Amidst a teen mental-health crisis, preventative and in-patient care can be hard to access, especially in rural areas

Emergency room visits for self-inflicted injuries,
ages 10-19. (New York Times chart)

The coronavirus pandemic has intensified a growing mental-health crisis among U.S. teens, affecting youth across the spectrum: rich and poor, urban and rural, among all races and ethnicities. "In December, in a rare public advisory, the U.S. surgeon general warned of a 'devastating' mental health crisis among adolescents. Numerous hospital and doctor groups have called it a national emergency, citing rising levels of mental illness, a severe shortage of therapists and treatment options, and insufficient research to explain the trend," Matt Richtel reports for The New York Times.

Richtel spent the last 18 months researching the phenomenon, interviewing teens and parents, health-care practitioners, scientists, policy experts and more, all of which informed a four-part series published over the past few weeks. It was a difficult project, Richtel writes in a brief explainer about how he and his editors tried to protect the privacy of those featured in the articles.

But, it's an important project, as mental-health disorders increasingly eclipse more traditional worries about teens such as binge drinking, drunk driving, pregnancy and smoking. "In 2019, 13 percent of adolescents reported having a major depressive episode, a 60% increase from 2007," Richtel reports. "Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60% by 2018, according to the Centers for Disease Control and Prevention."

Teenage girls are especially at risk (see chart), and are far more likely to visit the emergency room for self-inflicted injuries. But treatment is often difficult to access, especially in rural areas. Many teens who need in-patient psychiatric care can't access it and are forced to stay in hospital emergency rooms with no pediatric or mental-health specialists. In-patient programs are rarely found in rural areas, and there are fewer of them around these days anyway: The number of residential treatment facilities for minors fell from 848 in 2012 to 592 in 2020, a 30% decline resulting from "well-intentioned policy changes that did not foresee a surge in mental-health cases," Richtel reports. "Social-distancing rules and labor shortages during the pandemic have eliminated additional treatment centers and beds, experts say."

Preventative care can also be hard to find, Richtel reports. Mental-health practitioners are scarce in rural areas—70% of U.S. counties lack a psychiatrist who specializes in children or adolescents—and it can take months to get an appointment. Also, many don't accept private insurance, much less Medicaid. That means pediatricians with minimal mental-health training often bear the brunt of caring for teens with complicated psychiatric issues. Many told Richtel they feel poorly equipped to do so.

Richtel includes in the series a helpful Q and A for parents with guidelines on how to find a doctor, what to do if one's teen is feeling suicidal, and how to talk to teens about mental health. The Rural Health Information Hub has a resource guide on rural mental health that includes links to searchable databases on county-level availability of mental-health professionals.