Summary: Psychiatric diagnoses and medication use have risen sharply in the United States, raising concerns about overdiagnosis and overprescription. Expanded diagnostic criteria and reimbursement incentives are likely contributing to these trends. A recent US Department of Health and Human Services (HHS) initiative—which promotes informed consent, regular reassessment of psychiatric medications, and support for tapering patients off unnecessary drugs—is a step in the right direction, but reducing unnecessary medication use may require broader reforms to the policies and financial structures that shape mental-health care.

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Health Secretary Robert F. Kennedy Jr. announced an initiative last week to reduce the overprescribing of psychiatric medications, especially among children. In what’s being called a national mental-health crisis, psychiatric diagnoses in almost every category are reaching all-time highs. The Centers for Disease Control and Prevention reports that autism now appears in 1 in 31 children, a 381% increase since 2000. Childhood attention-deficit/hyperactivity disorder diagnoses nearly doubled between 1997 and 2022. Childhood anxiety diagnoses rose 54% between 2016 and 2022. Past-year prevalence of any mental illness among adults reached 23.1% in 2022, with young adults at 36.2%.

But much of the supposed surge in mental illness can be explained by a broadening of the American Psychiatric Association’s diagnostic criteria in recent decades and financial incentives for diagnosing more. The Mental Health Parity and Addiction Equity Act of 2008, extended by the Affordable Care Act in 2010, required health plans to cover mental-health services at parity with medical and surgical care. That addressed a genuine inequity in coverage, but made it so clinicians are paid more when they diagnose more cases.

The result is what economists call supplier-induced demand. Ideally, increased spending on mental-health care would yield better mental-health outcomes. Instead we have seen the opposite. Between 2000 and 2021, mental-health care spending in the U.S. more than tripled, from $40 billion to $140 billion, while mental-illness rates grew almost as dramatically.

Defenders of mental-health parity argue that spending and diagnoses are rising to meet previously unmet needs. But psychiatry is more subjective than other branches of medicine. No objective cutoff distinguishes ordinary worry from clinical anxiety, or grief from clinical depression. Findings are prone to distortion under the influence of nonpsychiatric factors.

When the National Institute of Mental Health says that half of all American adolescents have experienced mental illness, that isn’t psychiatry advancing as a field. It’s the result of various incentives for pathologizing ordinary struggle.

Wasteful spending and panic over a possibly nonexistent mental-health crisis would be bad enough. But psychiatric overdiagnosis creates an even more serious problem: overmedication. Roughly 1 in 6 American adults, an estimated 44 million people, are now on antidepressants. In young adults, those numbers are even higher. Thirty percent of college students take psychiatric medication, up from 9% in 2007.

For adults with mental conditions resistant to therapy, psychiatric medication can be effective. But we don’t understand the long-term consequences of many psychiatric drugs, particularly on young brains. We are running a large uncontrolled experiment on the developing brains of millions of young people, and we won’t know the full results for decades.

Meanwhile, the reimbursement architecture makes overmedication practically inevitable. Once a patient is on a drug, side effects are often addressed with a second drug rather than with a reassessment of the first. Clinicians call this the “prescribing cascade”: An antidepressant causes insomnia, so a sleep aid is added; a stimulant causes irritability, so a mood stabilizer follows. Each new prescription generates a billable visit, while tapering a patient off an ineffective drug takes time, monitoring and follow-up, which the billing system frequently doesn’t reimburse. Adding a prescription is the fastest, most reimbursable response at every stage of care.

The new HHS initiative rightly recognizes the harms of overprescription and the potential for negative side effects from long-term psychiatric medication in young people. It includes new reimbursement for clinicians who help patients taper off drugs, a “Dear Colleague” letter urging informed consent and regular reassessment, and a technical expert panel to develop formal tapering guidelines this summer.

These are sensible steps, but they don’t address the root cause. The fundamental problem is that federal law created an incentive structure that makes psychiatric medication the default for tens of millions of Americans who might be better served by therapy, lifestyle intervention or no clinical intervention at all.

To get physicians to stop overprescribing, the institutions that shape their choices should offer a greater reward for prescribing sparingly. In addition to new billing codes for deprescribing, what’s needed is a serious examination of whether the coverage mandates and reimbursement structures the ACA put in place are producing the outcomes they promised.

The mental-health system has improved over the past half-century. Effective treatments are more widely available, and people are more willing than ever to seek help. But the same mandates that have increased access to mental-health care have made overdiagnosis and overmedication the path of least resistance for a generation of clinicians and patients.

This article was originally published at the Wall Street Journal on 5/10/2026.

