School shortages, ER boarding, months-long waitlists – and what families are actually living through
New Hampshire loves being at the top of rankings. Second-best for overall child well-being in the country. High test scores. Low child poverty. All the “Live Free” bragging rights.
But dig into the mental-health data and something doesn’t fit the postcard.
According to the Annie E. Casey Foundation’s 2022 Kids Count Data Book, New Hampshire had one of the very highest rates of children ages 3–17 diagnosed with anxiety or depression in the entire United States – 18.4% in 2020, up from 14.4% just four years earlier. (New Hampshire Public Radio) Only Vermont’s rate was higher. Within New England, that effectively puts New Hampshire at or near the top of the anxiety pile.
Zoom out nationally, and the picture gets even starker. A 2023 federal data brief on adolescents found that between 2016 and 2023, diagnosed anxiety in U.S. teens jumped 61%, from 10.0% to 16.1%. (Maternal and Child Health Bureau) New Hampshire’s numbers are above that already-worrying national curve.
So how does a wealthy, relatively safe, well-educated state end up with some of the most anxious kids in the region?
The short answer: demand exploded, and New Hampshire never built a system that could realistically absorb it.
The long answer takes us into overburdened school counseling offices, crowded emergency rooms, small-town parents hitting dead ends on waitlists, and a fragmented system where “Call back in six months” is something families hear way too often.
1. The numbers: A quiet crisis hiding in great rankings
New Hampshire looks terrific on paper. The 2022 Kids Count Data Book ranks the state second in the nation for overall child well-being, citing strong economic, educational, and health indicators. (New Hampshire Public Radio) That same report, though, flags a big red asterisk: the share of kids with diagnosed anxiety or depression is among the highest in the country.
Key data points:
- 18.4% of NH children ages 3–17 had a diagnosed anxiety or depression condition in 2020, up from 14.4% in 2016 – an almost 28% increase. (New Hampshire Public Radio)
- Nationally, a 2023 federal brief found 16.1% of adolescents had diagnosed anxiety and 8.4% had depression. (Maternal and Child Health Bureau) New Hampshire’s rate is clearly on the high side of that curve.
- A New Hampshire Public Radio story highlighted that as NH’s overall child well-being improved, its child anxiety/depression rate “shot up” faster than most states. (New Hampshire Public Radio)
Now look at what the state’s own teen surveys say.
The Youth Risk Behavior Survey (YRBS), administered in NH high schools, is blunt about how kids are actually feeling. The latest statewide release from NH DHHS (2023 data, published in 2024) reported:
- Around 40% of New Hampshire high-school students said they had persistent feelings of sadness or hopelessness in the past year – slightly down from 44% in 2021, but still historically high. (The Rochester Post)
- Roughly a third of students reported their mental health was “not good” most or all of the time. (The Rochester Post)
- Measures of suicidal thinking and attempts decreased from 2021 but remain significantly elevated compared to a decade ago. (The Rochester Post)
This is all layered on top of a national emergency. In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association took the unusual step of declaring a “national emergency in child and adolescent mental health” – citing soaring rates of anxiety, depression, and suicide attempts. (AACAP) The U.S. Surgeon General followed with a public health advisory on youth mental health that same year. (HHS)
New Hampshire is not an outlier because its kids are uniquely fragile. It’s an outlier because it sits right at the collision point of rising youth anxiety and a small state system that was already straining at the seams.
2. “Like a part-time job”: What parents are actually going through
No spreadsheet captures what it feels like to parent an anxious kid in New Hampshire in 2025.
NHPR profiled “Jennifer,” a foster parent in Keene, who’s taken in a dozen kids over six years. The first thing she tries to do with a new foster child is get them into therapy. Lately, that simple step has turned into a slog of unanswered voicemails and “we’re not accepting new patients.” She described having kids stuck in emotional neutral:
They could be using that time to heal properly, and they just don’t have that ability. (New Hampshire Public Radio)
That’s not an exception. In a statewide survey cited in the same story, more than 60% of New Hampshire parents who sought mental-health care for their kids said it was “difficult or impossible” to access. (New Hampshire Public Radio)
Common themes you hear from Granite State families:
- Endless calling: Parents spend hours ringing every name on a referral list – only to hear “no openings,” “we don’t take your insurance,” or “we only do telehealth and we’re full.” (New Hampshire Public Radio)
- Medicaid dead ends: Providers that accept Medicaid are often already booked solid. For foster kids and low-income families, that’s a hard wall. (New Hampshire Public Radio)
- Clinician churn: At community mental-health centers, turnover can mean a child finally bonds with a therapist – and then loses them months later. (New Hampshire Public Radio)
- Parent burnout: One parent told NHPR that finding a therapist was “like a part-time job” stacked on top of work, caregiving, and school logistics. (New Hampshire Public Radio)
And those are the families who recognize what’s going on and are willing to fight the system. For every kid whose anxiety gets flagged, there’s another quietly melting down at home, refusing school, or “somaticizing” anxiety as stomachaches and headaches that never quite show anything on tests.
