presentation on children's mental health

Children’s Mental Health

Sep 11, 2014

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Children’s Mental Health. Services Overview Fall Prevention Provider Meeting. What is Mental Health?. Mental health is an integral and essential component of health. The WHO constitution states:

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• suicide prevention coordinator
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Children’s Mental Health Services Overview Fall Prevention Provider Meeting

What is Mental Health? Mental health is an integral and essential component of health. The WHO constitution states: • "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." An important consequence of this definition is that mental health is described as more than the absence of mental disorders or disabilities.

What is Mental Health? Mental health is a state of well-being in which an individual realizes: • his or her own abilities, • can cope with the normal stresses of life, • can work productively, and • is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.

What types of MH problems can children and youth experience? Certain disorders are usually diagnosed in Infancy, Childhood, or Adolescence: • Intellectual Disabilities (formerly referred to as MR) • Learning Disorders • Motor Skills Disorders • Communication Disorders • Pervasive Developmental Disorders & Autism Spectrum Disorders • Attention Disorders • Feeding & Eating Disorders of Infancy or Early Childhood • Tic Disorders • Elimination Disorders • Relational Disorders (RAD, Separation Anxiety, Elective Mutism)

Can Children & Youth have the same disorders as Adults? YES! While certain diagnoses typically have an onset in adulthood, children can suffer from Serious Emotional Disturbance including: • Anxiety • Depression • Thought disorders (like schizophrenia) • Psychosis • Substance Use Disorders • Bipolar Disorders (although often over-diagnosed)

How are Children & Youth needing MH Services identified? Society Children are involved in multiple systems, similar to a set of concentric layers. Anyone within the child’s “layered” systems can identify a MH need and refer the family to MH services. School Family Community

What MH Services are available to children? School-Based MH service providers Traditional culture specific helpers/healers Child Public MH service providers Faith-Based MH service providers Family Private Non-Profit MH service providers Private Practice & “For Profit” MH service providers

How do Children access Public MH services? There are 37 Community MH Centers in Texas, called Local MH Authorities, and 1 Behavioral Health Organization (NorthStar) in the Dallas area. • The following link to the DSHS website provides information on locating mental health services in all Texas counties. http://www.dshs.state.tx.us/mhservices-search/

What Children are eligible for Community MH Center services? DSHS Children’s Mental Health serves: • Children ages 3 through 17, • Who have a diagnosis of mental illness (excluding a single diagnosis of substance abuse, intellectual disabilities, autism or pervasive development disorder), • Who exhibit serious emotional, behavioral or mental disorders and who: • Have a serious functional impairment; or • Are at risk of disruption of a preferred living or child care environment due to psychiatric symptoms; or • Are enrolled in a school system’s special education program because of serious emotional disturbance.

Nature of CMH Services • CMH Services are based on the philosophy and principles associated with Systems of Care • Services are child focused and family driven • Services are based on evidence-based practices • Treatment planning is a collaborative endeavor between the family and the CMH treatment staff • Mental Health services and Substance Abuse Prevention and Treatment services are integral parts of the Systems of Care model

Screening for MH Services Screening: A process where staff from the local mental health authority/community mental health center, talks to the parents (or LAR) and child to gather information to determine if there is a need for a detailed mental health assessment. This can be conducted either face-to-face or over the phone.

Assessment A licensed professional will meet with the parent and child face-to-face to ask questions about: • the child's mental health • emotional and behavioral issues • relationships at home and with friends • health history • development • schoolwork • and other information needed to complete the assessment.

CMH Service Array Outpatient Services include: • Counseling/psychotherapy • Case management • Skills development training • Medication training and support • Family Partner services • Access to a psychiatrist • Flexible funds for non-traditional supports

CMH Service Array Crisis Services include: • Crisis Hot Line • Mobile Crisis Outreach Team • Access to state psychiatric hospital if clinically indicated

Crisis Services A child/adolescent seeking crisis services must meet the definition of a crisis cited in the Community Standards Rule: Crisis: A situation in which because of a mental health condition: • the child/adolescent presents an immediate danger to self or others • the child/adolescent’s mental or physical health is at risk of serious deterioration, or • a child/adolescent believes he/she presents as an immediate danger to self or others

What do I do if I think a child is Suicidal? A.S.K about suicide to Save a Life • Ask the question: • “Are you thinking of killing yourself?” -OR- • “Are you so upset you are thinking of taking your own life?” • -OR- “Are you thinking of suicide?” • Safety & SeekHelp: • Keep the child SAFE do not leave them alone • Know When & How to Refer: • Know the Resources for your town & Refer to a Mental Health Professional

Resources & How to ASK • Moderate RISK: • Take all Signs Seriously • Access Mental Health Services • Call National Line for a referral • PEOPLE who can HELP • School Counselor • Mental Health Professional • Counselor • Social Worker • Faith based Leader • High RISK: • Take Immediate Action • 911, go to ER • Notify Parents/ guardians Resources: • Local Crisis Hotline • MCOT Team • Local Mental Health Authority for your Region • Call National Suicide Prevention Hotline 1-800-273 TALK

LMHASuicide Prevention Coordinator • Each LMHA designates a Suicide Prevention Coordinator to work collaboratively with local staff, LMHA suicide prevention staff statewide, and DSHS’s Suicide Prevention Office to reduce suicide deaths and attempts by: • Develop collaborative relationship local suicide prevention coalition (There are 28 statewide!) • Participating in conference calls with DSHS Suicide Prevention Coordinator • Participating in the development of the local Community Suicide Postvention Protocols (as described by the CDC Postvention Guideline) • Participating in local Community Suicide Postvention Protocols • Participating in local community suicide prevention efforts.

Contact Information • Jenna Heise, Suicide Prevention Officer [email protected] (512) 776-3407 • Michael Hastie, CMH Lead [email protected] (512) 776-3186

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Resources for Students and Educators

The National Institute of Mental Health (NIMH) offers a variety of learning resources for students and teachers about mental health and the brain. Whether you want to understand mental health challenges, promote emotional well-being in the classroom, or simply learn how to take care of your own mental health, our resources cover a wide range of topics to foster a supportive and informed learning environment. Explore videos, coloring books, and hands-on quizzes and activities to empower yourself and others on the journey to mental well-being.

You can also find additional educational resources about mental health and other topics on NIH’s STEM Teaching Resources website  .

Childhood Irritability : Learn about symptoms of irritability, why it's important to study irritability, NIMH-supported research in this area, and new treatments for severe irritability in youth.

Get to Know Your Brain: Your brain is an incredible and complex organ! It helps you think, learn, create, and feel emotions, and it controls every blink, breath, and heartbeat. Learn more about the parts of the brain and what each area helps control.

NIMH Deputy Director Dr. Shelli Avenevoli Discusses the Youth Mental Health Crisis: Learn about youth suicide, the effects of technology and the pandemic on the developing brain, and tips for supporting the mental health of youth.

Getting to Know Your Brain: Dealing with Stress: Test your knowledge about stress and the brain. Also learn how to create and use a “ stress catcher ” to practice strategies to deal with stress.

Coloring and activity books

Print or order these coloring and activity books to help teach kids about mental health, stress, and the brain. These are available in English and Spanish. 

Get Excited About Mental Health Research!

This free coloring and activity book introduces kids to the exciting world of mental health research.

Stand Up to Stress!

This free coloring and activity book teaches children about stress and anxiety and offers tips for coping in a healthy way.

Get Excited About the Brain!

This free coloring and activity book for children ages 8-12 features exciting facts about the human brain and mental health.

Quizzes and activities

Use these fun, hands-on activities in the classroom or at home to teach kids about mental health.

Teen Depression Kahoot! Quiz  

Engage students in fun and interactive competition as they learn about depression, stress and anxiety, self-care, and how to get help for themselves or others.

Stress Catcher

Life can get challenging sometimes, and it’s important for kids (and adults!) to develop strategies for coping with stress or anxiety. This printable stress catcher “fortune teller” offers some strategies children can practice and use to help manage stress and other difficult emotions.

Brochures and fact sheets

Below is a selection of NIMH brochures and fact sheets to help teach kids and parents about mental health and the brain. Additional publications are available for download or ordering in English and Spanish.

Children and Mental Health: Is This Just a Stage?

This fact sheet presents information on children’s mental health including assessing your child’s behavior, when to seek help, first steps for parents, treatment options, and factors to consider when choosing a mental health professional.

The Teen Brain: 7 Things to Know

Learn about how the teen brain grows, matures, and adapts to the world.

How to Talk to Your Child About Their Mental Health

Know the warning signs.

Learn the common signs of mental illness in adults and adolescents.

Mental Health Coloring & Activity Book

Download NAMI’s “Meet Little Monster” children’s activity book.

Find Your Local NAMI

Call the NAMI Helpline at

800-950-6264

Or text "HelpLine" to 62640

Talking with your child about emotional topics, such as their mental health, can feel uncomfortable. This can be due to the stigma involved, lack of information or even fears of possible blame.

It may seem much easier to talk about other medical problems, such as food allergies, asthma or diabetes. There is typically more information available about those conditions, they are easy to diagnosis with medical tests and people seldom think they are anyone’s fault.

Too frequently, people blame mental health challenges on the person experiencing them by saying they aren’t trying hard enough, or they are doing something wrong. In result, we can feel like it’s our “fault,” or even our child’s “fault,” when they are facing mental health challenges.

However, openly talking to your children is a great way to help decrease this stigma. It can be tough to know how to start the conversation — let’s consider some helpful ways to talk with your children about their mental health.

“Meet Little Monster” Coloring & Activity Book

To help foster dialogue between children and the safe adults in their lives, as well as provide children a tool for helping express and explore their feelings in a fun, creative and empowering way, NAMI offers “Meet Little Monster,” a mental health coloring and activity book, available for download at no-cost.

Created by NAMI Washington, “Meet Little Monster” was developed in response to both the COVID-19 pandemic, when children were suddenly cut off from their friends, teachers, coaches, club leaders and school counselors, and the Black Lives Matter protests for racial justice after the murder of George Floyd. The book also includes a list of mental health resources.

Download “Meet Little Monster” Coloring & Activity Book

• Download in English
• Download in Spanish
• Download in Arabic
• Download in Korean
• Download in Mandarin
• Download in Vietnamese

Make an Analogy to a Medical Problem

Children often hear about their medical problems. They understand that if they have asthma, their lungs and airways tighten up in response to dust, pets, cold or exercise. They know that the wheezing makes them uncomfortable, so they need to take medications for relief and avoid situations that may trigger an attack.

Similarly, you can let your child know that mental health concerns, like anxiety, depression, ADHD and OCD, among others, are also physical conditions that start with their brain. The brain controls feelings, thoughts and behavior — like the “central headquarters” of the body. Sometimes, the brain gets “knocked off balance,” but, like other medical problems, they can learn to manage this with treatment, which can include medications and behavioral support (stress reduction, relaxation, psychotherapies, etc.).

