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The surgeon general's latest advisory highlights the youth mental health crisis


I've been reading an advisory this morning from the U.S. surgeon general. The paper from Vivek Murthy is called "Protecting Youth Mental Health." It argues that the pandemic multiplied the mental health challenges facing young people all the time. Surgeon General Vivek Murthy is on the line. Surgeon General, welcome back to the program.

VIVEK MURTHY: Well, thank you, Steve. Good to be with you again.

INSKEEP: OK. So anecdotally, I think we all understand the price of isolation, of remote learning, of general stress or even of a death in the family, which many people have faced - millions of kids have faced over the past couple of years. But is it clear to you statistically or academically that there is a problem here?

MURTHY: Well, the simple answer is, yes, Steve. There's a problem now. And there was actually a great crisis with youth mental health that we were facing before the pandemic. And consider these numbers, Steve. Before the pandemic, one in three high school students reported persistent feelings of sadness or hopelessness. That's a 40% increase from 2009 to 2019. In a similar time frame, suicide rates went up 57% among youth 10 to 24. And we've also seen that during the pandemic that rates of anxiety and depression have gone up. So this was a challenge before. The challenge has gotten worse. And I believe that this is a critical issue that we have to do something about now. We can't wait until after the pandemic is over. And that's why I decided to issue this surgeon general's advisory.

INSKEEP: I'm almost afraid to ask why you think the numbers are going up so dramatically even before the pandemic. I'm sure there are many causes. But can you zero in on one that's on your mind?

MURTHY: Well, I do think that many children and young adults who are struggling with loneliness and isolation before the pandemic arrived, that it worsened for many. But it was a problem that was in the shadows, one that was affecting people across the age spectrum. But I think, Steve, if you really want to understand what is driving, we also have to recognize that kids increasingly are experiencing bullying, not just in school but online, that they're growing up in a popular culture and a media culture that remind kids often that they aren't good-looking enough, thin enough, popular enough, rich enough - frankly, just not enough.

And there's an extraordinary amount of stress and trauma that children are experiencing these days, whether it's the stress of gun violence, the specter of climate change, the polarization and conflict that seems to be growing in society or racism and the racial reckoning, especially in the last couple of years, that we've been going through as a country. So you put all of this together, along with the growing influence of social media, which has been positive for some but harmful for others, and you have, unfortunately, the negative impacts on youth mental health that we've been seeing.

INSKEEP: I want to follow-up on social media because you attempt to spend a lot of time in this report on what different communities and groups can do. And one of your categories is "What Social Media, Video Gaming, And Other Technology Companies Can Do." So what can they do?

MURTHY: So they have an important role to play. Technology - and I should just say, we lay out 11 sectors, you know, including technology companies, but also including individuals, families, schools...


MURTHY: ...Workplaces, health care settings. They all have an important role to play here. But with technology companies in particular, this is a time where we need them to step up and, No. 1, acknowledge where harm is happening to our children. No. 2, they've got to be transparent with data on the harms and benefits so that we can understand which children in particular are most at risk. But most importantly, we need them in the long term and short term to design platforms that strengthen youth mental health. The current business model, Steve, of most platforms is built on how they maximize time spent - not time well spent, but time spent. And we need these platforms to be designed to strengthen the mental health of our kids to make them better. And right now, we're conducting this national experiment on our kids with social media. And it's worrisome to me as a parent.

INSKEEP: One of the people conducting that experiment is Adam Mosseri, the head of Instagram, who has to testify before Congress tomorrow, if I'm not mistaken. And some people will recall there were leaked documents from Facebook, which controls Instagram, leaked documents showing internal studies about harm that was done to people using these platforms. Facebook executive Monika Bickert was on this program. And she argued, wait, wait, wait. This is a study of a few dozen kids on Instagram. Instagram had lots of different effects, some of them negative but some of them positive. So let me ask you, do you feel you know enough to be sure that social media is a problem here?

MURTHY: Well, we know enough to know it's a problem for some kids. But what we need to do is to see and understand the data more thoroughly to know exactly who those kids are and what the extent of the harms are. And this is where transparency from the platforms is so important. But I also wanted to say, Steve, that as much as technology has an important role here, what we are calling for in this advisory are much broader changes as well. We're asking for individuals to take action to change how we think and talk about mental health so people with mental health struggles know that they have nothing to be ashamed of, and it's OK to ask for help.

That stigma is so powerful still around mental health, something I experienced as a young person who struggled with mental health. I didn't know that I could ask for help. And I was ashamed. But we're also calling for expanded access to mental health care, for increases in mental health counselors in schools and investments in social-emotional learning curricula in schools, as well as, finally, for parents to - for people to invest in relationships in their life, recognizing that it is our relationships with one another, Steve, that are some of our most powerful buffers to stress and greatest supports for our mental health and well-being.

INSKEEP: What was your struggle when you were young, Surgeon General?

MURTHY: Well, you know, as a young child, I was very shy and had a difficult time making friends. And I struggled a lot with loneliness and a sense of isolation, with anxiety. Certainly, when it came time to go to school, I wasn't nervous about tests, I was nervous about feeling isolated and alone. I unfortunately had to also deal with a lot of bullying, as many kids did and still do, when I was in middle school. And - but with all of that, I felt this same sense of shame, Steve, like it was somehow my fault. Even to this day, even though I have parents who I know unconditionally love me, I never felt comfortable telling them about it because I thought, you know, again, that this was my fault, that I did something wrong. And I didn't know where to go for help, Steve.

And I don't want that to be the reality for my children, who are 4 and 5 and growing up, you know, in this very complicated world. I don't want that to be the reality for kids like the ones I met yesterday at King/Drew High School in LA, who told me story after story about how they have struggled with anxiety and depression and loneliness, and have been unsure about where to get help. So I believe this is a moral imperative, for us to address the crisis of youth mental health. We can't wait any longer. Our kids' health, their well-being, their future, depends on it.

INSKEEP: As you're talking, I'm remembering the writer Brian Broome, who wrote a memoir and was on this program. And he said, quote, "I knew from very young that I was supposed to be tougher than other men. Black men - he's Black - were supposed to be more masculine." In about 20 seconds, what advice would you give to someone who's in a community that feel - they feel a kind of cultural pressure to just keep it all quiet?

MURTHY: Well, I would say, first, if you are struggling with your mental health, you are not alone. Many people are. You are also not broken. There's nothing wrong with you. We all struggle with our mental health. And asking for help is not a sign of weakness. It is a sign of strength.

INSKEEP: Vivek Murthy is the United States surgeon general. Surgeon General, thanks so much for your time today.

MURTHY: Thanks so much, Steve. Good to be with you.

INSKEEP: The surgeon general today has put out a new report on protecting youth mental health.

(SOUNDBITE OF DIAMANS' "PERCEPTION") Transcript provided by NPR, Copyright NPR.