By Gene Beresin, Executive Director and Khadijah Booth Watkins, Associate Director

Posted in: Multimedia, Podcast

Topics: Hot Topics, Mental Illness + Psychiatric Disorders

Why are our young people struggling so much?

In this special episode for Mental Health Awareness Month, Gene and Khadijah dive into the growing youth mental health epidemic. They explore the sharp rise in anxiety, depression, and other mental health challenges among children and teens since the 1980s—fueled by factors like social media, shifting family dynamics, economic inequality, and systemic discrimination. With only about 11,400 child and adolescent psychiatrists in the U.S. for the 14–20 million young people who need care, the workforce shortage is dire. Gene and Khadijah call for urgent advocacy—encouraging listeners to support change through actions like contacting lawmakers, engaging with local communities, joining peer support efforts, and promoting mental health education. Tune in for a candid, compassionate conversation about how we can all help make mental health care more accessible and equitable for our youth.

Media List

• Addressing the Youth Mental Health Epidemic (Springer)
• Severe Shortage of Child and Adolescent Psychiatrists (AACAP)
• Varying Estimates of Social Workers in the United States: Which Data Source to Use? (NIH)
• Ways to Help Your Lonely Teen Online Course (MGH Clay Center)
• Conflict Resolution Course (MGH Clay Center)
• Active Minds
• The Power of Peer Support (Shrinking it Down)
• Why Activism Is Good For Teens — And The Country (MGH Clay Center)
• If It’s Okay To Not Be Okay (See Me Scotland)
• What’s Up With Everyone? A Youth Mental Health Campaign With Academy-Award Winning Aardman (MGH Clay Center)

Episode Transcript

SPEAKERS: Gene Beresin, MD, MA; Khadijah Booth Watkins, MD, MPH;

[INTRO MUSIC PLAYS]

Gene 00:29

Welcome Back to Shrinking it Down: Mental Health Made Simple. I’m Gene Beresin.

Khadijah 00:33

And I’m Khadijah Booth Watkins.

Gene 00:35

We’re two child and adolescent psychiatrists at the Clay Center for Young Healthy Minds at the Massachusetts General Hospital, and today we’re here to discuss an urgent crisis affecting millions of young people around the world, and that is the youth mental health epidemic.

Khadijah 00:53

I mean, since 2010 and probably well before that, maybe thinking going back as far as like 1980 the rates of anxiety, depression and other psychiatric and mental health conditions. You know, such as stress, loneliness and relationship problems in children and young adults have been increasing at an alarming pace.

Gene 01:10

And you know, sometimes people just want to say that, like they ask, why is this happening? And you know, the low hanging fruit is always social media. Social media is blamed on almost everything. Well, it’s not great, but these skyrocketing rates are actually the result of a combination of factors, for example, age, race, sexual orientation, family factors such as relationships with loved ones, financial stability, or instability, trauma, adverse childhood experiences, community factors, such as relationships with peers, teachers, mentors, environmental factors, and that is things like neighborhood safety, access to green spaces, access to health care and, you know, of course, the introduction and explosion, largely the misuse of social and digital media, including things like cyber bullying and ghosting and canceling and societal factors. I mean social and economic inequalities, discrimination, governmental policies. So, it’s really a combination of factors, but they’ve all really if you look at the charts of rates of depression, anxiety, stress, loneliness and suicide and suicidal thinking, they’ve really escalated since, you know, the late 70s, early 80s.

