Are We Thinking About the Youth Mental Health Crisis All Wrong?

Chloé Johnson, 22, has been feeling hopeless lately.

She’s struggling to focus on classes at her local community college in Dallas while also working full-time, making $18 an hour as a receptionist.

Her car broke down, so the $500 that she had managed to save will now go toward a down payment for a used vehicle.

And she was recently passed over for a promotion.

“Right now it just feels, like, very suffocating to be in this position,” said Ms. Johnson, who was diagnosed last year with bipolar II disorder, depression and A.D.H.D. “I’m not getting anywhere or making any progress.”

It’s an endless loop: Ms. Johnson’s mental health has worsened because of her financial difficulties and her financial problems have grown, partly because of the cost of mental health treatment but also because her disorders have made it more difficult to earn a college degree that could lead to a more lucrative job.

“I’ve failed several classes,” she said. “I burn out really easily, so I just give up.”

The mental health of adolescents and young adults has been on the decline and it’s partly because of “harmful megatrends” like financial inequality, according to a new report published on Tuesday in the scientific journal The Lancet Psychiatry. The global trends affecting younger generations also include wage theft, unregulated social media, job insecurity and climate change, all of which are creating “a bleak present and future for young people in many countries,” according to the authors.

Why focus on global trends?

The report was produced over the course of five years by a commission of more than 50 people, including mental health and economic policy experts from several continents and young people who have experienced mental illness.

The authors argue that mental health is not merely an individual issue to be tackled after someone becomes unwell; it is also necessary to focus collectively on the environmental, social, economic, political and technological changes that contribute to mental distress.

While the “megatrends” identified in the report have been around for decades, the authors argue that they have worsened.

“We need to rapidly invest in early intervention” as well as new treatments and new ways of caring for people, said Dr. Patrick McGorry, the lead author of the report and a psychiatrist in Australia. “If young people end up dying, on welfare or even just underachieving in large numbers, then social cohesion and productivity are seriously affected. That is happening now.”

Financial and environmental worries weigh heavily on young people.

While research and public discourse tends to focus on the potential negative effects of social media and screen time, the report’s authors emphasized that economic and environmental factors can also play a large role in the decline of youth mental health.

According to the Lancet commission, economic trends of the last two decades have contributed to problems like rising student debt, disparities in wealth between the older and younger generations and the difficulty in both finding and keeping a job.

Young adults like Ms. Johnson have been reporting higher stress levels than older generations, according to a 2023 survey from the American Psychological Association. The survey found that people between ages 18 and 34 are more likely than older adults to report that they feel “consumed” by their worries about money.

Climate worry is also becoming a more common complaint. Online searches for subjects related to climate anxiety have surged. Professionals have created peer support groups, an online directory of climate-aware therapists, and certification programs in climate psychology.

Michael, 38, who is using his middle name to protect his privacy, said that his anxiety over the state of the environment began when he was in his early 30s and he has since sought therapy to treat it.

“It seems like there’s no care whatsoever for the world around us,” said Michael, who lives in Baltimore. Small things, like seeing fleets of trucks delivering items to people’s homes or trash in the waterways, make him feel angry or fearful about the future. The “reckless abandon” is “very hard to deal with,” he added.

The old approach isn’t working, experts say.

The commission’s decision to focus on the societal changes that contribute to mental health problems signals a paradigm shift in the field, said Dr. Lisa Fortuna, chair of the American Psychiatric Association’s council on children, adolescents and their families.

While it is important to make sure that an individual’s mental health needs are addressed, psychiatrists and other mental health practitioners are increasingly recognizing the importance of stepping back to look at the broader problems that affect people, including racism, income inequality and barriers to accessing mental health services, added Dr. Fortuna, who was not part of the Lancet commission.

The new report offers multiple suggestions, including additional public funding toward youth mental health, improved housing and rental affordability and accessible educational opportunities. The authors also emphasized the need to provide continuity of mental health care between the ages of 12 to 25 as patients transition into adult services upon turning 18.

“They were 17 yesterday. They’re 18 today, but they’re not that different,” Dr. Fortuna said. It’s a “very vulnerable age,” and teenagers can benefit from sticking with a provider who has a deep understanding of that stage of development, she added.

Other priorities include the need to develop mental health services that are sensitive to a client’s cultural identity and asking young people who have experienced mental illness to partner with the organizations that aim to help them.

The data clearly points “to an increasingly sick society,” Dr. McGorry said. “No one could claim to be in the dark anymore.”