This story was originally published as part of the February 2025 issue of the Breakthroughs newsletter.
Many have posited the reason for rising mental health concerns among kids and teens – social media, the COVID-19 pandemic, stigma, etc. But the reality is there is a constellation of factors that contribute to this crisis, according to experts.
Feinberg investigators are looking into the barriers kids and teens face to accessing mental health treatment. Observational studies at Northwestern have identified concerning issues facing youth trying to get mental health care. This work spans departments including Pediatrics and Medical Social Sciences.
Identifying a Lack of Inpatient Care
To provide care to those seeking help, the health system must be equipped to handle the demand. A recent study in JAMA Pediatrics found that the number of pediatric inpatient psychiatrics beds is not rising despite the increased need for mental health care.
In the study, Jennifer Hoffman, MD, assistant professor of Pediatrics in the Division of Emergency Medicine, and her collaborators reviewed hospital data between 2017 and 2020 from across the country. Then, the team mapped pediatric inpatient psychiatric beds per 100,000 children by state in 2020. They also assessed how the availability of beds in each state was related to median household income, percentage of children in rural areas, and pediatric racial and ethnic composition to assess for inequities in access to care.
There was no significant change in the number of pediatric inpatient psychiatric beds available nationally between 2017 and 2020, according to the study. The majority of beds available were in urban areas, which raised concerns for rural children.
“The number of inpatient beds hasn’t changed to catch up with the demand,” Hoffmann, who was senior author, said. “This fits with what I see as an emergency medicine physician. Many of my colleagues and I are seeing children get stuck in the emergency department waiting for an inpatient psychiatric bed.”
Insurance reimbursements for mental healthcare are often too low to fully cover the cost of care, Hoffmann said, which may be one reason why the number of beds is not rising quickly enough. Expanding Medicaid reimbursement for children’s mental health services could help the situation, Hoffmann said.
More research is needed to fully understand the financial and emotional toll this takes on children and families in crisis, Hoffmann said.
“Children should have access to mental healthcare no matter where they live in this country,” Hoffmann said. “I think the study illustrates the work that needs to be done to ensure that no matter where a child lives, they have access to mental health services.”
Seeking Parental Support and Consent
Teens living in states requiring parent consent for mental health treatment may be less likely to access care, according to a Northwestern Medicine-led study published in JAMA Pediatrics. Jessica Schleider, PhD, associate professor of Medical Social Sciences in the Divisions of Intervention Science and Implementation Science, was first and corresponding author of the study.
In the study, Schleider and her collaborators analyzed data on the prevalence of major depressive episodes in adolescents and compared the treatment rates in states that require parental consent and those that do not.
Adolescents who lived in a state requiring parental consent were less likely to receive treatment, according to the findings. Only 37 percent of young people who lived in states with parental consent laws received treatment, versus 46 percent of adolescents in states with no parental consent requirements.
“State policies have a significant impact on whether adolescents can access services when they need them for depression,” Schleider said. “The situation is still very bad in that most adolescents with depression are not accessing treatment. The findings explain a 10-percentage point difference in whether or not adolescents access care and represents a really meaningful opportunity for shifting policies in a way that could have a real impact on adolescent access to treatment.”
Previous research from Schleider’s lab, published in the Journal of Adolescent Health, found that among teens with depression who had difficulty accessing mental health treatment, approximately one-third cited their parents as the primary barrier to accessing care.
“The reasons for that were multiple: Sometimes adolescents didn’t feel like their parents would take them seriously,” Schleider said. “Some of them were concerned that their family wouldn’t be able to afford treatment, so they didn’t want to bring it up. Others were worried about stigma and that their parents would respond potentially in an invalidating manner.”
Addressing the Reality
According to Schleider, the youth mental crisis comes down to inaccessible mental health treatment rather than increasing mental health problems among youth. This point is bolstered by Hoffman’s study that inpatient treatment is not expanding, and children may sit in the emergency department waiting for pediatric psychiatric care.
The Lab for Scalable Mental Health, led by Schleider, focuses on single-session interventions, which are encounters with a program, provider or service that are designed to exert a detectable, meaningful change within a single encounter. With a focus on underserved youth who would otherwise not access any care, the team seeks to create digital self-guided interventions.
“It’s not that we don’t know what effective treatment looks like, but the kinds of effective interventions that we’ve developed over the years are not sustainably accessible to the vast majority of kids who could benefit from them,” Schleider said.
According to Schleider, about 80 percent of young people with mental health difficulties that are moderate or severe will not be able to access any form of treatment.
“I’m most worried about the kids will never get in the door in the first place. The kids who aren’t ever in our clinical trials because they don’t have access to them, because they don’t know what clinical trials are, because they aren’t disclosing difficulties to their parents. If we focus just on the kids who are visible to us, we’re never going to understand and appreciate the full scope of this problem.
“There is a stark gap between need and access that is becoming more and more apparent. And I think COVID, for example, highlighted that gap in a big way.”
More research is needed to continue to improve mental health treatment for kids and teens.
Olivia Dimmer contributed to this story.