Khadijah 02:43

Yeah, it is. It is quite the misconception that that thing just suddenly kind of turned upside down. And I think it’s important for us to talk about it, because then we can really address the issues. I’m actually giving a talk this week about the, basically the realities, the risk and the rewards of social media and digital learning, because it is not all bad, but there’s been a lot that’s contributed to it, but, but to that point, you know Gen Z, and those are people you know, between the ages of 13 and 28 and I clarify that because I always get the generations confused, but this generation is talking about their mental health in a way that no one other generation has like they’re open about it, they’re talking about it, they’re sharing their experiences. But you know, the stigma mental health conditions and the stigma around this perceived illness by older generations, along with some you know, cultural norms have really prevented and gotten in the way of kids and young adults coming forward and asking for help. So it’s something that we need to be aware of, so that we can again address these issues and try to get more people talking about their mental health conditions, their concerns, so that people can then have the space and the agency to seek help and access care when they need it.

Gene 03:59

Yeah, I agree. You know I’ve and all the kids that I’ve known patient you know, the patients and kids that I you know my resident or fellows see that they’re supervising. And kids in my own family have been talking about mental health issues more than ever. But it’s another thing to do something about it and to complicate matters, even if they even if, and we could talk about why they don’t seek mental health help if they tried. You know, our young people are suffering, but there’s such a workforce shortage. I mean, right now. I mean the latest data shows that there are about 11,400 practicing child adolescent psychiatrists in the whole nation, and there must be anywhere from 14 to 20 million kids and young adults that need help. And when you couple that with the number of clinical psychologists. Maybe four, 4000 and there it’s reported that they’re about 200,000 social workers, but many of those social workers are actually tied up as school guidance counselors, so we don’t really know the actual number of clinical social workers that actually see you, but let’s, let’s say it’s about 100,000 or 150,000 if, we’re talking about like 160,000 clinicians to take care of 20 million young people, it’s woefully inadequate. So, you know, we’ve got to advocate for more services. We’ve got to advocate for more seek help, seeking. And, you know, how do we do this? Khadija, I mean, what do we do?

Khadijah 05:50

That’s what we’re here to talk about today, because it’s important. You know, again, the younger generations are really great advocates, but they still need, like, it still takes a village. And so we’re here to talk about today, you know, the importance of mental health advocacy, and we today, hopefully will kind of define what it looks like and when and where and how we can promote it, and some methods that we can use to advocate that are effective. And I think because people have these kind of preconceived notions about what advocacy is and what it looks like and the time and energy and effort it takes, but I think hopefully today, we can kind of distill it down and make it into, you know, bite sized pieces so it can feel manageable, manageable for people who, you know, feel compelled to advocate. So

Gene 06:30

let’s back up. What would you say the major factors are that come into play that that result in the youth mental health epidemic.

Khadijah 06:42

Well, I think you mentioned, you know, the workforce shortage, which is incredible. And despite, you know, the workforce shortage growing, you know, there’s a the spaces for people who are going into child and adolescent psychiatry training don’t fail, and that’s probably for a number of reasons, but I think probably the top reasons are around the compensation that doesn’t match the compensation for other specialties. And also, you know, then having to do additional training makes it hard for people to commit to training in child psychiatry. But there’s also workforce shortage, like you said, in other kind of clinicians that provide care to young people. But there is other, many other factors, like, you know, the mental health system is incredibly complicated to navigate, even for people who are, you know, skilled, trained, highly educated. It with access and resources, it can be really difficult to navigate and figure out where to go. You know, who to who to ask, ask for different services. So, I think that’s another big one. But then also, you know, we’re just thinking about just the health inequities and disparities that really limit, you know, access to care due to, you know, maybe language not being available, insurance not being covered, transportation, the wait times are incredible. So, there are just tons of reasons why that we can go on and on about as to why it’s hard and why things are difficult for people to get access to care, other than just the workforce shortage. Yeah.

Gene 08:08

I mean, I have friends who are friends, who are doctors, you know. I mean, not psychiatrists. They don’t. They have no clue about how to, how to navigate the mental health system. And you would, you would think that they would know how to do that. They’re, they’re, they’re, you know, medical professionals,

Khadijah 08:23

It’s incredibly complicated, not straightforward, like, you just call your primary I mean, so we tell people all the time, like, you know, your primary care is a gateway, and that’s an easy call to make, but people don’t know that. That’s the first step to make, you know. And there’s also, you know, a lot of distrust around, you know, mental health, mental health treatment, because it’s not as concrete as some of the other sciences. And then again, like the stigma that we talked about earlier, like that, that also kind of gets in the way of people seeking help because of the preconceived notions about, again, mental health conditions and what it means to struggle with the mental health.