Give Them Concrete Explanations

Children can understand mental health issues better if they have a concrete explanation. Here is an example of how you could explain panic attacks:

“If you walked across the street and a car was about to hit you, you would jump out of the way, feel scared, have a racing heart, feel dizzy or hyperventilate (breathe too fast). All of this is a normal fight-or-flight response to a real threat of danger. A panic attack can include all the same physical and emotional reactions, except there is no car about to hit you. And while this might seem scary, there are ways to deal with it.

Many times, panic attacks happen in ‘normal’ situations, such as going to school, riding in a car, going up in elevators, and in other settings that are not actually dangerous. If you had panic disorder, you would most likely associate those places with panic. In other words, your brain would react as if something bad is going to happen, maybe even just from thinking about those situations.”

Listen to Them and Validate Their Experiences

Because there is often stigma attached to mental health conditions, children can feel ashamed to talk about their worries, obsessions, compulsions, impulsivity and other behavioral problems. Talk with them about what they are experiencing. Listen with curiosity and empathize with them.

It may be helpful to tell your child about other people who experience similar problems. If you or someone else your child trusts have mental health conditions, explain that the same way you would tell them about diabetes. These things can run in families, and they are not the only people who feel this way. If you or a family member can have a conversation with your child about their own mental health and how they manage it, it can be very reassuring.

Be Sure They Know This Is Not Their Fault

Many children with mental health conditions can feel that their condition is their fault or that it is an unchangeable feature of their personality or their identity. Stigma and misinformation often reinforce these feelings. You can help them see that mental health conditions are common and that it is not a sign that something is wrong with them as a person. Emphasize their strengths so they don’t see their mental health condition as the most important part of who they are.

Have Frequent Conversations

Many mental health conditions are considered intermittent — the symptoms can come and go throughout life and may fluctuate in severity depending on age, level of stress or any number of factors. It helps to have conversations about emotions, thoughts and behaviors that are a part of your child’s condition from the time it begins.

As they grow up, become more mature and are better able to understand themselves and their condition, your child will see you as a trusted resource they can consult if they have a relapse or experience new symptoms. Although it may not always be easy, maintaining an open and understanding relationship can be critical. Touching base with your child about their experiences is the best way to identify any new or developing issues and ensure they have the right treatment and support.

Let Them Ask You Questions

Children will have all sorts of questions about their symptoms and treatment, so being open and giving them information about the ways therapy and/or medications can help will be reassuring. If you do not have all the best information, plan to meet with your child and their mental health clinician together to discuss the problem and their questions. If your child asks a question you don’t know the answer to, it’s ok to say you don’t know and then work together to find an answer.

Include the Family

Ideally, a mental health condition should not be a secret. Your child may feel more secure if their siblings/ grandparents/others in the family know about it, can talk with them about it and accept it — just as they would accept any other medical problem, like diabetes. This kind of transparency is incredibly helpful to prevent feelings of shame or isolation.

Discuss Self-Care and Prevention

Mental health conditions are a complex interaction between biology, psychology and environmental factors. Teaching your child to practice self-care, including maintaining a healthy diet, exercising regularly, meditating and getting sufficient sleep, are instrumental in preventing relapses and diminishing symptoms.

Don’t Be Afraid to Ask About Suicide

In recent years, rates of death by suicide and suicidal thinking have increased in young people. Many parents and caregivers are wary of asking a child if they have suicidal thoughts, intentions or plans. They may be afraid that starting the conversation may cause suicidal behavior, but this connection has proven to be false . Asking about suicide may be a relief for people of all ages. If your child has a mental health condition, it’s important to check-in with them about suicidal thoughts .

Talking with your child about their mental health condition is not easy. However, you are more than capable of opening a dialogue.

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How to Support Your Child's Mental Health

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• Why Mental Health Is Important
• How to Support Mental Health

When to Get Outside Help

Most parents excel at keeping their kids physically healthy. They work to ensure they are eating well, getting their immunizations, and staying physically active. But a child's emotional and mental well-being is just as important to their quality of life as being physically healthy.

Supporting your child's mental health—just as you would their physical health—helps your child develop the resilience they need to deal with obstacles while growing into well-rounded and mentally healthy adults.

"Our mental health is connected to every aspect of our lives such as our physical, emotional, relational, and spiritual well-being," says Kerry Heath , LPC-S, NCC, CEDS-S, a licensed professional counselor with Choosing Therapy. "Each of these aspects of our lives are interrelated. If/when one or more areas are impacted, our mental health is likely to be adversely affected."  

Why a Child's Mental Health Is Important

When a child has good mental health, they are able to think clearly, make friends , and learn new things. They also develop self-confidence, build self-esteem, practice perseverance, learn to set goals, practice making decisions, learn coping skills, manage difficult emotions, and develop a healthy emotional outlook on life.

Learning these skills is not always easy and takes practice, especially if your child has a mental health issue like depression or anxiety . In fact, experiencing mental health issues is not that uncommon.

According to the American Psychological Association, an estimated 15 million young people in the US are diagnosed with a mental health disorder and many more are at risk of developing a disorder.

Left untreated, these mental health issues can have a significant impact on a child's life. Elementary school children with mental health issues are more likely to miss school and they are three times more likely to be suspended or expelled than their peers. Plus, there are long-term consequences to consider as well, like other mental disorders or chronic medical conditions.

"Also, early life mental health issues can lead to mental health and/or substance abuse disorders in adulthood," explains Heath. "It is crucial that children are taught effective coping skills to avoid the use of ineffective behaviors later in life...to manage emotions."

Parents can counteract these statistics by not only supporting their child's mental health but also getting them the help they need when they are facing mental obstacles. Here is what you need to know about supporting your child's mental health.

If you or a loved one are struggling with mental health issue contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database .

How Parents Can Support Mental Health

Being mentally healthy during childhood means reaching developmental and emotional milestones, learning healthy social skills, and knowing how to cope with problems. Mentally healthy children have a good quality of life and can function well at home, in school, and in their communities.

But being mentally healthy doesn't just happen organically. Parents and caregivers play a crucial role in fostering good mental health, seeking support when it's needed, and guiding their kids through life. Here are some ways to support your child's mental health.

Show Unconditional Love

One of the most important ways to support your child's mental health is to show unconditional love, says Jenni Torres, MEd, a former teacher and senior vice president of curriculum and instruction for nonprofit  Waterford.org . Regularly let your kids know that no matter what they are facing or dealing with that you love them unconditionally and that you are there for them.

Kids need to understand that we all make mistakes but that we can learn from these mistakes, she says. Make sure you are framing your child's mistakes as a way of learning instead of communicating failure. Even if you are disappointed in a poor choice, your child should know that the disappointment you feel has no bearing on your love for them.

Praise Their Character

Encouragement, praise, and affirmations are all ways in which parents can not only build their child's self-confidence and self-esteem but more importantly, support their mental health. Research shows that low self-esteem is associated with anxiety, depression, and academic stress, which all significantly affect a child's quality of life. Low self-esteem can even lead to suicidal ideation.

Kerry Heath, LPC-S, NCC, CEDS-S

Praise children for character traits more often than physical traits or achievement-oriented things.

"Praise children for character traits more often than physical traits or achievement-oriented things," says Heath. "Children respond well to positive reinforcement, and we want to reinforce the things we want to be repeated, such as being kind, showing empathy, [and] helping others."

Spend Time Together

Spending time together as a family not only strengthens family bonds but also gives parents much-needed face-time with their kids to learn what they are struggling with, and what their dreams are. It sends the message that your kids are important and that you care what's happening in their lives. You also will be more likely to recognize issues in your child's life if you are regularly spending time together.

"Parents can make time for their children by doing things like having family meals, taking walks together, completing projects together, assisting with homework, or playing games with one another," says Heath.

Heath says you also should get to know your child's friends. "Show your children that you care about the people they care about as well," Heath says. Plus, you can provide input when they are in unhealthy relationships or friendships as well as guide them on how to be a healthy friend.

Communicate Regularly

Talking on a consistent basis means you can help your child problem-solve difficult situations. You also can serve as a sounding board for them to talk about the emotions they are dealing with. "Open communication allows kids to feel free to explore their feelings," Torres says. "Parents are more likely to notice when things are amiss if they are talking with their child consistently."

Heath suggests asking open-ended questions. One place to start is to get them to share about their day after school, a party, or a special event. Getting your child to share these things—both the good and the bad—will provide opportunities for you to help them troubleshoot.

Build Trust

"One of the foundational needs of children is to feel safe," adds Torres. "When kids feel safe, they develop appropriately and learn appropriately. There also is less likelihood of mental health challenges and when mental health challenges do occur, they are just biological consequences."

One way to foster those feelings of safety and trust is to create an environment in your home where it is safe for your kids to discuss their feelings and struggles, says Heath. You can do that, she says, by being a good role model .

"Children learn by example," Heath says. "If they see that it is acceptable to share struggles and challenges, they will be more likely to come to parents with their own."

Although making the decision to seek the help of a mental health professional is not always easy for parents, it is one that is wise.

"Often when we see something happening with our children, we can sometimes feel like we failed, which can stop us from seeking help," says Torres. "But if we do take that step, we find out we are not alone, that others are experiencing the same things, and that we were not a failure. Instead of letting shame stop them, parents should take that step to speak up."

Torres also believes that parents shouldn't wait until things get bad or unmanageable before reaching out for help. Instead, she encourages them to be proactive about getting their child support so that they can learn healthy coping strategies, build resilience, and learn to manage difficult situations and emotions.

Signs Your Child May Need Outside Help

While every child experiences emotional ups and downs, there are some red flags that indicate that they may need to see a healthcare provider or a mental health professional. Reach out to someone right away if your child displays any of these red flags:

• Displays excessive worry or anxiety
• Appears less confident or feels bad about themselves
• Withdraws from you, their friends, or activities they used to enjoy
• Displays significant changes in eating or sleeping habits
• Struggles academically or has issues with friends
• Expresses hopelessness, seems depressed, or talks about suicide
• Engages in negative behaviors more often
• Talks about or participates in self-harming behaviors
• Participates in self-destructive behaviors or has issues with impulse control
• Seems overly irritable, emotional, or easily upset
• Makes comments like "Nobody would notice if I ran away"

Overall, if you are concerned about your child—even if their actions or attitude are not on this list—talk to a healthcare provider. They can help you determine what is normal and what is not based on your child's age and development. And most importantly they can make sure your child gets the help they need.

A Word From Verywell

When it comes to your child's mental health, it is important to be a consistent part of your child's life, not only talking with them but spending time together as well. Your child's mental health will benefit significantly from your involvement in their lives as well as your guidance, unconditional love, and your support.

By building trust, demonstrating strong communication skills, and being a good role model, you will have established a strong foundation for your child's mental health. And remember, part of supporting your child's mental health means getting them help or support when they need it.

You are the expert on your child. If they are acting in a way that seems strange or worrisome to you, talk to a healthcare provider. It is the most supportive and courageous thing you can do to get your child help when they need it, so don't let fear or embarrassment keep you from reaching out. With proper treatment and intervention, they will learn to care for their mental well-being.

American Psychological Association. Children's mental health .

How Mental Health Disorders Affect Youth . Youth.Gov

Centers for Disease Control and Prevention. What is children's mental health . Updated September 23, 2021.

