James' World 2

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Our teenagers are in trouble.

Headlines have been ringing loud alarms around adolescent mental health, and the data are sobering. In 2023, 40 percent of high school students surveyed by the Centers for Disease Control and Prevention said they persistently felt hopeless or sad in the past year. Nine percent had attempted suicide.

Some of it is because of COVID. Some of it is related to social media. Then there is bullying, the pressure to succeed academically, the pressure to fit in. Being a teenager in the U.S. is hard.

So it’s perhaps heartening to see President Donald Trump address mental health in a recent executive order (EO) targeting chronic health issues in children, one released as soon as Robert F. Kennedy, Jr., was confirmed as the director of the Department of Health and Human Services.

But nestled in this directive, which creates an RFK, Jr.–chaired commission to “Make America Healthy Again,” are words that speak to the doubt that he and Trump have tried to sow around established science. This includes suggestions that the research funded by the National Institutes of Health and other agencies isn’t “gold standard” and assertions that doctors are overprescribing medicines for conditions such as attention deficit hyperactivity disorder and

depression and that “medical treatments” might be part of the pediatric chronic disease problem. Perhaps most troubling is the language the administration uses to describe prescription medications for mood and behavior disorders—they are a “threat.”

That language stigmatizes families who choose prescription medication to treat their struggling children. It undermines the expertise of medical professionals. And it opens the door for unproven, improperly studied treatments to gain legitimacy.

The next era of snake oil dawns. Won’t anyone think of the children?

According to the CDC, in 2021 and 2022, more than half of U.S. teens talked to a health care provider about their mental health. About 14 percent of teens reported taking medication to manage their emotional state or for concentration and behavior. Yet 20 percent said they have unmet mental health needs.

The Affordable Care Act, and before it, the federal parity law, introduced a lot of Americans, including perhaps these teens’ parents, to parity in mental health coverage—in theory, insurance plans can’t deny mental health coverage, charge ridiculous rates for coverage that included mental health or put limits on the amount of mental health coverage a plan allows.

But even if you have insurance, depending on where you live, finding mental health care for children can be incredibly difficult. Many providers, whether therapists or psychiatrists, don’t take insurance, or don’t take certain plans. This includes Medicaid but also large commercial plans. Many primary care doctors, including pediatricians, have limits on what aspects of mental health care they are comfortable managing, including medication. In rural parts of the U.S., there are hundreds of counties that do not have a single child psychiatrist.

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