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- Definition: Number of hospital discharges for mental health issues among children and youth ages 5-19, by age group (e.g., in 2016, there were 25,772 hospital discharges for mental health issues among California youth ages 15-19).Number of hospital discharges for mental health issues per 1,000 children and youth ages 5-19, by age group (e.g., in 2016, there were 9.8 hospital discharges for mental health issues per 1,000 California youth ages 15-19).
- Data Source: California Office of Statewide Health Planning and Development special tabulation; California Dept. of Finance, Population Estimates by Race/Ethnicity with Age and Gender Detail 2000-2009; Population Reference Bureau, Population Estimates 2010-2016 (Aug. 2017).
- Footnote: Data are based on discharges, not individuals. Emergency room visits that do not result in hospital admission are excluded. County-level data reflect the patient's county of residence, not the county in which the hospitalization occurred. Cases for which county identification is unknown are included in state totals. A full list of diseases and disorders included in these data can be found here; this list and these data exclude disorders related to substance abuse. The notation S refers to rates that have been suppressed because there were fewer than 20 discharges for mental health issues in that age group, and to numbers (and their associated rates) that have been suppressed by the California Office of Statewide Health Planning and Development. N/A means that data are not available. Cases for patients with erroneous birth dates are excluded.
- Measures of Children's Emotional Health on Kidsdata.org
Kidsdata.org provides the following indicators of children's emotional health:
*Levels of school connectedness are based on a scale created from responses to five questions about feeling safe, close to people, and a part of school, being happy at school, and about teachers treating students fairly.
- The number and rate of children and youth ages 5-19 hospitalized for mental health issues, by age group
- The percentage of students with depression-related feelings (i.e., being so sad or hopeless every day for two weeks or more that they stop doing some usual activities) in the previous year, by grade level (7, 9, 11, and non-traditional), gender, level of school connectedness,* parent education level, race/ethnicity, and sexual orientation
- The percentage of youth ages 12-17 needing help in the previous year for emotional or mental health problems, and, in California and Los Angeles County, the percentage of those who receive counseling
- The percentage of children ages 2-17 who need mental health treatment or counseling and have received services in the previous year
- The percentage of school staff reports on the share of students who are well-behaved, the extent to which student depression or other mental health issues are a problem, and their level of agreement that helping students with emotional and behavioral problems is emphasized at their school, by type of school (elementary, middle, high, and non-traditional)
- Children's Emotional Health
- Hospitalizations for Mental Health Issues, by Age Group
- Depression-Related Feelings, by Grade Level
- Youth Who Reported Needing Help for Emotional or Mental Health Problems
- Receipt of Mental Health Services Among Children Who Need Treatment or Counseling (Regions of 70,000 Residents or More)
- Students Who Are Well-Behaved (Staff Reported)
- Student Depression or Mental Health Is a Problem at School (Staff Reported)
- School Emphasizes Helping Students with Emotional and Behavioral Problems (Staff Reported)
- Bullying and Harassment at School
- Bullying/Harassment (Student Reported), by Grade Level
- Bullying/Harassment for Bias-Related Reason (Student Reported), by Grade Level
- Disability as Reason for Bullying/Harassment (Student Reported), by Grade Level
- Gender as Reason for Bullying/Harassment (Student Reported), by Grade Level
