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Understanding the mental health crisis afflicting American teens

DAVE DAVIES, HOST:

This is FRESH AIR. I'm Dave Davies, in for Terry Gross. Last December, U.S. Surgeon General Vivek Murthy issued a special advisory about what he called an alarming increase in the mental health challenges facing American teenagers. Studies show that rates of depression, anxiety, self-harm and suicide have risen sharply in recent years among adolescents. Our guest, New York Times reporter Matt Richtel, has spent nearly two years reporting on the dimensions of this crisis - interviewing teens and parents about their experiences, visiting emergency rooms where teens in crisis spend multiple days in exam rooms waiting for an opening in treatment. And he spoke to pediatricians struggling to help families with these issues because there simply aren't enough mental health treatment options available to them.

In a series of articles in The Times, Richtel also explores possible causes of the crisis. While there's no clear consensus among experts on the root of the problem, there is research that provides important insights into the nature of teens' suffering and some treatments that show promise. Matt Richtel has been with The New York Times since 2000, where he's focused on science, technology and business. In 2010, he won the Pulitzer Prize for national reporting for a series on the hazardous use of cell phones, computers and other devices while driving. He's written several books, including one published this past spring titled "Inspired: Understanding Creativity." His series about the mental health crisis among American teens is available online. It's called "The Inner Pandemic."

Well, Matt Richtel, welcome back to FRESH AIR. You know, you write in the series that three decades ago - public health threats for teenagers have really changed over the last, you know, stretch of time. What were the concerns years ago? How have they evolved?

MATT RICHTEL: When I began this two years ago, I had an intuitive sense, as lots of people did, that anxiety and depression and suicide and self-harm were up among young people. That wasn't enough to launch a two-year investigation, if you will. It was a second set of stats that really blew me away, and that was this - when I was a young person 30 years ago, what public health worried about was binge drinking, drunk driving injury and death, cigarette smoking, teen pregnancy, drug use. All of those came down, some sharply. At the same time, we saw these internalized risks go up. And boom, what got me as a journalist was that we realized there had been a transformation in the kinds of risks facing adolescents.

DAVIES: Yeah. So give us a sense of how widely shared these problems are among American teens. How common are they?

RICHTEL: Yeah, they're common. If you look at, say, an episode of major depression, it has risen 60% since 2007. The suicide rate, which had been stable from 2000 to 2007, goes up 60% after 2007 to 2018. And among Black adolescents, we see suicide attempts leaping 80%, outpacing every other ethnic group. And you can see related statistics around visits to emergency rooms for self-harm, around increases in antidepressant use. There's hardly a category you can find related to mental health and mental well-being that has not spiked.

And by contrast, you've seen cigarette use plummet, binge drinking at 30-year lows, teen pregnancy down sharply, and early experimentation with sex and even with the opiates, overall drug use down. So you see a sharp crossing pattern between what I alluded to earlier scientists refer to as externalized risks - binge drinking, cigarette use - and internalized risks - anxiety, depression, suicide, suicidal ideation and self-harm. That is transformational change. And when we saw the change in statistics, we said, whoa, what the heck is going on? What do these kids look like? What do their lives look like in contrast to their parents'? What's happening?

DAVIES: Right. So there are a lot of elements to this story. That's - it's - you've spent nearly two years on it. So maybe we could begin with you telling us a story - one of the teens that you got to know well, just so we get a sense of what this looks like in real life.

RICHTEL: Yeah, I'll tell you about M, one of the first young people I met. M is a pseudonym, a pseudo initial, to protect M's anonymity, but very well encapsulates the story. M's father, characteristic of a prior generation, got his girlfriend pregnant in high school and struggled in school and just thought he was inattentive. There was no ADHD diagnosis. That's what a prior generation looked like. M starts to feel some really difficult feelings around middle school, starts spending a bunch of time online, becomes obsessed with an online character named Genocidal Jack (ph), or Genocidal Jill (ph), known by both. It's an anime serial killer, sort of a whimsical character. M even professes to fall in love with Genocidal Jack, Genocidal Jill. M starts self-harming with box cutters that M secretly purchased on Amazon. And these box cutters look like cats' paws. What could characterize this generation more than a child-like box cutter being used to self-harm?

