The nation’s youth mental health crisis has garnered attention from public health leaders and policymakers, and rightfully so. Data reveals that American adolescents (generally considered individuals ages 10-19) are increasingly suffering from high rates of both depression and anxiety. Furthermore, major depressive episodes are more prevalent among adolescents ages 16-17 (21.9%), specifically, than any other age group.
The mental health crisis is not limited to America’s adolescents, however. Young adults are also struggling: Individuals ages 18-25 have the second highest prevalence of major depressive episodes, at 17%. Moreover, studies suggest that young adult women and members of the LGBTQ+ community experience higher rates of behavioral health challenges. Other studies suggest significant disparities in treatment for behavioral health care among young adult people of color. Additionally, research shows that half of all lifetime mental health conditions most often begins between the mid-teens and mid-20s.
As it stands, our health and behavioral health care systems generally are only catching the adolescent half of this youth group and are often allowing young adults—those in their late-teens to mid-20s—to be overlooked. Intervention with our nation’s adolescents is imperative to protecting their long-term wellbeing. However, the mental health of our nation’s young adults remains just as vulnerable and, therefore, in need of greater attention from policymakers.
Here’s why young adults are falling through the behavioral health care cracks: At 18, many young adults are preparing for or are undergoing a considerable transition out of formal schooling and into the working world or higher education (in 2020, 40% of 18-24-year-olds were enrolled in college). Many are also preparing to live on their own and financially support themselves, navigating first jobs, and experiencing new social settings and dynamics. Some may be thinking about long-term career goals while others are considering or actively building families. In short, this age group is experiencing more change in just a handful of years than they may ever experience again.
Yet, the change doesn’t stop there: These young adults are often losing, unable to enroll in, or choosing not to enroll in health care coverage. While the ACA allows millions of young adults to retain health coverage through their parents’ insurance, the U.S. Census Bureau found that individuals ages 19-34 still have the highest uninsured rate as compared to all other age groups.
But even when these young adults do have insurance, they are transitioning into adulthood without solid access to a primary health care provider. This is a major problem, as primary care is an entryway into the health care system that young adults utilize less than other age groups. They tend to be healthier overall and, as such, may find the investment of time and money into finding a primary care provider less pressing than other immediate needs, such as paying for housing. Furthermore, finding a primary care provider can feel confusing, daunting, and time-consuming. Without this vital link to care that existed in their adolescence, many young adults are forgoing access to health and behavioral health services at the exact moment when they may need them most.
This trend is worrisome, as primary care providers remain one of the key entry points into the health care system at large. And thanks, in part, to increasing efforts to integrate behavioral health into primary care, primary care providers are increasingly a gateway for individuals to access behavioral health care services. (Coverage of preventative health services—including behavioral counseling—provided under the ACA are in jeopardy, pending Kelley v. Becerra, as of this writing.)
While addressing both adolescent and adult behavioral health challenges at large, we must not allow our nation’s young adults to fall through the cracks. The same reason we focus on adolescent mental health and wellbeing holds true for young adults: Health and wellbeing in these early years are a determining factor for health outcomes later in life.
Numerous studies have captured the causes of low health coverage enrollment rates—and subsequently low rates of primary care provider visits—among young adults. An oft cited—and quite reasonable—explanation is that young adults tend to be physically (although not always mentally) healthier than older adults and, therefore, more willing to forgo coverage. Policy makers often call this group “young invincibles.”
The price tag of both employer-sponsored insurance and ACA Marketplace plans likely compounds this reluctance to enroll in coverage: according to the Peterson-KFF Health System Tracker, an insured young adult, on average, spent about $3,834 on health care in 2019. Based on available income data, many young adults may therefore be spending more than the recommended 10% of income on health care costs. Moreover, even when health care is offered, affordable, and robust, access to behavioral health care providers can remain out of reach. Even an informal survey of young adults will reveal that many remain unsure of their health care options.
Consequently, it is important to rethink how we communicate with young adults about their health care—and more specifically, their mental health care—options, as well as how we address health care costs at large. The Department of Health and Human Services has attempted to assist young adults by providing them with more resources to help them navigate open enrollment in ACA marketplaces, for instance. The federal government also has online resources for young adults to help them better understand their choices. Furthermore, there is growing recognition that college students, more specifically, need assistance balancing their academic careers with behavioral health challenges. However, more can be done.
BPC continues to promote behavioral health and primary care integration to enhance patient access to mental health and substance use disorder treatments, improve patient outcomes, and support mental health parity. BPC also continues to recommend sustained federal support to fully implement the 988 Suicide and Crisis Lifeline, which offers an unprecedented opportunity to connect all Americans to the behavioral health care services they require. And, this January, we will release a report promoting greater use of the non-licensed behavioral health workforce (e.g., peer support specialists and community health workers) to help fill gaps in care due to the behavioral health workforce shortage and, ideally, expand access to care for all Americans. We also recently released a report addressing the increasing costs of employer-sponsored health insurance, which is important for young adults who are able to access insurance through their employers. Indeed, all of the recommendations we’ve made to boost the access to and strength of the nation’s behavioral health care system should benefit young adults.
Moreover, the increased attention to the youth mental health crisis and the subsequent awareness of the issue has resulted in real change. We have witnessed efforts by both the Biden administration and Congress—Democrats and Republicans—to address the crisis, as well as concerted efforts by policymakers, researchers, and advocates to integrate behavioral health care with pediatric primary care. BPC looks forward to promoting and advancing these efforts through additional work in 2023 to improve access to care and enhance youth mental health outcomes.
The nation’s future does not rest solely on our adolescents—America’s young adults also are our future. We must not forget about them when looking to address the nation’s behavioral health challenges.
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