Five years ago, youth mental health was at a tipping point. Pediatricians, child and adolescent psychiatrists and children’s hospitals saw this crisis playing out on the frontlines and our organizations took the step together to declare a national emergency in youth mental health.

While we’ve seen some bright spots of progress, children today are still struggling. Reflecting on this five-year anniversary, we hold two things true: the mental health emergency among children and teens is not over. And, it is a solvable crisis. A meaningful and sustained commitment to addressing it is required to make that possible.

Suicide remains a leading cause of death for young people, and while most recent data show the rates of major depressive episodes among adolescents have decreased slightly, still 15% of teens reported experiencing one in 2025. According to CHA’s Pediatric Health Information System (PHIS) data, over the last decade, pediatric emergency department visits for suicide-self injury rose by nearly 169 percent. In their daily lives, young people are also navigating ever-evolving digital spaces that have not been designed with their needs at the forefront.

When we reflect on today’s landscape, we think of the stories our colleagues share: the teens who show up in the emergency room in crisis, the parents forced to drive for hours to get specialized psychiatric treatment, and the families who cannot access lifesaving care simply because they cannot afford it or lost their health insurance coverage.

We need change that will make a real difference for our patients and their families.

First, supporting mental health means protecting and strengthening Medicaid. About half of the nation's children are covered by Medicaid, making it the single largest payer of mental health services for children in the country. Right now, this lifeline program is facing severe cuts, state budgets are under significant pressure, and policy changes have made it harder for families to stay enrolled or access needed care.

Medicaid cuts are also burdening an already strained pediatric mental health care system, worsening severe staffing shortages and making it harder for children and families to get the timely care they need.

Since January 2025, two million children have lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage – a trend that is continuing in the wrong direction, directly undermining child and adolescent access to mental health care. Through Medicaid, children receive the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which provides vital preventive health care services for children under the age of 21. However, states vary in how they implement mental and behavioral health coverage under EPSDT, and a child’s access to this benefit and how comprehensive it is should not depend on where they live.

Additionally, the law requires that we view mental health and physical health on the same playing field, and policymakers must do more to effectuate that promise. Only half of children receive needed pediatric mental health care, and families should not be forced to pay more or to pay out of pocket for the mental health care their children need. Mental health treatment must be accessible without discriminatory financial penalties, hardship, or stigma, regardless of the insurance source.

As with any public health issue, progress is not possible overnight. When we look inside our own clinic and hospital walls, we must ensure that vital work to prevent youth suicide can continue that connects young people with the right screening, assessment, treatment, and resources at the right time.

We also cannot diminish the progress we’ve seen. One example is the expansion of a federal program that connects pediatricians with specialized pediatric mental health teams for real-time teleconsultations. This program also works to build much-needed workforce capacity by providing training and education and increasing coordination between medical teams. It is up for reauthorization by Congress next year and must continue to be funded.

We’ve also seen bipartisan legislation advance that would keep young people safe online – another promising step to supporting youth mental health in today’s digital ecosystem and we call on lawmakers to pass it before the year’s end.

Our leaders must advance policies that increase access to care, not those that add barriers or jeopardize coverage. We need investment in programs designed to support youth mental health at both the national and state levels, not efforts that cause uncertainty around continued funding.

We see the resilience in the patients who come through our doors every day, and we’ve seen how policies show up in the exam room. Five years later, our resolve has not wavered, and our hope has not diminished. We urge the same from our policymakers who can drive change and put the needs of children first.

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Dr. Andrew Racine, president of the American Academy of Pediatrics, Dr. John T. Walkup, president of the American Academy of Child and Adolescent Psychiatry, and Matthew Cook, chief executive officer of the Children’s Hospital Association

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