental health at the local level and correcting misconceptions and biases. For example, community groups can partner with trusted messengers such as faith leaders and health care professionals to speak to community members about youth mental health needs. It’s particularly important to address misconceptions in populations that have an outsized influence over young people, such as families, educators, health care professionals, juvenile justice officials, online influencers, and the media.
• Implement evidence-based programs that promote healthy development, support children, youth, and their families, and increase their resilience. Examples include youth enrichment programs (e.g., mentoring, after-school programs), skill-based parenting and family relationship approaches, and other efforts that address social determinants of youth health such as poverty, exposure to trauma, and lack of access to education and health care. A few respected programs include The Incredible Years,²²⁰ Strengthening Families,²²⁰ The Martinsburg Initiative,²²¹ and the Drug-Free Communities (DFC) Support Program.²²²
• Ensure that programs rigorously evaluate mental health-related outcomes. For example, track outcomes around anxiety, depression, and suicide (including ideation, plans, and attempts), as well as around upstream risk and protective factors (e.g., social connectedness, coping skills, economic supports).²²³
• Address the unique mental health needs of at-risk youth, such as racial and ethnic minorities, LGBTQ+ youth, and youth with disabilities. Youth-serving organizations should think intentionally about how and to whom program services are offered. For example, actively recruit and engage populations who have historically been prevented from equal access to opportunities and may benefit the most from services. Engage with youth to understand what unique barriers prevent them from accessing mental health services. Recruit program staff directly from communities being served. Build program staff capacity to recognize personal biases, as well as structural challenges in these communities. For example, provide training on cultural and linguistic competence and related topics.
• Elevate the voices of children, young people, and their families. Youth are experts on their own lives, so it is important to engage youth in community-based mental health efforts. Explore youth advisory councils and other ways to involve young people in all phases of programming, from ideation to implementation. Gather feedback to understand what is and isn’t working. Include youth and families directly in delivering services, for example by creating peer support programs.

What Funders and Foundations Can Do

Philanthropic and other funding organizations play a critical role in supporting the mental health of children and young people across the full continuum of need. For example, they can make bets on promising but untested technologies or programs for which government funding may not be available. They can also serve as reliable partners to community-based organizations across the country, and promote and build cross-sector partnerships. Below are some recommendations for how funding organizations can support youth mental health:

• Create sustained investments in equitable prevention, promotion, and early intervention. Prioritize interventions that address social and economic factors known to affect children’s healthy development and mental health, such as poverty, discrimination, and inequality, among others.²²⁴
• Incentivize coordination across grantees and foster cross-sector partnerships to maximize reach and bring together a diversity of expertise. The scale and complexity of mental health issues among young people require collaborative approaches. Consider leveraging resources across sectors to advance practices, policies, and research that support the mental health of children, youth, and families. And support grantees in developing and sharing meaningful mental health outcome measures.
• Scale up evidence-based interventions, technologies, and services. Use a structured process to assess an intervention’s readiness to scale and support high-quality implementation at a community level.²²⁵ Share information and convene stakeholders to provide education and consultation to spread innovation.
• Invest in innovative approaches and research on mental health. For example, fund participatory research that involves young people in understanding their online experiences. Develop and test new solutions, including digitally enabled solutions that can reach young people at scale and in underserved communities. Consider different kinds of funding models, such as incubators and accelerators, that can drive funding toward promising projects at very early stages.^{226, 227}
• Elevate and amplify the voices of youth and families in all stages of funding and evaluation. Listening to young people is critical to understanding what kinds of solutions will work and what communities need to scale successful interventions. Bring young people, parents, and caregivers to the table to identify their needs and create ongoing meaningful opportunities to inform grantmaking strategies and decision-making. Engage youth from different identities and backgrounds—particularly those that come from vulnerable communities.

What Employers Can Do

Employers can play an outsized role in supporting the mental health of children and young people. They can directly help younger employees, such as high school students working part-time jobs or young adults starting out in the labor force after high school or college. For example, employers can provide affordable health insurance that covers mental health needs.

