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What is Global Mental Health?

Mental health
The capacity of thought, emotion, and behavior that enables every individual to realize their own potential in relation to their developmental stage, to cope with the normal stresses of life, to study or work productively and fruitfully, and to contribute to their community.

Mental disorder
Disturbances of thought, emotion, behavior, and relationships with others that lead to substantial suffering and functional impairment in one or more major life activities, as identified in the major classification systems such as the WHO International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders.

Lancet Commission

A new Lancet Commission report on mental health exposes a "collective failure to respond to this global health crisis", causing long-lasting and preventable harm to people, communities and economies. Mental disorders are on the rise in every country in the world and will cost the global economy $16 trillion by 2030.

The Lancet Commission on Global Mental Health and Sustainable Development brought together 28 global experts (including two of our GMH faculty!) in psychiatry, public health, neuroscience and advocacy, as well as people with first-hand experience of mental health conditions. Launched at the first-ever Global Ministerial Mental Health Summit in London, the Commission's report outlines a blueprint for action to promote mental wellbeing, prevent mental health problems and enable recovery from mental disorders.

Mental Health and the SDGs

Mental health made a giant leap to the global agenda with the inclusion of mental health in the United Nation's Sustainable Development Goals (SDGs) in 2015. However, mental health goes beyond SDG 3: Good Health and Well-Being. The promotion of mental health and prevention of mental illness will come through the success of many SDGs. Dr. Crick Lund reviews how SDGs can be framed within social determinants of mental disorders.

The Global Mental Health Timeline

From the Lancet Commission on Global Mental Health and Sustainable Development.

Want to Learn More?

Here are some key publications about Global Mental Health. Please note that these articles may require institutional permission to access.

Patel, Vikram, et al. "The Lancet Commission on Global Mental Health and Sustainable Development." Lancet (London, England), vol. 392, no. 10157, Oct. 2018, pp. 1553-98. PubMed, doi:10.1016/S0140-6736(18)31612-X.

Collins, Pamela Y., and Shekhar Saxena. "Action on Mental Health Needs Global Cooperation." Nature, vol. 532, no. 7597, Apr. 2016, pp. 25-27. PubMed, doi:10.1038/532025a.

Collins, Pamela Y., et al. "Grand Challenges in Global Mental Health." Nature, vol. 475, no. 7354, July 2011, pp. 27-30. PubMed, doi:10.1038/475027a.

Lund, Crick, et al. "Social Determinants of Mental Disorders and the Sustainable Development Goals: A Systematic Review of Reviews." The Lancet. Psychiatry, vol. 5, no. 4, Apr. 2018, pp. 357-69. PubMed, doi:10.1016/S2215-0366(18)30060-9.

Patel, Vikram, et al. "Addressing the Burden of Mental, Neurological, and Substance Use Disorders: Key Messages from Disease Control Priorities, 3rd Edition." Lancet (London, England), vol. 387, no. 10028, Apr. 2016, pp. 1672-85. PubMed, doi:10.1016/S0140-6736(15)00390-6.

Global Mental Health 2007. Series of six papers about global mental health. The Lancet

Corrigan, P. W., & Rao, D. (2012). On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 57(8), 464-469.

Murray, L. K., Dorsey, S., Bolton, P., Jordans, M. J. D., Rahman, A., Bass, J., & Verdeli, H. (2011). Building capacity in mental health interventions in low resource countries: An apprenticeship model for training local providers. International Journal of Mental Health Systems, 5, 30. https://doi.org/10.1186/1752-4458-5-30

Murray, L. K., Dorsey, S., Haroz, E., Lee, C., Alsiary, M. M., Haydary, A., ... Bolton, P. (2014). A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries. Cognitive and Behavioral Practice, 21(2), 111-123. https://doi.org/10.1016/j.cbpra.2013.06.005

Simoni, J. M., Safren, S. A., Manhart, L. E., Lyda, K., Grossman, C. I., Rao, D., ... Wilson, I. B. (2011). Challenges in Addressing Depression in HIV Research: Assessment, Cultural Context, and Methods. Aids and Behavior, 15(2), 376-388. https://doi.org/10.1007/s10461-010-9836-3

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The Program on Global Mental Health is a regional, interdisciplinary forum for research, training, and service-related activities to address gaps in the implementation of effective global mental health interventions.

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Mental Health of Adolescents Around The Globe

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Mental Health of Adolescents Around The Globe

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Adolescence (10-19 years) is a unique and formative time. Multiple physical, emotional and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Promoting psychological well-being and protecting adolescents from adverse experiences and risk factors that may impact their potential to thrive are critical for their well-being during adolescence and for their physical and mental health in adulthood.

