By Tatiana Villegas

“I feel like when talking to somebody you don’t know, you sort of have that feeling that they might judge you or not, like not believe something that you’re saying” – Youth focus group participant, Colorado, 2023

Rates of youth depression and anxiety have been on the rise for years and continue to increase. A recent report found that rates of anxiety and depression remained high in July 2023, with three in four young adults reporting some level of these challenges. A 2023 report by Mental Health in America found that 60 percent of youth with major depression are not receiving mental health treatment. Young people aren’t seeking help from mental health professionals for several reasons, one of which is that youth don’t trust them. Young people’s distrust of and fear in the mental health system is well-founded. This system has historically harmed Black and brown communities, LGBTQIA+ communities, people with disabilities, and other individuals  living at the margins. Many of these harms are ongoing, including through the continued use of forced treatment.

Over the past six years, our team has spoken with numerous young people. Many discussed a lack of trust in and relatability to mental health professionals and the system at large, and a desire to change the current mental health system. As the crisis escalates, it’s time we listen to what those most affected want and invest in their mental health and future.

“For me, I don’t really like, like for example if I go to a counselor, I don’t know this person. Like, I don’t know them, they don’t know me. So I have this feeling of like, why should I tell them everything about me, everything that I’m going through if I don’t know them deeply and I don’t know what their true intentions are with the information they’re going to get and how I can really trust them. Like, how do I know if they’re not going to go turn my back, maybe tell another student, tell a teacher, or even, like, tell someone that could possibly make me go into a let’s say…I don’t know, I don’t know. But just a place where I don’t want to be in because I’m just, it’s just scary to talk about your feelings with someone that you don’t know or trust.” – Youth focus group participant, Colorado, 2023

Discussing mental health concerns with a stranger is challenging. One issue is the inherent distrust youth, especially youth of color and LGBTQ+ youth, feel toward people they don’t know. This distrust stems from the lack of meaningful, bi-directional relationships between mental health professionals, who are often adults, and youth seeking help. The distrust also stems from the power dynamic between clinicians and patients; many young people we’ve spoken to question what therapists will do with the information they share, doubt the confidentiality of their sessions, and sometimes feel judged by these professionals. In a therapeutic relationship that relies on vulnerability, this lack of trust significantly hinders the effectiveness of mental health support.

Rather than persisting with a failing system, policymakers, mental health professionals, teachers, and school counselors must listen to what works for youth and incorporate their feedback to improve mental health access.

“I feel like it is better to talk to our peers like we doing now. ‘Cause the way our generation set up, we all have somewhat of a similar lifestyle. And I feel like this somethin’ we should do, like, every now and then.” – Youth focus group participant, Southeastern United States, 2017

“To be honest with you, I would rather talk to somebody that went to prison or came through here because they know the lifestyle. They know how it was. And they understand you.” – Youth focus group participant, Southeastern United States, 2017

In our conversations with youth, a consistent theme emerged: they turn to their peers, family members, or community members for support during times of emotional distress. Peers are a common source of comfort because youth can relate to them. They share similar life challenges and experiences, making the support feel genuine and validating. Likewise, many youth confide in family members, believing that their loved ones have their best interests at heart and deeply understand them. Both peer and family support are characterized by pre-existing deep relationships and a sense of relatability, fostering a caring bond that extends beyond professional obligations.

Not all young people have a safe community to rely on, making it crucial for them to have access to affirming mental health support. This underscores the need to reframe the mental health system to ensure all youth have this option. Young people who distrust or have been harmed by the mental health system often prefer non-clinical mental health supports, like youth peer support. Peer support is an equitable and effective mental health intervention rooted in trust and mutuality; however, policy barriers make it inaccessible to too many young people.

Relatability is especially crucial for youth of color and LGBTQ+ youth, as these populations typically experience higher rates of mental health conditions. Young people seek support from individuals who can genuinely empathize with their experiences and understand them. For queer or BIPOC youth, this may mean connecting with professionals or peers who share their identities or backgrounds, which can foster a sense of cultural resonance and understanding. For these communities, having a mental health professional who does not look like them or understand such an important part of their identity can make therapy inefficient and, in some cases, harmful. Therapists who do not share similar identities may struggle to provide effective guidance and could inadvertently perpetrate microaggressions against those they’re counseling. Additionally, 75 percent of mental health professionals are white, while 25 percent are BIPOC, which is not representative of the U.S. population. Racial inequalities and systematic discrimination are at fault for the historic and current underrepresentation of BIPOC mental health professionals in workforce pipelines and the system. This lack of representation has perpetuated inequities in mental health diagnoses and treatments, especially for BIPOC individuals.

We’re falling short in providing youth, particularly those from diverse backgrounds, with mental health care that meets their needs. Addressing the issue of youth distrust toward the mental health system and providers hinges on prioritizing their voices and preferences. To improve mental health care, we must enhance diversity in both identity and credentials among providers. This means increasing representation of people of color, queer individuals, and others with lived experiences relevant to the communities they serve. By offering scholarships and fostering peer support networks, we can encourage more individuals from diverse backgrounds to pursue careers in mental health. Having providers who share identities with the communities they serve is crucial for effectively engaging youth with the health care system. Additionally, young people deserve a choice of mental health supports beyond talk therapy and Western models of care, particularly young people who have been harmed by the mental health system. Above all, those with decision-making power have a responsibility to actively seek and integrate feedback from youth to improve the mental health system. By genuinely listening to the experiences and needs of young people, they can better tailor services and policies to ensure effective support for mental well-being.

“Certain things, you don’t want to talk to people about. Especially, I’m gonna just be honest, I ain’t too kindly with, you know, I ain’t fittin’ to have no white man sit in front of me and ask me questions about my life. What about ‘What your life about?’ Like, it’s stuff like that, because I feel like they really coming at you a certain type of way because people may think you got an issue, but you really don’t, you feel me? I just, I don’t know, it just suddenly everybody make you snap off or make you just blink off. Everybody is just different.” – Youth focus group participant, Southeastern United States, 2017