Summary: Growing concern over smartphones and social media has fueled claims that screens are driving an epidemic of adolescent mental illness. But the scientific evidence for this narrative remains mixed and often overstated, with many studies failing to distinguish correlation from causation or account for underlying social and psychological factors. Loneliness, family instability, social support and resilience appear to be far stronger predictors of youth well-being than screen time alone.

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As a member of Gen Z, I have studied the effects of social media on adolescent mental health from a perspective most psychology researchers lack: I grew up under its influence.

Between ages 12 and 17, I was obese, socially isolated and addicted to the fantasy video game RuneScape. I was home-schooled, lived with just my mother and rarely went outside. I logged over 10,000 hours in that game alone, nearly a third of my waking life during those years.

That doesn’t include countless additional hours I spent on other video games, television and, of course, social media. I made friends through online chatrooms and pen pal websites because I had none in real life. I averaged well over 10 hours a day on devices.

If ever there were a case study for the claim that screens destroy young minds, I would seem to fit it. And yet here I am as a 26-year-old developmental psychologist with a doctorate from Harvard. I am in good mental and physical health, with deep friendships online and off.

Maybe I’m the exception. Or maybe the harms are overblown.

Jonathan Haidt’s best-selling book “The Anxious Generation” argues that smartphones and social media have “rewired” childhood and caused an epidemic of mental illness. The book has helped inspire social media restrictions in Australia and several American states, and shaped how a generation of parents thinks about technology.

Restricting screen time and social media access are reasonable aspirations for child-rearing. But as a matter of public policy, the case for regulation rests on a scientific foundation far weaker than its proponents claim.

Haidt’s argument relies on the observation that adolescent mental health indicators worsened around 2010, when smartphones and social media apps popular with young people — such as Instagram and Snapchat — started becoming widespread. But correlation is not causation, and research suggests that some of the supposed mental health crisis is an epidemic of overdiagnosis. Wealthy Western democracies with the highest smartphone adoption rates have also seen expanded access to psychiatric services and a cultural shift toward identifying and labeling psychological distress, as Abigail Shrier argues in her 2024 book “Bad Therapy.”

Meanwhile, youth have been doing better on many other outcomes: less crime, less smoking, less drug use, fewer teen pregnancies and fewer high school dropouts. If social media were truly “rewiring” the adolescent brain, we would expect the damage to be more consistent than a selective worsening on some measures and improvement on others.

Many studies have reported on how social media use is associated with mental health problems among the young. However, a 2024 analysis in JAMA Pediatricsof 143 studies featuring data from over 1 million adolescents worldwide found that links between social media use and poor mental health among youth were small, inconsistent across studies and drawn mostly from nonclinical community samples.

One reason studies report mixed findings is that many fail to account for factors such as personality traits and social support that independently predict heavy screen use and mental distress. For example, social media use may be associated with anxiety and loneliness, not because it causes them, but because socially anxious individuals are more likely to seek out connections online. Statistically controlling for such factors often accounts for the relationship between social media and mental health.

I am not dismissing the possibility that some children are harmed by some content in some contexts. Many in my generation have had online exposure to graphic, violent and sexual imagery that no child should encounter.But the blanket claim that social media use drives generational mental illness does not align with the evidence.

Screens didn’t cause my problems. They were coping mechanisms for preexisting problems: loneliness, family instability, social anxiety, an absent father. The variables that predict youth mental health are not hours spent on social media but social support, resilience and a sense of belonging. To help struggling adolescents, the evidence points toward strengthening those capacities, not confiscating phones.

During my most isolated years, online connections were the only positive relationships I had. Internet forums helped me navigate college applications and taught me about calorie-counting, which sparked a weight-loss journey that changed my life. Even in RuneScape, I built discipline and goal-setting habits that I later transferred to academics and research.

Concerns about social media are well-intentioned. But sincerity is not proof. The dramatic assertions that children’s lives would be transformed by reducing social media exposure are more akin to moral panics over past technologies and obsessions — from radio to comic books to video games — fueled by weak social science and strong public emotion. In the United States, according to data from the Centers for Disease Control and Prevention, youth mental health has been improving recently, despite no change in access to social media. The simplest explanation might be that social media is not as harmful as people think.

This article was originally published at the Washington Post on 4/12/2026.

“Suicide deaths among young adults and youth declined after a federal agency simplified the phone number for a national crisis hotline and increased resources, a new study says…

Patel, a clinical fellow in surgery at Harvard Medical School and surgical resident at Brigham and Women’s Hospital, said that when researchers first examined figures for all age groups, the lifeline’s potential impact appeared to be slight.