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Back in 2017, psychologist Jean Twenge set off a firestorm in the field of psychology.

Twenge studies generational trends at San Diego State University. When she looked at mental health metrics for teenagers around 2012, what she saw shocked her. "In all my analyses of generational data - some reaching back to the 1930s - I had never seen anything like it," Twenge wrote in the Atlantic in 2017.

Twenge warned of a mental health crisis on the horizon. Rates of depression, anxiety and loneliness were rising. And she had a hypothesis for the cause: smartphones and all the social media that comes along with them. "Smartphones were used by the majority of Americans around 2012, and that's the same time loneliness increases. That's very suspicious," Twenge told NPR in 2017.

But many of her colleagues were skeptical. Some even accused her of inciting a panic with too little - and too weak - data to back her claims.

Now, six years later, Twenge is back. She has a new book out this week, called Generations, with much more data backing her hypothesis. At the same time, several high-quality studies have begun to answer critical questions, such as does social media cause teens to become depressed and is it a key contributor to a rise in depression?

In particular, studies from three different types of experiments, altogether, point in the same direction. "Indeed, I think the picture is getting more and more consistent," says economist Alexey Makarin, at the Massachusetts Institute of Technology.

A seismic change in how teens spend their time

In Generations, Twenge analyzes mental health trends for five age groups, from the Silent Generation, who were born between 1925 and 1945, to Gen Z, who were born between 1995 and 2012. She shows definitively that "the way teens spend their time outside of school fundamentally changed in 2012," as Twenge writes in the book.

Take for instance, hanging out with friends, in person. Since 1976, the number of times per week teens go out with friends - and without their parents - held basically steady for nearly 30 years. In 2004, it slid a bit. Then in 2010, it nosedived.

"It was just like a Black Diamond ski slope straight down," Twenge tells NPR. "So these really big changes occur."

At the same time, around 2012, time on social media began to soar. In 2009, only about half of teens used social media every day, Twenge reports. In 2017, 85% used it daily. By 2022, 95% of teens said they use some social media, and about a third say they use it constantly, a poll from Pew Research Center found.

"Now, in the most recent data, 22% of 10th grade girls spend seven or more hours a day on social media," Twenge says, which means many teenage girls are doing little else than sleeping, going to school and engaging with social media.

Not surprisingly, all this screen time has cut into many kids' sleep time. Between 2010 and 2021, the percentage of 10th and 12th graders who slept seven or fewer hours each night rose from a third to nearly one-half. "That's a big jump," Twenge says. "Kids in that age group are supposed to sleep nine hours a night. So less than seven hours is a really serious problem."

On its own, sleep deprivation can cause mental health issues. "Sleep is absolutely crucial for physical health and for mental health. Not getting enough sleep is a major risk factor for anxiety and depression and self-harm," she explains. Unfortunately, all of those mental health problems have continued to rise since Twenge first sounded the alarm six years ago.

"Nuclear bomb" on teen social life

"Every indicator of mental health and psychological well-being has become more negative among teens and young adults since 2012," Twenge writes in Generations. "The trends are stunning in their consistency, breadth and size."

Across the board, since 2010, anxiety, depression and loneliness have all increased. "And it's not just symptoms that rose, but also behaviors," she says, "including emergency room visits for self-harm, for suicide attempts and completed suicides." The data goes up through 2019, so it doesn't include changes due to COVID-19.

All these rapid changes coincide with what, Twenge says, may be the most rapid uptake in a new technology in human history: the incorporation of smartphones into our lives, which has allowed nearly nonstop engagement with social media apps. Apple introduced the first iPhones in 2007, and by 2012, about 50% of American adults owned a smartphone, the Pew Research Center found.

The timing is hard to ignore, says data scientist Chris Said, who has a Ph.D. in psychology from Princeton University and has worked at Facebook and Twitter. "Social media was like a nuclear bomb on teen social life," he says. "I don't think there's anything in recent memory, or even distant history, that has changed the way teens socialize as much as social media."

Murky picture becomes clearer on causes of teen depression

But the timing doesn't tell you whether social media actually causes depression in teens.

In the past decade, scientists have published a whole slew of studies trying to answer this question, and those studies sparked intense debate among scientists and in the media. But, Said says, what many people don't realize is scientists weren't using - or didn't even have - the proper tools to answer the question. "This is a very hard problem to study," he says. "The data they were analyzing couldn't really solve the problem."

So the findings have been all over the place. They've been murky, noisy, inconclusive and confusing. "When you use tools that can't fully answer the question, you're going to get weak answers," he says. "So I think that's one reason why really strong evidence didn't show up in the data, at least early on."

