Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory

Objectives

Advance a whole-of-society response to protect and promote the mental health, healthy development, safety, belonging and resilience of children, adolescents and young adults. Mental health is framed as an essential component of overall health, with many challenges treatable and preventable when young people receive compassion, early support and appropriate care.[1][2]

• Promote safe, stable, nurturing and affirming environments across families, schools, communities, health services and digital spaces, while strengthening supportive relationships with caregivers, trusted adults and peers.[3][4]
• Prevent distress and escalation into crisis through early recognition, accessible high-quality and affordable care, and a continuum from prevention and screening to early intervention, treatment and crisis support.[5][6]
• Reduce stigma, discrimination, bias and exclusion, and ensure culturally appropriate, family-centred, equitable and multilingual support for children and young people.[2][7]
• Prioritise young people facing intersecting risks, including poverty, adverse childhood experiences, trauma, disability, discrimination, rural isolation, housing insecurity, immigration-related barriers, LGBTQ+ stigma, and involvement with child welfare or juvenile justice systems.[8][9][10]
• Address social and economic determinants of mental health, including access to childcare, education, nutritious food, healthcare, safe housing and neighbourhoods, alongside family economic security.[5][11]
• Strengthen school wellbeing, educational participation and social and emotional learning through positive school climates, anti-bullying action, tiered supports and protection for students with higher needs.[4][6]
• Promote safer and healthier technology and media environments that prioritise children’s wellbeing over engagement, scale and profit, while recognising that digital tools can offer connection, learning, healthcare access and support as well as potential harms.[12][13]
• Enable young people and families to recognise and manage difficult emotions, maintain supportive relationships, seek help, care for physical and mental health, advocate for their needs, and use technology intentionally and safely.[2][14]

Implementation

Implement coordinated action across individual, family, institutional, community, commercial and government settings, recognising that institutions substantially shape young people’s daily circumstances and opportunities for wellbeing. Core stakeholders include young people, families and caregivers, schools and educators, health and behavioural-health providers, community organisations, employers, funders, technology and media companies, and federal, state, local and Tribal governments.[15][5]

• Strengthen family and caregiver capacity through positive role-modelling, open communication, predictable routines, early identification of distress, support for caregivers’ own mental health and substance-use needs, and reduced exposure to violence and harmful influences.[2][3]
• Deliver developmentally appropriate support through primary care, schools, childcare, community services and telehealth, with practical routes to counselling, therapy, peer support, specialised resources and crisis services.[5][14]
• Embed routine mental-health and risk-factor screening in primary care, schools, emergency departments and other settings, and link identified needs to timely follow-up care and wider economic, educational, legal or social support.[9]
• Establish school-based continuums spanning prevention, screening, early intervention and treatment; train staff to recognise changes in wellbeing; expand counsellor, nurse, social-work and psychology capacity; and coordinate with providers and governments. Project AWARE, Advancing Wellness and Resilience in Education, is an example of a school-provider partnership mechanism.[6]
• Integrate clinical provision with trusted child-serving systems, including public health, social services, child welfare, juvenile justice and community organisations, using trauma-informed, multidisciplinary and family-inclusive models.[7][10]
• Engage young people, parents and caregivers in advisory councils, peer-support programmes, participatory research, grantmaking, programme design and evaluation, particularly where communities experience greater vulnerability or exclusion.[14][16]
• Require technology companies to incorporate health, safety and wellbeing into leadership, organisational culture and product development; consult affected users and experts before deployment; and provide effective safety tools and user controls.[13][17]
• Limit online harms through age assurance, privacy-by-default settings, reduced amplification of harmful content, restrictions on targeted advertising and data collection, rapid removal processes, independent algorithm audits, screen-time and break tools, and options to avoid harmful material.[17]
• Improve media practice by using accurate, contextualised and person-centred coverage; avoiding stereotypes and simplistic explanations of suicide; applying recognised guidance; and directing audiences towards help, treatment, recovery and crisis resources.[18]
• Mobilise policy, investment, regulation and technical assistance to improve insurance coverage and payment, school-provider partnerships, broadband and telehealth, workforce recruitment and training, and crisis-care capacity. Potential financing mechanisms include public and private insurance, innovative integrated-care payment models, school-based financing, emergency relief funds, Project AWARE funds, flexible crisis-care funding and workforce loan repayment.[11][19]
• Support employers to offer comprehensive mental-health coverage with low or no out-of-pocket costs, family-friendly benefits, flexible work, affordable childcare support, clear benefit communication, trained managers and employee participation in workplace wellbeing design.[16][20]
• Build evidence and accountability through timely, integrated and disaggregated data systems; research on disparities, interventions and technology effects; public reporting of product wellbeing impacts; independent access to relevant platform data; and evaluation of outcomes and upstream protective factors.[5][17][21][10]

