Kidsdata.org provides the following indicators of children's emotional health:

• 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 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)

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 one in five 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).

There were 41,087 hospital discharges for mental health issues among California youth ages 5-19 in 2018: 14,128 for children ages 5-14 and 26,959 for teens ages 15-19. Overall, the statewide rate of youth mental health hospitalization was 5.2 per 1,000 in 2018, up from 3.4 per 1,000 in 2007.

In 2015-2017, an estimated 24% of 7th graders, 30% of 9th graders, 32% of 11th graders, and 33% 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 and those with low levels of school connectedness. More than 60% of gay, lesbian, and bisexual youth had experienced depression-related feelings in 2015-2017, compared with less than 30% of their straight peers.

According to 2015-2016 estimates, 19% of California youth ages 12-17 needed help for emotional or mental health problems (such as feeling sad, anxious, or nervous) in the previous year, up from 13% in 2009. Among those who needed help, fewer than two in five (38%) received counseling.

When asked whether their school emphasizes helping students with emotional and behavioral problems, 31% of responses by middle school staff, 27% of responses by high school staff, and 46% of responses by staff at non-traditional schools reported strong agreement in 2015-2017.

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:

• Ensuring that mental health funding is aligned with what is known about the age of onset of disorders, populations at high 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)