The Mental Health Crisis After Covid-19

The US Surgeon General Vivek Murthy, MD recently issued an advisory on the “youth” mental health crisis related to COVID-19 (US HHS, 2021), which, in this case, includes all children, adolescents, and young adults. He stated that the emotional wellbeing of American youth and families was already suffering prior to the pandemic, but now it has reached unprecedented levels of concern. According to Schmidt and Cohen (2020), this crisis was unfortunately expected. In their book on disaster mental health, published just a month before the COVID-19 declaration, the authors explained how vulnerable populations, including youth, are the most impacted by a major disaster, especially one as long-lasting and far-reaching as the pandemic. Further, those individuals who have more than one vulnerability fair the worst. The pandemic has most affected disabled, racial and/or ethnic minority, LGBTQ, rural, low-income, immigrant, and homeless youths. Since this pandemic started, most of the nation’s focus has been on medical concerns, with mental health taking a secondary role. The response to this worsening youth problem must be a nationwide effort taken as seriously as these medical challenges.

Introduction and Literature Review

Over the past several years, national surveys of youth have shown major increases in depression, anxiety, and suicidal ideation (Cohen & Abukhalaf, 2021a; Naser et al., 2020). From 2009 to 2019, the number of high school students with regular feelings of sadness or hopelessness increased by 40%; those who seriously considered a suicide attempt increased by 36%; and the number developing an actual suicide plan increased by 44% (CDC, 2020). Early estimates from the National Center for Health Statistics suggest there were over 6,600 deaths by suicide among the 10- to 24-age group in 2020.2 Between 2011 and 2015, youth psychiatric visits to emergency departments for depression, anxiety, and behavioral needs increased by 28% (Kalb et al, 2019).

COVID-19 has significantly added to youth mental health challenges because of increased isolation, reduced socialization, and less access to healthcare and social services (Cohen et al., 2021; Naser et al., 2021a; Varghese et al., 2021). Anxiety has been further aggravated because of their caregivers’ stress from issues such as reduced income, loss of employment, and maintaining family health and wellbeing (Cohen & Schmidt, 2020; Naser et al., 2021b).

The Surgeon General’s advisory called for a swift and coordinated response to this crisis while the country continues to battle the pandemic, and not waiting until after the medical problem subsides. He made numerous recommendations on how individuals, community organizations, technology companies, and governments can improve the mental health of today’s youth. Top recommendations included: 1) Understanding that mental health is an essential part of overall health and wellbeing, especially at educational institutions (Abukhalaf & von Meding, 2020), 2) Empowering youth and their families to recognize, manage, and learn from difficult emotional responses (Cohen& Abukhalaf, 2021b), 3) Ensuring that all people have the opportunity to access high-quality, affordable, and culturally competent mental health care, especially for minorities (Abukhalaf & von Meding, 2021b), 4) Supporting the psychological wellbeing of youth in instructional, community, and childcare settings, 5) Tackling the economic and social barriers that result in the youth’s and caregivers’ poor mental health, especially cultural differences and language barriers (Abukhalaf, 2021; Abukhalaf et al., 2022), 6) Stressing the need for well-considered data collection, technology, and research in order to better understand and more quickly respond to youth mental health needs (US HHS, 2021;).

Recommendations for the Media and Journalists

Of considerable interest was the advisory’s listing of specific responsibilities for media and journalists, who have had both positive and negative impacts on youth wellbeing. Over the years, the media have provided valuable information about current events and lessons for the youth’s adult years (Paediatrics, 2003). However, the media have increasingly been airing exaggerated and false information, which has enabled misconceptions and increased fears (McGinty, 2013)

Murthy pointed out that the media and journalists must be more diligent in their reporting of news events, with an emphasis on fact-based stories. They also need to promote ways that viewers can make a positive difference through volunteering and personal donations. Similarly, news reports need to avoid harmful stereotypes and promote supportive scientific information when covering mental health issues. Too often, reports generalize that the mentally ill are prone to violence, and the media use derogatory terms as “crazy,” “wacko,” and “loony.” Similarly, added Murthy, whenever depicting suicide or suicidal ideation, it is essential to explain how such behavior is complex and often caused by multiple factors, not a single event. Stories should also show how people are successfully getting treatment and recovering through the support of practitioners as well as friends, family members, and even caring strangers (US HHS, 2021).