Nguyen DT, Wright EP, Dedding C, Pham TT, Bunders J. Low self-esteem and its association with anxiety, depression, and suicidal ideation in Vietnamese secondary school students: a cross-sectional study .  Front Psychiatry . 2019;10:698. doi:10.3389/fpsyt.2019.00698

Cleveland Clinic. Signs that your child may need a therapist . Updated March 31, 2021.

By Sherri Gordon Sherri Gordon, CLC is a published author, certified professional life coach, and bullying prevention expert. 

Mental health of children and parents —a strong connection

The mental health of children is connected to their parents’ mental health. A recent study found that 1 in 14 children has a caregiver with poor mental health. Fathers and mothers—and other caregivers who have the role of parent—need support, which, in turn, can help them support their children’s mental health.   CDC works to make sure that parents get the support they need.

A child’s mental health is supported by their parents

Being mentally healthy during childhood includes reaching developmental and emotional milestones and learning healthy social skills and how to cope when there are problems. Mentally healthy children are more likely to have a positive quality of life and are more likely to function well at home, in school, and in their communities.

A child’s healthy development depends on their parents—and other caregivers who act in the role of parents—who serve as their first sources of support in becoming independent and leading healthy and successful lives.

The mental health of parents and children is connected in multiple ways. Parents who have their own mental health challenges, such as coping with symptoms of depression or anxiety (fear or worry), may have more difficulty providing care for their child compared to parents who describe their mental health as good. Caring for children can create challenges for parents, particularly if they lack resources and support, which can have a negative effect on a parent’s mental health. Parents and children may also experience shared risks, such as inherited vulnerabilities, living in unsafe environments, and facing discrimination or deprivation.

Poor mental health in parents is related to poor mental and physical health in children

A recent study asked parents (or caregivers who had the role of parent) to report on their child’s mental and physical health as well as their own mental health. One in 14 children aged 0–17 years had a parent who reported poor mental health, and those children were more likely to have poor general health, to have a mental, emotional, or developmental disability, to have adverse childhood experiences such as exposure to violence or family disruptions including divorce, and to be living in poverty.

Fathers are important for children’s mental health

Fathers are important for promoting children’s mental health, although they are not as often included in research studies as mothers. The recent study looked at fathers and other male caregivers and found similar connections between their mental health and their child’s general and mental health as for mothers and other female caregivers.

Supporting parents’ mental health

Supporting parents, and caregivers who act in the role of parent, is a critical public health priority. CDC provides parents with information about child health and development , including positive parenting tips , information and support when parents have concerns about their child’s development , or help with challenging behavior . CDC supports a variety of programs and services that address adverse childhood experiences that affect children’s and parents’ mental health, including programs to prevent child maltreatment and programs that support maternal mental health during and after pregnancy . CDC also examines issues related to health equity and social determinants of health , including racism, that affect the emotional health of parents and children. More work is needed to understand how to address risks to parents’ mental health.

To help parents and other adults with mental health concerns in times of distress, CDC funded the web campaign How Right Now as a way to find resources and support. CDC is also funding the National Academies of Science, Engineering, and Medicine to develop an online resource for parents to learn skills to cope with emotions and behavior using evidence-based approaches to improving mental health, which will be released this summer.

More Information

• CDC’s Children’s Mental Health
• CDC’s Child Development
• CDC’s Positive Parenting Tips
• CDC’s Information on Adolescent Mental Health
• CDC’s Information on Parenting Teens
• CDC’s Information on Depression During and After Pregnancy
• CDC’s Information on Managing Stress and Anxiety during a Pandemic
• HHS Information on Supporting Families
• HHS Information on Engaging Fathers

Wolicki SB, Bitsko RH, Cree RA, et al. Associations of mental health among parents and other primary caregivers with child health indicators: Analysis of caregivers, by sex—National Survey of Children’s Health, 2016–2018, Adversity and Resilience Science: Journal of Research and Practice. Published online April 19, 2021 [ read summary ]

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Child and Adolescent Mental Health

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• Open access
• Published: 14 September 2023

Children and youth’s perceptions of mental health—a scoping review of qualitative studies

• Linda Beckman 1 , 2 ,
• Sven Hassler 1 &
• Lisa Hellström 3  

BMC Psychiatry volume  23 , Article number:  669 ( 2023 ) Cite this article

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Recent research indicates that understanding how children and youth perceive mental health, how it is manifests, and where the line between mental health issues and everyday challenges should be drawn, is complex and varied. Consequently, it is important to investigate how children and youth perceive and communicate about mental health. With this in mind, our goal is to synthesize the literature on how children and youth (ages 10—25) perceive and conceptualize mental health.

We conducted a preliminary search to identify the keywords, employing a search strategy across electronic databases including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts and Google Scholar. The search encompassed the period from September 20, 2021, to September 30, 2021. This effort yielded 11 eligible studies. Our scoping review was conducted in accordance with the PRISMA-ScR Checklist.

As various aspects of uncertainty in understanding of mental health have emerged, the results indicate the importance of establishing a shared language concerning mental health. This is essential for clarifying the distinctions between everyday challenges and issues that require treatment.

We require a language that can direct children, parents, school personnel and professionals toward appropriate support and aid in formulating health interventions. Additionally, it holds significance to promote an understanding of the positive aspects of mental health. This emphasis should extend to the competence development of school personnel, enabling them to integrate insights about mental well-being into routine interactions with young individuals. This approach could empower children and youth to acquire the understanding that mental health is not a static condition but rather something that can be enhanced or, at the very least, maintained.

Peer Review reports

Introduction

In Western society, the prevalence of mental health issues, such as depression and anxiety [ 1 ], as well as recurring psychosomatic health complaints [ 2 ], has increased from the 1980s and 2000s. However, whether these changes in adolescent mental health are actual trends or influenced by alterations in how adolescents perceive, talk about, and report their mental well-being remains ambiguous [ 1 ]. Despite an increase in self-reported mental health problems, levels of mental well-being have remained stable, and severe psychiatric diagnoses have not significantly risen [ 3 , 4 ]. Recent research indicates that understanding how children and youth grasp mental health, its manifestations, and the demarcation between mental health issues and everyday challenges is intricate and diverse. Wickström and Kvist Lindholm [ 5 ] show that problems such as feeling low and nervous are considered deep-seated issues among some adolescents, while others refer to them as everyday challenges. Meanwhile, adolescents in Hellström and Beckman [ 6 ] describe mental health problems as something mainstream, experienced by everyone at some point. Furthermore, Hermann et al. [ 7 ] point out that adolescents can distinguish between positive health and mental health problems. This indicates their understanding of the complexity and holistic nature of mental health and mental health issues. It is plausible that misunderstandings and devaluations of mental health and illness concepts may increase self-reported mental health problems and provide contradictory results when the understanding of mental health is studied. In a previous review on how children and young people perceive the concept of “health,” four major themes have been suggested: health practices, not being sick, feeling good, and being able to do the desired and required activities [ 8 ]. In a study involving 8–11 year olds, children framed both biomedical and holistic perspectives of health [ 9 ]. Regarding the concept of “illness,” themes such as somatic feeling states, functional and affective states [ 10 , 11 ], as well as processes of contagion and contamination, have emerged [ 9 ]. Older age strongly predicts nuances in conceptualizations of health and illness [ 10 , 11 , 12 ].

As the current definitions of mental health and mental illness do not seem to have been successful in guiding how these concepts are perceived, literature has emphasized the importance of understanding individuals’ ideas of health and illness [ 9 , 13 ]. The World Health Organization (WHO) broadly defines mental health as a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, work productively and fruitfully and make a contribution to his or her community [ 14 ] capturing only positive aspects. According to The American Psychology Association [ 15 ], mental illness includes several conditions with varying severity and duration, from milder and transient disorders to long-term conditions affecting daily function. The term can thus cover everything from mild anxiety or depression to severe psychiatric conditions that should be treated by healthcare professionals. As a guide for individual experience, such a definition becomes insufficient in distinguishing mental illness from ordinary emotional expressions. According to the Swedish National Board of Health and Welfare et al. [ 16 ], mental health works as an umbrella term for both mental well-being and mental illness : Mental well-being is about being able to handle life's difficulties, feeling satisfied with life, having good social relationships, as well as being able to feel pleasure, desire, and happiness. Mental illness includes both mild to moderate mental health problems and psychiatric conditions . Mild to moderate mental health problems are common and are often reactions to events or situations in life, e.g., worry, feeling low, and sleep difficulties.

It has been argued that increased knowledge of the nature of mental illness can help individuals to cope with the situation and improve their well-being. Increased knowledge about mental illness, how to prevent mental illness and help-seeking behavior has been conceptualized as “mental health literacy” (MHL) [ 17 ], a construct that has emerged from “health literacy” [ 18 ]. Previous literature supports the idea that positive MHL is associated with mental well-being among adolescents [ 19 ]. Conversely, studies point out that low levels of MHL are associated with depression [ 20 ]. Some gender differences have been acknowledged in adolescents, with boys scoring lower than girls on MHL measures [ 20 ] and a social gradient including a positive relationship between MHL and perceived good financial position [ 19 ] or a higher socio-economic status [ 21 ].

While MHL stresses knowledge about signs and treatment of mental illness [ 22 ], the concern from a social constructivist approach would be the conceptualization of mental illness and how it is shaped by society and the thoughts, feelings, and actions of its members [ 23 ]. Studies on the social construction of anxiety and depression through media discourses have shown that language is at the heart of these processes, and that language both constructs the world as people perceive it but also forms the conditions under which an experience is likely to be construed [ 24 , 25 ]. Considering experience as linguistically inflected, the constructionist approach offers an analytical tool to understand the conceptualization of mental illness and to distinguish mental illness from everyday challenges. The essence of mental health is therefore suggested to be psychological constructions identified through how adolescents and society at large perceive, talk about, and report mental health and how that, in turn, feeds a continuous process of conceptual re-construction or adaptation [ 26 ]. Considering experience as linguistically inflected, the constructionist approach could then offer an analytical tool to understand the potential influence of everyday challenges in the conceptualization of mental health.

Research investigating how children and youth perceive and communicate mental health is essential to understand the current rise of reported mental health problems [ 5 ]. Health promotion initiatives are more likely to be successful if they take people’s understanding, beliefs, and concerns into account [ 27 , 28 ]. As far as we know, no review has mapped the literature to explore children’s and youths’ perceptions of mental health and mental illness. Based on previous literature, age, gender, and socioeconomic status seem to influence children's and youths’ knowledge and experiences of mental health [ 10 , 11 , 12 ]; therefore, we aim to analyze these perspectives too. From a social constructivist perspective, experience is linguistically inflected [ 26 ]; hence illuminating the conditions under which a perception of health is formed is of interest.

Therefore, we aim to study the literature on how children and youth (ages 10—25) perceive and conceptualize mental health, and the specific research questions are:

What aspects are most salient in children’s and youths’ perceptions of mental health?

What concepts do children and youth associate with mental health?

In what way are children's and youth’s perceptions of mental health dependent on gender, age, and socioeconomic factors?