DAVIES: You know, and I guess the thing that must have been so bewildering for M's parents and is to all of us is, well, why do you want to cut yourself? What's the psychological purpose it serves?

RICHTEL: One thing we know is that it can be infectious over the internet. People see it and think it is an OK thing to do. It also serves, weirdly as a coping mechanism, a kind of focal point when someone's feeling a lot of chaos. It's something - and doubtless we'll talk about more in this interview. But self-harm is a place where people go to distract themselves, if they will, and that's what happened here in this experience with M.

DAVIES: Yeah, I think one of the teens that you spoke to said that cutting was almost like taking a smoke break.

RICHTEL: Yeah. And it can release some pain analgesics. It can cause some kind of - I'm not sure exactly how the neuroscience, the neurology works on it but young people will talk about feeling a feeling of relief and they'll also talk about how addictive it can become. I want to say here flatly to young people, it doesn't work over the long run. It becomes very, very self-destructive. So please don't hear this as encouragement or license. Please reach out to someone for help. There are better ways.

DAVIES: And did you get a sense of the feelings that had driven M to do the cutting or to get into this intense following with this anime character - what was going on?

RICHTEL: You know, M said to me at one point, I felt so lonely. And I think that can be a word that means different things to different people, but M didn't feel understood by M's parents. M didn't feel like M had friendships in school. Some of the friendships that M had started to dissipate around middle school. Here, COVID happened, which didn't - is not the starting point for these problems as a society or even individual adolescence. But it certainly amplified those issues.

DAVIES: And I know from reading the series that M became aware of another teen who had died of an overdose...

RICHTEL: Yeah.

DAVIES: ...After saying, you know, I can't take this anymore or something to that effect in a note. So it must have been terrifying. There was a moment you describe where M - after their parents discovered things on their phone, M went running off into the woods, and they feared they would never see M again. Was it therapy? Was it medications? Do you have a sense of what made a difference for M?

RICHTEL: It was time. It was the help that M needed. There were some medications in there. There was very good counseling. There was love and understanding from the parents. But I can't underscore time enough here. One of the most valuable lessons, if not the single most valuable lesson I've learned, Dave, is particularly for young people - but for anyone who feels suicidal, those feelings are impulsive, and they pass. The thing that scientists say - and I'm going to interrupt myself here and say, if I - if you hear nothing else, those families that are feeling challenged or young people feeling challenged, please hear this. Suicide is considered by scientists to be a permanent solution to a temporary problem. And if you get past those impulses, if a young person gets past those impulses, they're very likely not to attempt suicide and have a greater understanding later on.

DAVIES: We should just maybe note at this point that if there are people who are having suicidal thoughts, that you can seek help through the suicide hotline, that is, you can get that by dialing 988.

We need to take a break here. Let me reintroduce you. We are speaking with Matt Richtel. He is a reporter at The New York Times. He has a series of articles about the mental health crisis among American teenagers. It's called "The Inner Pandemic." We'll continue our conversation in just a moment. This is FRESH AIR.

(SOUNDBITE OF OF MONTREAL SONG, "GRONLANDIC EDIT")

DAVIES: This is FRESH AIR, and we're speaking with Matt Richtel. He is a Pulitzer Prize-winning reporter for The New York Times. He has spent nearly two years investigating the mental health crisis among American teenagers. He has a series of articles that you can find online. They're titled "The Inner Pandemic."

We were just talking about one teen who suffered terribly from some of these issues. You call this teen M in the story. I thought we would talk about what experts say about what's happening here - why we're seeing these dramatic rises in anxiety, depression, self-harm and suicide. I guess one thing that people often blame is social media and young people's obsession with social media. I gather that's a very oversimplistic explanation that a lot of experts don't exactly buy. What's the role of the internet in all of this?