Gene 08:56

condition. And I think, I think to speak to the distrust it’s different in different cultural groups. I mean, people of color have not been treated as well as, you know, Caucasian Americans, I mean, and they’ve been, you know. I mean, many African Americans, you can speak to this. I mean, how many African Americans can, kind of, like, look at the Tuskegee, you know, syphilis research that was just an abomination and totally unethical. I mean, and, and there’s a lot of research to show that that people of color and marginalized folks, like immigrants, LGBTQIA, plus, you know, are treated differently. We had an episode of the podcast about obese people obesity, and they are discriminated against. And so, you know, how do we overcome that? The disparities? Care.

Khadijah 10:02

I mean, that’s a deliberate approach. We have to make healthcare more equitable, more accessible, you know, thinking about having, you know, providers, and not just in mental health, but in all of medicine that are that look more like the population that they serve, that speak the language of the population that they serve, you know, making sure that people aren’t afraid to go to their health care provider because they’re afraid of, you know, things related to their immigration status and things like that. And so, there’s so many things that we need to do just on the basic level. And then, of course, there’s, there’s a role of education, and really educating people about, you know, mental health, mental health conditions, you know, like, we talk about, like, what, what are the early signs that they can kind of access care early, you know, talking about it more so it’s more normalized. So, we’re not, you know, you know, coming at it with all of the stigma, shame and embarrassment, but making it kind of part of the normal conversation. So people kind of can talk about, you know, you know, there may be sadness, their anxiety, in the same way they may talk about, you know, their persistent headaches or their or their abdominal pain, so that they can access care and seek help, as opposed to delaying access to care or delaying seeking help or not seeking help at all.

Gene 11:10

So, we need to be advocates so let’s look at advocacy and how we can advocate to change the system.

Khadijah 11:23

What? What? What he What does advocacy look like to you? And why? And why should, why? Why is it so important? Why would? How could you help us understand why it’s so important? Well,

Gene 11:34

I think advocacy begins with education, you know, and you know, in places like the Clay Center, the public all need to know what the trusted resources are that provide sound evidence-based information. So, for example, I mean in the past, you know, before there were pap smears, mammograms, sunblock, car belts, car seats, seat belts. The public needed to be informed as to what the risks and dangers are of not having these screening tools. So it began with education, and these public health campaigns actually served as a forum as a means of beginning with advocacy. So, we move from education to ad campaigns and public forums, and sadly, there’s, really, there’s been no effective mental health campaigns. I mean the dare campaign. You know that image, this is your you know your brain on drugs with the frying pan, and that everybody remembers that image and the egg, but it failed. Friends don’t let friends drive drunk. That was fairly successful. But what was really successful was when there were alleged, there were state and regulations that driving under the influence was intolerable and was going to be punished severely. So, it has to reach state and national levels. And you know, we could go on, but you know, then it has to be brought to the local level. So having these issues discussed in community centers and schools and places of worship are super important. I’m concerned about we as physicians, not advocating for decreases in funding for research, for medical positions for our programs. You know, we’re currently in this particular political climate. We’re really in danger, and unless we stand up and have a voice, I don’t think it’s going to get better. So, you know, they’ve been cutbacks in the National Institute of Health and the CDC in access to care, and it’s created a greater hardship in our taking care of kids. So, what do you think where, where and when? Can mental health advocacy be helpful?