On top of it, psychology has a bad track record in this field, Said points out. For nearly a century, psychologists have repeatedly blamed new technologies for mental and physical health problems of children, even when they've had little - or shady - data to back up their claims.

For example, in the 1940s, psychologists worried that children were becoming addicted to radio crime dramas, psychologist Amy Orben at the University of Cambridge explains in her doctoral thesis. After that, they raised concerns about comic books, television and - eventually - video games. Thus, many researchers worried that social media may simply be the newest scapegoat for children's mental health issues.

A handful of scientists, including MIT's Alexey Makarin, noticed this problem with the data, the tools and the field's past failures, and so they took the matter into their own hands. They went out and found better tools.

Hundreds of thousands of more college students depressed

Over the past few years, several high-quality studies have come that can directly test whether social media causes depression. Instead of being murky and mixed, they support each other and show clear effects of social media. "The body of literature seems to suggest that indeed, social media has negative effects on mental health, especially on young adults' mental health," says Makarin, who led what many scientists say is the best study on the topic to date.

In that study, Makarin and his team took advantage of a once-in-a-lifetime opportunity: the staggered introduction of Facebook across U.S. colleges from 2004 to 2006. Facebook rolled out into society first on college campuses, but not all campuses introduced Facebook at the same time.

For Makarin and his colleagues, this staggered rollout is experimental gold.

"It allowed us to compare students' mental health between colleges where Facebook just arrived to colleges where Facebook had not yet arrived," he says. They could also measure how students' mental health shifted on a particular campus when people started to spend a bunch of their time on social media.

Luckily, his team could track mental health at the time because college administrators were also conducting a national survey that asked students an array of questions about their mental health, including diagnoses, therapies and medications for depression, anxiety and eating disorders. "These are not just people's feelings," Makarin says. "These are actual conditions that people have to report."

They had data on a large number of students. "The data comes from more than 350,000 student responses across more than 300 colleges," Makarin says.

This type of study is called a quasi-experiment, and it allows scientists to estimate how much social media actually changes teens' mental health, or as Makarin says, "We can get causal estimates of the impact of Facebook on mental health."

So what happened? "Almost immediately after Facebook arrives on campus, we see an uptick in mental health issues that students report," Makarin says. "We especially find an impact on depression rates, anxiety disorders and other questions associated with depression in general."

And the effect isn't small, he says. Across the population, the rollout of Facebook caused about 2% of college students to become clinically depressed. That may sound modest, but with more than 17 million college students in the U.S. at the time, that means Facebook caused more than 300,000 young adults to suffer from depression.

For an individual, on average, engaging with Facebook decreases their mental health by roughly 22% of the effect of losing one's job, as reported by a previous meta-analysis, Makarin and his team found.

Facebook's rollout had a larger effect on women's mental health than on men's mental health, the study showed. But the difference was small, Makarin says.

He and his colleagues published their findings last November in the American Economic Review. "I love that paper," says economist Matthew Gentzkow at Stanford University, who was not involved in the research. "It's probably the most convincing study I've seen. I think it shows a clear effect, and it's really credible. They did a good job of isolating the effect of Facebook, which isn't easy."

Of course, the study has limitations, Gentzkow says. First off, it's Facebook, which teens are using less and less. And the version of Facebook is barebones. In 2006, the platform didn't have a "like" button" or a "newsfeed." This older version probably wasn't as "potent" as social media now, says data scientist Chris Said. Furthermore, students used the platform only on a computer because smartphones weren't available yet. And the study only examined mental health impacts over a six-month period.

Nevertheless, the findings in this study bolster other recent studies, including one that Gentzkow led.

Social media is "like the ocean" for kids

Back in 2018, Gentzkow and his team recruited about 2,700 Facebook users ages 18 or over. They paid about half of them to deactivate their Facebook accounts for four weeks. Then Gentzkow and his team looked to see how a Facebook break shifted their mental health. They reported their findings in March 2020 in the American Economic Review.

This type of study is called a randomized experiment, and it's thought of as the best way to estimate whether a variable in life causes a particular problem. But with social media, these randomized experiments have big limitations. For one, the experiments are short-term - here only four weeks. Also, people use social media in clusters, not as individuals. So having individuals quit Facebook won't capture the effect of having an entire social group quit together. Both of these limitations could underestimate the impact of social media on an individual and community.

Nevertheless, Gentzkow could see how deactivating Facebook made people, on average, feel better. "Being off Facebook was positive across well-being outcomes," he says. "You see higher happiness, life satisfaction, and also lower depression, lower anxiety, and maybe a little bit lower loneliness."