Employers can also support children and youth indirectly. For example, they can offer insurance coverage for employees’ dependent children, offer parent-friendly benefits such as family leave and childcare, and promote work-life balance and a positive culture at work to reduce family stress.

Below are some recommendations for how employers can support the mental health of young people:

• Provide access to comprehensive, affordable, and age-appropriate mental health care for all employees and their families, including dependent children. Research shows that parental mental health challenges not only impact their productivity in the workplace, but can also affect the mental health of their children.^{228, 229} Employers should offer health insurance plans that include no or low out-of-pocket costs for mental health services, and a robust network of high-quality mental health care providers.
• Implement policies that address underlying drivers of employee mental health challenges, including both home and workplace stressors. Employers should:

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  Offer paid family leave and sick leave where feasible. Consider additional employee benefits such as respite care for caregivers and mental health and wellness tools.

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  Help caregivers secure affordable childcare, or offer more flexible work arrangements. This can reduce stress and improve productivity.^{230, 231}

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  Ensure employees are aware of and can easily make use of these benefits. For example, include information on mental health benefits in emails, webinars, and during onboarding and training for all new hires.

• Create a workplace culture that affirms the importance of the mental health and wellbeing of all employees and their families.

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  Create space for employees to speak up about how they are feeling and encourage company leaders to serve as role models for discussing mental health and modeling healthy behaviors. For example, ensure that senior leaders take advantage of benefits such as paid leave and vacation days.

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  Solicit ideas from employees about how to support their mental health and wellbeing as well as that of their children and families.

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  Adopt clear messaging that promotes mental health awareness and addresses common misconceptions about mental health (for example, that mental health issues are not a sign of weakness).

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  Provide managers and supervisors with training to help recognize negative mental health symptoms in themselves and colleagues and encourage employees to seek help.²³² Mental health employee resource groups, for example, can help increase mental health awareness, build community, and offer peer support.

• Regularly assess employees’ sense of wellbeing within the workplace. Tools such as employee surveys can help employers understand the wellbeing of employees across demographic groups (e.g., gender, race, sexual orientation), levels of seniority, business units, and geographies, and to identify opportunities for improvement. Employers should make sure to assess the wellbeing of young adults just starting out in the workforce, as well as of parents with young children.

What Federal, State, Local, and Tribal Governments Can Do

Note: For actions taken by the Biden Administration from January to October 2021 to support youth mental health, seeFact Sheet: Improving Access and Care for Youth Mental Health and Substance Use conditions.

Ultimately, youth mental health challenges cannot be addressed solely by the efforts of youth, their families, local communities, and private organizations. Federal, state, local, and tribal governments all have a role to play. While the below recommendations are not comprehensive, their implementation would mark an enormous step forward in supporting youth and their families:

