Addressing Common Misconceptions About the Child Mental Health Crisis

The US Surgeon General has called the child mental health crisis “the defining public health crisis of our time.” In 2020, 13 percent of US children aged 3 to 17 had a diagnosed mental or behavioral condition. In 2021, mental health services for children cost $31 billion—47 percent of pediatric medical spending. Childhood mental health issues are linked to lower educational attainment, reduced employment, and increased use of welfare programs. Also, youth suicide rates are especially high in the US; males aged 15 to 19 have a rate four times higher than in France. In Investing in Children to Address the Child Mental Health Crisis (NBER Working Paper 33632), Janet Currie explores three common misconceptions about this youth mental health crisis. 

The child mental health crisis is long-standing, suicide trends reflect external factors like firearm access in addition to underlying mental health, and targeted interventions from prenatal nutrition to school-based support have been shown to significantly improve outcomes.

First, she refutes the idea that the crisis is recent. Historical data show high, consistent prevalence of serious mental health conditions among children: 12 percent in a 1970 Congressional report and 11 percent in the 2000 Surgeon General’s report. Increases in diagnoses such as anxiety and depression reflect expanded diagnostic criteria, better screening, declining stigma, and some relabeling of other diagnoses. For example, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), introduced in 2013, broadened definitions of anxiety and depression. In addition, the adoption of the tenth revision of the International Classification of Diseases (ICD-10) by US hospitals in 2015 increased diagnoses by removing the option to classify the cause of an injury as “undetermined.” 

Changes in provider incentives also played a role. For instance, the 2011 US Preventive Services Task Force recommended annual depression screening for girls over 12, prompting more emergency visits with diagnoses of mood disorders. Reimbursement changes also encouraged hospitals to code depression as a secondary diagnosis.

Second, Currie challenges the belief that suicide trends solely reflect worsening mental health. Though youth suicides rose after 2011 and declined after 2017, self-reported hopelessness began rising only in 2017—just as suicides started falling. This disconnect points to external drivers. Moreover, while child mental health conditions are prevalent throughout the US, geographic variation in suicides is stark: youth suicide rates are about 6 per 100,000 in the Northeast and California, but exceed 30 per 100,000 in rural states like Montana and Wyoming. Notably, youth in states with the highest suicide rates had the lowest rates of screen time use in 2019, weakening potential social media explanations. 

Given the considerable geographic variation in suicide rates, Currie considers whether state firearm policies may be related to suicide rates. She uses state-level data from 1991 to 2021 to estimate that each additional gun safety law reduces youth suicides by 6 percent (from a 6.75 per 100,000 baseline). Conversely, “gun freedom” laws—such as those that repeal concealed carry permits—raise firearm suicides by 16.4 percent among males aged 10 to 19, with no evidence of substitution across suicide methods. 

Third, Currie refutes the notion that investments in children do not improve youth mental health. She reviews the evidence on interventions—from prenatal nutrition programs to school anti-bullying policies to the availability of high-quality medical treatment—that improve mental health. She concludes that this research shows the possibility of mitigating the youth mental health crisis through a range of investments in children throughout the prenatal, early childhood, and adolescent periods. 

— Leonardo Vasquez

The NOMIS Foundation provided financial support for much of the research, although the researcher is solely responsible for the conclusions.