Gentzkow and his team measured participants' well-being by giving them a survey at the end of the experiment but also asking questions, via text message, through the experiment. "For example, we sent people text messages that say, 'Right now, would you say you're feeling happy or not happy,'" he explains.

Again, as with Makarin's experiment, the effect was moderate. Gentzkow and his colleagues estimate that temporarily quitting Facebook improves a person's mental health by about 30% of the positive effect seen by going to therapy. "You could view that meaning these effects are pretty big," he explains, "or you could also see that as meaning that the effects of therapy are somewhat small. And I think both of those things are true to an extent."

Scientists still don't know to what extent social media is behind the rising mental health issues among teenagers and whether it is the primary cause. "It seems to be the case - like it's a big factor," says MIT's Alexey Makarin, "but that's still up for debate."

Still, though, other specifics are beginning to crystallize. Scientists are narrowing in on what aspects of social media are most problematic. And they can see that social media won't hurt every teen - or hurt them by the same amount. The data suggests that the more hours a child devotes to social media, the higher their risk for mental health problems.

Finally, some adolescents are likely more vulnerable to social media, and children may be more vulnerable at particular ages. A study published in February 2022 looked to see how time spent on social media varies with life satisfaction during different times in a child's life (see the graphic).

The researchers also looked to see if a child's present use of social media predicted a decrease of life satisfaction one year later. That data suggeststwo windows of time when children are most sensitive to detrimental effects of social media, especially heavy use of it. For girls, one window occurs at ages 11 through 13. And for boys, one window occurs at ages 14 and 15. For both genders, there's a window of sensitivity around age 19 - or near the time teenagers enter college. Amy Orben and her team at the University of Cambridge reported the findings in Nature Communications.

This type of evidence is known as a correlative. "It's hard to draw conclusions from these studies," Gentzkow says, because many factors contribute to life satisfaction, such as environmental factors and family backgrounds. Plus, people may use social media because they're depressed (and so depression could be the cause, not the outcome of social media use).

"Nevertheless, these correlative studies, together with the evidence from the causal experiments, paint a picture that suggests we should take social media seriously and be concerned," Gentzkow adds.

Psychologist Orben once heard a metaphor that may help parents understand how to approach this new technology. Social media for children is a bit like the ocean, she says, noting that it can be an extremely dangerous place for children. Before parents let children swim in any open water, they make sure the child is well-prepared and equipped to handle problems that arise. They provide safety vests, swimming lessons, often in less dangerous waters, and even then parents provide a huge amount of supervision.
Alyson Hurt created the graphic. Jane Greenhalgh and Diane Webber edited the story.

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The truth about teens, social media and the mental health crisis

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A striking decline in teen mental health has coincided with the rise of smartphones and social media. Is social media causing the mental health challenges? Finally, research can answer that question.

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Research on why kids are struggling and what can be done to help

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Research on why kids are struggling and what can be done to help

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Research is focused on child and teen mental health, exploring why they are struggling and what can be done to help them

Cite this

Abrams, Z. (2023, January 1). Kids' mental health is in crisis. Here's what psychologists are doing to help. Monitor on Psychology, 54(1). https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health

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The Covid-19 pandemic era ushered in a new set of challenges for youth in the United States, leading to a mental health crisis as declared by the United States surgeon general just over a year ago. But U.S. children and teens have been suffering for far longer.

In the 10 years leading up to the pandemic, feelings of persistent sadness and hopelessness-as well as suicidal thoughts and behaviors-increased by about 40% among young people, according to the Centers for Disease Control and Prevention's (CDC) Youth Risk Behavior Surveillance System.

"We're seeing really high rates of suicide and depression, and this has been going on for a while," said psychologist Kimberly Hoagwood, PhD, a professor of child and adolescent psychiatry at New York University's Grossman School of Medicine. "It certainly got worse during the pandemic."

In addition to the social isolation and academic disruption nearly all children and teens faced, many also lost caregivers to Covid-19, had a parent lose their job, or were victims of physical or emotional abuse at home.

All these difficulties, on top of growing concerns about social media, mass violence, natural disasters, climate change, and political polarization-not to mention the normal ups and downs of childhood and adolescence-can feel insurmountable for those who work with kids.

"The idea of a 'mental health crisis' is really broad. For providers and parents, the term can be anxiety-provoking," said Melissa Brymer, PhD, who directs terrorism and disaster programs at the UCLA-Duke University National Center for Child Traumatic Stress. "Part of our role is to highlight specific areas that are critical in this discussion."

Across the field, psychologists are doing just that. In addition to studying the biological, social, and structural contributors to the current situation, they are developing and disseminating solutions to families, in schools, and at the state level. They're exploring ways to improve clinical training and capacity and working to restructure policies to support the most vulnerable children and teens.