• Address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers. Priorities should include reducing child poverty and ensuring access to quality childcare, early childhood services, and education; healthy food; affordable health care; stable housing; and safe neighborhoods with amenities such as parks and playgrounds. Recent federal investments in child poverty reduction, safe school reopening, and other pandemic-related measures represent historic progress on this front, but additional investments are needed at all levels of government.²³³ Emphasis should be placed on preventing adverse childhood experiences (ACEs), which are strong risk factors for mental health challenges.¹²
• Take action to ensure safe experiences online for children and young people. Example opportunities include but are not limited to increasing investment in research on the role of social media and technology in youth mental health; educating consumers about potential mental health risks online; requiring companies to be more transparent with researchers and the public (e.g., disclosing meaningful data for research purposes, enabling systemic auditing of social media algorithms), and developing safety standards for online services (e.g., standards for data collection, age verification, user engagement techniques such as ‘nudges’, and advertising aimed at kids and teens). For instance, the United Kingdom’s Age appropriate design code has led companies including Instagram, TikTok, and YouTube to announce product changes to protect their users’ safety, rights, and privacy.^{234, 235} In addition, the Australian government’s Safety by Design initiatives have resulted in a set of principles for user safety, tools for companies to assess their safety practices, resources for investors and financial entities to manage online safety risks, and a pilot program with universities to embed Safety by Design materials into curricula.²³⁶
• Ensure all children and youth have comprehensive and affordable coverage for mental health care. Example opportunities include strengthening public and private insurance coverage for children and young adults (e.g., by promoting enrollment), ensuring adequate payment for pediatric mental health services, investing in innovative payment models for integrated and team-based care, increasing the participation of mental health professionals in insurance networks, and ensuring compliance with mental health parity laws.²³⁷ Local, state, and tribal governments can access outreach and enrollment resources to help enroll and retain eligible children in Medicaid and CHIP at InsureKidsNow​.gov.
• Support integration of screening and treatment into primary care. For example, continue expanding Pediatric Mental Health Care Access programs, which give primary care providers teleconsultations, training, technical assistance, and care coordination to support diagnosis, treatment, and referral for children with mental health and substance use needs.^{238, 239, 240} Expanding screening for ACEs is also critical. For instance, California recently enacted a law that will significantly expand coverage for ACEs screening.²⁴¹
• Provide resources and technical assistance to strengthen school-based mental health programs. Example opportunities include improving education about mental health, increasing screening of students for mental health concerns, investing in additional staff (e.g., school counselors) to support student mental health needs, improving care coordination, and financing school-based mental health services. As mentioned in the earlier section with recommendations for educators, the American Rescue Plan’s Elementary and Secondary School Emergency Relief funds can be used for these purposes, along with Project AWARE (Advancing Wellness and Resilience in Education) program funds, which provide support for state, local, and tribal governments in building school-provider partnerships and coordinating resources to support prevention, screening, early intervention, and mental health treatment for youth in school-based settings.²⁴² In California, a recent law will ensure that all middle and high school students learn about mental health in health education classes.²⁴³ And, in New Jersey, a recent program will provide funding for school districts to screen students for depression.²⁴⁴
• Invest in prevention programs, such as evidence-based social and emotional learning. Example opportunities include implementing developmentally appropriate social and emotional learning standards and programs, supporting professional development for educators, and providing funding for teachers and school leaders to work with families to support student health needs. For example, the CDC’s Legacy for Children program, which promotes positive parenting among low-income mothers, has been found to improve children’s behavioral, social, and emotional health.²⁴⁵
• Expand the use of telehealth for mental health challenges. Example opportunities include addressing regulatory barriers (such as limits on provision of telehealth across state lines), ensuring appropriate payment, and expanding broadband access. For instance, Colorado recently established the “I Matter” program, offering young people three free behavioral health sessions, primarily via telehealth.²⁴⁶
• Expand and support the mental health workforce. Example opportunities include investing in training and hiring individuals from a broader set of disciplines (e.g., peer supports, community health workers, family counselors, care coordinators), accelerating training and loan repayment initiatives, supporting the mental health and wellbeing of health workers, and recruiting a diverse workforce that reflects local communities. In the school setting, governments should invest in building a pipeline of school counselors, nurses, social workers, and school psychologists.²⁵³
• Expand and strengthen suicide prevention and mental health crisis services. Example opportunities include providing flexible funding to fund crisis care needs, increasing access to intensive outpatient and other “step-down” programs, supporting access to trauma-informed services for traumatized children, implementing the 988 mental health crisis and suicide prevention hotline, and promoting public awareness of crisis hotlines and other resources. Governments should also collaborate with the private sector and local communities to reduce access to firearms and other lethal means of suicide and promote best practices such as safe storage.
• Improve coordination across all levels of government to address youth mental health needs. One example is to ensure households eligible for social services and supports are receiving them. For instance, states can align renewal processes across Medicaid and the Supplemental Nutrition Assistance Program (SNAP), use data from SNAP files to complete Medicaid renewal, and allow qualified entities like schools to make presumptive eligibility determinations.²⁴⁷
• Support continued reduction in biases, discrimination, and stigma related to mental health. Example opportunities include enforcing laws that support the needs of at-risk youth (e.g., students with disabilities), identifying and improving policies and programs that inappropriately target or harm youth with mental health needs, and conducting targeted education campaigns to address stigma, promote new cultural norms, and increase safety and trust in local communities.
• Support the mental health needs of youth involved in the juvenile justice system. Example opportunities include investing in alternatives to incarceration (e.g., school, probation, and police-based diversion models for youth with mental health needs²⁴⁸), expanding mental health training for staff, supporting high-quality and trauma-informed mental health care inside these systems, and improving coordination across different youth-serving agencies.²⁴⁹
• Support the mental health needs of youth involved in the child welfare system. Example opportunities include expanding family-centered mental health services to prevent unnecessary entry and increase reunification;²⁵⁰ ensuring youth and caregivers are informed about medications; investing in peer support services; providing mental health services before, during, and after new placements and when emancipating from foster care;²⁵¹ ensuring youth have access to mental health services in community settings whenever possible; and avoiding unnecessary placements in non-family settings. Coordination should be improved across different youth-serving agencies.
• See “Where Additional Research is Needed” section for recommendations specific to research and data on youth mental health

