Are We or Are We Not in a Youth Mental Health Crisis?

For the last few years, I have felt uneasy about the portrait of today’s teenager as depressed, anxious, and obsessed with technology. This so-called truth tugs at my gut because I spend a lot of time with young people and I wasn’t seeing this portrait in real life. Knowing how impressions instead of information can famously lead humans astray, I stayed quiet. Just recently, however, I have noticed evidence that my gut instinct may not be “just a feeling.”  

Based on recent articles, books, and interviews with experts about adolescents and mental health, I see a convergence of a cultural factors that are inflating the so-called crisis:

1. Over-interpretation of emotions as disorder

2. Risky messaging of the wellness industry

3. The misleading use of health statistics to create an exaggerated representation of what’s happening with teens’ mental health  

Normal Emotions or Symptoms of a Problem?

A recent New York Times article posed an interesting question: are we talking too much about mental health? The article digs into a theory called the Prevalence Inflation Hypothesis (why does social science have to over-complicate everything?) that researchers Lucy Foulkes and Jack Andrews wrote about in a 2023 paper. 

The Prevalence Inflation Hypothesis states that the increased awareness about mental health has contributed to more reports of mental health symptoms rather than a higher incidence of those symptoms. So, because we are talking about mental health more than we ever have on a broad cultural level, people more readily equate how they are feeling with a mental health symptom. The benefit of this increased awareness is of course identifying mental health problems that need treatment. This is undoubtedly progress. Destigmatization of mental illness and treatment is critical to people accessing support. 

However, as with any form of progress, there’s often a downside that accompanies the benefits. In this case, the benefits of catching and treating mental health problems more reliably are accompanied by the risk for over-pathologizing ourselves. We are in danger of turning regular distress into a disorder. As the authors of the paper state: 

“Awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems. We propose that this then leads some individuals to experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual's self-concept and behaviour in a way that is ultimately self-fulfilling.”

This trend has been evident in the teens and young adults coming into my therapy office with the results of their online quizzes diagnosing them with a range of psychiatric disorders. 

As clinical psychologist and author Meg Jay writes in the description of her book, The Twenty Something Treatment, “most [twentysomethings] don’t have disorders that must be treated: they have problems that can be solved.” She shared her concerns during an interview on the Psychologists Off the Clock podcast¹ that this age group is too quick to self-diagnose and seek treatment for having emotions appropriate to stressful situations. Having specialized with people in their 20s for twenty-five years, she has witnessed these tendencies as an unintended consequence of increased openness to discussing mental health and mental illness. 

Photo by Markus Winkler on Unsplash

Similarly, psychology and neuroscience professor Tracy Dennis-Tiwary who authored, Future Tense: Why Anxiety Is Good For You (Even Though It Feels Bad), told me in an interview for my Washington Post piece (Not Everyone Needs Therapy) that we have developed a cultural “meta-anxiety” about anxiety rather than viewing anxiety as an understandable response to certain situations. We feel anxious about feeling anxious.

Think about how often you hear the words anxiety, trauma, and OCD used in casual conversation to describe commonplace feelings and experiences—not signs of a clinical disorder. This illustrates how our increased acceptance and awareness of mental health symptoms in our society can blur the line between what’s normal and abnormal.   

The Prevalence Inflation Hypothesis has its critics who worry its message could erode progress with destigmatization by dismissing real mental health concerns that need attention. To their credit, the authors frame the Prevalence Inflation Hypothesis as a theory that needs more exploration (it’s in the name – a hypothesis). However, I have seen this trend in my therapy practice: People feel anxious about their anxiety and uncomfortable with their discomfort. This is where the next cultural force comes in: the multi-billion-dollar wellness industry.

Wellness: The Great Sales Pitch

The wellness industry has thrived from the sales pitch that we should feel good all the time. Adolescent psychologist and bestselling author, Lisa Damour, addresses the effects of this pervasive messaging on teens in her book, The Emotional Lives of Teenagers. Damour repeatedly reminds readers that mental health involves having emotions appropriate to the situation, not never feeling bad. True mental health is experiencing a range of emotions and coping with them in healthy ways.

In my circles of mental health professionals, “wellness” has unfortunately become a bit of a dirty word.² Instead of referring to a focus on overall wellbeing, the concept of wellness is now associated with an influencer-saturated platform for making money from promises and products that have no scientific evidence and little regulation.³

What runs deeper than the lists of supplements, however, is the underlying messaging that if we feel bad, we need to fix it. (And that somehow if we do the right things, we won’t ever feel bad again. As if we could remove discomfort and distress from the human experience!)

How does this apply to parenting? I have seen (and personally experienced) how parents struggle to sit with their child’s distress and discomfort, wanting desperately to make sure their child is okay. (I have written about this before: The Empathy Problem and Hugging without Talking: Building Emotional Resilience.)

The wellness industry messaging has seeped into our consciousness because that’s what it’s designed to do. Simultaneously, we hear constant messages that our teens are experiencing the worst mental health in history. This combination understandably makes us vigilant about our child’s mental health symptoms. Parents don’t want to miss signs of a problem and they want to ensure their child is feeling good as often as possible. Subsequently, we may over-respond to a child’s appropriate emotional expression.

What can result from our most loving and protective parenting efforts is our children and teens feel like they shouldn’t feel bad and there’s something wrong with them if they do.

While Damour recognizes the negative influence of the wellness industry on the collective psyche of parents and their teens, she goes on to acknowledge evidence that unfortunately our teens are feeling worse than in the past.

