Inside the Adolescent Mental Health Crisis

PAULA NEWTON, CORRESPONDENT: Now, social media is one factor on a long list that could, in fact, contributing to a mental health crisis among teens. “The New York Times” Pulitzer prize-winning reporter Matt Richtel has spent more than a year interviewing American adolescents and their families as rates of anxiety and depression skyrocket. And he’ll talk to Michel Martin about his series called “The Inner Pandemic,” and the latest installment just out this week, which focuses on how the crisis is impacting teens of color.

(BEGIN VIDEO CLIP)

MICHEL MARTIN, CONTRIBUTOR: Thanks, Paula. Matt Richtel, thanks so much for talking to us.

MATT RICHTEL, PULITZER-PRIZE WINNING REPORTER, THE NEW YORK TIMES: Thanks for having me.

MARTIN: You’ve written a powerful series of articles about adolescent mental health and some of them are very scary, especially to parents and some of them are hopeful too. I just want to — I do want to say that. But what is it that got you started on this work?

RICHTEL: Michel, it actually sprung out of something a bit unexpected. When I started looking at this two years ago, I was intuitively aware, as many are, that saying anxiety and depression, suicide, suicidal ideation, have been going up among young people. And that wasn’t enough to get my interest to spend this much time on a series. What hooked me, Michel, was the second set of facts. And that is that since my generation was in its adolescents over the last, say, 20 to 30 years, there has been a decline in a bunch of other risks. Drunk driving injury and death, teen pregnancy, cigarette smoking, drug use. In other words, what hooked up my interest and our interest was a transformation in risk facing adolescents from those externalized risks to this mental health internalize risks.

MARTIN: I think that over the course of dealing with COVID, the COVID crisis, you know, all around the world, a lot of people, parents, people who are living with teenagers, became aware that something just wasn’t right.

RICHTEL: Yes.

MARTIN: And a lot of people attributed it to COVID or like having to deal with COVID.

RICHTEL: Yes.

MARTIN: But what I learned from your series is that’s just not true. That this predates that.

RICHTEL: COVID amplified a number of things and brought them home as family spent time with their kids. They brought this to the doorstep of emergency rooms, even though it was already happening. The reason that contacts that I alluded to earlier was so significant is we — I also began this by thinking, maybe this is a very recent phenomenon, when, in fact, the context is, this really has been going on since the turn of the century and roughly, let’s say around 2007, 2008, we begin to see these spikes and we begin to see these declines in other risks.

MARTIN: So, talk more about that. Like how did this start? And why did the start? A lot of people seem to think it’s like, oh, this generation is soft or this generation can’t handle anything. Tell me, you know, what is your research indicating? Like how did this start and why did this start?

RICHTEL: The way I describe what’s been happening the last, say, 20 years is that there has developed a kind of neurological mismatch. Now, that is a big phrase, all in packet. In the year 1900, puberty hit girls at the age of 14, boys a little bit later. But now, the average age of menstruation is about 12. It has been falling for a bunch of reasons, I don’t want to get hooked on it. This is the important point, when puberty hits, it awakens the adolescent brain to all kinds of social information. Young people crave that information because they are beginning to make the transition from being cared for by their families to adapting to a social world. What hasn’t changed though, Michel, is that the rest of the brain hasn’t developed any more quickly. The parts of the brain that help make sense of all that information. Here is your neurological mismatch. You have a very hyperaware brain, an early pubescent brain, combined with the thing a lot of viewers may be thinking about, an onslaught of information. And when that information hits the vulnerable brain, it can cause real mental distress.

MARTIN: Really? Like what? Like give me an example of how that works or how that plays out.

RICHTEL: So, everyone has seen beyond the borders of their community. What does it mean to be rich? What does it mean to be poor? What is going on in the protests? What’s going on in the war? The world has become much louder, and at times, the young brain is very sensitive at an earlier age. Now, why does that manifest as trouble for mental well-being? Well, if you’re trying to cope with all of this information, some brains susceptible to being overloaded begin to adapt through coping mechanisms. What do I mean by that? Anxiety, depression, weirdly enough, self-harm, sometimes they can cause or paralyze a brain to find a focal point when otherwise overwhelmed.

MARTIN: OK. Social media. It just seems that a lot of the things that you have talked about as being kind of root causes, some of those do seem to loop back to social media. I mean, you talk about sort of being very invested in technology. You talk about sleep deprivation. You talk about the lack of physical activity. So, why isn’t this a social media problem?