WHERE ADDITIONAL RESEARCH IS NEEDED

Despite the evidence that millions of young people are suffering and in crisis, there is still a lot we don’t know. Below are recommendations for the kinds of research questions and studies that should be prioritized to better understand and address youth mental health needs:

• Improve mental health data collection and integration to understand youth mental health needs, trends, services, and evidence-based interventions.

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  Today, data on youth mental health are collected and analyzed by multiple agencies and often take months or years to be released. The federal government should strengthen research and data integration across governments, health systems, and community organizations to ensure regular, longitudinal surveillance of national mental health trends across the age continuum. Data collection and data linkages should be improved to enable real-time surveillance (e.g., at the census tract level).

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  Data should be able to be disaggregated to enable analysis of trends (by age, gender, race, ethnicity, disability status and type, sexual orientation, socioeconomic background, family characteristics, insurance status, etc.)²⁵²

• Foster public-private research partnerships. For example, academic partners, community-based organizations, technology companies, health care companies, and others can partner to conduct novel studies using nontraditional data sources (e.g., data from wearables and online platforms) to better understand needs, track outcomes, and evaluate risk and protective factors for youth mental health.
• Increase investments in basic, clinical, and health services research to identify treatment targets for mental health conditions and develop innovative, scalable therapies. For example, conduct research to optimize stepped-care approaches to treatment for youth populations (e.g., different kinds of cognitive-behavioral therapy such as self-guided, computerized, and group-based vs. solely individual therapy).²⁵³
• Prioritize data and research with at-risk youth populations, such as racial, ethnic, and sexual and gender minority youth, individuals from lower socioeconomic backgrounds, youth with disabilities, youth involved in the juvenile justice system, and other groups.²⁵⁴ Researchers and research sponsors should ensure that these populations are represented in basic, translational, effectiveness, and services research studies. This will help improve understanding of disparities in risk and trajectories for mental illnesses, responsiveness to interventions, and access to, and engagement with, quality mental health services.
• Advance dissemination and implementation science to scale up and improve compliance with evidence-based mental health practices in systems that serve children, youth, and their families. For example, appropriate funding agencies can prioritize demonstration projects of effective evidence-based interventions in and across schools or other systems (e.g., primary care offices, clinics, treatment facilities, family services, child welfare settings, juvenile justice settings). Translate findings into actionable policy proposals and disseminate them effectively to improve adoption of best practices.
• Conduct research to expand understanding of social media and digital technology’s impact on youth mental health and identify opportunities for intervention. For example, explore the impact of frequent exposure to social comparisons, hateful speech, and graphic content on children and youth, and which groups are most- and least-affected. Also, identify opportunities for families to engage with youth around social media as a means of connection, and offer guidance in handling difficult interactions and content. Explore how pre-existing mental health status and environmental conditions in young people’s lives inform how they engage with and experience content online, and empower young people with effective strategies (e.g., mood management) to actively manage their online experiences.