Transcript Adolescent Mental Health: Population

Adolescent Mental Health:
Population-based Disaster
Prevention
Gwendolyn J. Adam, Ph.D., L.C.S.W.
Assistant Professor - Department of Pediatrics
Section of Adolescent Medicine and Sports Medicine
MCHB-funded Leadership Education in Adolescent Health
(LEAH) Program
Baylor College of Medicine
1
Goals & Objectives
• Goal: Understand critical issues in adolescent
mental health as public health opportunities for
population-based disaster prevention.
• Objectives:
– Utilize key data indicators of adolescent mental health
to motivate strategic action
– Identify conceptual and practical barriers to addressing
adolescent mental health needs
– Develop strategies for improving public health
cultivation of adolescent mental health
2
Adolescent Mental Health
Using Key Data Indicators to
Motivate Strategic Action:
Why We Need a Bracelet
3
Key Data Indicators Demonstrate
that Mental Health Issues:
• are prevalent among U.S. adolescents
– 1 in 10 children / adolescents suffers from mental
illness severe enough to result in significant functional
impairment - It is estimated that 20% of children /
adolescents have a diagnosable mental disorder
– (in 2004) 3.5 million youth (14%) ages 12-17 have
experienced at least one major depressive episode in
their lifetime
• lead to lethal thoughts and acts
– suicide - 3rd leading cause of death for adolescents
– 900,000 youths (3.6%) made a plan to kill themselves
during worst or most recent Major Depressive Episode
– 712,000 youths (2.9%) tried to kill themselves during 4
such an episode
Key Data Indicators Demonstrate
that Mental Health Issues:
• impact other behavioral health risks – e.g. drug
and alcohol use
• have family system implications - parent mental
health affects adolescent health risk behavior
• are not adequately addressed for adolescents - less
than half of depressed adolescents receive
treatment when they need it
• escalated for adolescents - between 1960 and 2000
the suicide rate among adolescents increased
128% as compared to an increase of 2% in the
general population.
5
Adolescent Mental Health
Identifying Conceptual and Practical Barriers
to Addressing Need:
What to Consider in Developing our Bracelet
6
Conceptual Barriers:
Understanding Adolescents
• Myths regarding adolescents undermine parental
and provider recognition of distress
– Youth want to be alone
– Youth don’t talk to adults
– Youth behavior is consistent – if depressed will look
depressed always / or at all
– Sulking, minimal eye contact, no communication, sleep
all day, outrageous moods, angry, violent, substance use,
not eating - are normal
– When in need youth just want adults to listen
7
Conceptual Barriers:
Understanding Adolescents
• Stereotypes of adolescents keep others away and
reinforce the myths
• Adolescents are rarely the “puppy of choice at the
pound”
• Stereotypes tend to influence adult approach to
interaction – little communication, passive
approach to parenting and intervention – reinforce
the expected disconnect between youth and adults
8
Conceptual Barriers:
Understanding Adolescents
• Risk behaviors are meaningful and may or may
not be rebellious / may be palliative
• Youth recognize distress in each other and go to
one another for help / give feedback
• Youth friends are often alienated by adults when
mental health issues emerge
• Manifestation of mental health issues in
adolescents differs from adults (e.g. sadness
versus irritability, overcompensation)
9
Conceptual Barriers: Stigma
• Parents are fearful of blame in seeking help – “I
love my child.”
• Concern regarding the records and the labels
• Parents sometimes choose risk of adolescent’s
death over risk to their future
• Fear of failure or reality as a parent – “this just
isn’t my kid” to “go ahead and kill yourself”
• Reliance upon parents to facilitate mental health
care access despite above concerns
• Youth stigmatize need for counselors – equate
with need for attention or to get out of school
10
Conceptual Barriers:
Public Health Expectations
• “There is no mental health equivalent to the
federal government’s commitment to childhood
immunization. ” – David Satcher, M.D., Ph.D.
• “Psychosocial Immunizations”
– imagine “required mental health screening” for school
– barriers reflect stigma around mental health issues and
problems with access to care
– outcomes of preventable diseases may be less lethal
than mental health crises
– parental expectation in responsibility differs from shots
– critical impact on educational process yet not
11
standardized
Conceptual Barriers:
Public Health Expectations
• Mental illnesses are “internal terrorists”
– Disaster prevention versus disaster preparedness versus
crisis intervention
– Public awareness and motivation regarding youth
mental illness are generally limited to headlines
– Columbine High School Massacre (1999) – 12
homicides / 2 suicides / 24 injured versus 4,243
completed suicides in 2001 for similar age group
– Opportunity to focus on impact of bullying, isolation,
depression, violent media, social relationships, anger
management, etc.
