The vast majority of mental health disorders in adolescents go undiagnosed and untreated, with young people who are African American, LGBT, homeless or under the jurisdiction of the child welfare or juvenile justice system least likely to get the care they need, a leading researcher into child well-being said Thursday.
About 20 percent of all adolescents have some kind of mental health disorder that can be diagnosed, yet between 60 to 90 percent of those young people do not get adequate treatment, said David Murphey, a senior research scientist at the Maryland-based Child Trends research center, emphasizing that more research is needed to pin down the data.
“We’re so reluctant to talk about mental illness as we do about physical illness,” Murphey said, speaking at a discussion on adolescent mental health organized by the nonprofit D.C. Campaign to Prevent Teen Pregnancy. “These labels that we’ve come to apply have unfortunately created stigma around mental illness that is a barrier for many teens and many adults for getting services.”
Studies show adolescents these days are under a lot of stress, both self-imposed and from outside forces, Murphy said. Young people are under pressure to be beautiful, to be talented, to succeed academically, to have a lot of friends, to master constantly changing technology, he said. “That can be a recipe for not feeling good.”
About one in four high school students shows symptoms of mild to severe depression, the most common mental health disorder for adolescents, a rate that jumps to one in three for female students, Murphey said.
Leaving mental health disorders unaddressed can lead to life-changing consequences: a decline in personal relationships, poorer school grades, a higher risk of unprotected sex and teen pregnancy, and even suicide – the leading cause of death for 10- to 24-year-olds, Murphey said.
Few adolescents seek out care for their symptoms because of the persistent stigma around mental illness, but other factors account for the gap in care as well, Murphey said. Health specialists across multiple systems and sectors often do a poor job of coordinating their care, meaning that symptoms noticed by one may not be flagged to the appropriate service provider. Other well-meaning adults in the adolescent’s life may notice something but not flag it because they may think it’s not their job. Or young people may simply lack health insurance that covers mental health services.
“Prevention and early intervention is the way to go,” Murphey said. Taking a pro-active approach could prevent things for getting worse later, he said, encouraging listeners to learn the tell-tale signs of common disorders, speak out if they notice any, and extend help to young people who look as if they need a hand. Treatment that combines talk therapy with medication has been shown to be most effective, he said.
Although private insurance plans may or may not include mental health services, access to these services may soon improve through government initiatives. Low-income children can get mental health assistance through Medicaid or SCHIP, and starting this year, the government-funded Early and Periodic Screening, Diagnostic and Treatment benefit will extend to all adolescents covered under Medicaid, Murphey said.
In addition, health insurance exchanges to be set up under the Affordable Care Act must include mental health and substance abuse services in their “essential benefits” package, Murphey said.
The impact of childhood trauma on adolescent mental health was likely to become clearer with more research, Murphey said. “I think we’re learning more every day how huge an issue that is, particularly in early childhood but any stage in life.”
Trauma that happens early and in a sustained way -- such as living in chronic poverty, witnessing domestic violence, or having a parent who was incarcerated, had a mental illness, or had alcohol or drug problems -- can have lasting effects on a young person’s life, he said. Such experiences affect “the brain, the immune system, and other body systems that regulate how we respond emotionally and how we behave.”
“My prediction is that within five to 10 years you’re going to see a lot more acknowledgment of the role of trauma,” Murphey said. “I think we’re getting there but we’re not there yet.”
Researchers are continuing to study what makes some adolescents more resilient and able to bounce back from negative experiences than their peers, Murphey said. Such resilience could result from a combination of genetics, the social ability to reach out for help and access to a social support network, like relationships with positive friends or a caring adult.
Understanding the factors behind some young people’s resilience could help others struggling to overcome their own challenges. Programs that work with adolescents can help foster resilience by focusing on developing interpersonal skills and treating adolescents as partners in their learning, so that they learn to manage their emotions and their behaviors, Murphey said.
“Acknowledging the fact of mental illness is the first step,” Murphey said. “The body doesn't distinguish between mental illness and physical illness. The body doesn’t say, ‘It’s OK for you to have the flu, it’s not OK for you to be depressed.’ The body just feels bad in either case. OK?
“We need to adopt the same attitude as a society,” Murphey continued. “We need to cut through the stigma, get over it, help people in need, acknowledge the toll that not getting care takes on our society, start taking care and getting care.”
Photo by Life Mental Health