Due to school closures caused by the COVID-19 pandemic, most children and adolescents, including college students, were compelled to attend online classes. Students suffered from deteriorating mental health, alcohol problems, and domestic abuse, all possible consequences of school closures, and social isolation [1, 2, 3, 4, 5, 6]. The Adolescent Behaviors and Experiences Survey (ABES) conducted on 7,998 high school teenagers in the United States (U.S.), by the Centers for Disease Control and Prevention (CDC) in 2021, revealed that 37.1% of them experienced poor mental health, 44.2% had persistent sadness or hopelessness, and 19.9% had seriously considered suicide of which 45.5% had attempted suicide [3]. However, the pandemic did not affect all children and adolescents in the same manner; those from families with limited resources were more likely to experience child abuse, poor academic performance, and mental health problems [1, 7, 8, 9].

Globally, more than 60% of the countries experienced significant disruptions in mental health services, particularly services offered to adolescents and the older adults [10]. The proportion of psychiatric emergency visits and the number of children and adolescents requiring crisis services for threat to self or others have increased substantially [8, 11, 12]. This increased need for mental health services is attributable to the unforeseen shifts in the social environment of children and adolescents. This editorial aims to examine experiences and challenges in addressing the mental health needs of children and adolescents in South Korea and the U.S. while responding to the threats posed by COVID-19.

In South Korea, government and mental health professional groups have partnered to design plans for addressing psychiatric crises among children and adolescents [13]. Overall, this response to the novel mental health challenges faced by the younger generation could have been more aggressive and robust. The provision of accessible and cost-effective mental healthcare has received limited policy attention, and counseling services have been limited to COVID-19-confirmed cases. The authors believe that the Korean Ministry of Education (KME) prioritized addressing learning gaps caused by remote education while allocating considerable funds to childcare and after-school activities unrelated to addressing mental health needs [14]. The KME could have provided more robust mental health services to school-goers, apart from delivering educational materials that only promote awareness of the ongoing mental health crisis for teachers, parents, and students. Moreover, few mental health services exist for teachers caring for students during the COVID-19 pandemic [14].

To better cope with potential pandemic-related mental health crises, South Korea can learn from the structural and legal transition in the U.S. in support of telehealth mental health services. With the pandemic increasingly making mental health services dependent on telehealth, U.S. federal and state government mental health regulations have expanded access to telehealth for mental well-being [8, 15, 16]. A systematic review identified 77 articles investigating the process through which mental health providers embraced and implemented telehealth over the phone or via online platforms in response to social distancing measures enforced in early 2020 to reduce the risk of COVID-19 infection [17]. A fifth of these studies found that telehealth was “acceptable” and “exceeded expectation,” although there was hardly any transition period from in-person to telehealth. Additionally, participants reported that they would like to use telehealth even after the pandemic ends [17]. A Spanish study by Sánchez-Guarnido et al. [18] discovered that participants using telehealth had significantly fewer emergency room visits and hospitalizations than the control group. During the transition from in-person to telehealth, technical consultation and regulatory assistance from governmental agencies were critical for the smooth adoption of this novel technology [8, 17].

Although telehealth is a good alternative for coping with a pandemic, it has several issues that require resolution. Palinkas et al. [8] studied government officers responsible for regulating mental health services who supervised the transition from in-person to telehealth mental health services during the early months of the pandemic. Respondents highlighted the issues faced by mental health clinicians and supervisors while providing telehealth services [8]. More than 80% of the government officials reported that many families and mental health providers in their jurisdiction had limited access to the Internet, equipment, and technology while transitioning to telehealth [8]. Moreover, 30% to 45% of the respondents experienced psychological resistance from consumers and providers, such that clients were reluctant to use telehealth. Providers faced significant challenges during telehealth sessions with younger children and considerable concerns about privacy issues were raised during the transition [8]. The ABES study found that only 8.5% of high school students may have accessed telehealth during the pandemic [6], indicating that hurdles to accessing mental health services persist in the U.S. [17].

We propose two recommendations for South Korea to remain resilient in the face of a mental health crisis caused by another pandemic and school closure. First, epidemiological data on the impact of school closure and social isolation on mental health among children and adolescents should be collected. The aforementioned ABES study [5] stimulated public dialogue regarding building capacity to address urgent mental health needs among children and adolescents during the pandemic. Health officials should partner with education experts to design and implement a population-representative study to promptly determine the scope and depth of mental health needs and their antecedents during the school closure and transition to distance learning. Second, telehealth should be examined as a delivery method for mental health services. Even before the pandemic, telehealth has been discussed as a possible alternative to in-person psychotherapy for adolescents who are reluctant to use psychiatric services because of stigma [19]. Although the need for public funding of telehealth for mental health treatments designed to serve low-income families was raised earlier in South Korea [13], at present it is mostly supplied by private providers with minimal government financing. We agree that the definition, boundaries, scope of practice, and ethical and legal issues associated with telehealth should be sufficiently discussed. Furthermore, laws and regulations should be established, government financing for equipment acquisition secured, core components of the services specified, and the efficacy of telehealth in delivering services evaluated. In the event of a future pandemic, telehealth will be a competitive and indispensable type of mental health care, despite these obstacles. Policymakers in South Korea can appreciate the potential barriers that consumers and providers may face throughout the shift from an in-person to a telemedicine mental healthcare system through U.S. experiences. Further, healthcare professionals should recognize the obstacles, competencies, and functions of the new mental health service system.