- Race or National Origin as Reason for Bullying/Harassment (Student Reported), by Grade Level
- Religion as Reason for Bullying/Harassment (Student Reported), by Grade Level
- Sexual Orientation as Reason for Bullying/Harassment (Student Reported), by Grade Level
- Other Non-Specified Reason for Bullying/Harassment (Student Reported), by Grade Level
- Cyberbullying (Student Reported), by Grade Level
- Student Bullying/Harassment Is a Problem at School (Staff Reported)
- Childhood Adversity and Resilience
- Disconnected Youth
- School Connectedness
- Caring Adults at School (Student Reported), by Grade Level
- High Expectations from Teachers and Others (Student Reported), by Grade Level
- Meaningful Participation at School (Student Reported), by Grade Level
- Total School Assets (Student Reported), by Grade Level
- School Connectedness (Student Reported), by Grade Level
- Adults at School Believe in Student Success (Staff Reported)
- Caring Adults at School (Staff Reported)
- School Gives Students Opportunities to Make a Difference (Staff Reported)
- School Motivates Students to Learn (Staff Reported)
- Students Who Are Motivated to Learn (Staff Reported)
- Youth Development or Resilience Is Fostered at School (Staff Reported)
- Services for Substance Abuse, Violence, or Other Problems Are Provided at School (Staff Reported)
- School Safety
- Perceptions of School Safety (Student Reported), by Grade Level
- Fear of Being Beaten Up at School (Student Reported), by Grade Level
- Perceptions of School Safety for Students (Staff Reported)
- Youth Alcohol, Tobacco, and Other Drug Use
- Alcohol/Drug Use in Past Month, by Grade Level
- Alcohol/Drug Use on School Property in Past Month, by Grade Level
- Alcohol Use in Past Month, by Grade Level
- Alcohol Use in Lifetime, by Grade Level
- Binge Drinking in Past Month, by Grade Level
- Drinking and Driving or Riding with a Driver Who Has Been Drinking, by Grade Level
- Cigarette Use in Past Month, by Grade Level
- Cigarette Use in Lifetime, by Grade Level
- E-Cigarette Use in Past Month, by Grade Level
- E-Cigarette Use in Lifetime, by Grade Level
- Marijuana Use in Past Month, by Grade Level
- Marijuana Use in Lifetime, by Grade Level
- Student Alcohol and Drug Use Is a Problem at School (Staff Reported)
- Substance Abuse Prevention Is an Important Goal at School (Staff Reported)
- Substance Use Prevention Education Is Provided at School (Staff Reported)
- Youth Suicide and Self-Inflicted Injury
- Why This Topic Is Important
Emotional health is an integral part of overall health, as physical and mental health are intricately linked (1, 2). Sound youth mental health—which is more than the absence of disorders—includes effective coping skills and the ability to form positive relationships, to adapt in the face of challenges, and to function well at home, in school, and in life (1, 3). Positive emotional health is critical to equipping young people for the challenges of growing up and living as healthy adults (1, 2).
Mental disorders affect as many as 1 in 5 U.S. children each year and are some of the most costly conditions to treat—mental health problems among young people under age 24 cost the U.S. an estimated $247 billion annually (1, 3). Unfortunately, the majority of young people who need mental health treatment do not receive it, and mental health problems in childhood often have negative effects in adulthood (1, 3, 4).Depression is one of the most common emotional health problems among youth, with an estimated 11% of U.S. adolescents diagnosed with depression by age 18 (4). One study found that depression accounted for 44% of all pediatric mental health hospital admissions in 2009, costing $1.33 billion (5). In 2015, 30% of high school students nationwide reported persistent feelings of sadness or hopelessness—one indicator of depression (6). Youth with depression are more likely to exhibit suicidal behavior, drop out of school, use alcohol or drugs, and engage in unsafe sexual activity, in addition to having difficulties with school and relationships (4, 6).