Khadijah 14:17

You know, there mental health advocacy, I think looks different, or can look like many different things, and can be different things to different people. But, you know, there, there are tons of ways to kind of enter into this advocacy space, and it could start with something, you know, as small but super meaningful, impactful, like writing or calling to your representative or Congress person. You know, we can do this on, you know, a local level, a state level, national level, so, so those are places that to start. You know, other ways to advocate is, you know, like we talked about how difficult to mental health system is to navigate, to navigate for many people, and advocacy could look like, you know, you being a person that has. Helps people do this, whether you do this through one of your community organizations or your place of worship or maybe you partner with you know, your primary health care provider. You know advocacy can happen in schools, again, similar to the mental health system, be difficult to navigate. Sometimes schools are really difficult to navigate when you’re trying to seek services and support for your young person. So there are many different ways to advocate, and it doesn’t all look like, you know, market, marketing, marketing and protesting, and it could, if that’s what you like, but it could, again, it’d be something small that you do on a personal level with maybe another person or friend that you know that needs help. Or could be bigger. So, I think there’s a space for everyone, if you so choose to kind of take on the role of advocacy. But I think it is something that we as physicians and providers of care need to really think about how we can do better to advocate for people that we care for. So, with that, what are some methods or initiatives that that are most effective in advocacy?

Gene 16:01

So, you know, I’ve mentioned, we both mentioned public mental health campaigns, public mental health education. But you know, at a more personal level, I think parents and caregivers, teachers, all those that work with youth need to support each other and need to kind of talk with each other. Have conversations. Their voices need to be heard, I think, I think, and then during those conversations, I think it’s important that we normalize, you know, mental health issues. I mean that it’s look, one out of two individuals will have a psychiatric disorder during the course of their lifetime, you know, and ended, you know, at any one point in time, about one in four individuals will have a psychiatric disorder, and 50% begin before 14 And 75% begin before age 26 so, you know, addressing the issues and needs of young people, I think, is super important. I think the other thing that really makes the difference is telling stories. I mean, there’s nothing more powerful than a parent or caregiver or a kid themselves, telling their story and using narratives to, kind of, you know, talk about what happened to them. So, we can, we need that. And then we also need to, kind of, like, use, you know, vote with our feet, attend town halls, go to local and state governments. Call your, you know, call, call your leaders. We need to go to PTA meetings, school boards, state departments, Departments of Education, and I think we need more online parenting modules and therapy services, which I guess, I don’t guess. I know we’re trying to do that at the Clay Center, and it’s happening in various other places around the country.

Khadijah 18:01

Would you consider, like peer support, a form of advocacy, like things, like Active Minds, Like groups like that. Would you consider that a form of advocacy?

Gene 18:09

Absolutely. I mean, so there’s Students Against Destructive Decisions, the sad group for high school kids, and then there’s Active Minds, which is largely college, but I think that that peers talking with peers, peers supporting each other, and then peers kind of speaking out together, is super important as a means of advocacy. So, for the parents and caregivers who are at home listening, what are the ways they can get started? Khadija, you know, do you have any examples of initiatives or movements where advocacy made a positive change?

Khadijah 18:55

So, so that’s a good question. I mean that you mentioned some earlier with the drunk driving, those kinds of things, but there, but there’s not a lot, there’s not a ton of mental health campaigns where, where we can kind of see that there’s been a huge change made. You know, there, there are some campaigns that I’m aware of, like, you know, helping people to, like, cc awkward, where we’re helping people, young people learn how to talk to one another and support one another, and in a way that that is not so burdensome. I learned about one yesterday where, I think it was called sounded out, where they are talking about, you know, again, how to help parents support their young people, because it’s hard and parents don’t often know what to do or what to say, but how to give them the tools and the strategies to help support their young people. But there are not a ton of campaigns that we know of that are mental health related that have been super successful.