RICHTEL: The research, when it comes to social media per se, is conflictual. For some young people, it appears to intensify negative feelings for others. It might even be a pleasant place that amplifies positive feelings and connections. I want to set that aside and say it gets too much blame too easily, but it's a subset of the environmental factors that are part of the equation shaping young people's mental well-being.

DAVIES: So give us a sense of what, you know, researchers have identified as some possible causes of this alarming rise in mental health problems for teens.

RICHTEL: The best explanation I've heard - and it is hypothesized, not proven but based on some really good science - is that young people are grappling with a neurological mismatch between what their brains are capable of right now and the level of information and the noisy environment they confront. Who would have thought I would have run into this set of statistics - certainly, I would not have - having to do with puberty?

In the year 1900, girls hit puberty at the age of around 14. That's first menstruation. Now it's 12. Boys are lagging a year behind, but with a similar pattern. And if you ask why we don't know so much about boys, it's because there's not a simple demarcation point like menstruation. So it gets a little vaguer with boys. Doubtless you're wondering and listeners are wondering, why is that? Why is puberty falling? We don't have a simple compact answer. But at the least, it appears that rising rates of nutrition and also obesity, by extension, caused the body to think it's ready to reproduce, which may be triggering early puberty.

DAVIES: Right. But I guess what happens then is you have, at younger ages, young people having these surges of hormones affecting their thinking and emotions. But you said there's a mismatch. So other parts of the brain maybe are on the old calendar. What happens here?

RICHTEL: A lot of times people think about puberty as having to do with the nether regions. In point of fact, it has a lot to do with the brain. And inside the brain, you start to see a hyperawareness to social information, a craving for social information. What is adolescence in the first place? It is the transition from childhood to adulthood. But to put a finer point on that, it's a transition from the time where you go from being cared for by your family to caring for yourself. That's a gigantic leap. And in order to go to care for yourself, you have to understand yourself in a social environment. You have to be aware of all these things beyond your parents and your siblings. So your brain is suddenly awake to this. And it's like, whoa. Look at all this stuff around me. Well, when puberty hits, it awakens this social brain. But to your wonderfully stated point, the rest of the brain is not on this new, faster calendar. The part of the brain that makes sense of all this information is still moving at the pace it always had. So now you're awake to certain information. You're not able to make sense of it quite the same way. And, boom, we're an environment where information is coming as it has never come before.

DAVIES: Right. So when you have these young people now having these hormones, which give them a whole different kind of emotional outlook, what does the lagging status of the other parts of the brain, their intellectual functioning, mean? What does it do to them? Why does it make things harder?

RICHTEL: Yeah. So I know that for me, when things get overwhelming, I can feel paralyzed at times. I can feel really profound anxiety. Which of these difficult choices am I going to make when there's job issues? Where should the family live? Where should the kids go to school? Now take that level of complexity and choice and layer it onto a brain that is reaching puberty early, is awake to all this stuff, can't make sense of it. And to answer your question you asked a little bit ago, what happens is the brain can really feel paralyzed. Like, it can look for places to land. And weirdly enough, you can think of things like anxiety, depression, even self-harm as coping mechanisms, a focal point, a port in the storm.

DAVIES: Right. And at the same time, we have a generation who has cellphones. I mean, one of them that you wrote about got a cellphone at age 10 because parents wanted to stay in touch with them. So there's the availability of all kinds of stuff online. There's a tendency to focus on screen time. And kids are getting less sleep, right? There's just more going on in their lives. How does that all fit in?

RICHTEL: Yeah, you've chewed off a lot with that question.

DAVIES: Right.