Monitoring & Evaluation

The Advisory promotes a multi-level evidence, monitoring and evaluation approach for youth mental health, combining population surveillance, routine screening, service follow-up, programme evaluation, workplace and school observation, and technology-company transparency. It does not set out a single consolidated national indicator framework, reporting timetable, evaluation protocol or lead accountability institution.[5][11][10]

• Develop integrated, real-time and longitudinal data infrastructure to track youth mental health trends, identify needs rapidly, link information across governments, health systems and community organisations, and support more timely local surveillance, including at census-tract level where possible.[5][10]
• Disaggregate surveillance and research data by factors including age, gender, race, ethnicity, disability, sexual orientation, socioeconomic background, family characteristics and insurance status, with particular attention to young people experiencing multiple risk factors.[5][10]
• Use routine screening in primary care, schools, emergency departments and other child-serving settings to identify mental health needs, adverse childhood experiences and related changes in physical health, sleep or behaviour, while ensuring links to appropriate follow-up care.[9][7]
• Monitor student wellbeing through staff recognition of withdrawal, behavioural change, concentration difficulties, trauma and other mental or physical health concerns, followed by referral or other appropriate action.[4][6]
• Track family circumstances alongside children’s needs by assessing parents’ and caregivers’ mental health, substance use, intimate partner violence, food insecurity and housing instability.[9][7]
• Evaluate programmes using mental health outcomes, including anxiety, depression and suicide-related ideation, plans and attempts, alongside upstream risk and protective factors such as social connectedness, coping skills and economic support.[21][22]
• Include young people and families in interpreting trends, designing responses and evaluation processes, and support grantees to develop and share meaningful outcome measures.[5][16]
• Assess interventions’ readiness before scaling them in communities and evaluate treatment targets, stepped-care models, innovative therapies, service access, engagement and effectiveness for groups at higher risk.[16][10][23]
• Assess workplace wellbeing through regular employee surveys, with disaggregation where relevant by demographic group, seniority, business unit and geography.[20]
• Improve research on digital technology through longitudinal and experimental designs, behavioural measures of online activity and analysis by user subgroup, activity type, age, developmental stage, sex or gender.[12][13]
• Require technology companies to measure health and wellbeing effects continuously, supplement engagement metrics with behavioural and user-reported measures, publish findings, enable independent data access and algorithmic scrutiny, and take corrective action when harms are identified.[13][17]
• Use transparency and systemic auditing to investigate social-media and technology effects, including algorithmic amplification and exposure to harmful content, while recognising that the evidence base remains contested and effects differ by person, platform and activity.[12][11][23]

Specific quantitative benchmarks are limited. The school workforce discussion cites the American School Counselor Association recommendation of one counsellor per 250 students, compared with a national average of one per 424 students, but this is presented as a workforce benchmark rather than a formal policy performance target.[6]

Costing & Financing

The Advisory identifies broad resourcing needs and potential funding channels for prevention, early intervention, school-based support, integrated care, crisis response, workforce development, research and action on social determinants of mental health. It does not provide a consolidated budget, programme-level costing method, quantified funding requirement, funding gap, resource-mobilisation target or economic assumptions.[11][19]

• Invest across all levels of government to reduce economic and social barriers associated with poor mental health, including poverty, childcare, education, food, healthcare, housing, neighbourhood safety and adverse childhood experiences.[11]
• Use public and private insurance, innovative payment models for integrated care, Medicaid, the Children’s Health Insurance Program and Marketplace coverage to improve access to behavioural health services and support enrolment of eligible children.[6][11][19]
• Mobilise federal, state and local resources for the recruitment, training and retention of school-based mental health personnel, including counsellors, nurses, social workers and school psychologists.[6]
• Draw on Elementary and Secondary School Emergency Relief funds, Project AWARE funding, school-based mental health financing, flexible crisis-care funding, workforce training investment and loan repayment as potential financing mechanisms.[6][19]
• Sustain investment by funders and foundations in equitable prevention, promotion and early intervention, community organisations, cross-sector partnerships, innovation and scaling of evidence-based services.[22]
• Use incubators and accelerators as potential financing models for early-stage innovation, without specified monetary commitments.[16]
• Support employers to offer comprehensive and affordable mental health cover, including low- or no-out-of-pocket costs where possible, alongside family-friendly benefits, leave and affordable childcare support.[16][20]
• Increase investment in basic, clinical and health-services research, and provide appropriate support for demonstration projects and public-private research partnerships.[10][23]

During the COVID-19 pandemic, governments invested trillions of dollars in mitigating family financial hardship, testing and vaccination, health and social services, and safe school reopening, but the supplied material does not quantify a distinct mental health share of this expenditure.[2]

Referenced funding announcements include Substance Abuse and Mental Health Services Administration grants of 74.2 million United States dollars in 2021 to strengthen youth mental health, plus separate 2021 American Rescue Plan announcements of 10.7 million and 14.2 million United States dollars to expand paediatric mental health care access.[24][25]