To the Editor The recent study by Hoffmann et al1 and accompanying editorial by Carroll and Hayes2 paint a sobering picture of the mental health system and access to care. We would like to make a few comments in response.

First, it is important to note that the while the study by Hoffmann et al focused on mental health conditions and the suicide rate, many adolescents and even younger children may require care for primary or co-occurring substance use disorders, developmental disabilities, and physical health conditions.3 Co-occurring conditions may exacerbate access to care challenges.