McKinsey Health Institute

Getting to the bottom of

the teen mental health crisis
From identifying the effects of social media and the COVID-19 pandemic, to
overcoming stigma and expanding accessibility to care, there’s lots to unpack
around teen mental health. How do we help tomorrow’s workforce today?

September 2023
 The stakes are high when it comes to tackling the Harold Koplewicz: The most chilling fact is that
unprecedented mental health issues facing today’s the numbers of teen suicides jumped from 2007
teens. In this episode of The McKinsey Podcast, to 2018.
global editorial director Lucia Rahilly speaks with
McKinsey partner and coleader of the McKinsey And that’s before the pandemic. I think the only
Health Institute Erica Coe and the founding president thing we can see that changed in society at
and medical director of the Child Mind Institute, that time was social media. We should seriously
Harold Koplewicz, about what the struggle means consider US Surgeon General Vivek Murthy’s
for society at large. advisory that social media could be very dangerous
for certain teenagers, and particularly ones who
Then, Maggie Smith, author of You Could Make This have a mental health disorder.
Place Beautiful (Atria/One Signal Publishers, April
2023), shares how grief can be transformative, in an
interview excerpt from our Author Talks series. The social media mire
Lucia Rahilly: Erica, you and some colleagues at
This transcript has been edited for clarity and length. the McKinsey Health Institute recently authored
an article on the impact of social media on Gen Z, in
The McKinsey Podcast is cohosted by Roberta particular. Many parents fret about social media
Fusaro and Lucia Rahilly. usage among their kids, citing FOMO [fear of missing
out], body image, and other challenges. What did
you learn from conducting this research?
A mental health imperative
Lucia Rahilly: We hear much about the crisis of Erica Coe: It was eye-opening. It was a global
mental health among teenagers. Harold, would you survey across 26 countries with over 40,000
give us a sense of what you’re seeing in your work respondents. We were able to not only get a close
leading the Child Mind Institute? look at Gen Z perceptions and behaviors but also at
how they compare to other generations. Gen Z
Harold Koplewicz: The youth mental health crisis is reported a perceived mental health that was much
very real, but it’s also a global crisis. Worldwide, at poorer than any other generation.
least 200 million children and teenagers struggle
with a mental health disorder. And in the US, around When it comes to social media and tech, we know
17.1 million young people have a mental health that they are not going away. Therefore, an important
disorder by the age of 18. aspect of the survey is how are people using social
media and tech? What is leading to the positive
Girls, in particular, are really in crisis. According to impacts versus the negative impacts? While a third
the CDC [US Centers for Disease Control and of respondents reported a positive impact on their
Prevention] report from earlier this year, almost body image, almost as many reported a negative
60 percent of US teen girls said they felt impact on their body image.
persistently sad or hopeless. And one in three
seriously had contemplated attempting suicide Interestingly, those in Generation Z were much more
in 2021. That’s almost a 60 percent increase likely to experience negative effects from social
from the decade before. media interaction, to interact in very passive versus
active ways, compared to older generations.
Lucia Rahilly: How much of this diminished mental
health do you attribute to the pandemic?

