The palpable weight of the day’s topic hung in the room when six former U.S. Surgeons General took the stage at Dartmouth on Monday in front of an audience of hundreds. The topic at hand? The global youth mental health crisis.
“The mental health of the most valuable resource we will ever have—our children—is at stake,” said M. Joycelyn Elders, MD, MS, who served as U.S. Surgeon General from 1993 to 1994, setting the tone for the dialogue.
After being introduced by Steven Leach, MD, who is serving as the acting dean of the Geisel School of Medicine at Dartmouth, and Lisa McBride, PhD, associate dean for Diversity, Equity, Inclusion, and Belonging at Geisel, the Surgeons General spoke candidly about the most urgent mental health challenges facing young people. They cited grim statistics, shared personal stories of mental struggles and isolation, and offered tangible solutions that both individuals and society could enact to improve and save lives.
“We all have a responsibility, and we all can do something,” Elders said.
Unprecedented Challenges to Mental Well-Being
Many culprits came up during the dialogue, which was moderated by Timothy Wilens, MD, president of the American Academy of Child and Adolescent Psychiatry and chief of the Division of Child and Adolescent Psychiatry at Massachusetts General Hospital. However, none were more prominent than smartphone and social media use. “Where did we lose our children? Social media,” said Antonia Coello Novello, MD, MPH, DrPH, HON ’25, who served as U.S. Surgeon General from 1990 to1993.
The unrestricted access to social media is particularly concerning, the doctors said. Elders spoke of the dangers of having smartphones available to teenagers at all hours, and the bombardment of information, negative headlines, opportunities for self-comparison, and uninhibited bullying that young people are experiencing as a result. And Jerome M. Adams, MD, MPH, FASA, who served as U.S. Surgeon General from 2017 to 2021, described how the immediate, easy access to other vices—such as gambling—online could significantly magnify those risk factors for mental illness and suicide.
“Right now, we’re living in an environment with no safeguards for social media,” said Vivek H. Murthy, MD, MBA, who served as U.S. Surgeon General from 2014 to 2017 and 2021 to 2025. And, he added, that’s largely because we’ve left it up to technology companies to manage safety. Murthy pointed to the shortcomings of that approach with the example of the introduction of the automobile: Most cars didn’t have seatbelts, despite the safety feature existing before automobiles. It wasn’t until regulators got involved decades later and required them that seatbelts became ubiquitous. The same kind of intervention may be needed for social media, Murthy said, adding that given what we know about adolescent brain development, one option that is “eminently reasonable and advisable” would be to delay access to social media for users under the age of 16, if not older.
We still have a lot to learn about the impact that smartphones, social media, and access to other new technologies have on adolescent brain development and mental wellness, added Richard H. Carmona, MD, MPH, FACS, who served as U.S. Surgeon General from 2002 to 2006. “I don’t think people fully appreciated the consequences of the new digital age,” he said, arguing for a national strategy for research. “We’re playing catch-up now.”
From Illness to Wellness
Monday’s panel discussion, which took place in the Spaulding Auditorium at Dartmouth’s newly renovated Hopkins Center for the Arts, was part of a three-day symposium, “A Global Turning Point: Why Youth Well-Being Is in Crisis—and What We Must Do About It,” co-hosted by Dartmouth and the United Nations Development Programme’s Human Development Report Office. It also bore echoes of a previous conversation at Dartmouth among this esteemed group of doctors: In September 2023, all living current and former U.S. Surgeons General convened at Dartmouth for dialogues about the future of mental health and wellness.
In both conversations, the Surgeons General underscored the importance of not only considering mental health during times of emergency. For example, Adams offered an alternative way of looking at mental health: Instead of focusing all efforts on diagnosing and treating mental illness, healthcare leaders should also focus on mental wellness, he said.
To make that shift, Novello added, mental health and physical health need to be treated equally and together by doctors.
This sentiment was echoed by David Satcher, MD, PhD, who served as U.S. Surgeon General from 1998 to 2002. “A balanced partnership between primary care and mental health provides an opportunity for the coordination and integration of patient care,” said Satcher. “Primary care providers must remember that they are not alone. The primary care provider is the quarterback of the healthcare team that collaboratively makes the system work.”
Adjusting our mindset could help with something the Surgeons General mentioned as a barrier to increasing mental wellness: stigma.
One aspect of reducing stigma, Murthy said, is to demonstrate how pervasive mental health struggles can be. To that end, Murthy shared his own isolating experiences during adolescence describing the feeling of not being worthy, not being likable or lovable. Indeed, he said, that’s one of the challenges with social media: The 24/7 access, which affects one’s self-esteem and exposure to intensified bullying.
“It’s hard to look at the world and not feel some sort of despair,” Murthy said, in reference to both social media and mainstream media. But “in real life,” he said, “you see neighbors stepping up and helping.” Buried under built-up cynicism, he said, “That is who we are. We are kind, we are generous, we are loving people.”
Exploring Antidotes
The primary antidote to technology-enhanced depression and anxiety, the Surgeons General said, is connection.
Social media isn’t inherently bad, and can be a tool for human connection, allowing people who are isolated from their home cultures to connect with each other from afar, for example, Murthy said. “The problem comes when instead of trying to supplement human care, we try to substitute it.”
Adams pointed to a use of artificial intelligence that is actually increasing human connection: He described how doctors using ambient technology scribes to take medical notes, giving the physician the freedom to turn away from their computer and speak directly to the patient. This increases connection, he said, as the doctor can be more present.
“There is a power to human presence,” Murthy said. While an artificial intelligence tool could mimic the words a human might say in a difficult moment, he said, it cannot sit with someone through their pain and empathize.
That means, he said, “we can all do something powerful” to make a difference in others’ mental health: Reach out, check-in, offer a helping hand, and be present.
On behalf of Geisel, Dartmouth College, and Dartmouth Health, Steven Leach and Lisa McBride presented the Surgeons General with the C. Everett Koop Medal at the panel’s conclusion to commemorate this moment.
Written by Eva Botkin-Kowacki, Senior Content Manager with Medical & Healthcare Advancement.
