In my clinic this week, all but two of the patients I cared for were either in need of mental health support or working closely with a mental health professional to help with mood symptoms, like feelings of hopelessness or trouble with sleep and appetite. Our provider inboxes are full of messages from families (and patients) requesting resources after calling multiple therapists and finding that, at best, they can be added to a waiting list, but more frequently that none have openings for new clients. Professionals with expertise in caring for the psychological needs of children and adolescents are in high demand with extremely limited supply. Pediatric providers like me are desperate to help but have too few tools in our toolbox.

Last week, U.S. Surgeon General Vivek Murthy released a report illustrating the crisis in youth mental health in America and saying “ … the challenges today’s generation of young people face are unprecedented …. And the effect these challenges have had on their mental health is devastating.”

This is an emergency, a crisis unlike any we have seen in our careers as pediatricians. Our state ranked 43rd in the nation in 2020 for kids’ access to behavioral health care. A March 2021 survey of Washington state students found about 45% of middle schoolers and nearly 60% of high schoolers felt depressed or sad most days in the past year. A 2019 state-level study found that nearly half of children with a treatable mental health condition did not receive the care they needed. BIPOC (Black, Indigenous and people of color) children and youth have even greater untreated mental health needs.

These statistics demonstrate the shocking prevalence of mental health issues in youth, but it is the stories of these young people that are most heartbreaking.

  • A youth with an eating disorder diagnosis who is admitted to the hospital due to the physical effects of malnutrition, yet their state insurance is not accepted at the private eating disorder facility.
  • A teen with increasing panic and separation anxiety from transitioning to in-person school, whose family called seven therapists who had no openings.
  • A student with depression and non-suicidal self-injury (cutting) who has had three different therapists over the past six months because the staff turnover is so high at their local behavioral health agency.

Children and adolescents were struggling with rising incidences of mental health concerns before the COVID-19, but there is no doubt that this crisis has been exacerbated and accelerated by the pandemic. Families are frustrated, scared, and losing hope.

Too often children and adolescents are an afterthought, lost in systems that are created for adults. Our state and our institutions have taken steps to help, but it has not been enough. This is the time to take bold steps if we want to see significant change. Our kids can’t wait for slow bureaucratic machinery to make incremental progress. We have a moral imperative to do everything in our power to address the crisis of youth mental health, and we urge the state Legislature to use the coming session to make a strong statement that kids count.


The Legislature’s Children and Youth Behavioral Health Work Group has studied the issues that hamper access to care since it was formed in 2019. It has advanced a list of 12 solutions that the state could and should enact without delay when the session begins in January. Three critical recommendations include:

∙ Establish a vision and actionable plan to support kids at all levels of need: From the first years of life to school-aged kids with mild or moderate needs to kids in crisis.

∙ Finance community health workers in primary care clinics to help families get their child into care.

∙ Provide resources for primary care clinics to implement behavioral health care as part of their team, so that kids can get the help they need right there in clinic.

These simple solutions would help dismantle barriers, like transportation and stigma, that so often hinder our patients’ ability to start — and continue — mental health care. We hope our state policy makers will meet this challenge with the strength, courage and creativity that the situation demands.