The media also frequently exacerbate already disturbing news. The repetitive coverage of disaster footage has been shown to greatly increase fears. Young children believe that each time the same visual is shown, another disaster has occurred (Stafford et al, 2012). The advisory asks the media not to provoke panic and anxiety with these unnecessary graphic images.

In addition, social media has become one of the most believed communication sources, although much of the reporting is incorrect, false, and damaging. Social media is a “double-edged sword,” according to Johns Hopkins computer scientist Mark Dredze (Volkin, 2020).

Although social media has been very effective at sharing positive messages during COVID-19 and previous calamities, it also has motivated people to spread rumors and false narratives. For example, during the pandemic, technology has helped youth connect meaningfully with friends and family, gain new skills, and access healthcare. Yet, much of their time spent online has not only been unhelpful but emotionally hurtful. Social media have led to an increase in areas already of concern as bullying, obesity, eating disorders, personal insecurity, depression, and self-harm (Hill, 2020).

Youth’s time online has continued to increase over the pandemic. The time in front of screens for non-school activities has risen from four to eight hours a day (Nagata, 2021). In 2020, 81% of 14- to 22-year-olds reported having used social media either “daily” or “almost constantly” (Rideout, 2020). As Murthy’s report noted, technology companies have often focused on maximizing time spent rather than time well spent, which has resulted in an increasing concern about its negative impact on the mental health and wellbeing of both children and youth (US HHS, 2021).

“Technology companies must step up and take responsibility for creating a safe digital environment for children and youth,” the advisory reported (US HHS, 2021). In many cases, companies are not transparent about the impact of their products; parents and youth have a difficult time making knowledgeable decisions, and researchers cannot recognize problems and define solutions. Murthy made these specific recommendations on how technology companies can place the wellbeing of users as more important than profit. First, prioritize user health and wellbeing throughout product development. Leaders should be accountable for creating a safe, accessible, and inclusive digital environment for their users and designing safe products. Second, be transparent and allow for independent researchers and the public to study the impact of company products on user health and wellbeing. Third, build user-friendly tools that help children and adolescents engage online in healthy ways. Finally, promote equitable access to technology that supports the wellbeing of children and youth.

Discussion and Conclusion

People of all ages and backgrounds are developing a greater reliance on rapidly expanding digital technology with both positive and negative impacts. One of the major concerns is the growing power of these technology companies. Facebook continues to be sued for data misuse, where private information is leaked. CEO Mark Zuckerberg typically makes his apologies, to U.S. Congress as well as the public, but a similar event typically occurs not too much later. Presently, Facebook has added virtual reality to its offerings and changed its name to Meta. Forbes calls this addition a “privacy nightmare,” since a company that already demonstrates its lack of concern about data misuse, “is placing more sensors in people’s homes, collecting vast amounts of data. You’re then trusting Facebook to keep data private” (O’Flaherty, 2021).

Amazon uses customer information for a host of marketing efforts. A North Carolina State University research study found a range of privacy concerns with user interaction and Amazon’s voice-activated assistant, Alexa. The company does offer privacy protections, including explicit requirements on eight types of personal data – including location data, full names, and phone numbers. However, the researchers found that 23.3% of 1,146 skills that requested access to privacy-sensitive data either did not have privacy policies or their privacy policies were misleading or incomplete (Anupam and Shipman, 2021).

However, it must be kept in mind that benefits also continue to be derived from technology, especially during the pandemic. For example, the growing use of telepsychiatry and digital interventions has been valuable for those individuals who cannot get to a doctor’s office. Cost-effectiveness is also a big asset. The digital platforms help mental health services overcome geographical and social barriers as well as the growing shortage of mental health facilities, especially in rural areas.

This discussion on whether the growing technology and social media are a benefit or disadvantage will surely continue, especially as this technology becomes more advanced and far-reaching. It is not possible to know the exact extent to which the increased use of technology has affected the mental health of youth and other users before and during the pandemic. However, research thus far, as noted above, indicates that it is necessary to be at least very mindful of technology’s growing footprint.

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