Always and Now: A Reflection on the Importance of Prioritizing AYA Mental Health
August 26, 2020

Reflection shared by:
Iliana White, MPH, CHES, CPH
Senior Program Manager, Adolescent Health
Association of Maternal & Child Health Programs

In the era of COVID-19, there is an increased spotlight on the emotional and mental tolls that this unprecedented pandemic has fueled. When it comes to adolescents and young adults (AYA), their experience in navigating back to school, college campus, or their return to the workforce can be met with stress, anxiety, and a lot of uncertainty. In a recent learning session for the AYA Behavioral Health CoIIN,  Dr. Sharon Hoover of the National Center for School Mental Health discussed strategies to address students’ and school employees’ needs as they return to some form of instruction, whether remote, in-person, or a hybrid approach. As part of her presentation, she touched on the concept of “Always and Now”. With coronavirus, many of our planned public health strategies and activities, including those related to AYA mental health, may have become suspended or shifted to accommodate more pressing emergency responses. When able to focus on the mental health needs of AYAs, strategies are changing to accommodate the current environment we are living in. With schools resorting to spring instruction completely online, stay at home orders, and sometimes the need to quarantine, the massive isolation of young people from their friends, classmates, and other supportive factors can have its toll. There may be an increased spotlight on the implications of being isolated and not being able to access the care or support needed to adjust and live through this modified state of society. Unusual, unprecedented circumstances—that is the Now. But what about the Always?

The concept of Always is a grouping of those ideal, core principles that we as providers, public health practitioners, and adult champions should be embedding in our work and systems that serve young people. Pre-COVID, adolescents were experiencing a variety of mental health conditions, with the top four most prevalent being ADHD, anxiety, diagnosed behavioral problem, and depression (Danielson et al., 2018, Ghandour et al., 2019). The rates of Major Depressive Episode (MDE) have been steadily increasing since 2008 among 12-17 year olds (NSDUH, SAMSHA, 2018); increased suicide rates, especially among females, Black and Latinx, and LGBTQ youth, has been cited as a growing concern for state Title V and MCH programs over the past several years. The bottom line is that youth have been dealing with increasing challenges of navigating their development while trying to understand and maintain their status of mental health since before the pandemic. We can’t simply STOP the work we Always do to improve AYA mental health…how do we ensure young people don’t become further disenfranchised? The prioritization and intention around strategies to address mental health and emotional well-being can’t be put on hold because COVID-19 came along. If anything, the pandemic may exacerbate some of the adverse experiences or lack of social support networks that youth experience. In a recent plenary discussion at the 2020 AMCHP virtual conference, several peer and young adult leaders shared their perspectives regarding mental health, resilience, and how we can support young people. A key theme that kept surfacing is the notion of investment—investing in their support now, so that they can thrive in the present, not just in the future.

We should Always have the calling to ensure that AYA mental health needs and concerns are met with empathy and action. Often, we see their mental health challenges be dismissed as a phase, a temporary episode “that will go away on its own.” The unmet needs of adolescents amplify into unmet needs as young adults. Stress and trauma can continue to be multigenerational. It is easy for young people to feel isolated, disconnected, frustrated, and anxious, especially with how drastically COVID-19 has changed our ways of interacting. In a recent MMWR Report from CDC, a survey found that 25% of young adult respondents ages 18-24 have seriously considered suicide in the past 30 days. Think about that—1 in 4 young adults, the highest out of all the age groups surveyed.

Prior to Coronavirus, and after, a significant amount of youth’s emotional well-being or mental health concerns were not addressed nor treated and thus left to exacerbate. We need to Always make sure we acknowledge their challenges and experiences; support their development in healthy spaces; and encourage them to seek care and act Now to protect and enhance their present and future development. There has been the optimistic mindset regarding the pandemic that “this too shall pass.” Let’s hope the heightened awareness, empathy, and acknowledgement of AYA mental health does not pass also, but rather remains a key priority to monitor and support, Always, and especially starting Now.