Teen mental health is in crisis. These steps can help.

As a teenager, there were many days when I thought about killing myself. I struggled to come out as gay. The weight of being repeatedly bullied, hearing people speak in disgust about my sexuality, and seeing others get beaten or killed for being themselves made it difficult to accept who I was. At the time, I felt that it would be easier to end the pain by dying. But then something happened.

On one of my darkest days in high school, I learned of someone who was planning a suicide attempt. At first, I was shocked. I didn’t realize why he could want to die; he was good at sports, in a relationship, and seemed to have it all. I was happy to hear that he sought help, and his actions helped me. I reached out to people I trusted and got support. The experience taught me an important, life-altering lesson: You never know what someone may be going through by just looking at them, and it’s better to assume they could be struggling or have been through trauma.

I started training at a suicide prevention hotline when I turned 18 years old and knew I wanted to incorporate suicide prevention work in my life somehow moving forward. As a volunteer suicide prevention counselor, I can remember sitting in an office building at night, alone. Each time I heard the phone ring, I’d get a little nervous knowing that any near-death situation could be on the other end.

Over time, I learned another life-altering lesson: Most people want or need someone to listen to them. People who called the hotline in crisis were from various socioeconomic backgrounds, sexual orientations, races, and ethnicities. We were more alike than we are different.

In college in Washington, D.C., I began to have hope that our nation was heading in the right direction to address the rising suicide rates and mental health public crisis. Federal leaders developed strategic plans to reduce suicide and made it seem like all would be better over time. When I volunteered for the legislative branch of a suicide prevention organization in college, the team was advocating for policy in the proposed Garrett Lee Smith Memorial Act. Named after a U.S. senator’s son who died by suicide, the bill was passed and provides funding (even to this day) for states to pursue youth suicide prevention efforts.

Now, almost 20 years later, the crisis is getting worse, and I’m more worried than ever. We have made some progress, and we have a long way to go. As a pediatric emergency medicine physician for the past 10 years, I have witnessed increasing rates of mental health-related emergencies and suicidality in my young patients.

In 2021, one out of five high schoolers who took part in a survey by the Centers for Disease Control and Prevention reported that they had seriously considered suicide within the past year. The risks were especially pronounced for certain segments of the teen population — nearly one out of three young women said that they had considered suicide, and almost two out of every three LGBTQ youth reported doing so.

In 2020, suicide was the second leading cause of death in the U.S. for youth ages 10-14, and the third leading cause of death for those ages 15-24. The COVID-19 pandemic further exacerbated mental health needs.

I work in an emergency department that cares for more than 100,000 pediatric patients each year. We see patterns, hear stories of struggles, see opportunities for improvement, and live through a spectrum of satisfying and gut-wrenching outcomes. It’s our job to identify and address emergencies, and I don’t know how to sound the alarm any louder regarding the mental health crisis. The barriers to mental health care and access — including limited mental health professionals, long wait times for services, and insurance difficulties — keep climbing, yet the need is higher than ever.

The crisis keeps us up at night, and we know that it is likely going to get worse before it gets better. The vicarious trauma my coworkers and I experience hearing and seeing the repeated struggles needs to be balanced with knowing we are trying our best to ensure children are given the best chance in life. The problems are complex, so we need to be prepared for complex solutions.

We need to start by treating the mental health crisis like the resuscitation of a critically ill patient. In the emergency department, when the code alarm rings, a team with preassigned roles converges to quickly identify the problems and act. If a child comes in with a gunshot wound, everyone has a role: airway management, intravenous access, comprehensive examination, medications, a leader to synthesize information and anticipate next steps, and surgeons at the ready to take the patient to a higher level of care in the operating room.

Each person is valuable, and the team approach offers the best chance for success.

To address the needs of patients in this mental health crisis, our players must include schools, insurance companies, legislators, social media influencers, community and cultural contributors, mental health professionals, and other health-care professionals and administrators — all working as a team to reduce mental health stigma, increase mental health education, minimize treatment barriers and wait times by expanding services and training, and address the difficulties with costs and reimbursements. Some of these solutions will take time; we need to plan for both short- and long-term solutions and simultaneously work on prevention and helping those in crisis.

These solutions will no doubt require a significant investment of resources. An investment upfront from institutions and government is key, but we also need a surge of donations and resources from anyone invested in the well-being of children and future generations.

My colleagues and I will continue to try our best. I am inspired by people already doing great work toward implementing solutions, such as integrating mental health training and clinicians in schools and health-care settings. We must continue to invest in our communities, support mental health legislation, listen to each other, be kind, and keep the best interest of our youth at the forefront. We could all use a boost of hope.

Jeremy Esposito is a pediatric emergency medicine physician at a local children’s hospital. In addition to clinical shifts, he works with teams to improve how we identify and care for youth with mental health concerns.