Many clinicians who work with young patients with mental health issues agree they lack enough resources to treat kids and that patients are worse off now than before the pandemic — but they don’t exactly agree on why that is.

POLITICO surveyed 1,400 clinicians to better understand the reasons behind the national youth mental health crisis that continues to perplex government, health and community leaders — who are scrambling to find solutions to slow the rise of kids in need of mental health services.

Here’s what we learned:

report by the National Center for Health Workforce Analysis, which found more than half of the U.S. population lives in an area with a shortage of mental health professionals, with many of those shortages in rural places.

The report also projected substantial shortages of addiction counselors, marriage and family therapists, mental health counselors, psychologists and psychiatrists in 2036.

POLITICO’s survey received 1,400 responses from clinicians, including psychiatrists, psychologists, social workers, counselors, school psychologists, pediatric nurse practitioners, pediatricians and nurses.

A majority of respondents reported a decline in mental well-being among kids since the start of the pandemic.

Survey respondents reported working with children and teens who live in all 50 states, but POLITICO found no connection between where clinicians work and their experience of increasing challenges since the pandemic. The worsening of kids’ mental health was reported widely across the country by clinicians treating patients in cities, suburbs and rural areas.

Respondents identified three top drivers of mental health issues in kids: Social media, social isolation and external events outside their control — such as school shootings, climate change, war and political instability. The clinicians also cited other driving factors, including a lack of independence skills, missing developmental milestones because of the pandemic, pressure to look or be perfect and family instability.

Mental health professionals also cited a number of contributing factors in the youth mental health crisis:

• “Lack of access to resources, poverty, abuse, neglect.”
• “When it comes to resiliency, many children don’t have the cognitive flexibility to adjust to changes in their environment.”
• “Pressures about college admission are another factor. Maybe the biggest factor is the anxiety adults have about teens which causes teens to lose confidence in themselves.”
• “It’s ironic because I believe social media and social isolation both contribute. Social media has been a boon to students previously isolated (LGBTQ+, autism spectrum), but also heightens social comparisons, FOMO, and harassment. Even adults get Zoom fatigue from being stared at by others attending meetings.”
• “Identity politics is causing huge swaths of children to feel unsafe, and is intensifying the need for conformity, therefore increasing pressure to be a certain way.”

Clinicians overwhelmingly reported that anxiety and depression were the top concerns and diagnoses they are seeing increase in frequency and severity among those under age 18.

“It’s anxiety and this fear of being able to step out and try things and being able to fail,” said Dr. Gabriel Cline, a psychologist in Missouri who participated in the survey and agreed to be interviewed. “Kids are more and more isolated. They are super connected via phones, but it’s still isolating. They are afraid of social judgment from their peers — whether it’s real or imagined — and they retreat.”

Cline said he’s seen a spike in juvenile cases of anxiety and depression and only expects the cases of depression to grow in coming years.

“When you have that anxiety and if it doesn’t get better, then they become hopeless and it turns into depression,” said Cline, who noted that he does see improvements when kids receive treatment.

But getting that treatment could prove challenging as providers reported a number of barriers to providing better mental health care to kids.

Here is what some providers told POLITICO about the barriers they face:

• “There are too few practitioners trained to treat children. There is particularly a shortage of prescribers trained to treat children.”
• “Families do not have the bandwidth to address mental health issues outside of school, but the providers cannot adequately address trauma in the schools. I have a hard time, as a social worker, getting a hold of parents and diagnosing problems. It is hard to do a thorough assessment.”
• “Having to choose between paying for therapeutic services and living expenses, inflation, [and] insurance coverage, thinking 4-6 sessions are sufficient.”
• “Insurance reimbursement is TERRIBLE and many providers are turning to self-pay which then limits services to clients that can afford to pay out of pocket.”

When it comes to solutions, survey respondents told POLITICO there isn’t one magic solution and urged policymakers to make multiple investments and reforms to solve the crisis.

Lisa R. Savage, co-founder of Clinicians of Color and a social worker whose Delaware practice employs nearly 100 clinicians focused on treating children and teens, said she wants to see governments stop throwing money at the mental health crisis without thinking through how to effectively use resources. She points to Delaware’s recent mandate that every elementary school employ a counselor or social worker.

“Trying to find social workers who are qualified and want to work with kids is really difficult,” said Savage, who participated in POLITICO’s survey and agreed to be interviewed. “And for the schools lucky enough to find social workers, there was no coordination. You have school social workers, school counselors, school psychologists and therapists — who work for me — all at the same school. There was a lot of support for the kids, but I felt there was a lot of duplication of services.”

In those situations, kids with behavior problems often receive a lot of the resources, while others who may be struggling but doing well in school may be overlooked for treatment, according to Savage.

Savage also points to insurance reform to help increase the number of mental health workers accepting insurance.

“It’s the low reimbursement rates but also insurance companies come in to look at your records and then look for reasons to claw back money and in some states, like Delaware, there is no time limit to do that,” said Savage, who said the clawback demands often total tens of thousands of dollars — long after her therapists have already been paid. “Insurance companies make mistakes, but it’s tough for us to deal with that.”

Methodology: How POLITICO surveyed clinicians about the youth mental health crisis

This report is based on survey data of 1,400 medical and mental health professionals. The survey originated from POLITICO’s efforts to hear directly from clinicians working closely with those under age 18 about what’s fueling a mental health crisis among youth and how to solve it. The survey respondents all self-reported that they were treating people under 18 at the time of the survey, which took place from Feb. 7 to March 20, 2024.

Senior Engagement Editor Erin Smith designed the survey with the help and input from representatives at six professional organizations, including National Association of Social Workers, American Psychiatric Association, American Psychological Association and American Counseling Association.

POLITICO reached out to more than 50 professional organizations for help distributing the survey. The survey was distributed through the organizations that helped with survey testing as well as two dozen other organizations which agreed to share the survey with their members, including American Academy of Child and Adolescent Psychiatry, American College of Emergency Physicians, American Psychiatric Nurses Association, American School Counselor Association, Association for Play Therapy, Association for Behavioral and Cognitive Therapies, Caucus of LGBTQ Faculty & Students in Social Work, Clinicians of Color, Latino Social Workers Organization, National Asian American Pacific Islander Mental Health Association, National Association of Emergency Medical Technicians, National Association of Pediatric Nurse Practitioners, National Association of School Psychologists and National Register of Health Service Psychologists.

Senior Engagement Editor Erin Smith and Health Reporter Daniel Payne read the survey responses. To identify trends and themes across the 1,400 responses while eliminating confirmation bias, Smith analyzed the data using excel sorting, as well as coding using Python programming language produced by ChatGPT-4, a generative AI tool. Data Reporter Jessica Piper fact-checked and updated the analysis using coding from R, a programming language, to account for small language differences in similar answers.