For more information on children's emotional health, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Murphey, D., et al. (2014). Are the children well? A model and recommendations for promoting the mental wellness of the nation's young people. Child Trends & Robert Wood Johnson Foundation. Retrieved from: http://www.rwjf.org/en/library/research/2014/07/are-the-children-well-.html
2. World Health Organization. (2013). Mental health action plan 2013-2020. Retrieved from: http://www.who.int/mental_health/maternal-child/child_adolescent/en
3. Perou, R., et al. (2013). Mental health surveillance among children—United States, 2005-2011. Morbidity and Mortality Weekly Report, 62(02), 1-35. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/su6202a1.htm
4. Avenevoli, S., et al. (2015). Major depression in the National Comorbidity Survey—Adolescent Supplement: Prevalence, correlates, and treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 37-44.e2. Retrieved from: http://www.jaacap.com/article/S0890-8567(14)00732-1/
5. Bardach, N. S., et al. (2014). Common and costly hospitalizations for pediatric mental health disorders. Pediatrics, 133(4), 602-609. Retrieved from: http://pediatrics.aappublications.org/content/133/4/602
6. Child Trends Databank. (2016). Adolescents who felt sad or hopeless. Retrieved from: http://www.childtrends.org/?indicators=adolescents-who-felt-sad-or-hopeless
- How Children Are Faring
There were 38,578 hospital discharges for mental health issues among California youth ages 5-19 in 2016: 12,806 for children ages 5-14 and 25,772 for teens ages 15-19. Overall, the statewide rate of youth mental health hospitalization was 5 per 1,000 in 2016, up from 4 per 1,000 in 2002.
In 2013-2015, an estimated 25% of 7th graders, 32% of 9th graders, 33% of 11th graders, and 38% of non-traditional students in California experienced depression-related feelings in the previous year (meaning they felt so sad or hopeless almost every day for two weeks or more that they stopped doing some usual activities). Depression-related feelings were more common among female students, those with low levels of school connectedness, and those whose parents did not finish high school. More than 60% of gay, lesbian, and bisexual youth experienced depression-related feelings in 2013-2015, compared to less than 30% of their straight peers. Among racial/ethnic groups with data, estimates of depression-related feelings ranged from less than 27% to more than 40%.
An estimated 21% of California youth ages 12-17 needed help for emotional or mental health problems (such as feeling sad, anxious, or nervous) in 2013-2014, up from 17% in 2005. Among those who needed help, approximately one-third (35%) received counseling. According to 2011-2012 parent reports, an estimated 63% of California children ages 2-17 who needed mental health treatment or counseling received services in the previous year, with county-level estimates ranging from 53% to 67%.When asked whether their school emphasizes helping students with emotional and behavioral problems, 28% of responses by middle school staff, 24% of responses by high school staff, and 43% of responses by staff at non-traditional schools reported strong agreement in 2013-2015.
- Policy Implications
The vast majority of emotional health problems begin in adolescence and young adulthood, with half of all disorders starting by age 14 (1, 2). Screening, early identification, and treatment are critical, as untreated mental illness can disrupt children's development, academic achievement, and their ability to lead healthy, productive lives (1, 2, 3). Health care and school settings are natural places to identify early warning signs, though many primary care providers do not routinely screen youth for mental health issues, and teachers may lack the training or time to identify such issues and refer students for services (1, 3, 4). Even if mental health problems are identified, children often face challenges with stigma and access to services; in fact, most children who need mental health treatment do not receive it (1, 3).
Experts recommend promoting mental wellness in addition to preventing and treating mental illness (1, 5). Mental wellness is influenced by socioeconomic, biological, and environmental factors, and promoting positive emotional health requires coordinated, cross-sector strategies that address influences at both the individual and community levels (1, 5).
Policy options that could promote children's emotional health include:
For more policy ideas and information on this topic, see kidsdata.org’s Research & Links section or the report, Are the Children Well? Also see Policy Implications under the following kidsdata.org topics: Youth Suicide and Self-Inflicted Injury, Bullying and Harassment at School, and School Connectedness.
