After founding my pediatric mental health care company in 2021, one of our first patients was a child who’d been referred to us from the emergency room (ER) after a deeply troubling experience in the healthcare system. She was put on medication by her primary care provider (PCP) to help her cope with emotional struggles following a breakup, but when the initial dosage didn’t seem to work, her doctor kept increasing it. Over time, she developed severe side effects, including self-harm behaviors like hair-pulling. Desperate for help, her mother begged the PCP to take her off the medication, but the provider didn’t know how to safely taper the dosage.

In a state of panic, they went to the ER, but the ER isn’t equipped to manage complex medication adjustments like this. It’s not something they do. The PCP had referred the family to the ER for help, but the ER essentially sent them back. This left the mother in shambles, caught in a system where no one seemed able—or trained—to help.

Sadly, this story is far too common. Providers often prescribe psychiatric medications without adequate training, relying on studies rather than clinical expertise. It’s like trying to treat chest pain by prescribing heart medication without consulting a cardiologist first. You wouldn’t manage an arrhythmia without expert input, yet we see this approach all the time in mental health care.

But it’s not the PCP’s fault—they’re not set up to handle mental health crises. Yet, the lack of collaboration and expertise in these situations have devastating consequences for families. It’s a glaring symptom of a much larger crisis: the youth mental health epidemic.

The alarming state of youth mental health

According to the Centers for Disease Control and Prevention (CDC), suicide rates among children and young adults increased by 62% between 2007 and 2021, with social media platforms contributing to feelings of inadequacy, isolation, and hopelessness. This alarming trend reflects a broader crisis: Between 2016 and 2020, 5.6 million children and adolescents were diagnosed with anxiety and 2.4 million with depression.

While these figures predate the pandemic, the crisis has deepened in recent years, especially among adolescent girls, who face mounting social pressures, academic stress, and the pervasive impact of social media. In 2023, 73% of adolescent girls reported at least one mental health issue, with nearly half (48%) experiencing comorbid conditions.

The unfair burden on pediatricians

The youth mental health crisis isn’t just staggering in numbers—it’s playing out every day in pediatric clinics. With 74% of U.S. counties lacking child psychiatrists, pediatricians, who didn’t sign up to manage mental health care, are now on the front lines because other mental health services are either full or inaccessible. These doctors have taken an oath to care for their patients, but they’re being asked to treat mental health conditions, often with inadequate resources and training.

It’s not their fault. The economics of mental health care in this country make it difficult to provide accessible, effective treatment, and the shortage of psychiatric prescribers only adds to the burden. The reality is, primary care providers are doing their best in a broken system that hasn’t given them the tools or support to succeed.

Consider this: fewer than 5% of pediatric patients are monitored according to the FDA’s recommended schedule for antidepressants with black-box warnings, despite black-box warnings about increased suicidal thoughts and behaviors. Meanwhile, antidepressant prescriptions in children aged 5–12 have increased by over 40% from 2015 to 2021. These medications are powerful, and prescribing them without therapy or close monitoring puts kids at risk.

Pediatricians are trying to do right by their patients, but the current system sets them up to fail. They need a model that supports them, alleviates the burden, and ensures kids get the right care.

The case for collaborative care

Collaborative care offers a solution that needs more attention. It’s a model that exists but isn’t widely implemented due to state regulations, reimbursement barriers, and provider shortages. By integrating psychiatry and therapy into the primary care setting, collaborative care makes the most of limited resources while ensuring kids receive holistic, evidence-based treatment.

Here’s how it works: Pediatricians oversee the medical home, supported by psychiatrists who provide guidance on medications, dosages, and side effects. Therapists work with families to build coping skills and address underlying issues. Together, these professionals create a comprehensive care plan that meets the child’s physical and mental health needs.

With the youth mental health crisis overwhelming existing systems, collaborative care extends the reach of scarce psychiatric resources and empowers pediatricians to provide informed, effective care. It’s a model that just makes sense.

Build a better system

Pediatricians shouldn’t have to shoulder the burden of youth mental health care alone. The crisis they’re facing in their clinics is a symptom of a larger systemic failure—one that can only be addressed by breaking down the silos between primary care, psychiatry, and therapy.

Psychiatric urgent care is an example of what’s possible. It provides immediate, specialized support for kids in distress, bridging the gap between crisis care and long-term treatment. But for these models to succeed, they need to connect seamlessly with primary care, ensuring that kids and families have continuous, coordinated support.

We also need changes in policy and reimbursement. Collaborative care must be reimbursed consistently across all states, including Medicaid. Without systemic support, even the best models can’t scale to meet the demand.

The path forward

It’s time to recognize mental health as an integral part of overall well-being. This means equipping pediatricians with the tools and training they need, supporting them with psychiatric expertise, and fostering strong partnerships across care teams.

The youth mental health crisis is urgent, but it’s not insurmountable. By embracing collaborative care and removing the barriers that prevent its widespread adoption, we can build a system that truly supports kids, families, and the providers who care for them.

As a child and adolescent psychiatrist, I’m calling on policymakers, healthcare leaders, and communities to take action. This isn’t just about fixing a broken system—it’s about creating a new one that ensures every child has the chance to thrive.

Monika Roots, MD is a child and adolescent psychiatrist, and cofounder, president and chief medical officer of Bend Health.