Psychologists were also behind new mental health recommendations from the U.S. Preventive Services Task Force, a group of volunteer health professionals who evaluate evidence on various preventive health services. The task force now recommends regular anxiety screenings for youth ages 8 to 18 and regular depression screenings for adolescents ages 12 to 18.

"I see these trends in children's mental health problems as being critical, but there are solutions," Hoagwood said. "If we refocus our efforts toward those solutions, we could see some of these tides turn."

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Sources of stress

Across the United States, more than 200,000 children lost a parent or primary caregiver to Covid-19 ("Covid-19 Orphanhood," Imperial College London, 2022). In the face of those losses, families had to curtail mourning rituals and goodbye traditions because of social distancing requirements and other public health measures, Brymer said. Many children are still grieving, sometimes while facing added challenges such as moving to a different home or transferring to a new school with unfamiliar peers.

The CDC also reports that during the pandemic, 29% of U.S. high school students had a parent or caregiver who lost their job, 55% were emotionally abused by a parent or caregiver, and 11% were physically abused (Adolescent Behaviors and Experiences Survey-United States, January-June 2021, CDC).

"Schools are crucial for keeping kids safe and connecting them with services, but the pandemic completely disrupted those kinds of supports," Brymer said.

Those extreme disruptions didn't affect all young people equally. Echoing pre-Covid-19 trends, the CDC also found that girls, LGBTQ+ youth, and those who have experienced racism were more likely to have poor mental health during the pandemic, said social psychologist Kathleen Ethier, PhD, director of the CDC's Division of Adolescent and School Health.

Contributing factors likely include stigma, discrimination, and online bullying, Ethier said. Female students also report much higher levels of sexual violence than their male peers, which can further harm mental health.

As much hardship as Covid-19 wrought, it's far from the only factor contributing to the current crisis. Biology also appears to play a role. The age of puberty has been dropping for decades, especially in girls, likely leading to difficulty processing complex feelings and knowing what to do about them ( Eckert-Lind, C., et al., JAMA Pediatrics, Vol. 174, No. 4, 2020). In early puberty, regions of the brain linked to emotions and social behavior are developing more quickly than regions responsible for the cognitive control of behavior, such as the prefrontal cortex, Ethier said.

Those developmental changes drive young people to seek attention and approval from their peers. For some, using social media fulfills that need in a healthy way, providing opportunities for connection and validation to youth who may be isolated from peers, geographically or otherwise.

For others, negative messages-including online bullying and unrealistic standards around physical appearance-appear to have a detrimental effect, but more research is needed to understand who is most at risk.

"There is clearly some aspect of young people's online life that's contributing [to the mental health crisis], we just don't know exactly what that is," said Ethier.

Finally, structural factors that affect millions of U.S. children, including poverty, food insecurity, homelessness, and lack of access to health care and educational opportunities, can lead to stress-response patterns that are known to underlie mental health challenges.

"Even in very young children, prolonged stress can trigger a cycle of emotion-regulation problems, which can in turn lead to anxiety, depression, and behavioral difficulties," Hoagwood said. "These things are well established, but we're not doing enough as a field to address them."

Building capacity in schools

The biggest challenge facing mental health care providers right now, experts say, is a shortage of providers trained to meet the mounting needs of children and adolescents.

"There's a growing recognition that mental health is just as important as physical health in young people's development, but that's happening just as mental health services are under extreme strain," said clinical psychologist Robin Gurwitch, PhD, a professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center.

Schools, for example, are a key way to reach and help children-but a 2022 Pew Research Center survey found that only about half of U.S. public schools offer mental health assessments and even fewer offer treatment services. Psychologists are now ramping up efforts to better equip schools to support student well-being onsite.

Much of that work involves changing policies at the school or district level to provide more support for all students. For example, school connectedness-the degree to which young people feel that adults and peers at school care about them and are invested in their success-is a key contributor to mental health. Youth who felt connected during middle and high school have fewer problems with substance use, mental health, suicidality, and risky sexual behavior as adults ( Steiner, R. J., et al., Pediatrics, Vol. 144, No. 1, 2019).

Through its What Works in Schools program, the CDC funds school districts to make changes that research shows foster school connectedness. Those include improving classroom management, implementing service-learning programs for students in their communities, bringing mentors from the community into schools, and making schools safer and more supportive for LGBTQ+ students.

