The Palo Alto Medical Foundation pediatrics department took an unprecedented step into the community debate on teen well-being this week, offering strong recommendations on several factors they see as key to bolstering students' mental health.

This step came in the form of a letter to the editor, submitted to this newspaper and signed by all 20 of the department's pediatricians, with the goal of asking both themselves and the community: What can be done differently to address Palo Alto teens' mental health and well-being?

"Although many teens in the area are doing well, many are not," the letter states. "Each day in the office we see students who are stressed, anxious, and depressed. Depression is a significant factor in teen suicide. But what is causing the depression? What are the factors putting our youth at such high risk?

"I think that there are factors out there that we've come to accept as normal that are very stress-producing and aren't so normal," pediatrician Linda Strain said in an interview with the Weekly.

As medical professionals who see multiple teenagers on a daily basis and are intimately informed about students' lives -- in a different way from the schools, they said -- the group of pediatricians decided to address several of these factors that affect teens and that they are most familiar with: sleep, electronics, academic pressure and home and family.

The letter urges later school-start times, citing the strong correlation between inadequate sleep and mood disorders, poor cognitive retention and increased distractibility. Surveys have shown that Palo Alto teens sleep an average of six and a half hours per night, compared to the nine hours of sleep it has been shown that teenagers need to function well, according to the doctors' letter.

The statement also references a recent American Academy of Pediatrics (AAP) policy that recommends that middle and high school students start school no earlier than 8:30 a.m. At Gunn High School, the day starts at 8:25 a.m., though just under 300 students are enrolled in both physical education and academic classes that meet during a zero period that begins at 7:20 a.m. Palo Alto High School starts at 8:15 a.m., with 102 students currently enrolled in physical education classes that meet at 7:10 a.m., the school's zero period.

Pediatrician Amy Heneghan, also a founding member of mental health professional coalition the HEARD Alliance, said Palo Alto was ahead of a national shift toward later school-start times when both schools moved their days to start at these times -- Paly in 2010 and Gunn the following year -- and should continue to uphold the American Academy of Pediatrics' policy.

"The data are pretty incontrovertible," Heneghan said. "The AAP doesn't endorse policies very often that strongly. This is a national trend."

Electronic devices play a critical and often detrimental role in sleep, time management and focus, the letter states, suggesting that teenagers shut off electronics at least 30 minutes before going to bed or that bedrooms be entirely free of electronics.

And though the pediatricians acknowledge they are not education specialists, they advocate in the letter for several school-based changes that they think could help Palo Alto teens.

The letter urges the Palo Alto school district to extend its homework policy, which limits the amount of homework students at each grade level should have each night, to apply to Advanced Placement (AP) and honors courses. The letter also mentions that many schools limit the number of AP classes a student takes during high school. Other suggestions include offering more nontraditional courses that allow students to pursue their passions, limiting the time commitment for both school and club athletics and integrating mindfulness education into the school curriculum.

"There's just this level of perfection expected in academics and in sports and in so many different areas, which really isn't -- it's not realistic," Strain said.

Stress levels at home as well as at school should be closely examined, the pediatricians wrote, recommending that families "find ways to protect family time and create opportunities for rest and leisure for their teenagers."

"One thing that we notice," pediatrician Rebecca Benton said, "as we watch kids grow up from the time they're toddlers to high schoolers is that within our society -- and it's not just specific to Palo Alto, it's across our country -- kids are so overscheduled.

"From the minute they can kick a ball, they're carted from this lesson to that class, and we strive so much toward trying to help them perfect skills that are going to help them somehow achieve the next goal that it's to the detriment of just down time (and) family time," she said.

The pediatricians in their letter also implore parents to "strive to keep their expectations for their children realistic and healthy.

"Ideally, discussions of plans after high school should include a variety of options. For the college-bound students, the wealth of excellent universities in this country should be emphasized, rather than narrowing the focus to a few of the elite."

The pediatricians said there was no clear tipping point prompting them to write the letter but that it's time for the entire community -- medical professionals, schools, parents, teens -- to start questioning practices that are perceived as the norm but might be contributing to a high-pressure culture driven by achievement and expectations.

"How can we as families, schools and as a community support our teens?" the letter asks. "Clearly, we must listen. We must provide hope, acceptance and encouragement. Overall, we must take a hard look at our goals as a society. Our culture is focused on achievement, but studies have shown that long-term happiness comes from giving, from meaningful relationships, and from purposeful work. Modeling these priorities as adults can help shape our youth's values."