- Ensuring that mental health funding is aligned with what is known about the age of onset of disorders, populations at higher risk (e.g., children in poverty, LGBT youth, and children in foster care, among others), and effective services and strategies, which include increased integration and coordination among mental health services and other systems, such as health care, education, child welfare, and juvenile justice (1, 2, 3, 5)
- Setting school policies that foster a positive, supportive environment and promote student engagement in school; also supporting comprehensive K-12 education for social-emotional learning, including communication skills, problem-solving, and stress management (1, 5, 6)
- Ensuring adequate funding and training for a range of school staff to recognize signs of mental distress and refer students to services; such training also should focus on how to promote a safe and supportive environment for all students, including LGBT youth (1, 4, 7)
- Promoting efforts in communities to provide youth with positive experiences, relationships, and opportunities, such as quality after-school programs and safe places to play and exercise (1, 8)
- Promoting mental health training for medical residents and pediatricians, and expanding the workforce of qualified mental health professionals serving youth, including school counselors, psychiatrists, and primary care physicians (1, 3, 9)
- Supporting efforts to promote parents' mental health and positive parenting skills, including increased screening for parental depression (1)
- Increasing access to high-quality early childhood education, especially for low-income children, and ensuring that early education staff are trained on social-emotional learning (1)
- Supporting training and media campaigns to reduce the stigma associated with mental health problems and increase knowledge of warning signs; trainings could include "mental health first aid" for wide-ranging audiences, focusing on how to recognize early warning signs, provide non-professional support, and help youth access community resources (1, 9)
Sources for this narrative:
1. Murphey, D., et al. (2014). Are the children well? A model and recommendations for promoting the mental wellness of the nation’s young people. Child Trends & Robert Wood Johnson Foundation. Retrieved from: http://www.rwjf.org/en/library/research/2014/07/are-the-children-well-.html
2. World Health Organization. (n.d.). Child and adolescent mental health. Retrieved from: http://www.who.int/mental_health/maternal-child/child_adolescent/en
3. Padilla-Frausto, D. I., et al. (2014). Three out of four children with mental health needs in California do not receive treatment despite having health care coverage. UCLA Center for Health Policy Research. Retrieved from: http://healthpolicy.ucla.edu/publications/search/pages/detail.aspx?PubID=1307
4. Dowdy, E., et al. (2010). School-based screening: A population-based approach to inform and monitor children’s mental health needs. School Mental Health, 2(4), 166-176. Retrieved from: https://link.springer.com/article/10.1007%2Fs12310-010-9036-3
5. World Health Organization. (2016). Mental health: Strengthening our response. Retrieved from: http://www.who.int/mediacentre/factsheets/fs220/en
6. Patel, V. (2013). Reducing the burden of depression in youth: What are the implications of neuroscience and genetics on policies and programs? Journal of Adolescent Health, 52(2, Suppl. 2), S36-S38. Retrieved from: http://www.jahonline.org/article/S1054-139X(12)00178-4/
7. Centers for Disease Control and Prevention. (2017). Lesbian, gay, bisexual, and transgender health: LGBT Youth. Retrieved from: http://www.cdc.gov/lgbthealth/youth.htm
8. Afterschool Alliance. (2014). Taking a deeper dive into afterschool: Positive outcomes and promising practices. Retrieved from: http://www.afterschoolalliance.org/documents/Deeper_Dive_into_Afterschool.pdf
9. Goodell, S. (2014). Mental health parity. Health Affairs. Retrieved from: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=112
- Websites with Related Information
- American Academy of Pediatrics: Mental Health
- Blueprints for Healthy Youth Development, Center for the Study and Prevention of Violence
- Center on the Developing Child, Harvard University
- Centers for Disease Control and Prevention: Mental Health
- Child Trends: Youth Development
- Headspace, Stanford Center for Youth Mental Health and Wellbeing
- MentalHealth.gov, U.S. Dept. of Health and Human Services
- National Institute of Mental Health: Child and Adolescent Mental Health
- National Registry of Evidence-Based Programs and Practices, Substance Abuse and Mental Health Services Administration
- National Technical Assistance Center for Children's Mental Health, Georgetown University Center for Child and Human Development
- Social and Emotional Development in Children and Adolescents Knowledge Path, National Center for Education in Maternal and Child Health
- Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Dept. of Health and Human Services
- Youth.gov, Interagency Working Group on Youth Programs
- Key Reports and Research
- 2018 California Children's Report Card, Children Now
- Annual Report on Health Care for Children and Youth in the United States: National Estimates of Cost, Utilization and Expenditures for Children With Mental Health Conditions, 2015, Academic Pediatrics, Torio, C. M., et al.