But when they broke down the data, they saw a significant decline among those age 15 to 34 — encompassing the high-risk teenage years — that had been masked by results in other groups.

The researchers noted a decline from both observed suicide deaths in 2022 and from predictions based on a long-term upward trend. In 2010, about 11 suicides per 100,000 were reported in that age group. By 2022, that had risen to nearly 18 per 100,000. Three years after the 988 number went online, however, that had fallen to approximately 15 per 100,000, according to the study…

In addition to the nationwide figures, state-by-state data also shows an association with the establishment of the 988 number.

The 10 states with the largest increases in calls after its establishment — 146.2 percent more — also saw a larger decline in suicide deaths, about 18.2 percent. The 10 states with the lowest call volume increase — about 23.6 percent — saw a lower, 10.6 percent decline.”

From Harvard Gazette.

Summary: Rising rates of psychiatric diagnoses in wealthy countries have fueled claims of a growing mental health crisis, but this trend is in large part a byproduct of greater mental health awareness. Subjective psychiatric standards—combined with expanded diagnostic criteria—have blurred the line between normal human struggles and clinical disorders. Healthcare incentives, such as those in the US, often encourage overdiagnosis by rewarding providers for labeling and treating more patients rather than ensuring accurate or necessary care. Overdiagnosis is a problem of prosperity—but preferable to underdiagnosis, and solvable with the right incentives.

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According to the World Health Organization, more than 1.1 billion people worldwide are living with a mental disorder. The figure has grown faster than the global population, and the burden falls disproportionately on the world’s wealthiest societies. In the United States, an estimated 49.5 percent of adolescents have met diagnostic criteria for at least one mental disorder at some point in their lifetime. Additionally, about 31 percent of American adults will experience an anxiety disorder at some point in their lives, and 21 percent a mood disorder, according to the National Institutes of Mental Health. 

In Australia, the National Study of Mental Health and Wellbeing found that 21.5 percent of adults over 25 and over 38 percent of young people aged 16 to 24 met criteria for a mental disorder in the previous 12 months. Across OECD nations, one in five adults experiences at least mild depressive symptoms, with over 9 percent of the population reporting clinical depression or anxiety. 

These trends have become perhaps the most common objection to the case for human progress: If life is getting better, why are so many people apparently unhappy? Why are hundreds of millions of people across the most prosperous nations on Earth labeled clinically mentally unwell? 

For one, rising mental health diagnoses may themselves be a sign of progress. Psychiatry as a discipline is barely more than a century old, and it was stigmatized and unscientific throughout most of its history. What we now call mental health problems are, in many cases, what our ancestors called the inevitable vicissitudes of life. When survival demanded hard physical labor from dawn to dusk, there was little room for psychoanalysis. Perhaps only in a world of material abundance, safety, and comfort—where mood swings and relationship conflict represent life’s biggest challenges for many otherwise healthy people—do we begin to treat such adversity not as fate but as a problem to be solved. 

That is not to dismiss the problem entirely. Our survival-evolved brains are navigating environments they were never built for. It was adaptive to be vigilant about threats in one’s local environment; there was no possibility of witnessing every catastrophe on Earth in real time. Social media, sedentary lifestyles, weakened community bonds, and the erosion of traditional sources of meaning all represent genuine evolutionary mismatches that plausibly contribute to psychological distress. 

But at least in the United States, there is strong reason to believe that a less-examined driver of the supposed rise in mental illness is the healthcare financing system itself, which pays more when providers diagnose more.

Psychiatric Overdiagnosis in the United States

Psychiatric diagnoses in the United States are rising across virtually every category, in every age group. According to the National Institutes of Mental Health, more than one in five U.S. adults—59.3 million people—lived with a mental illness in 2022. By these numbers, mental illness is not a rare affliction but a near-universal feature of American life, prompting some, including former US Surgeon General Vivek Murthy, MD, to declare a mental health epidemic.

The rise is evident across specific conditions as well. The Centers for Disease Control and Prevention (CDC) now places autism prevalence at 1 in 31, a 381 percent increase since 2000. Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses among American children nearly doubled from 6.1 to 11.4 percent between 1997 and 2022. Among adults, self-reported ADHD diagnosis among working-age adults has more than tripled since 2012, from 4.25 to 13.9 percent. Diagnosed anxiety among children aged 3 to 17 rose from 6.9 to 10.6 percent between 2016 and 2022—a 54 percent increase in just six years. Diagnosed depression among the same age group climbed from 3.1 to 4.6 percent, a 48 percent increase, in the same time period. Among adults, the past-year prevalence of any mental illness rose to 23.1 percent in 2022, with young adults aged 18 to 25 reporting the highest rate of 36.2 percent. 

