1. Introduction 1

1.1. Purpose and audience 1

1.2. Scope of the study 2

1.2.1. Age range and population covered 2

1.2.2. Geographic coverage 3

1.2.3. Definitions and conceptual focus 3

1.2.4. Boundaries of the study (what is out of scope) 6

1.3. Research questions and overall approach 7

1.4. Structure of the report 8

2. Current state of play: Youth mental health in a digital era 10

2.1. Symptoms and manifestations of the problem 10

2.1.1. Clinical and sub-clinical mental health symptoms 13

2.1.2. Behavioural and functional symptoms 14

2.1.3. System-level symptoms 15

2.2. The core problem: A crisis amplified by the digital era and compounded by systemic factors 16

2.2.1. Role of the digital era in shaping modern childhood and adolescence 17

2.2.2. Early childhood digital exposure and developmental foundations 19

2.3. Underlying causes 21

2.3.1. Technology and platform design 21

2.3.2. Regulatory and commercial drivers 23

2.3.3. Offline vulnerabilities and structural factors 25

2.3.4. System capacity and service‑design weaknesses 28

2.4. Consequences and impacts 29

2.4.1. Psychological and health consequences 33

2.4.2. Sleep, development and social functioning 34

2.4.3. Educational and labour‑market consequences 35

2.4.4. Societal and economic costs 36

2.4.5. Implications for EU-level action 39

3. EU and international policy and legal context 40

3.1. EU competences and legal bases 44

3.1.1. Core Treaty provisions and EU–Member State roles 44

3.1.2. The Charter of Fundamental Rights of the European Union 45

3.2. Core EU legislative framework on digital services and online risks 45

3.2.1. Digital Services Act (DSA) 46

3.2.2. Audiovisual Media Services Directive (AVMSD) 46

3.2.3. Artificial Intelligence Act (AI Act) 47

3.2.4. Combatting Child Sexual Abuse Material (CSAM) 48

3.3. EU strategies and initiatives on mental health, children, and youth 49

3.3.1. Strategies and initiatives 49

3.3.2. Data, monitoring, and research infrastructures 51

3.4. European Parliament and Council positions on youth mental health and digital risks 52

3.4.1. European Parliament resolutions 52

3.4.2. Council conclusions: Recognising the digital determinants of youth mental health 53

3.4.3. Shaping expectations for integrated EU‑level action 53

3.5. The international policy and legal framework 53

3.6. Gaps, challenges and governance issues 55

3.6.1. Enabling and constraining EU action 55

3.6.2. Absence of a fully integrated, binding EU mental health strategy 55

3.6.3. Limited child health input into digital legislation and governance 55

3.6.4. Fragmented implementation and an unlevel playing field 56

3.6.5. Critical data and evidence gaps 56

4. National policies and case study findings 59

4.1. Overview of national approaches 59

4.1.1. School-based promotion and prevention 62

4.1.2. Youth hubs and early intervention 62

4.1.3. Digital-era governance 63

4.1.4. Common challenges 65

4.2. Promising practices and evidence of effectiveness 66

4.2.1. Universal school-based prevention 66

4.2.2. Community-based youth 'hubs' 69

4.2.3. Addressing the 'Digital Era': Regulatory case studies 70

4.2.4. Barriers, equity, and the 'missing middle' 72

4.3. Lessons for transferability and scaling 74

4.3.1. Transferable models 75

4.3.2. Conditions for successful transfer 75

4.3.3. Limits and risks in scaling 76

4.3.4. Implications for EU‑level action 76

5. Policy options for EU action 78

5.1. Problem clusters to be addressed 79

5.2. EU levers and policy domains 80

5.3. Policy domains and option areas 81

5.4. Detailed description of the policy options 84

5.4.1. Option 0: Baseline / status quo 84

5.4.2. Option 1: EU support package for school‑based mental‑health promotion and digital wellbeing 85

5.4.3. Option 2: EU framework for youth‑friendly early‑intervention services ('youth hubs') 88

5.4.4. Option 3: EU initiative on social prescribing and community‑based pathways for vulnerable youth 91

5.4.5. Option 4: EU quality and safety framework for digital mental‑health tools and online support 93

5.4.6. Option 5: Child‑centred implementation and possible strengthening of EU digital regulation 95

5.4.7. Option 6: Data, monitoring and governance for youth mental health in a digital era 101

5.5. Link to impact assessment and comparative analysis 103

6. The cost of inaction: Modelling the economic case for EU action 104

6.1. Purpose and scope of the assessment 104

6.2. Modelling approach and key assumptions 105

6.3. Youth mental health in the EU-27: Prevalence and projections 105

6.4. The socio-economic cost of youth mental ill-health in the EU 107

6.5. Limitations and uncertainties 112

7. Impacts of the policy options 114

7.1. Purpose of the chapter 114

7.2. What the model can and cannot say 115

7.3. The scale of what is at stake 115

7.4. What different options could plausibly deliver 116

7.5. Comparing options on dimensions beyond cost 118

7.6. Trade-offs and combinations 119

8. Conclusions and recommendations 119

8.1.1. Answers to the four core research questions 119

8.1.2. Priority recommendations for the European Parliament and other EU actors 121

8.1.3. Implementation and governance considerations 123

8.1.4. Data and evidence gaps, and implications for future monitoring 123

Main references 125

Academic sources 125

Institutional and organisational sources 128

Annex I: Detailed research question matrix 130

Annex II: Detailed methodology 134

Annex III: Full case studies 156

The Netherlands 156

Australia 164

Italy 178

Norway 189

Poland 201

Ireland 216

England 229