- Are the Children Well? A Model and Recommendations for Promoting the Mental Wellness of the Nation's Young People, 2014, Child Trends & Robert Wood Johnson Foundation, Murphey D., et al.
- Behavioral Health Barometer, 2017, Substance Abuse and Mental Health Services Administration
- California Reducing Disparities Project Strategic Plan to Reduce Mental Health Disparities [in preparation], 2014, California Pan-Ethnic Health Network, et al.
- Children's Mental Health Report, 2015, Child Mind Institute
- Improving Access to Children's Mental Health Care: Lessons from a Study of Eleven States, 2013, George Washington University, Center for Health and Health Care in Schools, Behrens, D., et al.
- Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health, 2017, Substance Abuse and Mental Health Services Administration
- Mental Health and Suicidality Among Racially/Ethnically Diverse Sexual Minority Youths, 2014, American Journal of Public Health, Bostwick, W. B., et al.
- Mental Health Parity, 2014, Health Affairs, Goodell, S.
- Overlooked and Underserved: “Action Signs” for Identifying Children with Unmet Mental Health Needs, 2011, Pediatrics, Jensen, P. S., et al.
- Policies to Promote Child Health, 2015, The Future of Children
- Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity, 2015, California Dept. of Public Health, Office of Health Equity
- Reducing the Burden of Depression in Youth: What Are the Implications of Neuroscience and Genetics on Policies and Programs?, 2013, Journal of Adolescent Health, Patel, V.
- Serious Mental Health Challenges Among Older Adolescents and Young Adults, 2014, Center for Behavioral Health Statistics and Quality
- Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience, 2015, National Scientific Council on the Developing Child
- Three Out of Four Children with Mental Health Needs in California Do Not Receive Treatment Despite Having Health Care Coverage, 2014, UCLA Center for Health Policy Research, Padilla-Frausto, D. I., et al.
- County/Regional Reports
- 2016-17 California County Scorecard of Children's Well-Being, Children Now
- 2017 Kern County Report Card, Kern County Network for Children
- 2017 Wellbeing Index Findings Summary, City of Santa Monica & RAND Corporation
- Community Health Assessment and Community Health Improvement Plan, Los Angeles County Dept. of Public Health
- County of San Mateo Adolescent Report 2014-15, San Mateo County Health System
- Key Indicators of Health by Service Planning Area, 2017, Los Angeles County Dept. of Public Health
- Orange County Community Indicators Report, 2017, Orange County Community Indicators Project
- San Diego County Report Card on Children and Families, 2015, The Children's Initiative & Live Well San Diego
- Santa Clara County Children's Agenda: 2018 Data Book, Planned Parenthood & Kids in Common
- Santa Monica Youth Wellbeing Report Card, Santa Monica Cradle to Career
- The 23rd Annual Report on the Conditions of Children in Orange County, 2017, Orange County Children's Partnership
- More Data Sources For Children's Emotional Health
- California Health Interview Survey, UCLA Center for Health Policy Research
- California School Climate, Health, and Learning Survey (CAL-SCHLS) System, California Dept. of Education & WestEd
- Child Trends Databank: Adolescents Who Felt Sad or Hopeless
- Depression in the U.S. Household Population: 2009-2012, 2014, National Center for Health Statistics, Pratt, L. A., & Brody, D. J.
- Substance Abuse and Mental Health Services Administration (SAMHSA): Data, U.S. Dept. of Health and Human Services
- The National Longitudinal Study of Adolescent to Adult Health (Add Health), UNC Carolina Population Center
- Youth Risk Behavior Surveillance System (YRBSS), Centers for Disease Control and Prevention
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