RICHTEL: And I'll break it down into two small pieces. One is the access to devices is - presents all that information. I want to highlight it for a second because it's simple - it's easy to simplify that as social media. But it's really a much broader technological shift that delivers information not just directly to the kids, but to the kids through their parents, who are also on media all the time. Their parents may be talking about the state of the world, or what they heard, or academic competition, the walls well - what's happening well beyond the walls of their community. So this is a much broader shift into a technologically fast-paced environment. That's the environmental side.

And then you mentioned sleep. And it's foremost. So when you don't get enough sleep, whether you're an adult but in particular when you're a kid, your brain doesn't function the same way, in such a healthy fashion. Your decision-making is already off. It also makes it harder for the brain to develop. It craves - it needs that sleep as much as anything. And here the kids are with the device in the room or being interrupted by its noise. And that is not the same as social media causing a problem. It's a slightly different flavor, which is social media and other technological inputs interrupting sleep, interrupting more pastoral activities, like going out outside, interrupting in-person activities - all that lead to healthy brain development.

I just want to say, this is not a judgment of young people and their lifestyles. We are all part of this. It's more an analysis of why this particular period of time is causing mental wellbeing distress for this generation.

DAVIES: It was interesting that a number of the suffering teenagers that you spoke to said they were so lonely even though they had this device that would connect them to so many people.

RICHTEL: Yeah. And I don't think we know precisely why that loneliness is here. But it's so - I'm so glad you brought it up because it is one of those crystalline data points. Loneliness is one of the big precursors to or predictors of anxiety, depression, suicidal ideation. And for some reason, this generation feels particularly lonely, even though they are often connected. Now, that could be because they are not physically together. But it might be also because they're so aware through this early puberty of their social connections or lack thereof.

DAVIES: We're going to take another break here. Let me reintroduce you. We are speaking with Matt Richtel. He is a Pulitzer Prize-winning reporter for The New York Times. His series of articles about the mental health crisis among American teenagers is "The Inner Pandemic." He'll be back to talk more after this short break. I'm Dave Davies. And this is FRESH AIR.

(SOUNDBITE OF JOSHUA REDMAN'S "STOP THIS TRAIN")

DAVIES: This is FRESH AIR. I am Dave Davies, in for Terry Gross. We're speaking with Matt Richtel, a Pulitzer Prize-winning reporter for The New York Times. He's spent much of the last two years reporting on an emerging mental health crisis among American teenagers. Three decades ago, the public health threats to teens came from binge drinking, drunk driving, pregnancy and smoking. They've all fallen, Richtel reports, but rates of depression, self-harm and suicide have risen sharply. Richtel's series about the dimensions of the crisis and possible causes is "The Inner Pandemic." You can find it online.

These kids are also living through an age in which our notions of gender are certainly evolving. I want to be careful about this. But I mean, does this opening, you know, the gender binary - does that put pressure on kids in a way or - I don't know - create confusion?

RICHTEL: This is a quote from a young person who said to me, "I was straight, and then, I was pansexual. And then, I was a lesbian but then was nonbinary. But then, I was like, if I'm nonbinary, I can't be a lesbian, right? So then, I was like, I'm bisexual. And then, I went back to pansexual. But then, I realized, you can be nonbinary and lesbian. So yeah."

Look, it's very easy to politicize issues of sexuality and gender, which are two very, very different things. I would argue that one of the great ways in which society has opened up is permitting the freedom. I would also acknowledge that as young people grapple with these issues, they are among the many different facets of life that are presenting new opportunity and complexity to the world. This is not a politicized issue. It's merely an issue of grappling with really difficult, beautiful issues at a time in life when the brain is still trying to make sense of the world.

You see suicide rates very high still, at consistently high levels among LGBTQ+ young people. And the reason for that, according to the experts, is that in - even though society has become more accepting, ultimately, young people can still worry about the judgment of their own families. And this is a place where the internet can be quite foul. As one researcher said to me, you can find on a street corner one word of hate, but on the internet a million words of hate. So if you're a young person grappling with these issues of sexuality or gender and you wind up going on the internet, you can be called names for - infinitely. And so that can really add to the difficult feelings.

