Millennials May Be The “Therapy Generation,” But Gen Z Is Even More Open About Mental Health

By the time she was 16, Sadie Sutton had spent years in treatment for anxiety, depression, and suicidal ideation. Hers was both a unique and extraordinarily common experience: Unique because, unlike most teens, she was hospitalized for residential treatment as a 14-year-old, followed by a therapeutic boarding school in Montana. Common because, as she learned, many teens were going through mental health crises of their own.

In 2019, 70% of teens across gender, race, and income levels said anxiety and depression were major problems among their peers. Data released that same year by the American Psychological Association showed that members of Gen Z were more likely to have received professional mental health treatment than any other generation, even millennials, at 37% and 35%, respectively.

During her darker moments, the adults in Sadie’s life told her things would get better. But there was a disconnect — she wanted to hear from young people like her who had overcome similar struggles. So, once she came out the other side of treatment, she became that resource with her mental health podcast, She Persisted.

Today, Sutton is a 19-year-old psychology major and has produced more than 100 episodes covering topics as wide-ranging as acne, ADHD, optimizing therapy, diet culture, and substance abuse. Her podcast is one of an ever-growing number of mental health resources for Gen Z, often made by Gen Z. Though interest in mental health has been on the rise for years and millennials have been called the “therapy generation,” Gen Z-ers are advocating for themselves like no generation before.

“We’re really seeing a whole new generation of how we talk about mental health,” says Vaile Wright, psychologist and spokeswoman for the APA. “That was starting before the pandemic, it's just escalated since.”

As millennials grew up, they began to challenge the lingering, intergenerational biases around mental health. Celebrities including Demi Lovato, Selena Gomez, Michael Phelps, and Lady Gaga have spoken openly about their own struggles, which has helped open up the conversation about something that was once seen as a private issue.

Now, as Gen Z — those aged 10 to 25 — emerge from the pandemic, work through the trials of adolescence, and begin entering the workforce, it’s become clear that they’re pushing that conversation even further. “Young people are absolutely leaning toward talking about mental health, advocating for mental health,” says Elliot Pinsly, a licensed clinical social worker and president and CEO of the Behavioral Health Foundation. “But there’s still a lot of stigma and misunderstanding about what mental health really is.”

Shaking a stigma entrenched in thousands of years of history isn’t simple. Ancient civilizations believed ailments like depression were connected to spiritual concerns or possession. So-called treatment methods could be brutal — bloodletting was one such technique, starvation another. But, even as mental illness started to be better understood during the Enlightenment, discrimination against those with the conditions persisted. As psychiatrist Wulf Rössler wrote, “The most prominent stereotypes surrounding the mentally ill presume dangerousness, unpredictability and unreliability.” Institutionalization was used to control and punish those who didn’t conform, particularly women. “Women with symptoms were later diagnosed insane by reasons such as religious excitement, epilepsy, and suppressed menstruation,” details a paper from the Oshkosh Scholar. “Did these women truly need to be admitted to asylums, or was their admittance an example of their lack of power to control their own lives?”

Mental illness stigmatization wasn’t examined until the mid-1900s with books like the 1963 Stigma: Notes on the Management of Spoiled Identity. Even so, treatment became suspect during that time. “Overall, the 1960s and 1970s were full of an anti-psychiatry attitude, blaming psychiatry for being repressive, coercive and more damaging than helpful to patients,” as Rössler wrote. He pointed, in particular, to the 1962 novel and subsequent 1975 film One Flew Over the Cuckoo’s Nest with its nightmarish depiction of mental hospitals. Indeed, the scrutiny was warranted — if bloodletting was bad in ancient times, lobotomies and forced electroshock therapy were no better. As psychiatrist H. Steven Moffic wrote for Psychiatric Times, he spent time as a student at a state hospital in 1966 and saw conditions “even worse than that depicted in the book and movie.” Treatment became tied in the cultural imagination to loss of autonomy and being outcast.

Though Gen X began accessing treatment on more consumer-empowered terms, even mental health professionals retained bias about getting help. Caitlin Billings, a psychotherapist and licensed clinical social worker, writes about her experience as a Gen X-er in her upcoming memoir, In Our Blood. After surviving an eating disorder and sexual assault in college, Billings was held up at gunpoint near her home.

“It was really traumatic,” she says. “I minimized it. I was like, ‘This happens to a lot of people. I work with people whose trauma is so much worse. I just need to move on.’” Despite being a therapist herself, she didn’t seek treatment. Instead, she took a week off, cried a lot, and then returned to work. But the incident triggered debilitating post-traumatic stress disorder and the medication she was prescribed to curb the effects made her suicidal. Eventually, she was diagnosed with bipolar disorder. As she managed her mental health, she spent years living with two personas — the woman struggling privately with these issues and the outwardly successful therapist.

Experts now know that mental illness is prevalent, even a typical part of development. CDC data shows that more than 50% of Americans will be diagnosed with mental illness or disorder in their lifetime, and 1 in 5 children have or had a debilitating mental illness. Seeking help has also become widespread: Data from the National Institutes of Health shows that an estimated 52.9 million American adults had a mental illness in 2020 and 24.3 million of them received mental health services.

From 2010 to 2020, Billings watched millennial colleagues enter the workforce and noticed a shift. “They were coming into this environment and starting to speak out,” she says. “I was surprised about how open they were about their own struggles, about how there needs to be a different approach. And how we need to talk about our own clients in a non-stigmatizing way.”