2 Getting to the bottom of the teen mental health crisis

Lucia Rahilly: Erica, say a bit more about passive Harold Koplewicz: Well, there was a clear increase
versus active and what that means. in social media use by both kids and adults during
the pandemic. And following the pandemic, if
Erica Coe: There have been a number of studies parents were overusing the internet, their children
that have shown that passive interactions, like were likely to be overusing it too. Later, in February
scrolling through Instagram posts or seeing all the 2021, we found that these shifts persisted.
experiences others are having, could be linked to
declines in subjective well-being over time. We know that the more hours parents spend on the
internet has a definite effect on kids. As many as
If you are using social media in active ways, it might 50 percent of adults were watching digital media for
not only be DMing [direct messaging] people, four or more hours a day, along with 40 percent
but also using it for professional connections, and of their children. That is a worrisome amount of time,
to develop social circles. because the more hours you spend on the internet
or social media, the less hours you sleep. There
Compare that to passive interactions, where is more sleep deprivation, there’s less exercise, and
you’re seeing how many likes something can get. there’s less real live interactions. And we
Even giving something a thumbs up still falls certainly need all three of those for healthy
into the passive bucket, because you’re not actually brain development.
interacting with others in a different way.
After 24, you’re no longer considered an adolescent,
but adolescence and childhood are crucial periods
Stuck on screens for brain development. So problematic internet
Lucia Rahilly: Harold, what does your research usage can have a very severe effect presently and in
say about the amount of time teens are spending the future.
on screens?
Lucia Rahilly: Erica, did you want to add
Harold Koplewicz: We looked at problematic anything there?
internet usage throughout the pandemic, which was
defined as internet use habits that negatively Erica Coe: When we did our global survey across
impact quality of life. Our survey suggested that 26 countries, close to three-quarters of Gen Z
screen usage went up and stayed up in the first respondents felt they spent too much time online.
years of the pandemic. Between the baseline Often, there’s an acknowledgement that it’s
assessment in 2019 and our survey in May 2020, probably not the best thing, but it’s hard for them
the majority of kids went from spending less to get away from it.
than an hour a day gaming to spending one to three
hours or more. And prepandemic, less than Harold Koplewicz: There’s an addictive quality here
20 percent of kids used streaming video for four that has a different effect on an adult brain than on
hours a day or more, but by May 2020 (remember, a teenager’s brain. It’s widely known that algorithms
we were shut down by then) we found that are built to keep people on the platforms as long as
number had doubled, with 40 percent spending possible. Therefore, sometimes it’s directly harmful.
four or more hours a day watching video online. But the content on these platforms is based on very
user-specific data—for instance, someone worried
Lucia Rahilly: That’s such a significant jump. about their weight or someone thinking about
Anything more to say about the research on tech exercise and dieting. This can be very divisive content
usage among teens? for a teenage girl or for a teenage boy in a way that

Getting to the bottom of the teen mental health crisis 3

 ‘We believe our educational system is
so good that kids will just recover from
missing two years of school. I don’t
understand how a third grader who
doesn’t get back to school until
fifth grade can catch up without
some real remediation.’
–Harold Koplewicz

is particularly different. The adolescent brain is Somehow, we believe our educational system is so
much more vulnerable. good that kids will just recover from missing two
years of school. I don’t understand how a third grader
who’s mastering reading and doesn’t get back to
A pandemic is tough enough school until fifth grade can catch up without some
Lucia Rahilly: What are some of the other significant real remediation. That’s pretty obvious. However,
factors that are contributing to challenging mental I think it becomes less obvious but more chilling to
health among today’s teens? think about what happens to those anxious kids
who now have to go back and get back into social
Harold Koplewicz: COVID-19 took a bad situation interactions. So I think the rates of depression
and made it exponentially worse. Think about and anxiety and loneliness are going to continue to
worrying about your grandparents dying, or losing rise unless we start thinking about a whole different
a caregiver. Recovering from this trauma could take way of approaching this problem.
over a decade. If 30 percent of the approximately
17 million kids who have a mental health disorder get
treatment, that means there’s always about Raising mental health awareness
70 percent for multiple reasons who are not getting Erica Coe: To add on that, there’s so much value in
any intervention. early intervention and really focusing on prevention
and promotion. It’s useful to remember that not
I think those are the kids who have been most only is there value in addressing the immediate
affected by COVID-19, by the loss of two years of need right now among youth, but this can change
school and social interactions, and by worries about the trajectory of somebody’s life.
the future, their health, and their parents’ health.

4 Getting to the bottom of the teen mental health crisis

It may not just relieve a mental disorder or burden. with some amount of monitoring? They need
There’s so much co-occurrence of chronic health to experiment and experience even distress and
conditions on the physical side. You can change all failure so they can become more resilient, healthy,
of that if you teach some of these skills early on and and independent.
identify problems early.