DAVIES: You describe the experience of parents who took their daughter, who appeared to be suicidal, to an emergency room, the emergency room at Boston Children's Hospital, where you saw something that's emblematic of a growing problem. What happened?

RICHTEL: G went to Boston Children's and wound up spending nearly a month there waiting for an inpatient bed because G was suicidal and self-harming. And this turns out to be the second big pillar of this series, if you will. The first was the neurological mismatch. This second big pillar of this is the systemic mismatch.

DAVIES: And when you say spent a month there, you mean not in a hospital room, but in the emergency room? Like, what - in one of those exam rooms with curtains that pull back?

RICHTEL: Part of the time. They're ultimately moved into a spare room in the hospital. But that's not where this adolescent should have been. What has happened around the country is that our medical systems have not kept up with the transformation in risk from the externalized to the internalized - hence the systemic mismatch. And nowhere is a finer point put on it than emergency rooms. Every night, Dave, around the country, between 1,000 and 5,000 adolescents - children and adolescents really - are spending the night in emergency departments waiting for an inpatient bed because these patients are too much of a risk to themselves or others to go home. But there's nowhere else to go.

DAVIES: And what is the experience of someone who spends a day, two days, four days in an emergency room, 24 hours?

RICHTEL: Yeah. By almost every reckoning, it is not good. It doesn't meet the, quote-unquote, "standard of care," a term of art to describe what - how quickly these young people should be dispensed and put into a place where mental health care is what is the focal point. In other words, emergency rooms are not really equipped to be mental health care providers. So a young person may sit in a room that is stripped of all objects so no self-harm can be done. The cellphone or tablet or laptop is not allowed, so a young person can't look up ideas that might be triggering. The young person will invariably have the door left open so that someone - a minder, if you will - can be keeping an eye on the young person. The young person's clothing has been replaced so that there are no belts or shoestrings or anything else because this is a really austere, difficult environment for somebody who's already in terrible distress.

DAVIES: You know, there's a lot of research that shows solitary confinement for prisoners is harmful to mental health. This sounds like a similar experience almost.

RICHTEL: Yeah, certainly surrounded by loving, well-meaning people, including the parents who may be there. But you're right. This is not the environment that the young person needs to heal at a time of acute distress. And the emergency rooms, to be fair, are up in arms about this. They would love to see more community beds available. But this has happened against a backdrop where inpatient beds, Dave, have fallen, not risen around the country.

DAVIES: And why is that?

RICHTEL: It turns out to be for a reason that seems tangential and even was well-meaning to begin with. The idea in getting rid of some of these community inpatient beds came out of a philosophy that, say, foster kids and others in distress were better to be with their families or in homes. And so the idea was to create less of these inpatient facilities, but it didn't contemplate - that policy didn't contemplate this surge in mental health problems. So when I speak of systemic mismatch, there are a bunch of pieces that went to building an environment that is not as conducive to helping these young people as they now need.

DAVIES: And I think it's widely known that there's a shortage of mental health treatment and a lack of funding for it, I mean, both from private insurance plans and from government plans, aren't there?

RICHTEL: Yeah. I mean, this is - this gets into another vital piece, which is what are the economic incentives here? And to be plain, therapy, talk counseling, some of the skill treatments that we know work are super expensive. They're labor-intensive. They're expensive to reimburse for re-insurance and they're expensive to train. And we don't have enough of these people. By contrast, Dave, giving a pill is easier. It's less expensive. Insurers are more prone to do it. And so you've wind up - you wind up seeing this sort of helpful but ultimately half measure of medications used rather than more comprehensive treatments.

DAVIES: Let me reintroduce you. We're going to take another break here. We're speaking with Matt Richtel. He is a reporter for The New York Times. His series about the mental health crisis among American teenagers is "The Inner Pandemic." We'll continue our conversation after this break. This is FRESH AIR.