A surface-level reading of these numbers suggests that America is indeed in the midst of a mental health crisis. But diagnoses can change even when our underlying psychology does not.

Psychiatric diagnoses differ from most of medicine because they rely on subjective mental phenomena and behavioral symptoms instead of physical symptoms or biomarkers. There is no blood test for autism, no imaging scan that confirms ADHD, and no objective test that differentiates clinical anxiety from ordinary worry. Diagnosis depends on clinical judgment about whether a person’s behavior exceeds a threshold established by committee consensus in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

The DSM has progressively broadened the boundaries of major psychiatric categories over successive revisions. The DSM-5, published in 2013, collapsed previously distinct autism categories into a single spectrum, making “on the spectrum” a label elastic enough to encompass both nonverbal children requiring constant care and socially awkward adolescents who prefer solitude. The same revision loosened ADHD criteria, allowing symptoms to appear as late as age 12 rather than requiring onset by age 7, and reducing the symptom threshold for adults. Generalized anxiety disorder requires only that worry be “excessive” and cause “clinically significant distress or impairment,” judgments that depend entirely on a clinician’s interpretation of where normal worry ends, and disorder begins.

Defenders of modern psychiatry often claim that expanding diagnostic criteria reflect better screening, capturing subtler presentations, and that rising diagnoses reflect more accurate assessments of the true population prevalence of mental illness. But aside from the grim forecasts of living in a world where half of all young people have experienced mental illness, there is reason to believe that psychiatric diagnoses have become less precise, not more. 

Broad diagnostic criteria often interact with screening instruments that cannot reliably distinguish clinical conditions from normal variation. The CDC’s autism prevalence estimates, for instance, rely on surveys such as the Social Responsiveness Scale, which asks parents to rate statements like “Would rather be alone than with others,” “Has difficulty making friends,” and “Is regarded by other children as odd or weird.” These items describe behavioral traits common to social anxiety, introversion, and ordinary shyness and cannot reliably distinguish autism. Yet researchers routinely use high scores on such instruments as proxies for clinical diagnosis in prevalence studies, including in the CDC’s own data.  

The limitations of this approach became especially apparent after the COVID-19 pandemic. CDC autism prevalence surged an additional 40 percent in just four years, from 2018 to 2022—a period during which millions of children experienced prolonged social isolation, disrupted routines, and reduced peer interaction that would predictably elevate scores on parent-reported behavioral surveys measuring social difficulties, whether or not the underlying rate of autism had changed. 

None of this diminishes the reality of autism, ADHD, or anxiety disorders for individuals with significant functional impairment. But when the boundaries of diagnosis are inherently subjective, and when diagnosis is the key that unlocks streams of taxpayer-funded services, the system will predictably expand those boundaries.

How Medicaid and the ACA Reward Diagnostic Expansion

When diagnosis is subjective, and payment depends on diagnosis, the system will reward expanding the definition of illness.

Incentives drive behavior. Psychiatric overdiagnoses would matter less if the diagnosis were merely a label. But in the American healthcare system, diagnoses serve as keys that unlock streams of taxpayer dollars. 

The Mental Health Parity and Addiction Equity Act of 2008, extended by the Affordable Care Act (ACA), requires health plans, including Medicaid managed care plans, to cover behavioral health services at parity with medical and surgical services. Parity addressed a real problem: mental health conditions were historically under-covered. But parity also limits the tools that plans can use to manage utilization. Prior authorization requirements, visit caps, and annual spending ceilings can all be challenged on parity grounds. Plans that wish to avoid litigation or regulatory action have a strong reason to approve rather than deny.

Under the fee-for-service payment model within Medicaid, which 2008 parity provisions dramatically expanded, providers submit a claim to the state Medicaid agency. The state then pays the provider in accordance with the predetermined price of the service, otherwise known as the fee schedule. The fee schedule, in theory, serves to regulate providers’ room for maneuver with respect to payment claims, thereby preventing undue financial gain. The reimbursement structure underlying the fee-for-service model is designed to mitigate abuse by binding providers to a prearranged sum. 

However, the fee schedule only governs the prices to which providers are entitled for their services. It introduces no effective mechanism by which to govern the legitimacy of the services themselves. This empowers providers to profit by inflating the frequency of services, knowing that the fee-for-service model fixes only the pricing and not the services. This creates the conditions for supplier-induced demand.

In practice, therefore, providers have the freedom to manipulate demand by lowering the diagnostic threshold for services. Across states, weak spending constraints further subsidize this demand. This serves to distort natural market forces by enabling providers to expand mental health services beyond the point at which their cost would be acceptable to recipients, especially those with minimal diagnostic eligibility.