Literature search

A scoping review is a review that aims to provide a snapshot of the research that is published within a specific subject area. The purpose is to offer an overview and, on a more comprehensive level, to distinguish central themes compared to a systematic review. We chose to conduct a scoping review since our aim was to clarify the key concepts of mental health in the literature and to identify specific characteristics and concepts surrounding mental health [ 29 , 30 ]. Our scoping review was conducted following the PRISMA-ScR Checklist [ 31 ]. Two authors (L.B and L.H) searched and screened the eligible articles. In the first step, titles and abstracts were screened. If the study included relevant data, the full article was read to determine if it met the eligibility criteria. Articles were excluded if they did not fulfill all the eligibility criteria. Any uncertainties were discussed among L.B. and L.H., and the third author, S.H., and were carefully assessed before making an inclusion or exclusion decision. The software Picoportal was employed for data management. Figure  1 illustrates a flowchart of data inclusion.

PRISMA flow diagram outlining the search process

Eligibility criteria

We incorporated studies involving children and youth aged 10 to 25 years. This age range was chosen to encompass early puberty through young adulthood, a significant developmental period for young individuals in terms of comprehending mental health. Participants were required not to have undergone interviews due to chronic illness, learning disabilities (e.g., mental health linked to a cancer diagnosis), or immigrant status.

Studies conducted in clinical settings were excluded. For the purpose of comparing results under similar conditions, we specifically opted for studies carried out in Western countries .

Given that this review adopts a moderately constructionist approach, intentionally allowing for the exploration of how both young participants and society in general perceive and discuss mental health and how this process contributes to ongoing conceptual re-construction, the emphasis was placed on identifying articles in which participants themselves defined or attributed meaning to mental health and related concepts like mental illness. The criterion of selecting studies adopting an inductive approach to capture the perspectives of the young participants resulted in the exclusion of numerous studies that more overtly applied established concepts to young respondents [ 32 ].

Information sources

We utilized electronic databases and reached out to study authors if the article was not accessible online. Peer-reviewed articles were exclusively included, thereby excluding conference abstracts due to their perceived lack of relevance in addressing the review questions. Only research in English was taken into account. Publication years across all periods were encompassed in the search.

Search strategy

Studies concerning children’s and youths’ perceptions of mental health were published across a range of scientific journals, such as those within psychiatry, psychology, social work, education, and mental health. Therefore, several databases were taken into account, including Medline, Scopus, CINAHL, PsychInfo, Sociological abstracts, and Google Scholar, spanning from inception on September 20, 2021 to September 30, 2021. We involved a university librarian from the start in the search process. The combinations of search terms are displayed in Table 1 .

Quality assessment

We employed the Quality methods for the development of National Institute for Health Care Excellence (NICE) public health guidance [ 33 ] to evaluate the quality of the studies included. The checklist is based on checklists from Spencer et al. [ 34 ], Public Health Resource Unit (PHRU) [ 26 , 35 ], and the North Thames Research Appraisal Group (NTRAG) [ 36 ] (Refer to S2 for checklist). Eight studies were assigned two plusses, and three studies received one plus. The studies with lower grades generally lacked sufficient descriptions of the researcher’s role, context reporting, and ethical reporting. No study was excluded in this stage.

Data extraction and analysis

We employed a data extraction form that encompassed several key characteristics, including author(s), year, journal, country, details about method/design, participants and socioeconomics, aim, and main results (Table 2 ). The collected data were analyzed and synthesized using the thematic synthesis approach of Thomas and Harden [ 37 ]. This approach encompassed all text categorized as 'results' or 'findings' in study reports – which sometimes included abstracts, although the presentation wasn’t always consistent throughout the text. The size of the study reports ranged from a few sentences to a single page. The synthesis occurred through three interrelated stages that partially overlapped: coding of the findings from primary studies on a line-by-line basis, organization of these 'free codes' into interconnected areas to construct 'descriptive' themes, and the formation of 'analytical' themes.

The objective of this scoping review has been to investigate the literature concerning how children and youth (ages 10—25) conceptualize and perceive mental health. Based on the established inclusion- and exclusion criteria, a total of 11 articles were included representing the United Kingdom ( n  = 6), Australia ( n  = 3), and Sweden ( n  = 2) and were published between 2002 and 2020. Among these, two studies involved university students, while nine incorporated students from compulsory schools.

Salient aspects of children and youth’ perceptions of mental health

Based on the results of the included articles, salient aspects of children’s and youths’ understandings revealed uncertainties about mental health in various ways. This uncertainty emerged as conflicting perceptions, uncertainty about the concept of mental health, and uncertainty regarding where to distinguish between mild to moderate mental health problems and everyday stressors or challenges.

One uncertainty was associated with conflicting perceptions that mental health might be interpreted differently among children and youths, depending on whether it relates to their own mental health or someone else's mental health status. Chisholm et al. [ 42 ] presented this as distinctions being made between ‘them and us’ and between ‘being born with it’. Mental health and mental illness were perceived as a continuum that rather developed’, and distinctions were drawn between ‘crazy’ and ‘diagnosed.’ Participants established strong associations between the term mental illness and derogatory terms like ‘crazy,’ linking extreme symptoms of mental illness with others. However, their attitude was less stigmatizing when it came to individual diagnoses, reflecting a more insightful and empathetic understanding of the adverse impacts of stress based on their personal realities and experiences. Despite the initial reactions reflecting negative stereotypes, further discussion revealed that this did not accurately represent a deeper comprehension of mental health and mental illness.

There was also uncertainty about the concept of mental health , as it was not always clearly understood among the participating youth. Some participants were unable to define mental health, often confusing it with mental illness [ 28 ]. Others simply stated that they did not understand the term, as in O’Reilly [ 44 ]. Additionally, uncertainty was expressed regarding whether mental health was a positive or negative concept [ 27 , 28 , 40 , 44 ], and participants associated mental health with mental illness despite being asked about mental health [ 28 ]. One quote from a grade 9 student illustrates this: “ Interviewer: Can mental health be positive as well? Informant: No, it’s mental” [ 44 ]. In Laidlaw et al. [ 46 ], with participants ranging from 18—22 years of age, most considered mental health distinctly different from and more clinical than mental well-being. However, Roose et al. [ 38 ], for example, the authors discovered a more multifaceted understanding of mental health, encompassing emotions, thoughts, and behavior. In Molenaar et al.[ 45 ], mental health was highlighted as a crucial aspect of health overall. In Chisholm et al. [ 42 ], the older age groups discussed mental health in a more positive sense when they considered themselves or people they knew, relating mental health to emotional well-being. Connected to the uncertainty in defining the concept of mental health was the uncertainty in identifying those with good or poor mental health. Due to the lack of visible proof, children and youths might doubt their peers’ reports of mental illness, wondering if they were pretending or exaggerating their symptoms [ 27 ].

A final uncertainty that emerged was difficulties in drawing the line between psychiatric conditions and mild to moderate mental health problems and everyday stressors or challenges . Perre et al. [ 43 ] described how the participants in their study were uncertain about the meaning of mental illness and mental health issues. While some linked depression to psychosis, others related it to simply ‘feeling down.’ However, most participants indicated that, in contrast to transient feelings of sadness, depression is a recurring concern. Furthermore, the duration of feeling depressed and particularly a loss of interest in socializing was seen as appropriate criteria for distinguishing between ‘feeling down’ and ‘clinical depression.’ Since feelings of anxiety, nervousness, and apprehension are common experiences among children and youth, defining anxiety as an illness as opposed to an everyday stressor was more challenging [ 43 ].

Terms used to conceptualize mental health

When children and youth were asked about mental health, they sometimes used neutral terms such as thoughts and emotions or a general ‘vibe’ [ 27 ], and some described it as ‘peace of mind’ and being able to balance your emotions [ 38 ]. The notion of mental health was also found to be closely linked with rationality and the idea of normality, although, according to the young people, Armstrong et al. [ 28 ], there was no consensus about what ‘normal’ meant. Positive aspects of mental health were described by the participants as good self-esteem, confidence [ 40 ], happiness [ 39 , 43 ], optimism, resilience, extraversion and intelligence [ 27 ], energy [ 43 ], balance, harmony [ 39 , 43 ], good brain, emotional and physical functioning and development, and a clear idea of who they are [ 27 , 41 ]. It also included a feeling of being a good person, feeling liked and loved by your parents, social support, and having people to talk with [ 27 , 39 ], as well as being able to fit in with the world socially and positive peer relationships [ 41 ], according to the children and youths, mental health includes aspects related to individuals (individual factors) as well as to people in their surroundings (relationships). Regarding mental illness, participants defined it as stress and humiliation [ 40 ], psychological distress, traumatic experiences, mental disorders, pessimism, and learning disabilities [ 27 ]. Also, in contrast to the normality concept describing mental health, mental illness was described as somehow ‘not normal’ or ‘different’ in Chisholm et al. [ 42 ].

Depression and bipolar disorder were the most often mentioned mental illnesses [ 27 ]. The inability to balance emotions was seen as negative for mental health, for example, not being able to set aside unhappiness, lying to cover up sadness, and being unable to concentrate on schoolwork [ 38 ]. The understanding of mental illness also included feelings of fear and anxiety [ 42 ]. Other participants [ 46 ] indicated that mental health is distinctly different from, and more clinical than, mental well-being. In that sense, mental health was described using reinforcing terms such as ‘serious’ and ‘clinical,’ being more closely connected to mental illness, whereas mental well-being was described as the absence of illness, feeling happy, confident, being able to function and cope with life’s demands and feeling secure. Among younger participants, a more varied and vague understanding of mental health was shown, framing it as things happening in the brain or in terms of specific conditions like schizophrenia [ 44 ].

Gender, age, socioeconomic status

Only one study had a gender theoretical perspective [ 40 ], but the focus of this perspective concerned gender differences in what influences mental health more than the conceptualization of mental health. According to Johansson et al.[ 39 ], older girls expressed deeper negative emotions (e.g., described feelings of lack of meaning and hope in various ways) than older boys and younger children.

Several of the included studies noticed differences in age, where younger participants had difficulty understanding the concept of mental health [ 39 , 44 ], while older participants used more words to explain it [ 39 ]. Furthermore, older participants seemed to view mental health and mental illness as a continuum, with mental illness at one end of the continuum and mental well-being at the other end [ 42 , 46 ].

Socioeconomic status

The role of socioeconomic status was only discussed by Armstrong et al. [ 28 ], finding that young people from schools in the most deprived and rural areas experienced more difficulties defining the term mental health compared to those from a less deprived area.

This scoping review aimed to map children's and youth’s perceptions and conceptualizations of mental health. Our main findings indicate that the concept of mental health is surrounded by uncertainty. This raises the question of where this uncertainty stems from and what it symbolizes. From our perspective, this uncertainty can be understood from two angles. Firstly, the young participants in the different studies show no clear and common understanding of mental health; they express uncertainty about the meaning of the concept and where to draw the line between life experiences and psychiatric conditions. Secondly, uncertainty exists regarding how to apply these concepts in research, making it challenging to interpret and compare research results. The shift from a positivistic understanding of mental health as an objective condition to a more subjective inner experience has left the conceptualization open ranging from a pathological phenomenon to a normal and common human experience [ 47 ]. A dilemma that results in a lack of reliability that mirrors the elusive nature of the concept of mental health from both a respondent and a scientific perspective.