3. Inside the schools: Too many kids, too few counselors
If you ask where pediatric anxiety shows up first, the honest answer is: the homeroom.
Kids don’t typically walk into a psychiatrist’s office and say, “Hi, I have generalized anxiety disorder.” They show it in:
- chronic nurse visits,
- missing homework,
- school avoidance,
- explosive reactions to small stressors,
- perfectionism that turns homework into a nightly panic.
School counselors and school social workers are supposed to be the frontline buffer. But New Hampshire is asking them to handle a flood of mental-health need with ratios that would make any triage nurse wince.
The American School Counselor Association (ASCA) recommends a maximum student-to-counselor ratio of 250:1. (American School Counselor Association) According to ASCA’s 2023–24 data table, New Hampshire’s actual ratio is about 310 students per counselor. (American School Counselor Association)
Translation: for every school counselor in NH, there is an entire small town’s worth of kids attached to their caseload.
Some New England context:
- National average: 383:1
- Maine: roughly 378:1
- Massachusetts: 391:1
- New Hampshire: 310:1 – better than many states, but still well above the recommended level. (American School Counselor Association)
So yes, New Hampshire is doing less badly than a lot of the country on staffing. That’s not the same thing as “equipped for the current crisis.”
What this looks like on the ground:
- Counselors doing scheduling, testing coordination, and college planning on top of crisis management.
- “Check-ins” that are 10–15 minutes every few weeks instead of real ongoing therapeutic work.
- Kids with panic attacks or self-harm thoughts being walked to an office where three other students are already waiting.
To their credit, NH districts have been trying to fill gaps with school social workers, contracted clinicians, and federal COVID relief money. But those funds are temporary, and the underlying structure – one counselor for hundreds of students – was never designed for this level of anxiety and trauma.
4. ER boarding: When anxiety turns into an inpatient bed problem
For a small but very visible subset of kids, anxiety doesn’t stop at “trouble sleeping” or “test panic.” It slides into full-scale crisis: suicidal thoughts, self-harm, refusal to eat, violent outbursts, psychosis.
When that happens, families land in the most expensive, chaotic place in the system: the hospital emergency department.
New Hampshire has been under legal and political pressure for years over “ER boarding” – the practice of keeping psychiatric patients in emergency rooms, sometimes for days, while waiting for an inpatient bed. Hospitals sued the state, arguing it was violating patients’ rights and straining emergency departments not designed as holding units. (New Hampshire Public Radio)
A federal judge ordered New Hampshire to stop boarding psychiatric patients in ERs within a year. (New Hampshire Public Radio) The state responded with a multi-pronged push:
- Mission Zero: A DHHS initiative launched in 2023 to end emergency department boarding by 2025, in partnership with NAMI-NH and hospitals. (NH DHHS)
- Hampstead Hospital purchase: The state bought Hampstead Hospital, a youth psychiatric facility, and partnered with Dartmouth Health to expand child and adolescent beds. (InDepthNH.org)
- New adolescent units: Dartmouth Hitchcock Medical Center (DHMC) opened a new six-bed adolescent medical-psychiatry unit in 2024 to care for teens in crisis who also need medical support. (DHMC and Clinics)
Even so, the history here matters. In 2021, NHPR reported that as anxiety and depression rose, as many as 30 kids at once were waiting for one of the state’s 16 youth psychiatric beds. (New Hampshire Public Radio) NAMI-NH has called emergency department boarding “medically, legally, ethically, morally, and economically wrong,” and has documented cases where kids waited days or weeks for admission. (YouTube)
Recent reports suggest real progress for adults – at one point in 2025, DHHS announced there were no adults waiting for an inpatient psychiatric bed in ERs – but children and adolescents still experience delays, particularly during spikes in demand. (NHCBHA)
So the pipeline looks like this:
- Anxiety and depression rise.
- Outpatient and school-based support can’t keep up.
- Kids deteriorate until the only option left is the ER.
- The ER becomes a de facto holding cell for a system that runs short on inpatient capacity.
Nobody designed it that way. But that’s the system we have.