RICHTEL: It’s not a social media problem despite the assumptions that many of us made, including me when I started this, because the actual research is quite conflictual. It shows that some young people using social media per se are — feel worse for having done so, and some feel better. And so, you can’t pin this on social media, it depends somewhat on the susceptibility of the individual person. But we’re really talking about a much larger technological impact and influence on lives. And if I may put a fine point on that, here’s what I mean. You’ve got your kids on social media, but they’re not necessarily the ones who are mainlining the news or bad news as parents are and then, delivering that to kids at the dinner table. The influence of the larger technologically driven sense of competition, of a global economy, of the competitive nature of school, of athletics, of the, world that’s coming from all kinds of places. I can’t put that at the feet of social media even though social media is the dominant way that young people are bringing in their own information.

MARTIN: You talk both about the things that are increasing and also the things that are decreasing.

RICHTEL: Yes.

MARTIN: And the reason I think that this is so interesting is that I think when you — if you think about puberty happening earlier, I think you might think that what would go along with that is more sexual experimentation, right?

RICHTEL: Yes.

MARTIN: I mean, it’s just — it’s so sort of seems logical. But that doesn’t seem to be the case.

RICHTEL: But here’s what else has gone down. Sleep, physical activity, in- person interaction, those things, particularly sleep and activity, are known to help that brain develop. So, if you’ve got a sensitive brain and it’s consuming a lot of information or feeling highly sensitized and not getting that more pastoral time or the sleep, it is really struggling to metabolize that information. Here I borrow from Nora Volkow, who is the head of the National Institutes for Drug Abuse, one of our leading authorities in the country, and she said something that really blew my mind. She said, you know, a lot of these drugs are drugs of social interaction. Here’s a revelation from your “New York Times” reporter, sex requires in-person interaction. So, if you are not, you know, hanging out with other people, if you are online, isolated, you might not participate the same way. You can say there’s pros and cons to that. But factually speaking, the shift in lifestyle driven by technology has, in fact, shifted very much how young people spend their time. And in turn, the kinds of risks they’re experiencing.

MARTIN: And so, talk a little bit about how the shift is manifesting itself. I mean, you’ve already told us like drunk driving, teen pregnancy, a lot of those issues are declining. What is increasing?

RICHTEL: So, what’s increasing, we’re seeing increases in these, let’s call them mental health issues. When we see an increase like this, Michel, we would hope that just as our systems once dealt with broken bones and, you know, car crashes and other facets that pediatricians and emergency rooms were trained to do, we would hope that our current systems would keep up with a shifting risk. One of the issues that’s cropping up is, we have not kept up. There is a systemic mismatch now. So, that mismatch is between the problems young people are grappling with and the systems that we have in place to take care of it. We discovered in the course of the series that between 1,000 and 5,000 young people and adolescents are spending the night in emergency rooms because they are either suicidal, self-harming, or a risk for others, less so that, and there is no place for these young people to go. There are no good community impatient systems, there are fewer outpatient systems than we need. And so, you’re winding up with young people in a setting there that is deciding not set up for this kind of case. Separately, you see pediatricians grappling with stuff like complex mental health issues, that’s what they’ve trained to do. That’s what I mean by systemic mismatch.

MARTIN: So, tell me about the sleep deprivation, like what’s that about?

RICHTEL: My parents wouldn’t let us have a TV in the room, but now, every other device is baked into that iPad or the phone, that is keeping kids up and it’s interrupting their sleep. And if we, as adults, struggle to be in a good mood, struggle to have good relationships, struggle at work, when we’re not getting enough sleep, imagine what it’s like on a still developing brain. And that is still developing brain needs that sleep to develop. If I was to put a fine point on one word in this entire conversation, it would be sleep.

MARTIN: You know what’s interesting, I feel like this is a crisis that is almost hiding in plain sight.

RICHTEL: Yes.

MARTIN: And I’m wondering why — one of the things you’ve said several times is that this crisis is going on, but all the mechanisms to deal with these things aren’t dealing with it. And I’m wondering why you think that is.