(SOUNDBITE OF THE WEE TRIO'S "LOLA")

DAVIES: This is FRESH AIR. And we're speaking with Matt Richtel. He is a Pulitzer Prize-winning reporter for The New York Times. He has a series of articles about the mental health crisis among American teenagers. It's available online. It's called "The Inner Pandemic." One of the things that you've observed here is that among the providers that are really on the front lines of this crisis are primary care providers, the doctors that kids go to, pediatricians. You describe one in a community in rural Kentucky, Melissa Dennison. What did she say about her - how her practice has changed in this way?

RICHTEL: Yeah. So, Dr. Dennison - wonderful pediatrician I had a privilege to meet in Glasgow, Ky., one of the poorest towns there. And I went to visit her. And if memory serves, about 22 - you know, more than a third of the 60 patients she saw over two days were mental and behavioral health cases. And that is a quantum change for her as your proverbial country doctor from years ago when what she dealt with was scratches and bruises and broken arms and the sniffles and she gave out antibiotics. And now she's dealing with Zoloft and Clonidine and Adderall and mental and behavioral health cases.

After I met Dr. Dennison, I discovered this really powerful factoid from the American Academy of Pediatrics. In 2019, they put out an article that noted that physical - harm from physical activity had been surpassed by these mental health issues as the leading cause of impairment and limitation among children and adolescents. And they called for pediatricians to get new training and to become front-line providers. Now, think about that. That's such a profound change. Dr. Dennison, who's in her early 60s, was trained at a time when these prior risks were what her clinic was going to face and what she was going to face. And this is a perfect encapsulation of this - how this risk is playing out and how providers who were not expressly trained to deal with it are finding it at their feet.

DAVIES: God, you can only imagine what it would be like for a primary care physician to be confronted with what is obviously a serious, deep-seated, complex problem, you know, that people spend careers learning how to treat with therapy and medications, and you got to deal with it in your - what? - 20-minute office visit. What do they do?

RICHTEL: Well, credit these remarkable providers - I mean, she's been trying to come up to speed on her own. She's gone to conferences where she tries to learn about this stuff, but she recognizes that, I mean, that this is not ideal. I think she said to me, I would love that they went to a psychiatrist, a child and adolescent specialist. But there is not one around, or if there is one around, that person is too expensive or too far away or too booked.

And it is particularly true in low-income areas that there is a dearth, an absence of specialty mental health providers. It comes down to school counselors or pediatricians. It comes down to community therapists who - well-meaning, time-strapped and maybe not as versed in the prescription of these medications, which can be a serious problem.

DAVIES: Well, you know, besides what to prescribe, there's how to have that conversation. It's got to be really hard and not one that you'd want to try and do with when there are like two or three other patients that you're waiting to see.

RICHTEL: And what you wind up with is you wind up with a fallback on medications that may not be the right ones. They may be very helpful. I want to be very clear to the listener. Some of these medications can be very helpful. But we found in our reporting that many of these medications are prescribed at the doctor's discretion, which the doctor has every right and oftentimes capability of doing, but not with FDA approval for their use in adolescents and not with FDA approval in the combinations that are sometimes being given to young people, increasingly in combinations, to try to thwart all the symptoms.

DAVIES: One of the other things that you write about is what kids of color are experiencing in this. I mean, to what extent are the trends that you identify in the series different among African American and Hispanic kids?

RICHTEL: I mentioned this in the opening, but Black adolescents are seeing huge spikes in suicide attempts. It was from a relatively low number to begin with, but it's the fastest, sharpest upward curve of any ethnic group. That said, there are a lot of positives I took from this series, and one of them was how I got to know a lot more about teens of color. And it was through this really remarkable place I got to bear witness to. It's a clinic held on Tuesdays in Atlanta run by the psychiatrists for Morehouse Medical School. This medical clinic is kind of the exception that proves the rule. Most poor teens of color do not have access to specialty medical care. But here in Atlanta, through this program, this Tuesday clinic, they do, and the insights they provide are searing and powerful and really opened my eyes.