“Happy” was commonly used to describe mental health, whereas "unhappy" was used to describe mental illness. The meaning of happiness for mental health has been acknowledged in the literature, and according to Layard et al. [ 48 ], mental illness is one of the main causes of unhappiness, and happiness is the ultimate goal in human life. Layard et al. [ 48 ] suggest that schools and workplaces need to raise more awareness of mental health and strive to improve happiness to promote mental health and prevent mental illness. On the other hand, being able to experience and express different emotions could also be considered a part of mental health. The notion of normality also surfaced in some studies [ 38 ], understanding mental health as being emotionally balanced or normal or that mental illness was not normal [ 42 ]. To consider mental illness in terms of social norms and behavior followed with the sociological alternative to the medical model that was introduced in the sixties portraying mental illness more as socially unacceptable behavior that is successfully labeled by others as being deviant. Although our results did not indicate any perceptions of what ‘normal’ meant [ 28 ], one crucial starting point to the understanding of mental health among adolescents should be to delineate what constitutes normal functioning [ 23 ]. Children and youths’ understanding of mental illness seems to a large extent, to be on the same continuum as a normality rather than representing a medicalization of deviant behavior and a disjuncture with normality [ 49 ].

Concerning gender, it seemed that girls had an easier time conceptualizing mental health than boys. This could be due to the fact that girls mature verbally faster than boys [ 50 ], but also that girls, to a larger extent, share feelings and problems together compared to boys [ 51 ]. However, according to Johansson et al. [ 39 ], the differences in conceptualizations of mental health seem to be more age-related than gender-related. This could be due to the fact that older children have a more complex view of mental health compared to younger children.. Not surprisingly, the older the children and youth were, the more complex the ability to conceptualize mental health becomes. Only one study reported socioeconomic differences in conceptualizations of mental health [ 28 ]. This could be linked to mental health literacy (MHL) [ 18 ], i.e., knowledge about mental illness, how to prevent mental illness, and help-seeking behavior. Research has shown that disadvantaged social and socioeconomic conditions are associated with low MHL, that is, people with low SES tends to know less about symptoms and prevalence of different mental health problems [ 19 , 21 ]. The perception and conceptualizations of mental health are, as we consider, strongly related to knowledge and beliefs about mental health, and according to von dem Knesebeck et al. [ 52 ] linked primarily to SES through level of education.

Chisholm et al. [ 42 ] found that the initial reactions from participants related to negative stereotypes, but further discussion revealed that the participants had more refined knowledge than at first glance. This illuminates the importance of talking to children and helping them verbalize their feelings, in many respects complex and diversified understanding of mental health. It is plausible that misunderstandings and devaluations of mental health and mental illness may increase self-reported mental health problems [ 5 ], as well as decrease them, preventing children and youth from seeking help. Therefore, increased knowledge of the nature of mental health can help individual cope with the situations and improve their mental well-being. Finding ways to incorporate discussions about mental well-being, mental health, and mental illness in schools could be the first step to decreasing the existing uncertainties about mental health. Experiencing feelings of sadness, anger, or upset from time to time is a natural part of life, and these emotions are not harmful and do not necessarily indicate mental illness [ 5 , 6 ]. Adolescents may have an understanding of the complexity of mental health despite using simplified language but may need guidance on how to communicate their feelings and how to manage everyday challenges and normal strains in life [ 7 ].

With the aim of gaining a better understanding of how mental health is perceived among children and youth, this study has highlighted the concept’s uncertainty. Children and youth reveal a variety of understandings, from diagnoses of serious mental illnesses such as schizophrenia to moods and different types of behaviors. Is there only one way of understanding mental health, and is it reasonable to believe that we can reach a consensus? Judging by the questions asked, researchers also seem to have different ideas on what to incorporate into the concept of mental health — the researchers behind the present study included. The difficulties in differentiating challenges being part of everyday life with mental health issues need to be paid closer attention to and seems to be symptomatic with the lack of clarity of the concepts.

A constructivist approach would argue that the language of mental health has changed over time and thus influence how adolescents, as well as society at large, perceive, talk about, and report their mental health [ 26 ]. The re-construction or adaptation of concepts could explain why children and youth re struggling with the meaning of mental health and that mental health often is used interchangeably with mental illness. Mental health, rather than being an umbrella term, then represents a continuum with a positive and a negative end, at least among older adolescents. But as mental health according to this review also incorporates subjective expressions of moods and feelings, the reconstruction seems to have shaped it into a multidimensional concept, representing a horizontal continuum of positive and negative mental health and a vertical continuum of positive and negative well-being, similar to the health cross by Tudor [ 53 ] referred to in Laidlaw et al. [ 46 ] A multidimensional understanding of mental health constructs also incorporates evidence from interventions aimed at reducing mental health stigma among adolescents, where attitudes and beliefs as well as emotional responses towards mental health are targeted [ 54 ].

The contextual understanding of mental health, whether it is perceived in positive terms or negative, started with doctors and psychiatrists viewing it as representing a deviation from the normal. A perspective that has long been challenged by health workers, academics and professionals wanting to communicate mental health as a positive concept, as a resource to be promoted and supported. In order to find a common ground for communicating all aspects and dimensions of mental health and its conceptual constituents, it is suggested that we first must understand the subjective meaning ascribed to the use of the term [ 26 ]. This line of thought follows a social-constructionist approach viewing mental health as a concept that has transitioned from representing objective mental descriptions of conditions to personal subjective experiences. Shifting from being conceptualized as a pathological phenomenon to a normal and common human experience [ 47 ]. That a common understanding of mental health can be challenged by the healthcare services tradition and regulation for using diagnosis has been shown in a study of adolescents’ perspectives on shared decision-making in mental healthcare [ 55 ]. A practice perceived as labeling by the adolescents, indicating that steps towards a common understanding of mental health needs to be taken from several directions [ 55 ]. In a constructionist investigation to distinguish everyday challenges from mental health problems, instead of asking the question, “What is mental health?” we should perhaps ask, “How is the word ‘mental health’ used, and in what context and type of mental health episode?” [ 26 ]. This is an area for future studies to explore.

Methodological considerations

The first limitation we want to acknowledge, as for any scoping review, is that the results are limited by the search terms included in the database searches. However, by conducting the searches with the help of an experienced librarian we have taken precautions to make the searches as inclusive as possible. The second limitation concerns the lack of homogeneous, or any results at all, according to different age groups, gender, socioeconomic status, and year when the study was conducted. It is well understood that age is a significant determinant in an individual’s conceptualization of more abstract phenomena such as mental health. Some of the studies approached only one age group but most included a wide age range, making it difficult to say anything specific about a particular age. Similar concerns are valid for gender. Regarding socioeconomic status, only one study reported this as a finding. However, this could be an outcome of the choice of methods we had — i.e., qualitative methods, where the aim seldom is to investigate differences between groups and the sample is often supposed to be a variety. It could also depend on the relatively small number of participants that are often used in focus groups of individual interviews- there are not enough participants to compare groups based on gender or socioeconomic status. Finally, we chose studies from countries that could be viewed as having similar development and perspective on mental health among adolescents. Despite this, cultural differences likely account for many youths’ conceptualizations of mental health. According to Meldahl et al. [ 56 ], adolescents’ perspectives on mental health are affected by a range of factors related to cultural identity, such as ethnicity, race, peer and family influence, religious and political views, for example. We would also like to add organizational cultures, such as the culture of the school and how schools work with mental health and related concepts [ 56 ].

Conclusions and implications

Based on our results, we argue that there is a need to establish a common language for discussing mental health. This common language would enable better communication between adults and children and youth, ensuring that the content of the words used to describe mental health is unambiguous and clear. In this endeavor, it is essential to actively listen to the voices of children and youth, as their perspectives will provide us with clearer understanding of the experiences of being young in today’s world. Another way to develop a common language around mental health is through mental health education. A common language based on children’s and youth’s perspectives can guide school personnel, professionals, and parents when discussing and planning health interventions and mental health education. Achieving a common understanding through mental health education of adults and youth could also help clarify the boundaries between everyday challenges and problems needing treatment. It is further important to raise awareness of the positive aspect of mental health—that is, knowledge of what makes us flourish mentally should be more clearly emphasized in teaching our children and youth about life. It should also be emphasized in competence development for school personnel so that we can incorporate knowledge about mental well-being in everyday meetings with children and youth. In that way, we could help children and youth develop knowledge that mental health could be improved or at least maintained and not a static condition.

Availability of data and materials

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

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Beckman, L., Hassler, S. & Hellström, L. Children and youth’s perceptions of mental health—a scoping review of qualitative studies. BMC Psychiatry 23 , 669 (2023). https://doi.org/10.1186/s12888-023-05169-x

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New study finds mental health emergencies in kids were more severe during the pandemic

by Ann & Robert H. Lurie Children's Hospital of Chicago

A new study has found that during the pandemic pediatric emergency departments (EDs) saw more children and adolescents who needed a psychiatric admission, as well as an increase in severe conditions, such as bipolar disorder, schizophrenia and substance use disorders.

The higher demand for a psychiatric inpatient bed often exceeded availability, resulting in over 12-hour stays in the ED awaiting admission for nearly 20% of children with mental health emergencies in 2022, up from 7% before the pandemic . Findings were published in Academic Emergency Medicine .

"Our data shows that pediatric emergency departments saw more severe mental health presentations during the pandemic, even while the actual number of visits decreased in 2022," said lead author Jennifer Hoffmann, MD, MS, emergency medicine physician at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

"The dramatic increase in prolonged ED stays attests to the strain on the system and difficulties finding appropriate psychiatric care for children, whether in the hospital or in the community."

Dr. Hoffmann and colleagues retrospectively studied mental health ED visits by children aged 5 to less than 18 years at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. They described these visits by period—pre-pandemic (January 2017–February 2020), early pandemic (March 2020–December 2020), mid pandemic (2021) and late pandemic (2022).

In addition to the increased severity of mental health emergencies, they found that during the mid and late pandemic, mental health ED visits increased beyond expected rates among girls, but not among boys.

"We observed a unique vulnerability for girls during the pandemic, which indicates that girls' mental health requires more attention," said Dr. Hoffmann, who also is the Children's Research Fund Junior Board Research Scholar at Lurie Children's.

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A new book has amplified fierce debate around teens, mental health and smartphones

A new book has embroiled the academic community in a heated debate over whether spending time on smartphones affects young people’s mental health and, if so, how.

Social psychologist Jonathan Haidt’s “ The Anxious Generation ,” published last week, argues that the smartphone-driven “great rewiring of childhood” is causing an “epidemic of mental illness.” He suggests four ways to combat this: no smartphones before high school, no social media before age 16, no phones in schools; and prioritizing real-world play and independence.

“I call smartphones ‘experience blockers,’ because once you give the phone to a child, it’s going to take up every moment that is not nailed down to something else,” Haidt told TODAY.com , adding, “It’s basically the loss of childhood in the real world.”

Phones and social media have become a ubiquitous part of everyday life. But as much as researchers study their impact, there remains no easy answer to how exactly these technologies affect the mental health of kids and teens.