5. The invisible middle: Waitlists and the great outpatient bottleneck
In theory, most pediatric anxiety should never reach the ER. Cognitive-behavioral therapy (CBT), family-based treatment, medication when appropriate – these are well-researched, highly effective interventions when delivered early. (Journal of Pediatrics)
In practice, New Hampshire’s outpatient mental-health system for children is the choke point where everything backs up.
There isn’t a perfect statewide snapshot of how long kids wait for therapy or psychiatry, but several indicators point in the same direction:
- Providers and state programs acknowledge a shortage of child and adolescent mental-health professionals, especially in rural areas. (New Hampshire Public Radio)
- A national workforce study cited by NHPR found that rural regions typically have fewer clinicians per capita, compounding access problems in parts of NH. (New Hampshire Public Radio)
- Many private therapists listed on directories like Psychology Today or Zencare explicitly note that they don’t take insurance or don’t accept Medicaid – leaving families to pay out of pocket or keep searching. (Psychology Today)
- One New Hampshire psychiatrist’s website describes a three-month waitlist just to become a new patient – and that’s for adult care; child specialists are often harder to find. (Brenda Vale)
The state and partners have tried to do some system-level triage. The NH Mental Health Care Access in Pediatrics (MCAP) program offers tele-consultation and support to pediatricians so they can manage milder anxiety and depression in primary care instead of punting every case to psychiatry. (NH DHHS)
Meanwhile, the NH Pediatric Improvement Partnership has built a pediatric behavioral-health referral directory to help providers and families identify available services. (NH Pediatric Improvement Partnership)
But directories and consult lines don’t magically create new therapists. They mostly help families navigate scarcity more efficiently.
For parents, the middle of the system still feels like this:
- Your child is clearly anxious and struggling.
- The school can offer short check-ins but can’t do weekly therapy.
- Your pediatrician agrees there’s a problem but has limited time and tools.
- The community mental-health center says, “We can put you on a waitlist.”
- Private clinicians either don’t call back or are out-of-network and $150+ a session.
So families improvise: they lean on social media, TikTok “therapists,” YouTube coping videos, unvetted mindfulness apps, and well-meaning but untrained school staff. Some of those tools are legitimately helpful. Some are nonsense. None are a substitute for a functioning system.
6. Why are NH kids so anxious? It’s not one thing.
There’s no single reason New Hampshire kids report such high rates of anxiety. But a few overlapping forces stand out, backed by both national research and local advocates.
6.1 The national pressure cooker
The U.S. Surgeon General’s 2021 advisory lays out a grim national context: kids are juggling academic pressure, social media, pandemic disruption, family stress, and a steady feed of school-shooting and climate-disaster headlines. (HHS)
National data show:
- Diagnosed mental or behavioral conditions in adolescents increased 35% from 2016 to 2023. (Maternal and Child Health Bureau)
- Anxiety specifically jumped 61% in that period. (Maternal and Child Health Bureau)
None of that is specific to New Hampshire, but it sets the stage.
6.2 Affluence, expectations, and “achievement anxiety”
New Hampshire is relatively affluent. That’s a good thing – until it isn’t.
Research on high-achieving communities (not specific to NH) has found elevated rates of anxiety and depression in kids who feel constant pressure to perform academically and extracurricularly. They’re not worried about surviving; they’re worried about failing. (JAMA Network)
In an “A-minus is a disaster” culture, anxiety easily masquerades as dedication, right up until the kid stops sleeping.
6.3 Rural isolation and thin services
Parts of New Hampshire are as rural as it gets in New England. National and state analyses of workforce distribution show that rural areas consistently have fewer mental-health providers, longer travel distances, and more transportation barriers. (New Hampshire Public Radio)
That means a teen in suburban Nashua might eventually find a therapist after a frustrating search. A teen in Coös County could realistically have no one nearby taking new patients, especially if they’re on Medicaid.
6.4 Phones, social media, and the “Anxious Generation” effect
New Hampshire parents are having the same fight at the dinner table as everyone else: phones in bedrooms, TikTok at midnight, the endless scroll.
Local groups like YouthWell NH have been hosting events explicitly framed around Jonathan Haidt’s The Anxious Generation and the impact of screens and social media on youth mental health. (Manchester Ink Link)
National reporting on Gen Z shows:
- Over a third of Gen Z reports an anxiety disorder.
- Nearly half report feeling anxious “often” or “always.” (Parents)
That’s not all the phone’s fault. But relentless comparison, cyberbullying, doomscrolling, and late-night group chats are gasoline on any underlying anxiety.