– Response – gun control / metal detectors versus mental12
health screening and responses
Conceptual Barriers:
Public Health Expectations
• Adolescent “failure to thrive” concept missing
• Quality of life – “I survived.” – Daniel
• Symptoms are not the only thing to consider
– emotional and social readiness for school
– impact of staying sad or anxious for several years
during key development period
– impact on learning and social development
• Most of the treatments / services adolescents
typically receive have not been evaluated to
determine efficacy across developmental periods
13
Conceptual Barriers:
Public Health Expectations
• Challenges exist in identifying mechanisms by
which ethnicity, race and culture account for
disparities in behavioral and emotional problems
and service delivery
– Lack of early detection by providers and parents
– Untrained and / or culturally insensitive providers
– Lack of parent / provider knowledge of
developmentally appropriate AND efficacious treatment
– Insurance status
– Settings where mental health care is delivered
14
Conceptual Barriers:
Public Health Expectations
• National measurement focus on teen suicide
and teen pregnancy – “negative orientation”
• Asset-based measurement – screen for
strengths and measure impact over time
• Cultivating mental health versus
documenting mental illness – role of public
health in shifting focus
15
Conceptual Barriers:
Public Health Expectations
• Estimating economic burden of mental health
concerns in adolescents is understudied and
difficult to assess:
– multiple systems providing services
– serious events – severe criminal acts / suicide
– loss in later educational and work productivity, parental
productivity
– positive impact of prevention programs to decrease role
of current treatment and increase productivity later
– must involve multiple stakeholders
16
Adolescent Mental Health
Developing Public Health Strategies that
Cultivate Adolescent Mental Health:
Designing Our Bracelet
17
Public Health Strategies: Using
What Evidence Demonstrates
• Psychosocial intervention enhances
pharmacological treatment
• Multi-systemic therapy promising– addresses
child and child context
• Some forms of institutional care do not lead to
lasting change when adolescent is returned home
• Services to delinquent youth like boot camps and
residential programs – generally ineffective
• Some peer-group based interventions actually
increase behavior problems
18
Public Health Strategies: Need
for Interdisciplinary Approaches
• Must eliminate discipline insularity
• Effective treatment practices must be shared
across disciplines
• Primary care and mental health disciplines
must jointly develop and utilize screening
and prevention tools
• Research should include mental health and
health disciplines
19
Public Health Strategies:
Making Science Accessible
• Development of research should begin with
the context and placement of the
intervention as a focus
• Must involve youth and family, community
and treatment stakeholders, in partnership
with researchers from the beginning
• Factors influencing ultimate dissemination
must be considered during development
20
Public Health Strategies:
Impact is Everything
• Messages must be clear and organized to
overcome adolescent-specific issues:
– difficult to imagine the icon of adolescent mental health
– many adolescent mental health difficulties by nature
include resistance (depression – lack of energy or hope,
substance addiction, eating disorders)
– risks are behavioral – involve blame
– developmental process may require that providers be
vulnerable to be effective with youth
21
Public Health Strategies:
Impact is Everything
• Message must be compelling:
– Enlist creative partnerships to finance
interventions and outreach – who will adopt the
adolescent population
– Time-limited – adolescence is a “statutory
offense / opportunity”
– Now or later approach – untreated mental
health issues in adolescents often become adult
problems and / or disabilities
22
Public Health Strategies:
Impact is Everything
• Message must be effective:
–
–
–
–
–
–
Issues are life-threatening – disaster prevention
Mental illness has no lobby – or does it?
Enlist public interest, energy and outrage
Involve youth
Empower families
Encourage evaluation to measure impact
23
Public Health Strategies:
Impact is Everything
• Message must be exponential:
– Maximize public health power / minimize
public health expenditures
– “Intentional epidemic” / outbreak / wildfire –
public health expertise reversed
– Involve all layers / stakeholders
– Increasingly self-sustaining
24
Adolescent Mental Health
What will our bracelet be?
25
Summary
• Discussed critical issues in adolescent mental
health as public health opportunities for
population-based disaster prevention
• Encouraged use of adolescent health key data
indicators to motivate strategic action
• Identified conceptual and practical barriers to
addressing adolescent mental health needs
• Developed strategies for improving public health
cultivation of adolescent mental health
26
“I survived.”
- Daniel
27
References
• Blueprint for Change: Research on Child and Adolescent Mental
Health, Report of the National Advisory Mental Health Council’s
Workgroup on Child and Adolescent Mental Health Intervention
Development and Deployment, Executive Summary and
Recommendations (2000)
• DASIS Report: Adolescents with Co-Occurring Psychiatric Disorders:
2003
• National Adolescent Health Information 2004 fact Sheet on Suicide:
Adolescents and Young Adults. NAHIC (2004).
• National Survey on Drug Use and Health Report: Depression Among
Adolescents. Substance Abuse and Mental Health Services
Administration (2004).
• National Survey on Drug Use and Health Report: Mother’s Serious
Mental Illness and Substance Use Among Youths. Substance Abuse
and Mental Health Services Administration (2004).
28
References
• National Survey on Drug Use and Health Report: Office of Applied
Studies. Substance Abuse and Mental Health Services Administration
(2003-2004).
• National Survey on Drug Use and Health Report: Suicidal Thoughts
Among Youths Aged 12 to 17 with Major Depressive Episode.
Substance Abuse and Mental Health Services Administration (2004).
• New DAWN Report: Disposition of Emergency Department Visits for
Drug-Related Suicide Attempts by Adolescents, 2004
• Preventing Child and Adolescent Mental Disorders: Research
Roundtable on Economic Burden and Cost Effectiveness (2004)
• U.S. Public Health Service, Report of the Surgeon General’s
Conference on Children’s Mental Health: A National Action Agenda.
Washington, DC: Department of Health and Human Services, 2000.
29