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In part two of this exclusive video interview, MedPage Today editor-in-chief Jeremy Faust, MD, talks with Admiral Rachel Levine, MD, the assistant secretary for health at the Department of Health and Human Services (HHS), about how HHS is addressing mental health issues among U.S. kids and adolescents.

Watch part one of the interview here.

The following is a transcript of their remarks:

Faust: Let's turn to a discussion of mental health. It's an area that you've spent a lot of time and expertise on -- it was your fellowship training, so long before your government service.

The teen mental health crisis in this country is not new. The pandemic made it worse. I feel like maybe social media is not helping. If you were just to give me the napkin pitch on what is the root cause of this is? What would you say?

Levine: Well, there's no simplistic answers to that, in terms of root causes. Again, there are many different factors.

Youth mental health was challenged before the pandemic, you're right. I'm an adolescent medicine specialist and a pediatrician, and my whole career has been treating children, adolescents, and young adults, particularly with that intersection between physical health and mental health. That was in academic medicine, primarily at Penn State College of Medicine, and then as the physician general and the secretary of health of Pennsylvania. Of course, I've been very active in that role in my current position. I'm co-chair of the Behavioral Health Coordinating Council for Secretary Becerra -- with my friend and colleague Assistant Secretary Delphin-Rittmon of SAMHSA [Substance Abuse and Mental Health Services Administration] -- and we have a specific subcommittee looking at child and adolescent mental health.

I think that there are many different causes of this. The social determinants of health, of course, are involved. I think social media plays a role, and the surgeon general, [Vice] Admiral Murthy, has been very vocal in terms of impacts of social media. All of this has been exacerbated during the COVID-19 pandemic, and we're left with significant mental health challenges. So we are looking at depression and anxiety, suicidality, we're looking at eating disorders, we're looking at the risk of substance use and the full range of mental health challenges that youth face.

Many different activities are going on with our subcommittees. We're looking at further integration of physical and mental health, which means having mental health providers in our community health centers sponsored by HRSA [Health Resources and Services Administration]. We're looking at availability of psychiatric and psychological consultations for pediatricians through our HRSA hotline. We're looking at working on the workforce capacity for mental health professionals, and HRSA has many different activities with that. CMS is looking at in terms of reimbursement. We're always looking for new treatments and protocols from NIH and the NIMH [National Institute of Mental Health].

So many different activities across the range of divisions looking at youth mental health, looking at prevention, looking at access, and looking at treatment.

Faust: Do you think that the COVID-19 pandemic operated on this in a way that had more to do with isolation or the virus itself? Because I think there's an easy out to say, "Oh, people, their mental health was hit because of all the isolation." But a lot of times you look at kids and you say, "Look, how many thousands of kids lost a parent or a grandparent," and that is the downstream effect of our failure to control this virus or take it seriously. So it's not a yes either/or, but do you think that that gets lost in the conversation when people talk about this?

Levine: I think it does get lost, and certainly the isolation experience was really challenging. But this was a global pandemic the likes of which we haven't seen in 100 years. It was, of course, going to have a serious impact on the health and mental health of our nation and the world.

The same mental health challenges we're seeing in the United States we are seeing globally. And you're right, many, many youth were impacted either by illness or illness of their parents or loved ones. Significant impacts all around from the COVID-19 pandemic in its acute phase, and we're doing everything we can to help challenged youth and families in our nation.

Faust: But I think sometimes even the CDC -- again, that's not you -- the messaging was, "Suicide attempts in teenage girls went up during the pandemic." But then when you looked at it, it coincided with the re-opening of schools. And I wonder if we're missing a bigger problem, which is: is school really a safe place for our kids these days? I mean, yes, they have to be -- but are we missing the picture there that school is where a lot of good things happen, but it's also where a lot of toxic things happen?

Levine: Well, I think schools are absolutely necessary for the education of young people. And it is our job in the federal government working with the states and communities to make school as safe and nurturing a place as possible. I'm sure that's what the Department of Education is doing, and [what] we are working on in terms of, for example, school-based health professionals and school-based mental health professionals.

But there are other challenges in schools, and one of the challenges that the president has spoken a lot about is the issue in terms of gun violence. The president has called for numerous common sense gun control efforts, and so we call upon the legislature to follow the president's recommendations.

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