A recent study from the Brookings Institution contains a statistic that sticks with you. Nearly 43% of children with mental, emotional, or behavioral disorders in Pennsylvania alone—one state, not the entire nation—received no treatment at all. Not insufficient care. not postponed medical attention. Nothing. Furthermore, according to the paper itself, Pennsylvania outperforms the majority of the country.
It’s difficult to forget that detail. Take a moment to consider this: kids who have already been flagged by parents or schools as having difficulties continue to fall between the gaps. The prevalence of the mental health crisis among young children may not be the most concerning aspect of it, but rather the silent normalization of ignoring it.
The Brookings study, which focuses on Pennsylvania but has implications for all states, uses data from the National Survey of Children’s Health from 2023 to illustrate how pervasive the issue has become. Anxiety is the most prevalent mental, emotional, or behavioral disorder, with an estimated 14.5% of Pennsylvania children between the ages of 3 and 17 having one. The percentage rises to 16.8% nationally. These projections are not abstract. They depict actual kids sitting in classrooms, having trouble focusing, having trouble breathing normally, and having difficulties in ways that the majority of the adults in their immediate vicinity are either unprepared to notice or discreetly choose not to.
The Brookings analysis is notable for not treating this as merely a public health issue. It treats it like an investment issue. The researchers treat early childhood programs and school-based mental health interventions as assets rather than costs using a technique known as the Marginal Value of Public Funds framework, which is used to determine the long-term economic return of public spending. Programs that pay for children’s mental health now often pay for themselves many times over in the future, according to a well-reasoned argument supported by demographic data and historical policy analysis. The data indicates that early Medicaid expansions aimed at children in the 1980s and 1990s produced quantifiable downstream benefits in adult earnings, health outcomes, and decreased dependency on public assistance.
Policymakers seem to have known this all along, in the back of their minds, but they have never been able to put it into practice. It is challenging to maintain long-term investment logic during short budget cycles. When a program pays off in twenty years, it doesn’t appear in the following election cycle. Therefore, the math continues to favor cuts over commitments, particularly when those most impacted—children from low-income families, children on Medicaid, and students in underfunded schools—don’t cast ballots.
An additional level of complexity is introduced by the report’s depiction of demographics. In Pennsylvania, approximately 14% of girls reported anxiety, compared to figures ranging from 3% to 9% for other disorders across both sexes. Adolescent girls in particular are experiencing anxiety at rates that should create more urgency than they do. In contrast, teens between the ages of 13 and 17 are more than seven times more likely than younger children to suffer from depression. The researchers take care to point out that these figures probably underestimate the true scope because parental underreporting tends to suppress statistics for disorders like depression and anxiety, which don’t always make a big impression.
What the report says about geography is equally important. The Pennsylvania data revealed that children in metropolitan and non-metropolitan areas received care at almost the same rates—roughly 57 to 58%—contrary to many presumptions about rural versus urban mental health access. In other words, the crisis is not limited to either urban or rural areas. Targeted regional solutions won’t be sufficient because it is dispersed throughout both.
It’s difficult not to get a little frustrated as you watch all of this happen. This is not a preliminary or thin body of evidence. Economic modeling, school-based intervention studies, and decades of Medicaid expansion research all show that investing in children’s mental health pays off. We have the means to slow the worsening of the mental health crisis among young children. Unfortunately, it is still unclear whether there is the political will to use them.