DAVIES: Yeah, well, share some of those insights with us.

RICHTEL: One of the things I learned there, I'll tell through a story. There's a 17-year-old kid who comes in one day. And to be clear, I only heard the - got to hear the doctors talking about these patients. I didn't see the patients. Their anonymity is guaranteed. I'll speak of them in more general terms. But a 17-year-old comes in, and he's seen by Dr. Omade. And he's been kicked out of school for fighting. He's got ADHD. He comes in with a diagnosis also of something called intermittent explosive anger disorder. I hadn't heard of that previously. But in short, this is a kid who looks to be in real trouble. Well, after this evaluation and diagnosis, what the psychiatrists learn is that this is a kid who's had a gun or says he's had a gun pulled on him by police, whose dad has been arrested multiple times and tells his son that he has been thrown against the wall by police. And this is a kid who's seen a bunch of stuff happening in his community against people of color.

And what the doctors realize is that this heavy-duty diagnosis of intermittent anger disorder is not actually appropriate, that this kid does have ADHD, yes, but what this kid is suffering is some trauma, maybe some PTSD, maybe some depression. They haven't gotten that far, but that the trauma of this kid's life has led to some really deep feelings that cause him to feel very defensive and to fight classmates, not people in positions of authority, and to only fight when challenged. And so the doctors decide that this is a kid wrongly diagnosed with a hostility and aggressive disorder, rather than sadness or trauma or PTSD, which might happen with a kid who is not a kid of color.

DAVIES: Are there studies that show that Black kids can be misdiagnosed by white mental health professionals?

RICHTEL: Precisely. And this was the big walkaway from this clinic, which is that they are often seeing kids diagnosed with disorders of hostility and aggression that may be something else. All of the psychiatrists are Black. And the head of the clinic, Dr. Sarah Vinson, who's this sort of growing luminary in the field, says it's not that you need to be Black to diagnose these kids, but you have to be aware of the structural racism and implicit bias in these kids' lives that can lead to diagnoses that may be wrong and put them on the wrong medications. And so this clinic becomes, as I say, the exception that proves the rule where a group of doctors hyper aware of these issues is probably getting to more precise and accurate diagnoses than they may be getting in settings where there just aren't - there is no specialty care. Just a last note, Dr. Omade, who saw this 17-year-old, winds up saying to him, listen, man to man and Black man to Black man, these are issues we all face. And that was really telling to me about the kind of care and ability to listen to a community that teens of color often are starved for.

DAVIES: Let me reintroduce you. We're going to take another break here. We're speaking with Matt Richtel. He is a reporter for The New York Times. His series about the mental health crisis among American teenagers is "The Inner Pandemic." We'll continue our conversation after this break. This is FRESH AIR.

(SOUNDBITE OF KYLE EASTWOOD'S "SAMBA DE PARIS")

DAVIES: This is FRESH AIR. And we're speaking with Matt Richtel. He is a Pulitzer Prize-winning reporter for The New York Times. He has a series of articles about the mental health crisis among American teenagers. It's available online. It's called "The Inner Pandemic."

You have one section in this series online, the headline is "How To Help Teens Struggling With Mental Health." I mean, you're not diagnosing things, you're not treating people but just some some basic questions that might be helpful. One of them was how to start a discussion with an adolescent about these issues. What can you tell parents that's helpful?

RICHTEL: This leads us into the good news section, and there is good news. The science that explains the problem also helps to explain a solution. And one of the things we understand is during that neurological mismatch, young people can experience really intense emotions. It's not a very nice politically correct word these days, but it can come across as hysteria. I think lots of parents have seen a kid in a really, really intense emotional state. The first thing to recognize, Dave, is you can't really talk someone out of that state. You can't say, hey, you know, just realize it's OK. That doesn't reach someone who's in that neurological mismatch where the environment is overwhelming them - but if you can help a young person get through that emotional moment and begin to settle, settle down.