Psychologists are also building training programs to help teachers and other school staff create supportive classrooms and aid students who are in distress. Classroom Wise (Well-Being Information and Strategies for Educators), developed by the Mental Health Technology Transfer Center Network and the University of Maryland's National Center for School Mental Health (NCSMH), is a free, flexible online course and resource library that draws on psychological research on social-emotional learning, behavioral regulation, mental health literacy, trauma, and more ( Evidence-Based Components of Classroom Wise (PDF, 205KB), NCSMH, 2021).

"We're using evidence-based practices from child and adolescent mental health but making these strategies readily available for teachers to apply in the classroom," said clinical psychologist Nancy Lever, PhD, codirector of NCSMH, who helped develop Classroom Wise.

The course incorporates the voices of students and educators and teaches actionable strategies such as how to create rules and routines that make classrooms feel safe and how to model emotional self-regulation. The strategies can be used by anyone who interacts with students, from teachers and administrators to school nurses, coaches, and bus drivers.

"What we need is to build capacity through all of the systems that are part of children's lives-in families, in schools, in the education of everybody who interacts with children," said psychologist Ann Masten, PhD, a professor of child development at the University of Minnesota.

Other training efforts focus on the students themselves. Given that preteens and teenagers tend to seek support from their peers before turning to adults, the National Child Traumatic Stress Network (NCTSN) created conversation cards to equip kids with basic skills for talking about suicide. The advice, available in English and Spanish, includes how to ask about suicidal thoughts, how to listen without judgment, and when to seek guidance from an adult ( Talking About Suicide With Friends and Peers, NCTSN, 2021).

While training people across the school population to spot and address mental health concerns can help reduce the strain on mental health professionals, there will always be a subset of students who need more specialized support.

Telehealth, nearly ubiquitous these days, is one of the best ways to do that. In South Carolina, psychologist Regan Stewart, PhD, and her colleagues colaunched the Telehealth Outreach Program at the Medical University of South Carolina in 2015. Today, nearly every school in the state has telehealth equipment (Wi-Fi and tablets or laptops that kids can use at school or take home) and access to providers (psychology and social work graduate students and clinicians trained in trauma-focused cognitive behavioral therapy). Students who need services, which are free thanks to grant funding or covered by Medicaid, meet one-on-one with their clinician during the school day or after hours (American Psychologist, Vol. 75, No. 8, 2020).

"We learned a lot about the use of technology during the pandemic," Ethier said. "At this point, it's very much a matter of having sufficient resources so more school districts can access those sources of care."

Expanding the workforce

Limited resources are leaving families low on options, with some young people making multiple trips to the emergency room for mental health-related concerns or spending more than six months on a waiting list for mental health support. That points to a need for more trained emergency responders and psychiatric beds, psychologists say, but also for better upstream screening and prevention to reduce the need for intensive care.

"Just as we need more capacity for psychiatric emergencies in kids, we also need an infusion of knowledge and ordinary strategies to support mental health on the positive side," Masten said.

In New York, Hoagwood helped launch the state-funded Evidence Based Treatment Dissemination Center in 2006, which offers free training on evidence-based practices for trauma, behavioral and attention problems, anxiety, depression, and more to all mental health professionals who work with children in state-licensed programs, which include foster care, juvenile justice, and school settings, among others. The center provides training on a core set of tools known as PracticeWise ( Chorpita, B. F., & Daleiden E. L., Journal of Consulting and Clinical Psychology, Vol. 77, No. 3, 2009). It also offers tailored training based on requests from community agency leaders and clinicians who provide services to children and their families.

Hoagwood, in collaboration with a consortium of family advocates, state officials, and researchers, also helped build and test a state-approved training model and credentialing program for family and youth peer advocates. The peer advocate programs help expand the mental health workforce while giving families access to peers who have similar lived experience ( Psychiatric Services, Vol. 71, No. 5, 2020).

Youth peer advocates are young adults who have personal experience with systems such as foster care, juvenile justice, or state psychiatric care. They work within care teams to provide basic education and emotional support to other youth, such as giving advice on what questions to ask a new mental health practitioner and explaining the differences between psychologists, psychiatrists, and social workers. Youth peer advocates in New York can now receive college credit for their training in peer specialist work.

"Making community health work into a viable career can also increase diversity among mental health workers and help us address structural racism," Hoagwood said.

Pediatricians are another group that can provide a first line of defense, drawing on their relationships with parents to destigmatize mental health care.

"Pediatricians are in many ways uniquely positioned to help address the mental health crisis in youth," said Janine A. Rethy, MD, MPH, division chief of community pediatrics at MedStar Georgetown University Hospital and an associate professor of pediatrics at Georgetown University School of Medicine. "We have the privilege of building long-term relationships with children and their families over many years," with at least 12 well-child checkups in just the first three years of a child's life, followed by annual visits.