6.5 Trauma, addiction, and family instability
New Hampshire has been living with the long shadow of the opioid epidemic – and now fentanyl – for more than a decade. Behind the headlines about overdose deaths are thousands of kids living with:
- parents cycling through treatment and relapse,
- sudden deaths,
- grandparents stepping into emergency caregiver roles,
- child protective services involvement.
The YRBS and NH behavioral-health foundations have repeatedly flagged trauma, family stress, and exposure to substance use as major correlates of youth mental-health problems in the state. (NH Charitable Foundation)
Put all of this in one pot, add an under-built mental-health system, and you don’t get a “small uptick” in anxiety. You get an epidemic.
7. Are we doing anything about it? Yes. Is it enough? Not yet.
To be fair, New Hampshire hasn’t been sitting on its hands. The last few years have seen an unusual level of bipartisan agreement that youth mental health is a structural problem, not a passing fad.
Some of the major moves:
- Mission Zero (ED boarding) – A joint initiative by DHHS and NAMI-NH to end emergency department boarding of psychiatric patients by 2025. Early evidence suggests serious progress for adults, with work ongoing for kids. (NH DHHS)
- State purchase & expansion of Hampstead Hospital – Turning a private youth facility into a statewide resource for children and young adults with serious psychiatric needs, with Dartmouth Health providing clinical leadership. (InDepthNH.org)
- New adolescent medical-psychiatry unit at DHMC – A six-bed unit opened in 2024 specifically for adolescents in mental-health crisis who also need medical care. (DHMC and Clinics)
- NH MCAP (Mental Health Care Access in Pediatrics) – Tele-consultation and training for pediatricians to manage anxiety, depression, and other behavioral conditions in primary-care settings, especially where psychiatrists are scarce. (NH DHHS)
- Children’s Behavioral Health Resource Center & System of Care – A state-backed hub that organizes children’s services into five tiers, from low-intensity supports to hospital care, and provides guidance to families on navigating options. (UNH Children’s Behavioral Health)
- YouthWell NH and local initiatives – A new 501(c)(3) focused on funding and coordinating youth mental-health programs, plus groups like NAMI-NH’s Family Network and “Magnify Voices” art contest that amplify youth experiences. (Youth Well NH)
These are not window-dressing changes. They add inpatient capacity, support pediatricians, and give families more structured ways to find help.
But they don’t change some uncomfortable basics:
- New Hampshire still does not meet recommended school counselor ratios. (American School Counselor Association)
- There is still a shortage of child psychiatrists and therapists, especially in rural regions and for Medicaid families. (New Hampshire Public Radio)
- Anxiety diagnoses are still rising faster than the workforce is growing. (Maternal and Child Health Bureau)
Policy-wise, the next frontier is less about announcements and more about math: funding and incentives at a scale that actually changes the number of trained people in the system.
8. For parents on the ground: Practical steps in an imperfect system
Until the system catches up, New Hampshire parents are stuck doing triage in real time. A few evidence-based, NH-specific strategies can blunt the edge of that anxiety epidemic.
8.1 Start with your pediatrician – and ask about MCAP
Given workforce shortages, your child’s pediatrician may be your most accessible mental-health provider. Thanks to programs like NH MCAP, primary-care clinicians can:
- consult with child psychiatrists by phone,
- get support on diagnosis and medication decisions,
- access care coordinators who know the local referral landscape. (NH DHHS)
Ask directly:
“Can you use the NH Mental Health Care Access in Pediatrics program to help manage my child’s anxiety while we wait for specialty care?”
8.2 Use reputable online resources to fill (some) gaps
The internet is a mess, but there are credible tools you can lean on while you hunt for a therapist:
- Child Mind Institute – anxiety hub: Clear explanations of anxiety types, school anxiety, and treatment options, designed for parents and teens.
👉 https://childmind.org/topics/anxiety/ (Child Mind Institute) - Child Mind Institute video: How To Help Your Child Deal with Anxiety
👉 https://www.youtube.com/watch?v=0zPol27IL1g (YouTube)
- “10 Tips for Parenting Anxious Kids” – Child Mind Institute:
👉 https://www.youtube.com/watch?v=c5ASysmOH_I (YouTube)
- “Pediatric Anxiety Epidemic: A New Approach to Treatment” – McLean psychiatrist Kathryn Boger
👉 https://www.youtube.com/watch?v=w4FJ8XFqnPs (YouTube)
- Anxiety coping skills for kids and middle-schoolers
👉 https://www.youtube.com/watch?v=XfcZ0McM-RI (YouTube)
For NH-specific context and stories:
These are not substitutes for treatment, but they can give you language, frameworks, and concrete skills to work with while you fight the waitlists.
