Mental healthcare as a practice requires regular temperature checks and community feedback to remain effective. Recent data suggests that providers should be re-examining their approach to care to reflect the lived realities of different generations. A national survey from Rula Health, supported by public policy research from The Brookings Institution, reveals that both youth behavioral health and older-adult services alike face distinct challenges in access, trust, and delivery.
In March 2025, Rula Health surveyed more than 2,000 adults across the U.S., finding that over half have accessed mental health care at some point. Anxiety, depression, and trauma were among the most common reasons for seeking treatment.
A third of the young-adult demographic aged 18–24 (referred to as “Gen Z”) reported seeking therapy due to trauma, “a reflection of the broader existential crisis this generation has faced,” said Doug Newton, M.D., M.P.H., Rula’s Chief Medical Officer. “From the pandemic to social injustice, climate anxiety, and economic uncertainty, today’s young adults are navigating a near-constant state of stress. Providers must be equipped to offer trauma-informed care that’s accessible, validating, and grounded in real-world experiences.”
Brookings notes the capacity to meet these needs is strained in schools where an introduction to a young person’s relationship to mental healthcare often begins:
“In 2022, three-fourths of public school leaders reported increased concern about youth mental health since the pandemic had started… During the 2023–24 academic year, there was only one psychologist for every 1,065 students in K–12 schools across the United States; while school counselors can also provide general mental health support, counselor staffing levels are also low, at about one counselor for every 376 students. Less than half of school leaders said they could meet all students’ mental health needs.”
Meanwhile, older adults often face silent struggles. Although nearly one-third of survey respondents aged 65 and older say they don’t know what kind of therapy would benefit them, mass underdiagnosis of mental health disorders, SUD, and behavioral health crises leave the nation’s seniors underserved despite their comorbidities. Dr. Zaira Khalid, interviewed by Fierce Healthcare, explained:
“In terms of mental health and substance use disorder treatment, it is definitely underreported and underdiagnosed in our elderly patients. That said, the numbers are still very high… Their prevalence of having psychiatric disorders is going to be anywhere between 40% to 50%… I believe the last time I saw a good study was in 2022. Eleven in 60 adults, older adults, had a substance use problem.”
She adds, “That’s only those that are being diagnosed. You know, I can tell you from personal experience, it’s a lot higher than that. We just don’t recognize it.”
From youth services constrained by school staffing shortages to seniors who are confused or ignorant about treatment, the survey underscores a series of critical gaps in behavioral health strategies. As the industry makes concerted efforts to notice those who are overlooked by traditional care, these groups carry on under-addressed without their developmental, cultural, and clinical needs being met in their entirety.
Key Findings:
- Generational Gaps Are Widening: Younger adults are more likely to access care but feel services are not aligned with their experiences, particularly concerning trauma.
- School Systems Are Overwhelmed: Staffing shortages in most schools hinder the ability to address rising youth mental health needs despite growing demand.
- Older Adults Are Underserved: Many seniors remain untreated or misdiagnosed, with stigma and gaps in understanding that compound access challenges.
- Personalization is Crucial: Tailored care models considering age-specific barriers and preferences are key to building a responsive behavioral health system.
- Cross-Sector Actions are Needed: Bridging gaps in communication requires coordination between healthcare, education, policy, and community organizations both to educate the public and support populations in private.
Looking Ahead
The call for patient-centered mental healthcare is growing louder. Behavioral health providers are refocusing their practices to adopt age-responsive approaches, invest in staff training, and continue to advocate for proactive funding as the behavioral health landscape matures.
Sources:
Fierce Healthcare: Mental health’s growing importance for many Americans, Rula Health finds
Brookings: Governors address youth mental health and well-being amid federal funding cuts