During these visits, they can watch for warning signs of social and behavioral problems and screen for maternal depression and other issues in parents, which is now recommended by the American Academy of Pediatrics (PDF, 660KB). Several new resources provide guidance for integrating mental health care into pediatric practices, including the Behavioral Health Integration Compendium (PDF, 4.1MB) and the Healthy Steps program. But most pediatricians need more education on mental health issues in order to effectively respond, Rethy said-yet another area where psychologists may be able to help. Psychologists can provide direct consultations and training to pediatricians through the Pediatric Mental Health Care Access program.

"The more we can weave mental health knowledge, capacity, and checkpoints into places where parents feel comfortable-like the doctor's office and at school-the better," Masten said. "All professionals who work with young people really need the knowledge that's being generated by psychologists."

11 emerging trends for 2023

Further reading

Science shows how to protect kids' mental health, but it's being ignored
Prinstein, M., & Ethier, K. A., Scientific American, 2022

How pediatricians can help mitigate the mental health crisis
Rethy, J. A., & Chawla, E. M., Contemporary Pediatrics, 2022

Review: Structural racism, children's mental health service systems, and recommendations for policy and practice change
Alvarez, K., et al., Journal of the American Academy of Child and Adolescent Psychiatry, 2022

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Kids' mental health is in crisis. Here's what psychologists are doing to help

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Research is focused on child and teen mental health, exploring why they are struggling and what can be done to help them

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School program gives teens struggling with mental health tools to overcome difficult emotions

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One of NAMI's main goals is to ensure that people get help early. Since mental health conditions typically begin during childhood, adolescence or young adulthood, we have compiled essential information and resources intended to help young people get the mental health support they need.

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Finding Help, How to Talk to Friends, Social Media and Mental Health, and More

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Finding Help, How to Talk to Friends, Social Media and Mental Health, and More

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Teens | NAMI: National Alliance on Mental Illness

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Teenage years bring on so much change that it can leave your head spinning. Your body begins to change, you sound/look more like an adult and keeping up with friends can feel like a full-time job. What you may not realize is that while your body matures, so does your brain.

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Drawing can be an act of self-care - releasing stress, boosting creativity, and promoting mindfulness.

Drawing therapy, while not an official name, is essentially drawing as a form of coping and self-care.

Many believe that art (and other forms of creativity) can be healing. Drawing - and other forms of art - can help you release stress and anxiety.

You can draw at home to boost your imagination and creativity, be more mindful and grounded, and relieve anxious thoughts. You can also work with an art therapist to help you manage mental health conditions or trauma.

The phrase "art therapy" is often thrown around to describe art as therapy, but there's also a type of psychotherapy called art therapy.

According to the Art Therapy Credentials Board, Inc. (ATCB), "art therapy uses art media, the creative process, and the resulting artwork as a therapeutic and healing process."

Anyone can use art as a form of self-care, mindfulness practice, or a way to cope with stress. But in art therapy, you're typically working with a trained mental health professional to manage symptoms and conditions - often working on issues that are harder to express in words, like trauma.

Essentially, art therapy is art plus psychotherapy.

A lot of research of varying quality and size has explored the benefits of art and art therapy for mental health.

In a 2010 research review, researchers said that engaging in art had noteworthy positive benefits on health. When doing art, you're exercising your creativity and imagination, which can help you find your identity and capacity to heal.

According to the ATCB, art therapy can benefit people by helping them:

have also noted that creative art therapy can help with the burden of physical and mental health symptoms, and help you adapt in stressful situations.

Lots of research has shown potential benefits, including:

A 2018 study found students had more mindfulness and less test anxiety, whether coloring or free drawing.

A small 2020 study in 60 undergrad students reported that whether they were assigned to draw a design, color a design, or draw to express negative thoughts, students' anxiety decreased, along with their heart rate.

A 2019 trial suggests 10 to 12 sessions of art therapy lowered anxiety and improved quality of life in women diagnosed with anxiety disorders.

It's important to note that most research does study art therapy - art activities under the guidance of a mental health professional. Still, you can find many personal benefits from doing art on your own.

'Stress drawing' for stress relief

With the amount of possible things you can do to relieve stress and prioritize self-care, you might wonder: Why choose drawing?

It's accessible. You really only need some blank paper and a pencil. Unless you want to get fancy, it's affordable, and you can do it from anywhere.

It's flexible. You can do it alone or with friends, virtually, or in person.

It's good for everyone. All ages and identities are welcome.

You don't need to be an artist. You might think some skill at drawing is necessary, but that's not true at all. It's about the process of drawing, not the art produced.

You may find that drawing helps you express yourself, grounds you, or just distracts you from ruminating thoughts.