During this time, Billings got a call from school about her eldest child, a member of Gen Z who was then 12 years old. “My eldest child was cutting and attempted suicide, and I had no idea until the school counselor called me,” Billings says. “I took my child to the emergency room and they were hospitalized — it was this completely overwhelming experience. Really, I was like, ‘What the f*ck?’ This was all very much too familiar to me.” For her, it became a reckoning. “What is my generational training around this?”

Even for those unaccustomed to talking about mental health, COVID-19 pushed the conversation front and center out of necessity. In one 2021 study of about 2,100 American adults, 81% reported at least one symptom of depression, with younger adults aged 18 to 24 the most likely to rate their mental health as poor or fair. The U.S. surgeon general even issued an advisory on the “youth mental health crisis.”

Beyond the pandemic, mental health remains an urgent topic for young people. The APA has conducted Stress in America reports for 15 years. “Year after year, younger adults always report the highest levels of stress,” Wright says. Every American generation has encountered unique, formative stressors: The Great Depression for the silent generation, the fear and reality of being drafted for baby boomers, the looming threat of nuclear war for Gen X, the reverberating effects of Sept. 11 for millennials. For their part, Gen Z reports concerns about climate change, mass shootings, and political stratification.

So if young people have been stressed out for decades, what’s changed?

As adolescents, millennials began to share their experiences with each other online via AIM, LiveJournal, and MySpace. Gen Z has found its own outlets on social media platforms like Instagram, YouTube, and TikTok. “The role of social media cannot be overestimated in terms of the amount of information people have to take in and the cultural words that it’s popularizing,” Wright says.

Of course, it’s tricky: There’s a balance between information versus misinformation, spreading awareness versus increasing stress. “The availability of media rich news and information tailored to individuals’ concerns and interest through algorithms can exacerbate underlying mental health vulnerabilities,” says Janelle Peifer, a licensed clinical psychologist, assistant professor of psychology at the University of Richmond, and founder of the Center for Inclusive Therapy + Wellness. Think: doomscrolling or falling into self-harm communities. Social media also creates more visibly around overwhelming existential concerns like climate change. “Gen Z has much more immersive exposure to these stressors through media and social media,” Peifer says.

On the other hand, social media has connected young people to resources to get help and identify their experiences — and it’s often coming from people like them. “With TikTok, you can talk directly to people your age and give advice,” Sutton says. “You don’t have to have 12 years of school and a doctorate and all this amazing experience to give people tips on what works and what doesn’t. And it’s easier to connect with than reading a 400-page book about cognitive behavioral therapy.” Teens get a bad reputation for self-diagnosing based on what they’ve seen online, but they look to those resources when support systems fail them or they don’t feel comfortable asking for help.

Gen Z-ers are also more likely to identify and name their mental health concerns, says Peifer. “So, the actual presence of mental health related concerns may not be higher — but open and transparent discussions of these issues may be more prominent,” she says. This reverberates throughout their approach to school, work, and treatment.

For those who do seek mental health services like counseling and therapy, younger clients tend to embrace a more authentic experience, transgressing traditional therapy norms. Billings says her Gen Z clients — and even some millennial clients — want a relationship that isn’t stilted. The old boundaries — no taking calls outside of set therapy sessions, keeping things impersonal, and so on — are out. “They want me to cuss, they want me to say off-the-cuff stuff,” Billings says. And she adds that her Gen Z clients are open to intervention and suggestions. “They want to understand, well, why do I have a PTSD diagnosis? Let’s go through the DSM-5 and you can tell me how I meet the criteria because I really want to understand.”

Jody Dianna, a licensed clinical social worker, says her clients do need “old-fashioned” help with boundaries, communication skills, and symptom management. “They experience shame around their mental health as well, but they often take advantage of the option of owning it early, rather than hiding,” she says.

“Most teens just want to feel validated and feel seen. I don’t think that’s something that was articulated 30 or 50 years ago.”

In the workforce, younger people expect a different experience, too. “They are going to be more open; they are going to want more support,” Pinsly says. “And companies are starting to be held more accountable for providing comprehensive benefits and wellness programs.” As Peifer puts it, Gen Z expects mental health to be treated like physical health. “Corporations need to be ready,” she says. “Equipped with their education and language for diagnoses and mental health struggles, they often expect workplaces to be trauma-informed and positioned to support the holistic functioning of employees.”

In the years since Sutton tackled her own mental health, she’s seen a huge shift in how the topic is approached. “When I first started struggling, my parents didn’t know what signs to look for; they didn’t know what adolescent depression and anxiety looked like because that conversation wasn’t happening,” she says. Her paternal grandfather struggled with bipolar disorder, so her father was around mental health challenges. “Even then, he didn’t know this was happening,” she says. “That’s definitely a reflection of growing up in that generation.”

Initially, she didn’t tell anyone about her podcast. Though her parents and close friends knew about her time in treatment, even her extended family didn’t know what she’d gone through. “But I wanted to share it with other teens because I knew that they could also experience the same shift that I did,” she says. “Most teens just want to feel validated and feel seen. I don’t think that’s something that was articulated 30 or 50 years ago.” Now, of course, she’s open about her experience. And Sutton’s grandmother has reached out to her about it. “Her husband was the one that struggled with bipolar,” Sutton says. “She says, ‘We kept it a secret; it wasn’t spoken about.’ To hear me speak about it so openly gives her a lot of hope.”