Haidt’s book quickly has generated a wave of both support and backlash, including a viral review in the scientific journal Nature that argues Haidt is contributing to a “rising hysteria” around social media and screen time that’s unproductive in addressing the “real causes” of teen depression and anxiety.

“We have a generation in crisis and in desperate need of the best of what science and evidence-based solutions can offer,” psychologist Candice Odgers wrote in her scathing review. “Unfortunately, our time is being spent telling stories that are unsupported by research and that do little to support young people who need, and deserve, more.”

Over the past decade, scholars and politicians have grown increasingly concerned about the potential impact of social media and screen time on young people. A Senate hearing in January grilled the CEOs of several major social media companies on a variety of topics related to child safety, including their platforms’ impacts on youth mental health.

Also in January, California introduced a bill aimed at protecting children from social media addiction. And last week, Florida Gov. Ron DeSantis signed into law a ban on children under 14 joining social media, which takes effect next January.

Research linking social media use to poor youth mental health led U.S. Surgeon General Vivek Murthy to issue an advisory last year warning of social media’s potential harms to child and adolescent well-being. Up to 95% of youth ages 13 to 17 say they use social media, according to the report , with more than one-third saying they use it “almost constantly.”

Some academics and scientists remain unconvinced that current evidence shows a causal link between social media and poor mental health. Christopher Ferguson, a psychology professor at Stetson University, said he believes the concern is part of a recurring moral panic largely driven by older adults.

He pointed to a cyclical pattern in which disruptive new technologies — from TV to video games to, more recently, generative AI — almost always undergo periods of uproar over their potential harms. He said the buildup of concern around smartphones started slower than most, only taking significant shape in the late 2010s.

But the toothpaste can’t be squeezed back into the tube. The kids who are on smartphones and social media now will be using those technologies well into old age, Ferguson said, and it’ll be their turn to “freak out” once a new, unfamiliar technology threatens to displace their habits.

“I just think this is how it is now. It’s just a matter of getting used to that,” Ferguson said. “For some reason, society always wants to throw a temper tantrum when a new thing comes along. And eventually, like all temper tantrums, they go away.” 

But researcher Jean Twenge, author of “Generations” and “iGen,” said there’s a “reasonably robust” consensus among academics that smartphones and social media are at least partially linked to the rise in teen depression, self harm and loneliness.

She said she believes the pushback comes from a smaller group of academics whose arguments imply that screen time and social media are harmless. Unlike Ferguson, Twenge said she believes the skepticism around them will continue to grow over time.

“The critics in this area need to answer one important question,” said Twenge, a psychology professor at San Diego State University. “If smartphones and social media are not behind the increase in teen depression, what is? Because over and over, the answers that they have given have not been supportable.”

Ninety percent of this debate is basically just back-and-forths about different studies that are subtly designed differently and create totally different results.

-Joseph Bak-Coleman, an associate research scientist at the Columbia School of journalism

Joseph Bak-Coleman, an associate research scientist at the Columbia School of Journalism who studies collective decision-making, said part of why the effects of phone and social media use are so difficult to study is because research subjects cannot be fully isolated from the impact of these technologies.

This leads to conflicting research results, he said, as even individuals who eschew social media and smartphones still live within networks of people who do use them — and in a world already shaped by them.

As Bak-Coleman puts it: “ Ninety percent of this debate is basically just back-and-forths about different studies that are subtly designed differently and create totally different results. And then everyone fights.”

While social platforms and regulators have an obligation to figure out how to protect children and teens, he suspects any restrictive protections would be a “nightmare” to enforce. Measures such as removing access to phones entirely could cause different troubles in a world where kids rely on cellphones to contact their parents, he said, and where many aspects of life now take place in the digital realm.

And because the average effects of social media use might also look different from the effects on those who are most at risk for certain harms, Bak-Coleman said it could be more worthwhile to hone in on specific concerns instead of trying to identify a broad trend in how phones impact mental health.

“Rather than asking, is it a net negative or positive, which is an absurd discussion,” he said, “it’d be much nicer if we could ask: What are the impacts? To who? And which thing does it, and how can you change it?”

Angela Yang is a culture and trends reporter for NBC News.

New Urgent-Care Centers Step In to Treat Children in Mental-Health Crisis

Rather than fevers, sprains and strep throats, a new type of clinic provides mental-health care

Mental - health urgent - care sites are proliferating across the U . S . to treat the spiraling numbers of children and adults who need mental-health care.

A Vermont urgent-care clinician holds a feelings mirror used to teach youngsters about moods. It includes images showing children’s emotions.

The sites are starting to change the face of mental-health treatment, offering a much - needed alternative to emergency departments that have become strained by an increase in visits during the pandemic.

The sites also can see patients quickly , a big difference from many psychologists’ offices, which have wait lists averaging three months or even longer for appointments.

Anxiety monsters—crafted from tissue boxes, paints and pipe cleaners—help children manage their emotions.

More than 20 mental - health urgent - care centers have opened in the past year in locations from Colorado to Virginia.

Psychiatric Urgent Care for Kids, or PUCK, in Vermont has a library that includes board games.

With a pink kitchenette and mini trampoline, Psychiatric Urgent Care for Kids, or PUCK, in Vermont is more like a fun recreation center than a sterile doctor’s office. Instead of sitting at an exam table, patients can dangle in a hanging swing.

On a recent day, staff sought to engage children in activities aiding relaxation . A clinician climbed into a life-size sensory sock that helps relieve anxiety and excess energy, while a colleague stepped on liquid-filled floor cards.

The clinic is run by United Counseling Service of Bennington County, a Vermont nonprofit that provides services such as outpatient counseling and addiction treatment at its 15 facilities.

Some of the young visitors arrive angry and upset, sometimes ripping down the window blinds or charging at staff.

A volcano experiment at the PUCK center demonstrates bottled-up emotions. Cups of baking soda represent feelings such as sadness and worry.

Clients spend at least two hours while a team of clinicians provides a screening, and also do therapeutic worksheets to help identify triggers for their emotional challenges.

In the same experience, anger is represented by vinegar—a catalyst for explosive reactions.

They leave with discharge and safety planning and a follow-up therapy appointment if needed. The cost varies based on length of time and services provided , and the clinic also provides a sliding-fee scale and takes Medicaid.

“ We ’ ve been asked by parents , ‘ What are you doing up there , cause it ’ s working ,’” said Desiree Pechtel, a clinician at PUCK.

Photo editor: Maïa Booker Produced by Leah Latella

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Mental health care is hard to find, especially for people with Medicare or Medicaid

Rhitu Chatterjee

With rates of suicide and opioid deaths rising in the past decade and children's mental health declared a national emergency , the United States faces an unprecedented mental health crisis. But access to mental health care for a significant portion of Americans — including some of the most vulnerable populations — is extremely limited, according to a new government report released Wednesday.

The report, from the Department of Health and Human Services' Office of Inspector General, finds that Medicare and Medicaid have a dire shortage of mental health care providers.

The report looked at 20 counties with people on Medicaid, traditional Medicare and Medicare Advantage plans, which together serve more than 130 million enrollees — more than 40% of the U.S. population, says Meridith Seife , the deputy regional inspector general and the lead author of the report.

Medicaid serves people on low incomes, and Medicare is mainly for people 65 years or older and those who are younger with chronic disabilities.

The report found fewer than five active mental health care providers for every 1,000 enrollees. On average, Medicare Advantage has 4.7 providers per 1,000 enrollees, whereas traditional Medicare has 2.9 providers and Medicaid has 3.1 providers for the same number of enrollees. Some counties fare even worse, with not even a single provider for every 1,000 enrollees.

"When you have so few providers available to see this many enrollees, patients start running into significant problems finding care," says Seife.

The findings are especially troubling given the level of need for mental health care in this population, she says.

"On Medicare, you have 1 in 4 Medicare enrollees who are living with a mental illness," she says. "Yet less than half of those people are receiving treatment."

Among people on Medicaid, 1 in 3 have a mental illness, and 1 in 5 have a substance use disorder. "So the need is tremendous."

The results are "scary" but "not very surprising," says Deborah Steinberg , senior health policy attorney at the nonprofit Legal Action Center. "We know that people in Medicare and Medicaid are often underserved populations, and this is especially true for mental health and substance use disorder care."

Among those individuals able to find and connect with a provider, many see their provider several times a year, according to the report. And many have to drive a long way for their appointments.

"We have roughly 1 in 4 patients that had to travel more than an hour to their appointments, and 1 in 10 had to travel more than an hour and a half each way," notes Seife. Some patients traveled two hours each way for mental health care, she says.

Mental illnesses and substance use disorders are chronic conditions that people need ongoing care for, says Steinberg. "And when they have to travel an hour, more than an hour, for an appointment throughout the year, that becomes unreasonable. It becomes untenable."

"We know that behavioral health workforce shortages are widespread," says Heather Saunders , a senior research manager on the Medicaid team at KFF, the health policy research organization. "This is across all payers, all populations, with about half of the U.S. population living in a workforce shortage."

But as the report found, that's not the whole story for Medicare and Medicaid. Only about a third of mental health care providers in the counties studied see Medicare and Medicaid patients. That means a majority of the workforce doesn't participate in these programs.

This has been well documented in Medicaid, notes Saunders. "Only a fraction" of providers in provider directories see Medicaid patients, she says. "And when they do see Medicaid patients, they often only see a few."

Lower reimbursement rates and a high administrative burden prevent more providers from participating in Medicaid and Medicare, the report notes.

"In the Medicare program, they set a physician fee rate," explains Steinberg. "Then for certain providers, which includes clinical social workers, mental health counselors and marriage and family therapists, they get reimbursed at 75% of that rate."

Medicaid reimbursements for psychiatric services are even lower when compared with Medicare , says Ellen Weber , senior vice president for health initiatives at the Legal Action Center.

"They're baking in those discriminatory standards when they are setting those rates," says Steinberg.

The new report recommends that the Centers for Medicare & Medicaid Services (CMS) take steps to increase payments to providers and lower administrative requirements. In a statement, CMS said it has responded to those recommendations within the report.

According to research by Saunders and her colleagues at KFF, many states have already started to take action on these fronts to improve participation in Medicaid.

Several have upped their payments to mental health providers. "But the scale of those increases ranged widely across states," says Saunders, "with some states limiting the increase to one provider type or one type of service, but other states having rate increases that were more across the board."

Some states have also tried to simplify and streamline paperwork, she adds. "Making it less complex, making it easier to understand," says Saunders.

But it's too soon to know whether those efforts have made a significant impact on improving access to providers.

CMS has also taken steps to address provider shortages, says Steinberg.

"CMS has tried to increase some of the reimbursement rates without actually fixing that structural problem," says Steinberg. "Trying to add a little bit here and there, but it's not enough, especially when they're only adding a percent to the total rate. It's a really small increase."

The agency has also started covering treatments and providers it didn't use to cover before.

"In 2020, Medicare started covering opioid treatment programs, which is where a lot of folks can go to get medications for their substance use disorder," says Steinberg.