Basically, giving people an increased mental Bring out the role models
health literacy of what’s normal, what isn’t, and how Erica Coe: Peer influence can be strong early on, so
to pick up on the signs that intervention may be how do we harness that? In recent discussions
necessary. That way, so much disease burden can we’ve had with youth leaders, we often clearly hear
be avoided later in life. that youth want to be able to help their friends, but
they don’t always feel equipped. How do we enable
Harold Koplewicz: We also have to help parents them and really invest in a peer support model for
become smarter. Most parents know that you’re youth? Equipping them with that agency could
supposed to walk at one, have your first words by unlock a lot of potential.
two, and be toilet trained by three. But I’m not sure
we teach parents when your kids are supposed Harold Koplewicz: Peer support has really changed.
to interact with friends, when they’re supposed to Young people aren’t as quiet about whether they
sleep through the night, or what are baseline kinds go to therapy, take medicine, or if they’re having
of appetite and energy levels. I think that kind of difficulty. They share that information. Knowing how
information and education could be very helpful, their peers have overcome struggles can be very
almost like a mosquito net to malaria; what are the helpful for teenagers.
prevention models we should be looking at?
At the Child Mind Institute, we’ve invested in public
Lucia Rahilly: Parents talk a lot about safety awareness campaigns since 2017. Most recently, we
and about striking that balance between safety and did the You Got This campaign. And I am amazed
independence. Our generation had much more at the power of athletes like Kevin Love or Brandon
freedom than many kids today. We were mobile and Marshall. They’re the epitome of physical health,
out in the world. Any counsel for parents on agency so when they talk about their anxiety or their
and teen mental health? depression, teenage boys really respond to that and
draw inspiration in dealing with their own mental
Harold Koplewicz: It doesn’t take much for a parent health problems.
to feel worried or guilty about something their kid is
experiencing. To give them some freedom, we have Lucia Rahilly: Harold, you mentioned gender as a
to sometimes fight our need to protect them. We strong factor in susceptibility to mental health
need to recognize when they’re able to walk to school issues. How does that come into play in terms of
on their own or when they can ride on a bus, with the treatment? Are there approaches that work
understanding that guardrails have to be up. particularly well for girls and young women?

I think COVID-19 made that worse for parents, so we Harold Koplewicz: Girls are much more available.
have to retrain ourselves to say, “This is in the past.” They talk about things. They seem to have less
How do we as parents put our cell phones away, have shame and less embarrassment about their
cell-free time, and have conversations at dinner struggles. Frankly, we’ve always had an easier time
that last at least ten minutes? How do we get our getting female actors and athletes to participate
kids back outside, playing sports with their friends, in these programs.

Getting to the bottom of the teen mental health crisis 5

 So in May 2017, it was Emma Stone talking about her attributed to SSRI use, but they couldn’t prove it. In
anxiety. It was life-changing for girls to see an fact, several times when they did autopsies on
impressive, creative person—who on screen looks these kids who had been prescribed SSRIs, it was
completely carefree—say that they’ve struggled in found that they never took the medicine. So it’s hard
life and that therapy worked and made things easier. to blame the medicine. Nevertheless, there were
hearings in Congress, and a black box was put on all
I think one of the reasons we see higher numbers SSRIs indicating that they could cause suicidality. I
of anxiety and depression in girls postpuberty don’t know what that really means. It was a new word.
is that there is a hormonal difference. We see many It could mean slapping yourself in the face.
more boys who are disruptive in prepubertal times.
But we know that girls wait a shorter period of time Inevitably, pediatricians stopped prescribing SSRIs.
to get help. When they’re in pain, they are more The suicide rate generally went back up, but if
likely to tell a friend, and they’re more likely to seek you looked at the data by zip code, you could
help. I think boys tend to be more vulnerable to see that it just remained the same in African
looking weak. That’s one of the reasons athletes American neighborhoods.
seem to have so much more power as influencers
than we previously imagined in the mental So we need to think about what kind of education,
health sphere. what kind of campaigns we’re doing for the
African American community and for the Hispanic
American community so that we can raise
Demographic perception varies awareness and decrease stigma.
Lucia Rahilly: Are there geographic, class, or
cultural variations even within the United States There are workforce problems too. It’s very hard to
in the way that treatment and approaches get a male therapist of color. There are very few. We
affect these kids? just started a pilot program recently called the
Youth Mental Health Academy. In California, we’re
Harold Koplewicz: Take SSRIs, for instance— going to find 2,500 bright high school kids in 11th or
selective serotonin reuptake inhibitors. In the 1980s, 12th grade who are interested in mental health.
Prozac was released. And it turned out that it They’ll get paid internships and hands-on experience
was also good for obsessive compulsive disorder, with research and clinical care. This is with the
and it may have been good for other anxiety hope that we can expose them to the possibility of
disorders. And it starts getting released at a rate becoming a child mental health professional in
that’s quite amazing. the future.