If you're ready to draw to relieve stress or connect with your creativity, here are some ways to start:

1. Prepare. Grab your supplies, whatever that may be. You don't need to go shopping - you can use any supplies you already have lying around. You can start with a blank piece of paper, plus any pens, pencils, or markers.

2. Find your space. Sit down in a space where you can (hopefully) have at least 20 minutes to yourself. Consider sitting down with a glass of water (or bonus: a calming tea!) and sitting comfortably.

3. Set your timer and breathe. You can set a timer for 20 to 60 minutes, though you may want to start with 20 and work your way up. If you want to add some mindfulness, once you hit start, begin with a few deep breaths (5 or 10) to ground yourself in the moment.

4. Draw. Try to be present while you draw, and remember: There's no judgment here. You can scribble circles for 20 minutes if you want - it doesn't need to be museum-worthy.

The content of what you draw doesn't really matter if it brings you joy or a moment of release. If you're still not sure where to get started, here are a few options you can try at home.

1. Scribbling

Some people flourish with a blank canvas, while others may find the possibilities too overwhelming.

You might want to start with a blank piece of paper and see what happens. Try scribbling to your heart's desire.

Just remember that you don't have to create something beautiful. Think of it like stream of consciousness, but with shapes, squiggles, and words.

2. Drawing shapes

If scribbling without direction just doesn't work for you, you could set yourself some shapes. You could draw tons of tiny circles in a large square, lines, or a mix of shapes like creating your own game of Tetris art.

Whatever shape (pun intended) your drawing takes, let it.

3. Drawing prompts

Whether you're a professional artist or only have a #2 pencil, there are thousands of prompts online to give you some inspiration to draw.

Here are just a few that you can try:

Drawing designs that resonate with you, like your favorite animal, flower, or memento.

Drawing at least 10 things that symbolize or express what you're grateful for. (Bonus: Gratitude can also help boost your mood.)

Drawing what you see from where you sit - the surface, what you're drawing with, the window, the decor.

Drawing to express what you're feeling right now. Sketching out your negative thoughts or stress about a situation are two good examples. You can even split the time between opposites by drawing negative thoughts for 10 minutes and then logical, positive ones for another 10 minutes.

4. Mandalas

Mandala drawing has a long history, but made its way into psychology with Carl Jung, founder of analytical psychology.

Mandalas are spiritual symbols, often in a circle with geometric shapes. The complexity of the patterns and repetition can promote mindfulness.

In a , researchers concluded that mandala drawing could reduce negative emotions and improve spirituality. And according to a small study in 2005, coloring a mandala was shown to reduce anxiety much more than coloring other designs or on a blank page.

You might want to color pre-drawn mandalas, or create your own (and then color them!). This can be a meditative act as well as a creative one.

You can search "mandala drawing prompts" for hundreds of ideas, or start here.

5. Sketching

If you're done with shapes but are adamant that you can't freehand, sketching might be a great option to try.

Sketching involves tracing images, often done with a lighter tracing paper placed on top of whatever you want to draw. You can sketch mandalas, magazines, photos - the limit doesn't exist.

Consider coloring your sketch afterward for continued creativity.

6. Coloring

While some may argue that coloring is not drawing, art is art. Also, a lot of the research on art therapy involves coloring activities, so it can grant us the same stress relief without the need to draw something from scratch.

Coloring options are abundant, with pages you can print online and numerous adult coloring books. You could also color your own drawings, or add color to your drawings with colored markers, ink, or pencils.

7. Mixing mediums

Drawing is one of the most accessible types of art therapies, but you don't have to stop with a pen or pencil. If you've got the supplies lying around or feel like you want to express yourself in more than one way, you can mix art mediums.

Consider:

adding paints, crayons, colored markers, etc.

creating a collage with your drawing by gluing pictures or magazine clippings to it

writing around your drawings (like things you're grateful for, for instance)

You can also add the benefits of music by playing something soothing or your favorite songs while you draw.

Including more art in your life can be as easy as grabbing a pencil and paper.

Still, if you feel like you'd benefit from true art therapy, you can find an art therapist via the American Art Therapy Association's art therapist locator or the Art Therapy Credentials Board (ATCB)'s art therapist search.

If they're certified through the ATCB, they'll typically have the credentials ATR (registered art therapist) or ATCS (art therapy credentialed supervisor).

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Drawing Therapy Techniques to Relieve Stress

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Drawing and other forms of art can be therapeutic in helping to relieve anxiety and stress. Here's how to start.

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Mindfulness and Meditation for Mental Health

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Mindfulness and Meditation for Mental Health

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Daily Calm | 10 Minute Mindfulness Meditation | Be Present