8.3 Lean on NH-specific supports
New Hampshire actually has more supports than many families realize – they’re just scattered:
- NAMI-NH Family Network: Peer support, parent/caregiver groups, and resources for families of kids with mental-health challenges.
👉 https://www.naminh.org/nhfn/ (Naminh) - Children’s Behavioral Health Resource Center – Families & Youth portal: Explains the “tiered” Children’s System of Care and helps you figure out what level of support your child might need.
👉 https://childrensbehavioralhealthresources.nh.gov/families-youth (UNH Children’s Behavioral Health) - Kids Mental Health Foundation – NH state page: Curated list of mental-health resources for children, including crisis lines and local options.
👉 https://www.kidsmentalhealthfoundation.org/mental-health-resources/national-state-resources/new-hampshire (Kids Mental Health Foundation)
If your child is in immediate crisis – suicidal thoughts, self-harm, unable to function – this is not the time to worry about “overreacting.” Call:
- 988 (national mental-health crisis line)
- NH Rapid Response (linked via DHHS and local mental-health centers) (NH DHHS)
8.4 Treat phones and social media like a health exposure
This part is not going to be popular with teenagers, but the data is ugly: heavy social-media use is strongly associated with increased anxiety and depression in youth. (Parents)
Practical, non-magical steps:
- No phones in bedrooms overnight.
- Clear rules about social media for middle school.
- Use content filters and app timers, but don’t outsource everything to software – talk explicitly about how algorithms are designed to keep them hooked.
- Swap some of that screen time for sleep, movement, and offline friends.
Is that going to fix the whole epidemic? No. But your kid doesn’t live in “the system,” they live in your house. Controlling what you can control is not trivial.
9. Where this leaves New Hampshire
New Hampshire isn’t unique because its kids are weak or its parents are coddling them. It’s unique because:
- It has data transparency that makes the problem hard to ignore. (NH DHHS Wisdom)
- It has a youth-mental-health surge that mirrors – and often exceeds – the national crisis. (New Hampshire Public Radio)
- It built an education and health system optimized for a “normal” level of student distress, then got hit with a once-in-a-generation spike in anxiety and depression.
The result: New Hampshire sits near the top of national charts for both child well-being and pediatric anxiety. That’s not a contradiction; it’s the new American paradox.
The kids most likely to be anxious are not always the ones dodging bullets or going hungry. Increasingly, they are the ones staring at honor-roll certificates, test prep, college admissions, social-media feeds, and the creeping sense that the world is on fire and failure is unforgivable.
New Hampshire’s response has been better than many states: more beds, Mission Zero, support for pediatricians, new nonprofits like YouthWell, and a stronger Children’s System of Care. (NH DHHS)
But the numbers don’t lie: until the state actually closes the gap on school counseling, outpatient therapy, and child psychiatry – not on press releases, but on who can see your kid next month – New Hampshire will keep topping the wrong charts.
This is the hidden epidemic behind the glossy rankings. Whether we keep pretending it’s just “kids these days” or treat it as the structural failure it is will say a lot about what “Live Free or Die” actually means for the next generation.
References & further reading
- Annie E. Casey Foundation, 2022 Kids Count Data Book; NHPR coverage: “N.H. ranked second for overall child well-being, but depression and anxiety on the rise.” (New Hampshire Public Radio)
- NH DHHS, Youth Risk Behavior Survey data and 2023 highlights. (The Rochester Post)
- NHPR, “For many New Hampshire families, finding a therapist for their kid is ‘like a part-time job.’” (New Hampshire Public Radio)
- American School Counselor Association, Student-to-School-Counselor Ratio 2023–2024. (American School Counselor Association)
- HRSA / NSCH, Adolescent Mental and Behavioral Health, 2016–2023 data brief. (Maternal and Child Health Bureau)
- U.S. Surgeon General, Protecting Youth Mental Health advisory (2021). (HHS)
- AAP, AACAP, CHA, Declaration of a National Emergency in Child and Adolescent Mental Health. (AACAP)
- NH DHHS, Mission Zero and mental-health resources. (NH DHHS)
- Dartmouth Health & NH DHHS, information on Hampstead Hospital and DHMC adolescent psychiatry services. (Dartmouth Health)
- Children’s Behavioral Health Resource Center (NH Children’s System of Care). (UNH Children’s Behavioral Health)
- YouthWell NH and associated events on youth mental health. (Youth Well NH)
- Kids Mental Health Foundation – New Hampshire resources. (Kids Mental Health Foundation)
In other words: the data are in, the stories are here, and the question for New Hampshire isn’t whether youth anxiety is real – it’s how serious we are about building a system that isn’t constantly improvising around it.
