against isolation, though it certainly doesn’t replace our in-person lives. So the solution isn’t to cut it out of young people’s lives, but to help them develop a healthy relationship with it. Q: Across so many measures, COVID-19 has hit low-income and minority communities the hardest. Is the mental health toll of the pandemic also disproportionately affecting these communities? A: We know that the pandemic exacerbated economic inequalities, and economic stress and hardship are among the greatest predictors of mental health incidents. Often, there’s a focus on mental health in youth as being related to academic stress and pressure to perform. That’s true, but it’s secondary compared to financial hardship and the stress of living in poverty. Also, the pandemic has led to much higher rates of death and illness among people of color in the U.S., and the resulting grief and stress have undoubtedly contributed to additional mental health challenges. Q: What is your takeaway regarding the U.S. surgeon general’s advisory on the need to address the nation’s youth mental health crisis? A: I was really pleased that the report reflected a public health approach to mental health. It’s clear that the
solutions must involve not just providing more access to mental healthcare, but doing more on prevention and creating healthy, supportive environments in schools, families, and neighborhoods. Mental health is affected by many different factors, and the response needs to be multifaceted rather than just focusing on individual problems and treatments.
“ Mental health for children and young adults was already on the rise as a public health issue, and the pandemic has shone a brighter spotlight on that.”
Q: What should we be investing more in from a public health standpoint? A: First, we could do a better job of using evidence to guide our investments. There are a number of programs and services with strong evidence of both efficacy and cost-effectiveness that reach a very small percentage of people who would benefit, while many programs and services without great evidence reach a large number of people. At the youngest ages, home visiting programs such as the Nurse-Family Partnership, in which a trained professional visits families on a schedule to help parents get their child off to the best possible start in life, have been shown to be very effective. Schools over the last few decades have increasingly adopted programs where the idea is to teach not just academic skills, but also social and emotional skills, and we have good evidence that some of
these programs improve children’s behavioral and emotional outcomes. And on the treatment side, for adolescents who are experiencing severe mental health problems, multisystemic therapy, which provides intensive services to assist caregivers of these at-risk youth, shows good evidence that it can help turn things around and prevent costly outcomes. I think it’s important to be realistic about the fact that our evidence about what’s effective is not as complete for prevention approaches. The problem is that our system is skewed toward generating more evidence for treatment and less for prevention. Prevention programs are harder to study, because they operate on a larger scale. But we need more and better research, in addition to more investment in a prevention and public health approach to mental health. ph.ucla.edu
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