Remarkable suicide rates among teenagers drop

across the country. But African Americans really Talking about it
hesitate on any kind of treatment that even smells Lucia Rahilly: Mental health is so much more in the
like it is research or experimental. But if you public discourse than it was when I was growing up.
looked at zip codes, it was very clear that there were
less suicides and attempted suicides in areas where Harold Koplewicz: When I was a kid, you wouldn’t
pediatricians were prescribing these meds. tell someone you had a reading tutor, but today
people are much more open and willing to talk about
But then there was a backlash. There were deaths it. So I’m optimistic. I think the COVID-19 pandemic,
caused by violent events like shootings, that people while awful, had two silver linings.

6 Getting to the bottom of the teen mental health crisis

One is that everyone started to be concerned about I think childhood cancer is serious, and we should
their children’s mental health, even if they didn’t support the work on it, but it pales in comparison to
have a disorder. So it became part of the national the scale of the mental health crisis.
conversation. The second is the concept of
telehealth jumping in popularity and usage because
of the isolation we had. Evolving the mental health system
Lucia Rahilly: As we’re looking ahead to this
Lucia Rahilly: Erica, you’ve done a lot of work on next-gen workforce, are there any particular
stigma. Have you seen any demonstrable change in challenges you see as today’s teens begin to grow
the workplace? into professionals and enter the job market?

Erica Coe: One thing we are seeing is pressure on Harold Koplewicz: We have an educational system,
employers. About three-fourths of Gen Z around the but do we have a system that’s going to treat mental
world said that the availability of mental health health symptoms and mental health disorders
resources—whether that be access to therapy or with the same kind of respect, scientific rigor, and
mental well-being programs—is one of the key funding that led to the advances we’ve made in
things when they’re selecting an employer. This is cancer or diabetes or seizure disorders?
different than it has been for other generations.
There are costs to not investing in such a system.
Harold Koplewicz: Just think about the fact Kids who have a mental health disorder are more
that mental health disorders do not have parity in likely to have academic failure, to drop out of school,
insurance with physical disorders. One of the to use illicit drugs, or to have interactions with
reasons for that is that employees don’t demand it. the juvenile justice system. They’re also more likely
There was so much stigma. “Why do you want to have physical complaints later on and utilize
coverage for depression?” The fact that new more physical-health services than the kids who
employees are actually questioning what the mental don’t have these disorders.
health coverage is only means that hopefully sooner
than later we will see more parity.

‘About three-fourths of Gen Z around

the world said that the availability
of mental health resources is one of
the key things when they’re selecting
an employer.’
–Erica Coe