Gene 19:55

I think the ones that I’m most familiar with, for example, in the UK. Uh, there was a campaign, if it’s okay not to be okay in Scotland. See me, Scotland was extremely effective. There was that BBC funded program that our dear friend Paul Crawford at the University of Nottingham and the Institute of Mental Health in England, did, and called What’s up with everyone, using Ard-man and those characters, I mean, those things were, they had positive, very positive.

Khadijah 20:32

outcomes. And I think I know that I’ve seen some of these through the Ad Council around you know, again, it’s okay not to be okay. I’ve seen those kinds of things, and I think it does give people again, permission, like we talked about earlier, like the normalizing of the conversations, permission to say that they’re not okay. And they also kind of give, often, they give some tools or talking points so that you can help, help your friend, your child, to kind of help them through, and help them talk about some of the things that are bothering them. So, I think those things can be really helpful. It’s just really how do we disseminate that information and make sure that people that need it and need access to these tools, or this education, this information can have it, because I think a lot of these things we know because we do this work, and we’re in the space. But I think for the people who are looking for this help and looking for this guidance, it’s hard for them to kind of find it so to that at a community or societal level, what do legislators want to know, like, if we’re going out to advocate on that level, what do they want to hear from us or hear from parents to help them, you know, make decisions that are in the best interest of kids and health and well being

Gene 21:51

well, I think those are great questions. So, I think you know legislators, whether they’re local, regional, statewide, they want to know what are the merits of the issues, what impact does this have on his or her district? So, they can represent their constituents. Does it involve possible job losses or job gains? In other words, what’s the economic impact of this. So, what is the cost? What are the what’s the impact on economy and business? I mean, for example, we know that depression globally is the number one burden of illness. It means more loss of income, disability, job loss, and adverse effects on physical as well as emotional health. So, what’s the outcome? What are we trying to do? Does it have the support of the governor at the highest level? I mean, I think we’re fortunate here in Massachusetts, because Governor Healy has been a very strong advocate for mental health, as has Mayor Wu and the city of Austin. So we’re fortunate, and we can, we can speak to their comments if we’re, if we’re going to be advocates, but I think, I think folks need to learn the positions of their leaders in the states in which they’re trying to speak up, and also, what’s the public sentiment about the issue? I mean, is there an outcry? Is there an outcry for more services, for more access to care, for better, better here from for care, but for lower insurance costs, for less deductibles, for the for lower price of medications. So, I think you know, a lot of those issues are super important,

Khadijah 23:54

so we have our work cut out for us, really, and, and parents and, you know, again, people who, who may be struggling with mental health conditions, but, but there is a space in place for anybody really who wants to advocate and push for change so that people who need care can access care, can access care and the language that they’re most comfortable with it. Can access care with a provider who, you know, looks like them, if they so choose, or they that they feel like they can connect to. So, there’s a lot of work to be done. But again, I think what I want people to know is that there, there’s a space for you, however you want to do it. It doesn’t all look like, you know, becoming a politician, and it doesn’t have to be. It could be something, again, as small as working with on a community level, working in your, you know, your place of worship, working out on a school level. But it also could be, you know, working on, on policy level and in that, in that way. So, to wrap up, maybe I could ask one. Has been your experience with advocacy or activism, because I know that you have shared a lot of experience with me. What could, what could we share with the group? What would be, what would be shareable with the group?

Gene 25:14

Well, I mean, I got in, I get in trouble in activism, but, I mean, look, that’s all I know. I get in trouble because, you know, look, but look, I was in college. I wasn’t, you know, I grew up in the 60s and I went to college 67 to 71 so I was very involved opposing the war in Vietnam. I was very involved with the civil rights movement. You know, sadly, I was, I’m old enough to remember when John F Kennedy, Martin Luther King, Robert Kennedy, were assassinated. I remember a lots of heart Huey Newton. I mean, I remember lots and lots of situations in civil rights that I was I was struggling with, with, but collectively and women’s liberation. I mean, women, you know, we’ve still never passed the Equal Rights Amendment, but, but, but we work. We all worked hard. So those were my formative years, and, you know, I think they made a lasting impact on me, because I do think we got some things done. Did we solve the problems? No way, but, you know, did I was I threatened? I probably took some pretty big risks, you know. But I think you know, in all protests and in all activisms, you know, you got to be willing to take some risks, no