Statistics: More Than Meets the Eye

But even that conclusion has some holes. On the Plain English With Derek Thompson podcast, science writer and NYT columnist David Wallace-Wells teases out why the statistics sound worse than reality. He also details his argument in this article, which is truly music to any social scientist’s ears. It perfectly illustrates why taking scary findings at face value can be so misleading. 

As just one example of many, Wallace-Wells shares some especially shocking statistics that have been used as evidence of the teen mental health crisis:

“…over about a decade, an alarming 48 percent increase in such emergency room visits [for nonfatal self-harm] among American girls ages 15 to 19 and a shocking 188 percent increase among girls ages 10 to 14.”

Well, that sounds downright terrifying.

He then points out how these dramatic increases coincide with the onset of systemic changes from the passage of the Affordable Care Act, which required more screening of mental health problems in medical settings as well as new coding requirements for self-harm and suicide attempts. The numbers are higher because they are being recorded, not necessarily because there’s a change in the feelings and behavior of American girls.

It is critical to remember that all statistics require substantial context to impart meaning, but our quick-consumption media often does not add that context. What happened in New Jersey perfectly illustrates this phenomenon. Wallace-Wells recounts:

“The effect of these bureaucratic changes on hospitalization data presumably varied from place to place. But in one place where it has been studied systematically, New Jersey, where 90 percent of children had health coverage even before the A.C.A., researchers have found that the changes explain nearly all of the state’s apparent upward trend in suicide-related hospital visits, turning what were “essentially flat” trendlines into something that looked like a youth mental health “crisis.” 

He provides similar examples that challenge statistics representing suicide rates and overall happiness. These examples add more context, nuance, and even optimism to the dismal numbers. By interviewing a range of scientists around the world, Wallace-Wells concludes that teens in general are better off than we think they are. The scientific consensus in this group is that the evidence points to not being in the midst of a crisis.

This does not exclude the reality that some groups of teens may be suffering a mental health crisis. You may be parenting one of those children; the idea that there may not be a global/national crisis does not take away the difficult experience of your family.

To really help these teens, however, we need to be more precise about how we interpret statistics so we can be more effective in how to ensure access by these teens to the right resources. One thing all experts can agree upon is the dangerous shortage of high-quality, accessible mental health treatment.

Flipping the Script

I worry about the impact of believing there is a teen mental health crisis if there isn’t one. It undoubtedly affects our experience as parents, adding stress and fear that trickles down to our children. As I argued in my piece about technology and parenting, I urge us to flip perspectives on our children’s mental health. Instead of expecting our child to be anxious and depressed, let’s put energy into supporting our child’s foundation of emotional health and well-being.

To replace hypervigilance that does not serve us or our child, I suggest we focus on the following:

1. Model and practice a wide emotional vocabulary⁴ (beyond the basics of sad, mad, happy) and how the mind and body connect. (Understanding how emotions affect physical sensations is foundational for children’s emotional awareness!) Help your child label emotions and notice how their body feels. When one of my children starts to get upset, I suggest they put their hand on their chest and feel their heartbeat. If they seem receptive, I also ask them to see if they can feel it slow down when they take deep breaths.⁵ 

2. Model and practice distress tolerance, or being okay with not being okay. We need to start by allowing our children to feel all their feelings without rescuing or fixing! 

3. Build your child’s confidence that they can cope with difficult emotions and stressful experiences. You can do this by expressing trust that they can handle it, reminding them of times in the past when they have endured, and – again – not fixing it for them.

4. Coach and model that emotions are normal and temporary, not warning signs of pathology. For example, “it makes sense you feel this way.” Remind them of times in the past they felt similar distress and that it doesn’t last forever. For kids at the ages (or who have the personality and temperament) of not taking in your wisdom, talk about your own emotions in the same way. Trust me, they absorb it even if it doesn’t look like they’re paying any attention. 

Mental Health Always Matters

Even if the current conditions may not warrant the word “crisis,” there are still too many children and teens suffering from mental health struggles. It’s always a worthy goal to decrease rates of diagnosable mental illness in our young people by doing good prevention and intervention work, including continuing to destigmatize mental illness.

I can’t say with absolute confidence that there is not a youth mental health crisis. But there’s enough evidence to suggest it’s reasonable to start questioning what has felt like a declared truth. Evidence that we need to start integrating with the dominant narrative.

Maybe, just maybe, the kids are actually better off than we think.

What are your thoughts? I want to know!

In parenting solidarity,

Emily

P.S. Two chapters in my book (info below) expand on how to use autonomy-supportive strategies to promote emotional wellbeing and modify approaches with a child struggling with depression or anxiety.

**You can order Autonomy-Supportive Parenting: Reduce Parental Burnout and Raise Competent, Confident Children on Amazon and Bookshop.

1. Full disclosure: I’m a co-host on this podcast so I admit a bias toward recommending it, although I do my best to exercise discernment. My colleague, Jill Stoddard, did this interview and the themes fit well with the thesis of questioning of a true mental health crisis.

2. I recently read Wellness by Nathan Hill. A novel about a midlife marriage that weaves in several themes of modern life, the psychology of the wellness industry takes a central role. I tore through the more than 500 pages and couldn’t get enough.

3. I highly recommend season 2 of Jane Marie’s podcast, The Dream, which traces the shady history of how wellness products have escaped regulation and can make false promises without legal consequences.

4. You may have seen this Wall Street Journal article telling us to stop asking our children how they feel. Melinda Wenner Moyer took this on in her Substack, but let me be clear: I’m not suggesting you constantly ask your child how they feel! But when they are obviously having a strong emotion, help them label it. This simple act has been shown over and over in the research to diffuse the intensity of difficult emotions and contribute to healthy coping overall.

5. My new book, In Your Feels: A Journal to Explore Your Emotions, was designed to help kids ages 8-12 do all of this!