Our recent report, The Ripple Effects of the Adolescent Behavioral Health Crisis, draws attention to an issue deeply connected to health but that cuts across many other areas as well, including education, economic hardship, and productivity.
This is the fifth report in our “ripple effect” series that leverages the analytic and modeling expertise of Boston Consulting Group. As with our previous reports on opioids, COVID-19, food insecurity, and firearms, we seek to synthesize vast amounts of data into a digestible compendium that elucidates the health and non-health components of a large societal issue. We focus on areas that have been under-addressed or where the long-term implications of limited action have substantial ramifications for society as a whole. We use multiple sources to create a data narrative that examines national, state, and city outcomes for each issue area and also model downstream economic and societal impacts.
Our aim is to not only educate our audience but to elevate perspectives on big societal issues affecting health that may not have been sufficiently considered, if at all. Ultimately, we hope these data narratives help advocates and decision-makers transform our health ecosystem to support the health and well-being of our communities more equitably.
THE BURDEN OF UNMET NEED
One key takeaway from our most recent report: while the number of adolescents ages 12 to 17 experiencing behavioral health symptoms has increased over the past decade, so has the number of adolescents who do not receive appropriate and timely care. As an example, nationally, only 39 percent of adolescents in need of behavioral health care for major depressive episodes were able to access care in 2021 as compared to 56 percent of adults. And in New York state, 42 percent of adolescents experiencing one or more behavioral health conditions in 2022 did not receive needed behavioral health care.
It’s a crisis that disproportionately affects Black and Latine high schoolers both nationally and in New York City, where these teens are significantly more likely to contemplate or attempt suicide when compared to their white peers. Similarly, lesbian, gay, and bisexual students are about twice as likely to feel persistent sadness, over three times more likely to consider suicide, and over four times more likely to attempt suicide nationally, statewide, and in New York City.
Recently, New York State and City have made over a billion dollars of historic and long-overdue investments in our mental health system, which will be critical in better addressing behavioral health needs. State budget and Medicaid 1115 waiver investments in loan repayment and career pathway training programs include a focus on child-serving providers and are positive developments in addressing the workforce shortage. But workforce development takes time, and it is uncertain the degree to which it will help bend the curve in addressing immediate unmet adolescent mental health needs. We have an opportunity to use the workforce gap analysis that is required under the Medicaid waiver and combine it with the identification of health-related social needs by the social care networks to better align policy efforts and clinical interventions with areas of greatest need. This will hopefully mean that these much-needed additional clinicians can make the most difference in alleviating access to care shortfalls in communities around the state that are most in need.
PREVENTION-FOCUSED SOLUTIONS
State and City investments are important, but we should understand that we cannot prescribe or therapize our way out of this crisis. The year-over-year increases in depression and anxiety over the last decade demand that we address not only treatment and crisis but also focus on prevention. This includes more holistic approaches to supporting healthy adolescent emotional development by going beyond the clinical and encompassing education, the arts, and athletics.
The current array of services for adolescents with behavioral health conditions across the country, New York State, and New York City forms a tenuous ‘system’ that is fragmented, under-resourced, and disjointed. Articulating a coordinated vision for better adolescent behavioral health that drives change across sectors and focuses not just on treating the acute crisis—but also on prevention—is greatly needed to ensure the next generation of adolescents doesn’t become the next-highest point on the bar graph of this growing crisis.
This commentary appears in the 2024 spring/summer issue of Blueprint.