DAVIES: So you don't want to minimize or deny what the youngster is experiencing, right?

RICHTEL: It's very hard to validate that feeling 'cause from the outside, you're like, well, there's no reason to be this worked up. But in point of fact, there is a reason, and it has to do with what's happening inside the brain. If you can validate those feelings - and then, there are some steps that can be learned by the young person, him or her or themselves, like splashing water on the face, exercising, listening to a song that breaks that mood. What happens is that temporary state that feels overwhelming can begin to settle down. And then, a really powerful second step is that the young person can begin to put words to the feelings they are experiencing.

Now, this turns out to be not just, like, a way of connecting to an adult. In fact, that's not even the main purpose of it. What happens when a young person can put words to those feelings is the regulatory parts of the brain, these more intellectual, analytical parts, start to get involved, and they begin to connect to those intensely emotional parts that come out of this pubescent state. And a young person can begin to actually make sense of what they're feeling. So bringing the language online to connect to the intense emotion as it begins to dissipate can help lead young people out of the woods.

DAVIES: That sounds like something that you write about, a dialectical behavioral therapy? Is...

RICHTEL: Yes, and cognitive behavioral therapy. And again, this is the place where I'd really urge parents to take a look at this and young people to take a look at this because there are solutions. And these therapies are shown to help bring people out of these most intense, acute moments and help them find their footing. We kind of have some ideas about what to do.

DAVIES: Yeah. You mentioned that there is some good news that you discovered. Are there are other things you want to share?

RICHTEL: Yeah. I mean, like, the good news is for all the neurological mismatch and systemic mismatch, as I've mentioned, we are learning what to do. These therapies are telling us what to do. If we had the will as a society and gave access to young people to these tools, imagine this wonderful future where young people learned coping skills to these difficult, emotional issues earlier in life. Rather than having a midlife crisis later on, they might have a teen life crisis and have lots of skills available to them for many more years than our generations did.

DAVIES: Well, Matt Richtel, thanks so much for your reporting and for speaking with us.

RICHTEL: Thanks, Dave.

DAVIES: Matt Richtel is a Pulitzer Prize-winning reporter for The New York Times. His series of articles about the mental health crisis among American teenagers is "The Inner Pandemic."

On tomorrow's show, it's a Questlove Christmas. Ahmir Questlove Thompson plays his Christmas recordings - some favorites and some unusual ones. He's perhaps the most popular DJ in America. In addition to being the co-founder of The Roots and the house band for "The Tonight Show With Jimmy Fallon" (ph), this year, he won an Oscar for his documentary, "Summer Of Soul." I hope you can join us.

(SOUNDBITE OF SONG, "SANTA CLAUS, SANTA CLAUS")

JAMES BROWN: (Singing) I've been good - Lord, have mercy - so good, you know. Why, oh, why do I have to suffer so? Santa Claus, Santa Claus, please, please, please, don't make me - don't make me suffer so. Christmas come but once a year. Oh, won't somebody please...

DAVIES: FRESH AIR's executive producer is Danny Miller. Our technical director and engineer is Audrey Bentham with additional engineering help this week from Adam Staniszewski. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Roberta Shorrock, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Ann Marie Baldonado, Thea Chaloner, Susan Nyakundi and Joel Wolfram. Our digital media producer is Molly Seavy-Nesper. Seth Kelley directed today's show. For Terry Gross, I'm Dave Davies.

(SOUNDBITE OF SONG, "SANTA CLAUS, SANTA CLAUS")

BROWN: (Singing) Lord, I've been good, oh, so good, I know. Why, why, why, why, why, why... Transcript provided by NPR, Copyright NPR.

Dave Davies is a guest host for NPR's Fresh Air with Terry Gross.