Getting to the bottom of the teen mental health crisis 7

 If there are greater numbers of kids who are You might need a few more sessions. You might
symptomatic than before, I think it necessitates a need to engage parents in between. You might have
reevaluation of how we’re going to take care of to use coaches or emails to keep them engaged
these kids and take preventative measures. More in a way that you might not if you were doing it the
importantly, when symptoms strike, we need to old-fashioned way in person. But I think the fact that
do early intervention. 20 percent of them are using it but 80 percent are
finding it helpful means that we’re on the right path.
Erica Coe: I would 100 percent agree. These things We just need to make sure that path is smoother
only go so far if services are inaccessible. So much and more effective.
of it has to be around evolving the mental health
system as part of the overall health system. Getting Erica Coe: One other point, returning to passive-
rid of the lack of parity will be at the root of a lot versus-active social media use: we know that the
of improvement. There’s an interesting question Gen Z respondents were the least likely of all age
around digital mental health solutions in general. cohorts to report actually actively posting and,
Obviously, there’s been a proliferation, so instead, report higher hours of passive social media.
sometimes it’s hard to figure out what is helpful But imagine some pop-up on your phone that gives
and what isn’t. you a reminder of how much your time has been
passive versus active. In the same way we teach what
One thing that stood out in our survey was a very are healthy foods, and what they should be doing
interesting contradiction. About 22 percent of for physical exercise, we need to equip them with
Gen Z respondents reported using digital mental more information to make smart decisions.
health tools. Yet for those who did use them,
80 percent reported them as effective but often Harold Koplewicz: That’s a terrific idea, because
didn’t stick with them. So there’s a real question it’s using data and coming up with an intervention.
of how we engage Gen Z users to really utilize the When I was in training, patients smoked and doctors
power of digital innovation. smoked. Now people don’t smoke in schools, in
buildings, or on an airplane. They don’t even smoke
Harold Koplewicz: We have a grant to look at the in the airport. So you could change that behavior.
next generation of digital therapeutics. It sounds And remember, it’s much easier to teach someone
great, but does everything really work? Evidence- who has a young brain, 24 or younger, new habits
based psychotherapy or psychopharmacology, than old people.
particularly with young people, is very challenging.
To pretend that we can just switch a program and Erica Coe: I know within Utah, there’s been great
say, “Now we’re going to do it on a screen,” I think uptake of the SafeUT app, which the Huntsman
really minimizes the fact that we have to have Mental Health Institute has been behind. It is a
different techniques. That’s going to require study. resource for youth to be able to reach out and get
information they need if they have a friend they’re
I could tell you anecdotally that the Child Mind worried about.
Institute still does around 50 percent of our sessions
online. But we find that 30 minutes is about the Harold Koplewicz: You have different groups, new
maximum we can keep a young person on a screen family foundations, making very big investments in
versus 45 minutes or an hour when we would mental health, because it’s real, it’s common, it’s
see them in person. So that means you have to pace treatable. Everyone who’s listening to this podcast
yourself differently. knows and loves one of these kids. If you’re lucky

8 Getting to the bottom of the teen mental health crisis

enough that it’s not your children, then it’s your over as I know it. How did I get here?” The answer to
niece or nephew, it’s your best friend’s child, or it’s that really needs to be, “OK, this is how I got here,
your child’s best friend. So when it reaches these but also now where am I going?” I think making peace
numbers, we have to step back and figure out with the past helps us live more with the possibilities
what’s going on. If we just continue to deny it, that of the present and the possibilities of the future.
denial could levy a tremendous amount of future
costs, whether deaths or suicide attempts or a There’s a sort of narrative that we need to forgive
productivity deficiency among a large percentage people who we perceive as having done us wrong. I
of our population. agree with that, and yet I think there is a difference
between really forgiving someone and just being
Lucia Rahilly: Erica and Harold, thanks so much for able to get to a place of greater peace and
joining us today. acceptance with what has happened. Part of that
is also owning your own stuff. By that I mean
Harold Koplewicz: My pleasure. I’m so delighted all relationships, all systems, whether it’s a working
you’re highlighting this topic. relationship or a family or a marriage, all of
those relationships and systems are co-created.
Erica Coe: Yes. Many thanks.
We also have to own our part in creating that
environment. We have to forgive ourselves and
accept that what’s done is done. Figure out how can
Roberta Fusaro: Mental health is top of mind for so we learn from it, and then move forward with some
many of us, including Maggie Smith, author of You greater wisdom to make some different decisions
Could Make This Place Beautiful. today and in the future.

Maggie Smith: This book is really written out of the Now what do I have to do to gather myself, stand in
upheaval of my divorce, but also other big life my own power, remember who I am, and reach out
changes. I think one of the unkind stories we tend to to my community. I think those are all things we have
tell ourselves is, “OK, what is my life now? Life is to do. My thinking is that change is the only constant.

‘I think making peace with the past

helps us live more with the possibilities
of the present and the possibilities of
the future.’
–Maggie Smith

Getting to the bottom of the teen mental health crisis 9

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Erica Coe is a partner in McKinsey’s Atlanta office and coleader of the McKinsey Health Institute. Harold Koplewicz is
the founding president and medical director of the Child Mind Institute. Roberta Fusaro is an editorial director in the Waltham,
Massachusetts, office; and Lucia Rahilly is the global editorial director and deputy publisher of McKinsey Global Publishing
and is based in the New York office.

Comments and opinions expressed by interviewees are their own and do not represent or reflect the opinions, policies, or
positions of McKinsey & Company or have its endorsement.

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Copyright © 2023 McKinsey & Company. All rights reserved.

10 Getting to the bottom of the teen mental health crisis