And starting this year, Medicare also covers "mental health counselors, which includes addiction counselors, as well as marriage and family therapists," she adds.

While noteworthy and important, a lot more needs to be done, says Steinberg. "For example, in the substance use disorder space, a lot of addiction counselors do not have a master's degree. And that's one of their requirements to be a counselor in the Medicare program right now."

Removing those stringent requirements and adding other kinds of providers, like peer support specialists, is key to improving access. And the cost of not accessing care is high, she adds.

"Over the past two decades, [in] the older adult population, the number of overdose deaths has increased fourfold — quadrupled," says Steinberg. "So this is affecting people. It is causing deaths. It is causing people to go to the hospital. It increases [health care] costs."

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Bestiality references allegedly made during presentation at Renmark High School

Warning for readers: This article contains graphic language.

The South Australian Department for Education is investigating a presentation delivered to year 9 girls in a regional high school that allegedly referenced bestiality as being accepted by the LGBTQIA+ community.

Female students said teachers at Renmark High School told them to leave their lessons and attend a presentation in a separate classroom.

Students who attended the presentation on March 22 say two staff from the Headspace centre in the neighbouring town of Berri introduced a "third-party" presenter who facilitated an hour-long presentation focused on relationships.

Parents said they were not notified about the presentation, nor was it consented to.

Students said they were left unsupervised for the duration of the presentation.

Student Courtney White, 14, said she felt confused and blindsided by the presentation.

"We had a teacher that told us to grab a chair and sit in front of the board, and then the Headspace people came in and then [the teacher] left, so then we're sitting in front of a board alone with no teachers, just the Headspace people," she said.

"The first slide of the PowerPoint on the board was 'You can see queerly now' and 'No point hiding.'"

Girls felt 'really uncomfortable'

Fourteen-year-old Emelia Wundenberg said the presenter was graphic when referencing their own sexual preferences and spoke in sexually explicit terms about growing up and being confused about whether they idolised people of the same gender or wanted to be intimate with them.

Students say they were then given an explanation of the initialism LGBTQIA+, with each word and its meaning displayed on the screen.

"There was a slide for what the 'plus' means, and they just started randomly saying words that no-one knew, like bestiality," Emelia said.

"It was on the board when they were showing what the 'plus' meant."

The students said bestiality was then explained in detail and the presenter seemed to imply it was something practised by people who identified as LGBTQIA+.

"They said [the queer community] just accepts all of it, even though … isn't it illegal?" Emelia said.

As the talk went on multiple girls, including Courtney, began to feel uncomfortable and asked to leave the classroom to "go to the bathroom".

"We're all just sitting there like, 'What the hell? What are we doing here? Why are we learning about animals having sex with humans?'" she said.

"It was really disgusting, it was really uncomfortable."

Emelia said many of those who asked to leave the classroom did not return.

When the ABC sought comment from the presenter a response was sent on the person's behalf asking that reporters refrained from reaching out or naming them in its coverage.

'Normal procedure' not followed

Letters seen by the ABC that were sent to parents on behalf of Renmark High School principal Mat Evans stated that the presentation was meant to discuss "respectful relationships".

The letter acknowledged that the school's "normal procedure for notifying parents ahead of specific presentations was not followed".

Mr Evans said the third-party presenter had "been suspended from department schools while the department undertakes an investigation".

"We are undertaking an internal review to ensure that processes around such notifications and procedures with regard to third parties attending at our school are always met," he said.

The ABC contacted the Department for Education, which provided a similar statement and said the presentation was being investigated.

SA education department chief executive Martin Westwell said the presentation was "unacceptable" and "shouldn't have happened".

Speaking with ABC Radio Adelaide on Thursday, Professor Westwell said conversations about sexual health, societal norms, stereotypes and sexuality were normal parts of the Australian curriculum, but the presentation at Renmark High School was not.

"The core idea that students should understand sexuality and other sexualities is, I think, really important — but the way [the presenter] went about it was unacceptable," he said.

"The school has clearly made some mistakes.

"There should have been a teacher in the room when that occurred, but there wasn't and the principal has apologised for that.

"They hadn't reviewed the content.

"There was a few things that went wrong and it ended up with this inappropriate language and a few things being discussed in that session that were just not appropriate."

Support being provided to students

Headspace's national head of clinical leadership Nicola Palfrey said the organisation was aware of concerns raised by members of the Renmark community.

"We take all feedback very seriously and are reviewing how we can support and guide Headspace centres … to ensure presentations they facilitate or deliver are aligned with evidence and best practice and are safe and appropriate for young people," she said.

FocusOne Health Board chair Ian Gartley said the "focus at Headspace Berri, operated under licence by FocusOne Health, is on the mental health and wellbeing of young people".

"We are aware of concerns raised by local members of the Renmark community following a presentation delivered by a lived experience speaker that Headspace Berri facilitated at Renmark High School," he said.

"Our priority right now is ensuring that any young people and their families who may be experiencing distress receive the support they need."

All parties involved in the alleged incident declined to provide the presentation to the ABC.

Following the presentation, a follow-up letter seen by the ABC was sent to parents offering counselling services from the education department, which had arranged a social worker to attend the school to help support affected students.

Parents express shock and outrage

Parents of students who attended the presentation said it was a poor representation of the queer community and had raised many concerns about the school's protocols for third-party presentations.

"Who vetted this material? Who made sure it was safe for 14- and 15-year-old girls? Some of them are still 13," Emelia's mother Kristy Fyfe said.

"It has done a huge disservice to the [queer] community."

Following the presentation, Courtney's mother Nicki Gaylard removed her three children from Renmark High School. 

"My kids are in limbo," she said.

"They're not in an education department at this point.

"I'm not putting them anywhere until I know this won't happen again.

"Under no circumstances should a child in that school ever feel trapped and unsafe without someone with their certificate, meaning a teacher."

The ABC has spoken to five other parents whose children attended the presentation.

They substantiated the two girls' claims.

LGBTQIA+ educators condemn 'slur'

Sexuality educators and LGBTQIA+ inclusion advocates Mel Brush and Eleonora Bertsa-Fuchs conduct consent and queer inclusion training for schools, parents and workplaces via their social enterprise Let's Talk About X.

Both are secondary teachers and Mx Bertsa-Fuchs said queer education was important but should be delivered in a safe and appropriate setting.

"The teachers are the people that these young people have a relationship with, that they are familiar with, that they're comfortable with," Mx Bertsa-Fuchs said.

"When you're in a vulnerable situation, like a respectful relationships workshop or seminar, there should be someone in the room that you are familiar with."

Mx Brush said the alleged use of the word bestiality in the presentation was damaging to the queer community.

"It's pretty shocking to think about that term being thrown around like that, especially given how loaded it is, and for a historical context of the way that it's been used as a slur and to discriminate against LGBT+ people," Mx Brush said.

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Local News | Ulster County considers children’s mental…

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Local news | ulster county considers children’s mental health clinics in kingston, ellenville.

KINGSTON, N.Y. — Ulster County is considering opening children’s mental health clinics on Broadway and in the village of Ellenville with the ability to serve approximately 1,200 children annually. The clinics could open as soon as later this year.

“We’re responding to what has been unprecedented anxiety and emotional distress amongst young people through the country and our county today,” Ulster County Executive Jen Metzger told the Freeman on Thursday, April 4. “They really need additional support and mental health support to really thrive.

Metzger said there is a shortage of such services in Ulster County, adding that the county’s Department of Mental Health recommended the county fill these gaps by providing expanded services.

Metzger said the two locations would be at the new Ulster County Center for Well-Being at 368 Broadway and the Trudy Resnick Farber Building at 50 Center St. in Ellenville.

“We’re constructing a crisis stabilization center for both youth and adults,” Metzger said. “It’s a one-stop for people in crisis, people need support and services for youth.”

Children’s and adult services would be completely separated, she added.

Metzger’s office said the new children’s clinic would initially be funded with $700,000 in American Rescue Plan Act funding. Metzger added that the program would later be sustained through health insurance payments from Medicaid and private insurers.

The County Legislature is set to vote at its Tuesday, April 16, meeting on using the ARPA funding for the Center. This would clear the way for a Request for Proposals for non-profit vendors who would operate the center and employ the providers, she said.

The RFP process will take a few months, according to Metzger. Still, she expressed confidence the locations could open this year.

Planned services include diagnostic assessments, individual and family therapy, medication management and crisis intervention, Metzger said. The program could minimally serve 100 children a month or about 1,200 children annually, she added.

She said anxiety and depression are both very common amongst young people.

“When you’re dealing with these kinds of stressors as a young person it’s hard to focus on school,” she said. Over the years teachers have told officials these are the number one challenge they’re seeing in the classroom, she added.

This can hold youngsters back unless they get the support they need, she said.

The program will build on the county’s Mental Health in Schools Program, which provides clinical support to middle school students in every school district in the county, Metzger said that program is also funded by ARPA funding.

“We’ve gotten positive feedback from educators, school administrators as well as those served,” she said.

But she acknowledged the need is so much greater and that is what prompted the county to consider the two new clinics.

As for what hours the centers might operate, Metzger said there will need to be flexible hours to ensure children and families can access the service. “It’s very important to have flexibility, especially for young people,” she added.

Services at the two centers will be available year-round, not just when school is in session, she said.

As for what’s causing the uptick in the need for mental health services for children and youth, Metzger admitted COVID-19 has been a major contributing factor, The lockdowns and restrictions disrupted daily routines and youngsters experienced prolonged periods of social isolation along with fears of illness, she said. She suspects other factors like social media also contribute to the stress children are experiencing.

“We’re very excited to be able to offer these additional services to our youth,” Metzger said. “This is a real priority of my administration for the county to address what we see as the mental health needs of youth and families.”

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Why Britain’s mental health crisis threatens to doom a new generation

Ailing workforce risks spiralling further unless deep-seated issues are addressed

Psychiatrists speak in the most dramatic terms when describing the explosion in demand for mental health services among young people.

“It is horrendous and incredible,” says Dr Lade Smith. Depression, anxiety and eating disorders have all seen a “massive increase”, she says. “It has gone up enormously, particularly over the past three or four years since the pandemic.”

Britain as a whole is in the grip of a mental health crisis that has reached such a scale that it is now having an economic impact. Ministers have made tackling the problem – and helping people back to work – a priority.

Yet the worrying prevalence of mental health issues among young people suggests the problem is deep-seated and could leave long-lasting economic scars.

“If you don’t treat the child, that child does not complete their GCSEs. If they don’t finish school, they don’t go to university,” says Smith. “If they don’t go to university, they are less likely to get a job that pays the kind of wages that puts loads of money into the tax coffers.”

Experts such as Smith believe more support is needed in schools to tackle the problem before children drop out of education.

The pandemic has fuelled the child mental health crisis but the problem did not start there.

“For the past 10 or 15 years, we have had an increase in the percentage of people requiring mental health support,” says Smith, who focuses on treating young adults.

The reasons are complicated and manifold, she says, but include the long economic impact of the financial crisis, which put families under strain, as well as the crippling effects of the pandemic and lockdown, which increased loneliness and isolation .

She also cites expensive and insecure housing as a factor, as well as the potential for social media to feed users a cycle of negative posts.