RICHTEL: I think it’s an economic phenomenon. We have a system that’s built to care for things a certain way and insurance reimburses a certain way. Let’s take therapy or talk therapy, which is going to lead us to the positive side of this conversation, there are things we can do, they are expensive. They are expensive to put in schools, they take a human power, meaning manpower, woman power, people power, to help get the coping skills to young people. It is easier in many ways to prescribe a pill. It’s easier for the family maybe than going to the counseling. It’s harder to find counseling. Councilors are not well reimbursed. We have not train enough of them. The story that is recently run is about Morehouse Medical School where you see this in the most extreme borne out of a historically black institution. Morehouse Medical School, staffed by black psychiatrists is treating poor teens of color in Atlanta, and this is a group where you see, in the most extreme, the lack of medical specialists, that this is a clinic in Morehouse is the exception that proves the rule. But we’re talking about whole swaths of the country that don’t have access to the high-level specialists or even counseling that they need to address these issues.

MARTIN: Give me an example of somebody — of one of the people that you reported on in the series that just kind of encapsulates this dilemma. One of the things that struck out to me was a kid who had prescribed all of these different medications in a way that just absolutely kind of didn’t make sense.

RICHTEL: This is Renee Smith. She lives in Long Island. And over the course of her high school years, after she became painfully depressed and anxious was prescribed 10 different medications, not all at the same time, but staggered. Many of those medications, Michel, are not expressly approved for use in young people. They’re not expressly approved for use in the combinations that she was getting them. She was not getting better. To be clear, doctors often have the — or do have the wherewithal and the latitude to prescribe these drugs, but she wasn’t also able to find a counselor during that same period. And so, she wound up in this maelstrom of being medicated, of getting worse, of having trouble keeping up in school, of feeling intense pressures. It’s really — I would recommend for readers to go check out the story. But it really shows how a system was out of step with a young person’s internal exploration and suffering.

MARTIN: One of the things that your series does though is it points out that these issues cut different people differently, right?

RICHTEL: Yes.

MARTIN: I mean, that if you’re a middle-class person, if you have educated parents, if you have access to — or, let’s say, educated in the way that gives you access to certain kinds of benefits, then you could wind up being over treated.

RICHTEL: Yes.

MARTIN: And then — but then you also point out in a piece that has just recently run, is that if you are kid who is of means or maybe you’re of the dominant ethnic group, you know, then you wind up being labeled in a whole different way, right?

RICHTEL: What’s happening at the lower end of the economic spectrum were the very same phenomenon, Michel, are happening combined with some young — some early trauma, this is known as an adverse childhood experience and it’s known to create a lot of challenges, psychologically, for young people in a community where there is even less access to specialists. There is such an absence of specialty care that you have school counselors strapped and primary care physician strapped. And here is the punchline. At least in this story that I did, drawing on research going back a decade, you wind up seeing young kids of color who do not have access to care being misdiagnosed often with diagnoses of hostility and aggression when, in fact, they are suffering trauma, depression, anxiety, the same things those upper class or higher class socioeconomic class kids are suffering from. Why is that? Because of the implicit bias and even outright racism that would suggest a person of color is more hostile. That is something that, unfortunately, goes back in our country to its origins. But it’s playing out mental health of young people today in this country.

MARTIN: Well, one of the other things that you point out in your piece and that, frankly, others have noted is that the rate of suicide and self-harm among black kids is rising rapidly.

RICHTEL: Yes.

MARTIN: So, it’s —

RICHTEL: Fasted than any other group. And I’m not sure we exclusively know why, to be frank. But we know that we’ve got to do something about it. It just puts a fine point on what we’re seeing across society.

MARTIN: In the course of reporting, this, I mean, you met a lot of kids and a lot of families. Is there somebody in particular who you just really were inspired by that you hope people will think about when they think of this series?

RICHTEL: Oh, I can’t even put it down to one. I mean, the bigger picture, Michel, that I’ve picked up here is that — and it’s a subject of a longer conversation, and a book I’m writing about “The Purpose of Adolescents.” But what we’re seeing is that these kids are breaking away from their families, since they have always done, and they are, perhaps, suffering, perhaps experiencing some individuality. But then they are returning home wiser. And I have met multiple young people who are going to be the future of our society who have made it through this, ultimately, with more wisdom, much more wisdom than they went into it with and maybe than our society went into this generation understanding. And they’re also equipping us, as parents, with a broader sensibility about what mental health means. And it’s going to be really good for all of us if we get through this moment of crisis.

MARTIN: Matt Richtel, thanks so much for talking to us today.

RICHTEL: Thank, you Michel.