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Isolation caused by the COVID-19 pandemic, increasing academic and social pressures, and traumatic events are contributing to a growing mental health crisis among children and adolescents, experts say. As Mental Health Awareness Month approaches in May, they say heightened awareness of these issues may help employers and plan sponsors to assess whether their health plans and other benefits are adequately addressing the needs of youths.

The following statistics illustrate the trends.

• “In 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40% from 2009,” a 2021 report from the U.S. Surgeon General states.

• While the use of some substances by youths has declined over time, the number of drug overdose deaths among adolescents more than doubled from 253 in 2018 to 723 in 2022, according to a Kaiser Family Foundation (KFF) report.

• Suicides are the second leading cause of death among adolescents, although these deaths have declined between 2018 and 2022, the KFF report states. Statistics compiled by the Trevor Project show that LGBTQ+ young people are four times more likely to attempt suicide compared to their peers.

• Eating disorders are also on the rise. A FAIR Health report states that, from 2018 to 2022, “eating disorder medical claims rose 65% nationally as a percentage of all medical claim lines,” and in 2022, the largest percentage of claim lines related to eating disorders—at 28%—were from people aged 14 to 18.

• In an American City Business Journals survey cited in the On Our Sleeves 2022 report, more than half (56%) of working parents said their child’s emotional health and development or behavioral status made the stressors of their jobs much harder to handle.

• A 2022 Pew Research Center survey reports that 40% of adults with children under 18 are very or extremely worried that their children might struggle with anxiety or depression at some point.

What’s Behind the Trends?

 “These are not new issues. Unfortunately, the pandemic has highlighted them, but luckily, we’re much more aware of it,” said Joel Axler, M.D., national behavioral health leader from insurance broker Brown & Brown.

He noted that the pandemic aggravated feelings of loneliness since many children had to attend school virtually and were isolated from friends. The pandemic notwithstanding, children also have less face-to-face contact with their friends, choosing to play video games or texting/instant messaging instead. “When children are on their screens, they are usually alone. So even though they might be socializing with friends, this device usage can be quite isolating. This results in changes to how they perceive themselves, causes issues like anxiety and loneliness, and has a clear impact on their interpersonal skills and ability to form real-life relationships,” Axler said.

Youths who experience loneliness and social isolation are at increased risk of depression and anxiety now and in the future, according to Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.

Other factors exacerbating mental health issues include heightened academic and social pressure, with the latter often being fueled by social media, Axler added. The trauma caused by the news or fear of mass and school shootings, natural disasters and war has also led to more insecurity. Adults are experiencing many of the same issues, but “the differences, I believe, are that our youths’ brains are not fully developed, they’re not mature,” Axler commented. Research shows that the human brain doesn’t fully develop until the mid- to late 20s.

“I’m most concerned about the stress and the depression in our youth because that’s the foundation of a lot of mental health issues,” Axler said. “If depression is unrecognized for a period of time, and it’s aggravated by environmental stress or family stress, it can lead to self-esteem issues or feelings of low self-worth or hopelessness or suicidal thoughts.”

“If we don’t raise awareness to this mental health crisis in our youth, we’re doing a disservice to our youth and their parents,” he said.

The pandemic has most heavily affected the mental health of those who were already vulnerable, including youths with disabilities, in racial and ethnic minorities, who identify as LGBTQ+ and who are in other marginalized communities, the U.S. Surgeon’s General Advisory on Protecting Youth Mental Health explains.

Health plan sponsors can expect to see an increased number of young people identifying as LGBTQ+ because increasing societal acceptance has helped them gain comfort in being their true authentic self,” said Colin Quinn, president of Included Health Communities at Included Health, an integrated health navigation and virtual care provider. For their mental health needs to be met, youths need to have both physical and behavioral health providers who can create safe spaces for them.

How Can Employers and Plan Sponsors Respond?

Quinn and Axler identified several actions that employers and plan sponsors can take to ensure that their plans are meeting the emerging mental health needs of youths and their parents.

• Ensure access to appropriate providers. Youths need access to suitable mental health providers who are using quality-based measurements, such as rating scales for attention-deficit/hyperactivity disorder (ADHD), depression and anxiety, Axler recommended. Other specialists to look for include those trained in the treatment of eating disorders and those trained in LGBTQ+ health needs who can create a safe and welcoming environment. “Having safe spaces from a health care perspective is incredibly important at any age, but it is particularly important for a young child coming of age and grappling with their sexual orientation or gender identity,” Quinn noted.

• Conduct an equity assessment of the benefit plan and its offerings. Despite progress, underserved populations still face health care inequities. The National Institute on Minority Health and Health Disparities (NIMHD) estimates that racial and ethnic health disparities have cost the U.S. economy $451 billion. “Benefit plans need to understand their plan population to make sure coverage is meeting its needs. This includes collecting and analyzing race, ethnicity, ancestry and language (REAL) and sexual orientation and gender identity (SOGI) data,” Quinn said. “By asking and collecting that information, a plan will start to understand how large its minority populations are, including its LGBTQ+ populations, and which groups are underserved, because there is no one-size-fits-all approach in health care.”

• Offer care navigation services. Care navigators may be able to help parents find providers who specialize in the issues that the child is experiencing.

• Increase engagement with employee assistance programs (EAPs). Axler suggests that employers consider finding ways to increase awareness and use of their EAPs. These programs can be attractive to both parents and children because initial visits are often free and confidential.

• Support time off and flexible working arrangements for parents. Parents may need time to make phone calls and attend appointments with their children who are struggling with mental health issues. Axler pointed out that allowing flexibility will likely reduce presenteeism and decrease the stress on parents.

• Develop parenting employee resource groups or networks. Groups could be created for parents of young children, adolescents or LGBTQ+ youths. This allows parents to share their experiences with others and serves as a form of peer support.

• Offer additional support for parents. That can include mental and behavioral health support, educational resources or connecting them with a local chapter of an advocacy group.

• Provide telehealth benefits. Virtual options can help plans supplement their provider networks if they are finding inadequacies in providers. Axler noted that having online care options also may alleviate some of the scheduling concerns for parents because they don’t have to physically take their child to an appointment.