Treating so many people is tough and there are not enough doctors to meet the need. Almost one-fifth of consultant posts are vacant in the specialism, says Smith, who is also president of the Royal College of Psychiatrists.

NHS numbers tell a similar story. Last year 1.2 million people were on the waiting list for community mental health services .

More than a quarter of a million children and young people referred to mental health services in 2022-23 were still waiting for support at the end of that period, the Children’s Commissioner for England has found.

This is not merely a crisis for the individual patients or for the health service as a whole. Poor mental health is now so widespread that it is becoming a drag on the economy.

“The number of young people not working due to poor health has doubled in the last decade. People in their early 20s are now more likely than those in their early 40s to be out of work due to poor health. That is really quite striking,” says Louise Murphy, economist at the Resolution Foundation.

“It is very different to what we saw 25 years ago, when there was a very straightforward trend that the older you got, the more likely you were to have poor health and therefore the more likely you were to be out of work.”

Worsening mental health is a key factor behind this trend.

Missing out on the early stages of a career can have lifelong effects on earning power , known to economists as “scarring”. In effect, people never catch up after missing out on these crucial early opportunities.

Policymakers are worried and searching for solutions. However, at the moment it looks as if the situation is only likely to get worse.

A growing number of school children are suffering with mental health conditions, meaning that unless something changes dramatically a new generation of youngsters are likely to struggle when they leave education and – if they are well enough – seek work.

More than one in five pupils aged between eight and 16 are believed to have a “probable mental health disorder”, according to NHS surveys. That is up from one in eight before the pandemic.

On top of that an additional 12pc are deemed to have a “possible disorder”.

The figure rises to nearly a quarter among older teenagers, aged from 17 to 19. In this group, almost one in three young women are thought to have a probable disorder.

Half of mental illnesses start before the age of 14, says Smith, with 75pc beginning by the age of 24. Early treatment can cure around one-quarter of cases completely. Waiting risks leaving sufferers with chronic conditions and relapses.

Tackling this mental health crisis – and the associated worklessness that goes with it – has become a priority for the Government.

Employers are desperately short of staff – there were more than 900,000 open vacancies at the start of the year, according to the Office for National Statistics. Doing more to hire and keep those with mental health conditions in work would be good for the workers and good for the companies.

Mel Stride, the Work and Pensions Secretary, last month unveiled plans to make 150,000 people signed off with mild mental health conditions look for work.

“As a culture, we seem to have forgotten that work is good for mental health,” he said, in remarks which attracted some criticism.

“While I’m grateful for today’s much more open approach to mental health, there is a danger that this has gone too far. There is a real risk now that we are labelling the normal ups and downs of human life as medical conditions which then actually serve to hold people back and, ultimately, drive up the benefit bill.”

The Government has announced multiple schemes aimed at helping people suffering from mental health conditions into work.

Tony Wilson, director of the Institute for Employment Studies, says some initiatives, such as the Individual Placement and Support in Primary Care Initiative, have yielded good results.

The scheme sends employment advisers to help patients in hospital with job applications alongside their normal treatment, with the aim of breaking the cycle of poor mental health and worklessness.

“The integration of employment advice with mental health talking therapies and mental health support is really important,” says Wilson. “It is achieving really significant impacts, and those impacts bring real benefits to individuals and the Exchequer, as the alternative would usually be people staying off work for a very long time.”

The scheme requires both the Department for Work and Pensions and the Department for Health to work together.

Smith believes collaboration such as this is key to tackling the mental health crisis among young people. The NHS must work with the education system to help identify and treat problems early.

More specialist support in schools is key, says Smith. Assessing pupils in situ allows “short, sharp treatment [so they can] get better and get back on with their lives”.

Murphy’s research found four in five 18 to 24-year-olds who are out of work because of ill health have no qualification beyond GCSEs.

The situation can become self-reinforcing. No work means no extra experience or on-the-job training, making it harder to get on the career ladder. No work breeds isolation and can be bad for mental health.

“Work is good for your health,” Smith says, “as long as it is meaningful, useful, you know what your role is, and you can be productive.”

Financially, it also helps fund a better lifestyle that can improve your health : paying for gym membership, say, or relaxing holidays.

Smith says: “If you want UK Plc to be successful, you have to have children who become adolescents who become functioning adults.”

A government spokesman said its £2.5bn Back to Work Plan was helping people with mental health conditions “break down barriers to work and put an additional 384,000 people through NHS Talking Therapies”.

They added that the Government was “continuing to roll out mental health support teams in schools and colleges, investing £8m in 24 early support hubs and expanding talking therapies services”.

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California sheriff’s deputies kill 17-year-old boy with mental health issues

Boy, as yet unidentified, is third child killed by San Bernardino law enforcement in less than two years and second in under a month

Southern California sheriff’s deputies shot and killed a 17-year-old boy with mental health issues after he armed himself with a knife and locked himself inside a bathroom at a home, authorities said on Wednesday.

The teen was being transferred from a hospital, where he had been treated after cutting himself, to a mental health facility when he escaped on Tuesday, the San Bernardino county sheriff, Shannon Dicus, said.

The boy, a foster youth who lived in Hesperia, later showed up at a home in Victorville, about 90 miles (145km) east of Los Angeles, where his sisters live in foster care, Dicus said. Someone at the home called deputies to come arrest him, Dicus added, because he had caused trouble there before.

The teen, who had a knife, locked himself in a bathroom, and deputies tried to get him to come out for about a half-hour, according to the sheriff. But when the boy threatened to harm himself, deputies kicked down the door and tried to apprehend him, Dicus said.

A video and still images of the encounter show the teen holding a knife, the Riverside Press-Enterprise reported. Deputies pepper-sprayed him, and one deputy’s hand was sliced by the knife, the newspaper said.

The teen was backed into a bathtub, where police shot him, Dicus said. He was pronounced dead at a hospital.

The death came less than a month after San Bernardino deputies shot and killed 15-year-old Ryan Gainer, who had also been a foster child but was adopted as a toddler. He was killed on 9 March when officers responded to a 911 call from one of his family members, who reported he was breaking things in their house in Apple Valley – two hours east of Los Angeles – and “hitting” his sister, but that she wasn’t injured. Body-camera footage shows that two San Bernardino sheriff’s deputies shot Ryan within roughly five seconds of seeing him.

“He was strong and always happy, no matter what he was going through,” his father, Norman Gainer, said .

The shooting death of the 17-year-old, who was not identified by the sheriff, also follows the recent release of law enforcement footage of San Bernardino sheriff’s deputies shooting 15-year-old Savannah Graziano , whose father, Anthony Graziano, was suspected to have had abducted her after fatally shooting her mother the day before.

Savannah was killed on 27 September 2022. In California highway patrol (CHP) footage released on 29 March, Savannah can be seen getting out of a vehicle on the side of the highway in Hesperia, 80 miles (130km) east of Los Angeles, as law enforcement yells for her to walk toward them before deputies begin shooting at her.

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After the shooting, a CHP dispatcher can be heard saying: “Oh, no.”

Dicus said on Wednesday that in both Ryan Gainer’s and the 17-year-old’s cases, deputies had been met with violence. He said parents need more access to mental health services for their troubled children, so that law enforcement isn’t the only option in times of crisis.

“My record as sheriff for the last several years is I have championed having a better mental health system,” Dicus said. “The corrections environment and our public environment have been challenged a number of times where the only mental health resource we have in our community is law enforcement, and that’s the only 24/7 resource that we have.”

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First project to receive ARPA funds completed, children's mental health access expanded

OKLAHOMA CITY – The Office of Management and Enterprise Services applauds the University Hospital Authority and Trust (UHAT) for completing its emergency room expansion project at the Oklahoma Children’s Hospital OU Health. This project was the first to receive American Rescue Plan Act (ARPA) funds appropriated by the Oklahoma State Legislature, and its completion marks tangible progress toward improving the lives of Oklahoma’s children and their families.

Oklahoma Children’s Hospital OU Health hosted a ceremonial ribbon-cutting on March 7 to celebrate the emergency department expansion. Funded by $7.5 million in ARPA dollars, the project added additional beds to increase capacity and decrease wait times for care, a sensory playroom and flexible rooms designed to accommodate pediatric behavioral health patients.

“This expansion is nearly 7,500 additional square feet to our emergency room and allows us to serve more Oklahoma children,” said Kendal Pinkston, chief administrative officer of Children’s Services. “I would like to thank all of the elected and appointed officials as well as the state OMES ARPA team who recognized this need and advocated for this project.”

In addition to Pinkston, speakers at the ribbon-cutting ceremony included Jayme Phillips, director of community relations and strategic programs at OU Health; Dr. Robyn Cowperthwaite, section chief for pediatric psychiatry at the Oklahoma Children’s Hospital; Sen. Roger Thompson; Allie Friesen, commissioner for the Oklahoma State Department of Mental Health and Substance Abuse Services; and Christy Gillenwater, president and CEO of the Greater Oklahoma City Chamber of Commerce.

According to Sen. Thompson, many families in Oklahoma have difficulty finding services for their children, a concern that grew during the COVID-19 pandemic. Seeing the need, the Oklahoma Legislature chose to invest ARPA funding into the Oklahoma Children’s Hospital OU Health to both expand its emergency department and build a brand-new Behavioral Health Center , which is slated to open in December 2026. While the Behavioral Health Center is still under construction, the completion of the emergency department now provides a bridge in the gap to treat behavioral health conditions for more young Oklahomans.

Oklahoma Children’s Hospital OU Health is Oklahoma City’s only comprehensive 24/7 pediatric emergency department and referral center for complex and serious conditions. The emergency department serves approximately 40,000 patients per year. The emergency department expansion increases access to critical care for the children and families of Oklahoma that need it most, right in their home state.

For a full list of all ARPA programs, please view the  2023 SLFRF report . To track live progress of all State of Oklahoma ARPA programs, check out the  ARPA Program Tracker dashboard .

About OMES The Office of Management and Enterprise Services provides financial, property, purchasing, human resources and information technology services to all state agencies, and assists the Governor’s Office on budgetary policy matters. Our mission: Provide excellent service, expert guidance and continuous improvement in support of our partners’ goals. For more information on the agency, visit  oklahoma.gov/omes . For more information on the state’s American Rescue Plan Act (ARPA) progress, visit  oklahoma.gov/arpa .

About UHAT The University Hospitals Authority (UHA) and University Hospitals Trust (UHT), collectively (UHAT), were created to operate the University Hospitals on the Oklahoma Health Center campus in Oklahoma City and to ensure that the hospitals support the teaching and research missions of the University of Oklahoma. Together, they support the patient care, research and educational missions of various entities such as the University of Oklahoma, OU Health, Oklahoma Health Care Authority, Hearts for Hearing and the Oklahoma Dental Foundation. In 1997, legislation was enacted to privatize the operations of the hospitals via the University Hospitals Trust (UHT).

OMES media contact

Christa Helfrey [email protected]

OMES Grants Management Office 2401 N. Lincoln Blvd., 2nd Floor Oklahoma City, OK 73105 Open Monday-Friday, 8 a.m. to 5 p.m.

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