Khadijah 26:50

risk, no rewards, yeah. How about you? I mean, so when I think about the advocacy that I’ve done, probably most recently, like I have, on many occasions, gone down to Washington, DC, usually with the, you know, Academy of Child and Adolescent Psychiatry to advocate for mental health conditions, mental health treatment. Usually, we would bring other families so that they could speak about their experience and things that that were helpful and things that were needed and things that were missing. But I also feel like, you know, my advocacy also comes out when I’m with patients and they’re sharing their experience, and I see that there is, you know, they’re not getting the services that they need, or that they’re not, you know, being connected in the right way, or things aren’t happening quick enough. And so, when I call the school, or, you know, call their call their agency to kind of explain what I think is going on, what’s happening. Like, I see that as advocacy, but I also see advocacy when you know a family member or a friend calls me and they share, like, their challenges with navigating the system, and I kind of give them instruction and guidance as to do this, then that, and then this should be, this should kind of get you in the right place, because most of the time, people just don’t know, you know what, what is even the first step to take? So, I feel like there’s tons of different ways that I advocate, and it all kind of brings me immense joy to feel like I’m doing something that can hopefully make a change for someone and make things better for them.

Gene 28:18

Do you feel, I mean, in some ways, being outspoken in today’s society. I’m not going to go political on this, but I’ll venture near that area. Do you do you feel worried about, about speaking up, about, about using your voice?

Khadijah 28:40

So, I feel worried. May not be the right feeling that I have, but it definitely gives me a little bit more pause and has me being more even more thoughtful. I feel like I had always, I was always thoughtful about things that I say, but even feeling like I have to be even more thoughtful so that I am still able to use my voice. It’s like striking that balance of trying to do what you need to do, to advocate for people, but also knowing that I don’t want to lose my space to have my voice and the platform that I have. So how do I say things that won’t hopefully draw too much attention? But I think at some point there, there has to be like you said, no risk, no reward. There has to be when things need to be said or things need to be done, they have to be done. But I do think it is something that I think more about trying to strike that balance around, you know, the risk versus the benefit, and how to say things in a way that can be perceived and can be helpful, but not, you know, get in the way of me continuing to do the work that I need

Gene 29:40

to do well, no, I certainly worry about that. I mean, so for example, let me just give you a recent example. I was, I was interviewed by the Huffington Post just on Friday. Uh, they didn’t use my interview, but it was about Trump’s post on Taylor Swift. You know, I hate Taylor Swift, and she’s not hot anymore. Okay, that’s the president United States, and I was going to comment on it, but, you know, I had to be somewhat careful, because I’m a Harvard professor, you know, I mean, you know, Harvard is being, you know, taken, taken on by the government. We represent Mass General Brigham. So one of the things I wanted to focus on was not necessarily making a diatribe about the president, but talking about the risks of cyber bullying and how whether you’re president or whether you’re a parent, the kids are watching and making statements like that, and being kind of aware of who’s making the statement, Who you’re making it to, and how we’re making it I think is really important.

[OUTRO MUSIC STARTS]

And I think every individual that has a voice needs to be thinking about their context, their community, you know, who they’re speaking for, and how it’s going to be, how it’s going to be taken. So, for those of you at home, if you like what you’ve heard today, consider leaving us a review, and consider how you might, you know, serve as an advocate. So as always, we hope that our conversation will help you have yours. I’m Gene Beresin

Khadijah 31:41

and I’m Khadijah Booth Watkins. Until next time.

[OUTRO MUSIC ENDS]

Episode music by Gene Beresin

Episode produced and researched by Spenser Egnatz