Similar risks persist in managed care, which pays per patient rather than per service. While this model improves cost predictability, it does little to ensure services are necessary. Providers still control enrollment, and expanding the number of patients can drive spending just as effectively as increasing the number of services. Changing the payment mechanism does not eliminate the incentive—it simply shifts how it is exploited.

Additionally, under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, states must cover all medically necessary services for children under 21, even services not otherwise included in the state’s Medicaid plan, including mental health services. 

When diagnoses rest on subjective behavioral criteria, and when coverage means open-ended reimbursement for services billed by the hour, the connection between spending and genuine clinical need begins to erode.

Then there is the federal matching structure. Medicaid’s open-ended Federal Medical Assistance Percentage reimburses states for 50 to 83 percent of Medicaid expenditures. When a state spends a dollar on autism services, it pays 17 to 50 cents. Federal taxpayers cover the rest. And because the match is open-ended, more spending automatically brings in more federal dollars. States bear only a fraction of the cost, weakening the fiscal discipline that comes with spending their own money.

Once therapy became mandatory, states used Medicaid waivers to circumvent standard rules and expand services and eligibility with federal funds. These waivers—and similar authorities—opened the door for providers to significantly increase Medicaid billing.

Enhanced federal matching rates during the COVID-19 public health emergency further reduced the state share, especially during the period when mental health spending grew the fastest. The pandemic significantly increased both the supply of and demand for psychiatric services. Telehealth services for mental health conditions surged 16- to 20-fold during the first year of the pandemic, according to a RAND study of over 5 million commercially insured adults, more than compensating for the drop in in-person care. By August 2022, overall mental health service utilization was 38.8 percent higher than before the pandemic. Mental health and substance use diagnoses grew from 11 percent of telehealth visits in early 2019 to 39 percent by mid-2021. The share of all outpatient visits carrying a mental health or substance use diagnosis doubled from 4 to 8 percent. 

Pandemic emergency waivers and telehealth policies further loosened restrictions on how services could be delivered and reimbursed. States such as Massachusetts, North Carolina, Indiana, and Colorado expanded telehealth eligibility (including audio-only services) and adopted payment parity for telehealth, effectively turning remote services into scalable, high-volume billing opportunities. The result was not just a shift in how care was delivered, but a notable increase in utilization and spending, often in the tens of millions of dollars per state annually, consistent with policy changes that reduced the marginal cost of delivering and billing for services.

A substantial body of research suggests that financial incentives can influence psychiatric diagnosis rates. In the United States, eligibility for school services and insurance coverage often depends on specific diagnostic categories. For example, states offering more autism-specific services tend to report higher autism prevalence, while classifications of other developmental disabilities decline—a pattern consistent with diagnostic substitution. A 2009 study estimated that at least 26 percent of the increase in autism diagnoses in California between 1992 and 2005 could be explained by diagnostic substitution, primarily from children previously classified as having intellectual disability.

A Problem of Prosperity?

In economic terms, what has unfolded in American mental healthcare is supplier-induced demand operating within a system that lacks the price signals, utilization controls, and outcome accountability mechanisms that would normally constrain it. The therapy industry has expanded to absorb the available reimbursement, exactly as economic theory would predict in a fee-for-service system with elastic diagnostic criteria, open-ended coverage mandates, and absent oversight.

That is worth stating clearly, because the rising tide of psychiatric diagnoses is often cited as proof that modernity has failed; that the improvements in life expectancy, poverty reduction, literacy, income, and so forth are hollow, because they mask a deeper spiritual or psychological collapse. That narrative is understandable. It is also incomplete.

The story of mental health in the modern world is not one of pure decline. It is a story of multiple forces operating simultaneously, some genuinely concerning and some artifacts of the very prosperity that makes psychological well-being a priority in the first place. Wealthy societies can afford to screen for, name, and treat conditions that our ancestors endured in silence or never recognized at all. That is a form of progress. But when the systems designed to deliver that care are structured to reward volume over value, diagnosis over outcome, and spending over accountability, the result is predictable: an ever-expanding pool of diagnoses that dilutes resources away from those with the most severe impairment.

There is reason to be optimistic. The fact that societies are wealthy and secure enough to attend to psychological suffering at all—rather than simply enduring it—represents a remarkable achievement. 

But the same ingenuity that produced modern medicine, market economies, and unprecedented material abundance can also produce perverse incentive structures that undermine the goals they were designed to serve. Understanding that human systems, like the humans who design them, are imperfect and responsive to incentives, is not an argument against progress. It is a precondition for sustaining it. Progress, as ever, depends on getting the incentives right.