The mental health of children and young adults has been uniquely impacted during the past two years. An already strained system prior to the pandemic, mental health services in Texas have struggled to keep up with the demand. Mental health providers are seeing a flood of referrals to their programs, leading to wait lists for precariously overstretched mental health professionals.
Recently, some voices have been advocating for improved access to mental health services for vulnerable young people. The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national emergency in child and adolescent mental health, and the White House produced a fact sheet on improving access and care for youth mental health.
Both reports underscored suicide, the second leading cause of death for 10-to-24-year-olds. The risk for suicide goes up with age during this span, and young adults ages 20 to 24 are at the greatest risk.
Each report suggested solutions, including widely used approaches such as school-based services, coordination of care for children and families, and psychiatric consultation for pediatricians. But the reports largely leave out suggestions to build access and supports for young adults — something that should be in them. Excluding young adults from the mental health conversation is all too common and reflects our health care systems.
On top of the disruptions, young adults face social isolation and economic challenges as results of the pandemic. It is also the time when serious mental illness, such as bipolar disorder, typically develops, yet young adults are the least likely age group to have access to or engage in mental health supports. That’s a critical gap in services.
Of the billions of dollars in the American Rescue Plan Act dedicated to mental health, only a tiny fraction is earmarked for young adults. This should change. Rather than exploring and working to fill gaps in care, we continue to focus only on the expansion of programs already in place. This is simply not enough. We owe our young adults — who have shouldered much of the economic burden of the pandemic, lost out on “normal” young adult experiences, and will be expected to become contributing members of society with little to no support. We owe them innovative, community-based solutions that prioritize their needs and preferences.
Young adults are frequently blamed for their lack of engagement with mental health care, an assumption that they are flexing their new-found freedom. Research suggests otherwise. Almost all health care systems structure themselves as either a pediatric or an adult provider. These fragmented systems are rarely effective at building transition processes that ensure young people successfully move between the two, creating a “service cliff” for emerging adults.
Our research in Texas found that less than 40% of Texas youths receive one adult service after aging out of child services. And less than 10% of those individuals remain engaged in care by age 19.
These findings mirror results found in other states. In interviews we conducted with young people in mental health services, they consistently expressed that their preferences, needs and goals are not met by either adult or pediatric systems. The experience is worse for young adults new to accessing care, as they report that they feel there are no options for mental health care. The result is an extraordinary disengagement from care for this population, a problem even more profound in the context of the pandemic.
In other countries, particularly Australia (Headspace), Ireland (Jigsaw) and Canada (Foundry), young adult mental health care is driven by providing youth-friendly, multidisciplinary services in low-stigma environments (e.g., community colleges, malls). We must model these successful approaches within our community with the proper political will. Investing in the mental health and well-being of young adults benefits us all. It reduces burden on systems such as hospitals and jails, and boosts the economy with an influx of healthy, productive adults.
Deborah Cohen is an assistant professor in Dell Medical School at The University of Texas at Austin.
Laura Stevens is lead clinical trainer in the Center for Youth Mental Health in Dell Medical School at The University of Texas at Austin.